Angels with Dirty Faces

By Richard Zoglin

Doctors are television's perfect heroes. From Richard Boone in Medic through doctors Casey, Kildare and Welby to the bustling gang in St. Elsewhere, they have wielded their power like benevolent dictators. With a flick of the scalpel, they can make decisions of life and death, and with a consoling word reconcile people to either. They are privy to their patients' closest secrets, deepest fears, most traumatic life moments. Dressed in white, they watch over them like angels. And when they make their bedside pronouncements, they do it from above, like God.

The doctors on ER, however, are somewhat different. They don't look very glamorous, for one thing. Rushing with their gurneys through the busy Chicago emergency room where they work, they wear frazzled expressions and five- o'clock shadows. Patients come and go so quickly -- a gunshot victim here, a drug overdose there -- that the doctors have little time to accept congratulations, grieve over failure or make speeches about the wonderful work they do.

But these TV doctors are miracle workers nonetheless. ER, created by best- selling author Michael Crichton (Jurassic Park, Disclosure), made its debut on NBC in mid-September with a cloudy prognosis. Hour-long TV drama had been in a long-term slump, pushed aside by the proliferating prime-time magazines. ER was scheduled, moreover, opposite the season's one other new medical drama -- CBS's Chicago Hope, which boasted bigger stars (E.G. Marshall, Mandy Patinkin) and the kind of high-pitched melodramatics that viewers seem more comfortable with. Yet ER was instantly a huge hit. In its first five weeks, the show has drawn an average Nielsen rating of 18.3, ranking in the top five among all prime-time series. It trounced Chicago Hope so thoroughly that the rival show had to slink away to another time slot. To be sure, ER gets a major boost from NBC's powerful Thursday-night lineup, anchored by Seinfeld. But that didn't help a limping L.A. Law in the same time slot last season; ER has improved on that show's audience by 43%.

Some have attributed ER's success to Americans' current anxiety about health care. A more likely explanation is simply that it supplies something that's been missing from TV for years. Medical dramas have long been out of fashion; the last successful one, St. Elsewhere, was less concerned with the nuts and bolts of medical care than with often baroque interpersonal drama and nuthouse comedy. ER has rediscovered the primal appeal of the doctor show, and a new generation of viewers is eagerly watching.

If that were all ER had going for it, then Chicago Hope would be a big hit too. But ER is probably the most realistic doctor show TV has ever done. That realism goes beyond the graphic operating-room scenes and rapid-fire medical jargon ("O.K., we gotta go with it -- 5,000 units heparin, tPA 10 milligrams, push. Sixty over one hour. Let's get another EKG. Keep him on the monitor ..."). The show's hopped-up pace and jumbled texture -- stories start, stop and overlap seemingly at random -- set it apart from almost anything else on the air. "There's a rhythmic instinct to slow down in television," says Crichton. "But our show had to go as fast as the real thing. We got rid of the pauses, those actors' moments, the hanging looks that mean nothing. Medical shows have been at the Marcus Welby pace: meet a patient, portray the disease of the week and finish with some heart-wrenching solution. Here we just rip people in and out."

Actually, that is a good description of the adrenaline-pumped two-hour premiere episode. Since then, ER has settled back into more conventional storytelling, with predictable character developments, comic interludes and some unwelcome sentimentality. On last week's episode, surgeon Mark Greene (Anthony Edwards) brought his young daughter to the hospital, and her wise- child observations were enough to induce diabetic shock. (Talking to a little girl whom her father has just treated: "My daddy's your doctor." "(Will) he help make me better?" "That's what doctors do.") Still, the show has retained its grungy immediacy, without the hand-held-camera affectations of NYPD Blue, its only rival as TV's best dramatic series.

The script for ER had been sitting in Crichton's trunk since 1974, when the former Harvard medical student wrote it as a movie screenplay. It languished until the late 1980s, when Steven Spielberg read it and got interested. But Spielberg was more interested in another Crichton project -- Jurassic Park -- and ER sat around for a few more years, until someone at Spielberg's Amblin Productions suggested turning it into a TV pilot. "Almost nothing was changed," says Crichton, "except cleaning up the language."

Crichton has stayed closely involved in the series, taking part in some story meetings and watching the "dailies" -- footage from each day's shooting. "I get notes on dailies that he's written at 4 a.m.," says fellow executive producer John Wells, a former China Beach hand who was brought in to run the show. Spielberg too has been a surprisingly active presence. Supervising producer Robert Nathan says that for one episode he wrote, Spielberg sent him three-page memos on each draft of the script. Later Spielberg watched the rough cut and offered more suggestions. "He was amazing," says Nathan. "He would look at a scene and say, 'I think Take 2 was a little dryer.' He remembered everything from the dailies two or three weeks earlier."

Despite the authenticity of its hospital scenes, ER has not escaped criticism from the medical community. Dr. Gerald P. Whelan, a member of the American Board of Emergency Medicine, complained in the Los Angeles Times that ER shows untrained medical students doing procedures they would never be allowed to perform in a real emergency room. "The American public is being presented with a picture of emergency medical care that is 20 years outdated," he wrote. Dr. Lance Gentile, an emergency-room physician who is on the ER staff as writer and technical consultant, dismisses such complaints. "These groups are concerned with the public's perception of emergency medicine," he says. "The fact is that in real-life emergency rooms, supervised students do give medical care."

ER is populated by journeymen TV actors who redefine that overused term, "ensemble cast." Anthony Edwards (who had a recurring role in Northern Exposure and supporting roles in such films as Top Gun) is probably first among equals, but with his thinning hair, glasses and unassuming manner, he never steals a scene. George Clooney, as playboy pediatrician Dr. Doug Ross, is the most traditional hunk of the bunch, but the actor is self-effacing to a fault. "The writers are so good that even I can't screw up," he says. "For an old TV actor, it's great to have Steven Spielberg and Michael Crichton come by and talk to you. It's so nice to be on a quality show. You can hold your head high."

All of TV is high on ER's success. The show is giving another boost to the comeback of serious TV drama. It has shown that the networks can still create hits without the help of surefire time periods. And it has proved that viewers will try something challenging when given a chance. As Crichton relates, "People in the entertainment business said, 'Viewers won't understand this show.' Finally, there's a recognition that people are smart." Television sometimes is too.

With reporting by Martha Smilgis/Los Angeles