By Deborah Starr Seibel

She’d been suffering from terrible headaches. “It’s just stress,” friends told Angela Cooper, a then 28-year-old mother of two from Edgewood, Texas. And for a time, the harried young mother believed it. But that was before she saw a 2002 episode of the classic NBC medical drama ER. A year later, she wrote a letter to emergency physician Dr. Joe Sachs, one of the show’s writers, which stated, simply, “I’m alive because of your show.”

Can a television show really save lives? If it’s ER — the series with the most Emmy nominations (in a television drama category) in history, and a launch pad for such Hollywood luminaries as George Clooney, Anthony Edwards, Sherry Stringfield, and Noah Wyle — it can. Following in the grand tradition of Ben Casey and Dr. Kildare in the 1960s, Marcus Welby, MD and M*A*S*H in the 1970s, and St. Elsewhere and Trapper John, MD in the 1980s, ER burst onto the scene in 1994 with enough heart-pounding realism to eclipse them all. Now entering its 15th and final season, the show has become television’s longest-running medical drama.

It’s remarkable when you consider that when ER debuted, no one — not even NBC’s own executives — believed that the show would survive past its first season. Sure, it was written by famed novelist (and Harvard Medical School graduate) Michael Crichton and executive produced by the legendary Steven Spielberg, but critics fussed: it was too dark, too disturbing. The whiplash-inducing camera movements and constant flow of medical jargon demanded too much of the viewer. And it was up against another medical drama, Chicago Hope, which had more star power and was easier to follow.

But the public instantly fell for the men and women who wore blue scrubs like body armor in their modern-day battle against illness and injury. The stories were heart-wrenching, the pace electrifying. “Our stories come from our experience, consultants, reading, and our files,” says Dr. Sachs, one of seven physicians who work on the show. “We never start with the medicine. We never say, ‘Hey, let’s do an episode about prostate cancer.’ It’s always about some kind of conflict between our characters. Then we find the medicine to fit.”

Real-Life Drama

That young mother from Texas had seen the episode where Edwards’ character, Dr. Mark Greene, has a sudden recurrence of what would ultimately be deadly brain cancer. “Mark is talking to Dr. Susan Lewis (Stringfield),” Dr. Sachs explains. “He bites his tongue and it starts bleeding. So Susan says, ‘Stick it out.’ But instead of sticking straight out, the tongue goes over to the right side. And she says, ‘No, stick it straight out,’ and he says, ‘I am.’ And that’s how we as an audience know that something bad is happening.”

The Texas mom, Angela Cooper, was experiencing the very same tongue control problem. She went to her local emergency room, described the similarities to that ER episode, and was given a CT scan. Doctors discovered a life-threatening tumor behind her nose. Since completing a course of radiation and chemotherapy, she’s been in remission for five years. “We’re in the business of telling entertaining stories,” says Dr. Sachs, who treasures her letter. “But with current and accurate information, then as a side effect, the public will become educated.”

The actors are getting an education as well. Parminder Nagra, 32, who joined the cast in 2003, was at first overwhelmed by the prospect of practicing medicine, even on television. She had shot to fame in her starring role as a young British soccer player in Bend It Like Beckham but had no idea how to play a doctor. So she asked if she could observe a day in the life of UCLA’s emergency department. She wanted to drink in the atmosphere and take notes on staff behavior. “It was literally about fixing whatever has gone wrong,” says Nagra, awed by the single-minded focus of the ER staff. “It was, ‘What can we do right now to help the situation?’”

That day will forever be etched in Nagra’s memory because it shapes the way she approaches the role of brainy Dr. Neela Rasgotra: in order to be effective, emotions have to be carefully set aside. “A young guy came in who had gotten his head caught in the wheel well of an airplane,” she recalls. “They rushed him in, tore off his clothes, and asked for a paper clip, of all things, to lift his eyelid up to see if there was a blood clot there. They were worried he’d lose his eyesight. I saw a nurse slightly tear up for two seconds, because I don’t think this guy had much family. And she literally had to shake it off because she still had her job to do.”

Nagra’s job as an actress is made easier by the fact that the ER set is designed with real hospital equipment and supplies. “Sometimes we joke that we’re better supplied than many community hospitals,” says Dr. Sachs. As a rule, the actors don’t get squeamish around all the fake blood. “But some of them have been bothered by some very realistic amputations or open skull injuries where the brain is exposed,” he says. “And we’ve done a lot of stories about neonatals (newborns). Those silicone babies are very realistic, and they can be upsetting when you see them out of the corner of your eye.”

Medical Moments

Surprisingly, the one actor who’s had the most problems on the ER stage might have become the best suited for the job.

Scott Grimes, otherwise known as prickly chief resident Dr. Archie Morris, describes himself as a hypochondriac. Grimes, 37, a divorced father of two, has had enough medical disasters in real life to trump even his own overactive imagination. His frightening experiences — try getting a slap shot in the face with a hockey puck and losing seven teeth — left him hating the look, the smell, and even the feel of hospitals, including the fake emergency room that in 2003 became his workplace on the lot at Warner Bros. Studios.

“We don’t have vials of Lidocaine sitting around,” says Grimes, referring to an anesthetic. “But the set here is so real. The rubber gloves, the gurneys, the bright lights, all bothered me.” 

But Dr. Sachs has been impressed with Grimes’ ability to stay focused. “What are the characteristics of being a good emergency physician?” he asks. “You need to be smart. You need to keep your cool under pressure. And you have to have the ability to multitask. Scott has all of those things. I actually think he might have the personality it takes to be an emergency physician.”

Still, Grimes and company gladly step aside when the fake problems on the set become all too real. It doesn’t happen often, but acting in this fictionalized teaching hospital can be such a full-contact sport that people get hurt.

“We know enough to be dangerous but not enough to be useful,” says Nagra. Last season, for example, actress Maura Tierney, 43, who plays Dr. Abigail “Abby” Lockhart, was running down a hallway where she had to bump into a man standing there. “And Maura, being the great actress who goes for it every time, just kept bumping the guy harder and harder,” says Grimes — until the final take, when she said, ‘Uh, oh.’ She had broken a rib.”

She’s not the only one who’s gotten hurt. Nagra tore a ligament during an episode filmed at Burbank’s Pickwick Gardens Ice Skating Rink. Her left skate went one way, her left knee the other. “I tore my medial collateral ligament,” says Nagra.

A broken rib, a torn ligament. That’s when the real doctors employed by the show — one of three rotating physicians assigned specifically to the ER set — jump into action. “Those guys are great,” says Grimes. “They assess the situation. They make the call about transport to a nearby emergency room. They give you a lot of confidence.”

Those physicians might be giving more confidence to viewers as well. For many doctors, the emergency department has become a calling — emergency medicine is a specialty in which doctors are trained to handle any and all acute conditions. Since ER went on the air, residency applications have soared 300 percent. “In the old days,” says Dr. Sachs, “the ER was a place where young doctors went to work before they got established with a career. Twenty years ago, it wasn’t uncommon for a patient to ask you, ‘So, what are you going to do when you’re done with the ER?’ But because of this show, I think people are more aware that emergency medicine is a specialty.” And a very engaging place to stage a television drama.

Final Rounds

“Our show is just a river of chaos,” jokes actor Troy Evans, who has been there from the beginning and plays desk clerk Frank Martin. Evans himself is a veteran of some hair-raising real-life emergency department runs. His last foray was about six years ago, when he and his wife were driving to their second home in Montana. On the way they stopped along a stream to snip the willow branches he needs for his hobby — making teepees — and Evans almost cut off his left index finger with his garden shears. “When I saw it, I thought that finger was gone,” he says, “because it was bleeding so profusely.”

Evans ended up in an emergency department in Ronan, Mont., a tiny town on the Flathead Indian Reservation. “And the care was wonderful,” he says. “Here’s this guy they’ve seen on TV in a fake emergency room. When I was recognized, it created a slight light-headedness for me. It was very sweet. But I always knew I was in good hands,” he says.

As the writers gear up for the final season, they are too busy preparing scripts to think about closing the floodgates of County General Hospital for good. “I don’t think it’s really set in yet that we’re coming to the end of an era,” says Dr. Sachs. “But we are.”

Down the home stretch, there will be some new doctors doing final rounds. Tierney will exit after the first few episodes, as will Goran Visnjic (who plays Lockhart’s love, Luka Kovac). Angela Bassett will join the cast as an attending physician who returns to Chicago after several years abroad. And viewers should be on the lookout for Noah Wyle, who will appear in at least four episodes, as well as other former cast members (they’ve sent out feelers to Clooney, Edwards, and Stringfield) who might return for the last hurrah.

Actress Linda Cardellini, 33, who plays nurse Samantha Taggart, doesn’t think the producers will wrap up the series in a neat little bow. Instead, she believes the final scene will be yet another gurney slamming through the ER’s doors with yet another patient in dire straits. Just like in the real world, there’s always another emergency. “I think that at the end, the producers will make it seem as if the hospital will go on. You just won’t see it.”

Reality Check

When a gurney slams through the doors of NBC’s ER, you might wonder if what you’re about to see — and what you’ve been seeing for 15 celebrated seasons — is what really happens in the more than 4,000 emergency rooms across the country. Or is it an exaggerated, Tinseltown version of emergency care?

“At the hospital where I work, we have three to four major traumas a day,” says Dr. Joe Sachs, a writer, executive producer since 2006, and one of seven real-life doctors who work on the show. He was plucked from L.A.’s busy Northridge Hospital Medical Center during ER’s first season (1994–1995) and still works a weekly emergency department shift. “People ask, ‘Is it really that crazy, that insane?’ If you were to take all the highlights of a 12-hour shift and compress them into 42 minutes, it often is.”

But the clock isn’t the only thing getting squeezed. When you have less than an hour to tell multiple stories, medical procedures get done in record — and totally unrealistic — time. Which ones are shortened for dramatic purposes? “Almost all of them!” says Dr. Sachs, laughing. “Putting in a chest tube for a collapsed lung. Opening the chest to repair a hole in the heart. Putting in a central line, which is a large IV that’s often inserted under the collarbone. And when we’re giving medications — like if somebody’s going to get an antidote to a toxin — it might work in 15 seconds rather than five minutes. In TV, we can’t sit around and wait five minutes for it to work.”

It takes a small army of medically trained personnel to make it all look real. “People think the medical technical guys (three rotating physicians) sit around and make sure the actors are saying the words correctly,” says Dr. Sachs. “That’s less than one percent of the job. The hard part is choreographing all the medical action and getting everyone to work together.”

“During the first run-throughs, the actors look like a bad imitation of The Three Stooges,” says Dr. Sachs. “Everyone’s bumping into each other, nobody knows where anything is, it’s all wrong. And within 10 or 15 minutes, they look like professional doctors who’ve been doing this all their lives.” The trauma scenes are so realistic, in fact, that Dr. Sachs has never made a habit of watching ER with his medical colleagues. “They’ll say, ‘I can’t watch the show because it’s too much like work.’ It’s kind of a compliment.”