honored to welcome you to tonight's conversation between dr. thomas fisher and natalie moore. this is a nonprofit organization to present the speakers series on a wide variety of topics including human development, mental health, education, and social justice among others. we have over 175 videos of past events archived on our website and youtube channel. people shirt -- be sure to explore. thomas fisher is a board certified emergency medicine physician at the university of chicago medical center where he serves the same southside community where he was raised. previously has served as 82010 and 2011 white house fellow and a special assistant to a secretary. he worked on affordable care act regulation and the health and human services action plan for reducing ethnic and racial health disparities. "emergency" is his first book and he has garnered high praise for his poignant portrayal of humanity in crisis and underscoring the critical obligation we all have to care for each other. natalie moore is an award-winning journalist based in chicago whose reporting tackles rates, housing, economic development, food and, violence, segregation, and inequality. her latest book is a play about abortion published by haymarket books. her book "the southside, a portrait of chicago and american segregation." received the chicago books award for nonfiction and was buzzfeed's best nonfiction book of 2016. she contributed to southside, a collection of stories about the criminal justice system in chicago in collaboration with them marshall project and amazon in 2018. for the 100th anniversary of the 1919 chicago riots she cowrote an audio drama with the make-believe association. six c -- 16th theatre adopted part of it in 2019. we are grateful for her engagement with our programming. now, let's welcome dr. thomas fisher and natalie moore. >> i am excited to be in conversation with my friend tommy. before we dig into the book, i would like you to tell us a little more about your origin story. the southside is just as much a character in this book as you and as your patients. tell me your people are and who you come from. dr. fisher: it is so good to be here with you. thank you for agreeing to be my partner in this conversation this evening. this is something i have a forward to for quite some time. i am a chicago native. i grew up in hyde park. i grew up not far from 53rd and hyde park boulevard. that is a park that sits right across the street from where mayor harold washington lived when he was mayor. i was a kid at that time, in grade school. i remember clearly when he was elected mayor. how much of that area changed. there was security sitting across from his apartment building. the snow got cleaned and much faster along our streets. i grew up in one of the few richly diverse communities in the city. but it was and is still a black community and my parents were very intentional about making sure that we were a part of all of it. we went to a fish store owned by a black man. we had a shoe repair that was black owned. we ate baldwin ice cream that was black owned and we would point at the boats in jackson park harbor owned by pillars of the community. we ate leon's barbecue that was black owned. we were part of a dense community that was people like us. i think in many ways, that is how we became friends. but it has also launched so many other folks like us. i think one of the things i remember really clearly was when obama's star was rising and we were as happy as everybody else in the country. i remember how the news media remarked about how this was an amazing and unusual individual. i was like, he is an amazing individual. unusual? we see folks like this. there are professional folks who went all the best schools who went -- live on the south side. natalie: that is what michelle obama's used to say. she would say, craig and michelle are not special. there are a bunch of craig's and michelle's on the south side. dr. fisher: nationally maybe that is unusual, but it was not unusual for us. natalie: i knew many of the parallels we had. where we are from, education, family. being grandchildren of the great migration. but, one thing that i did not know, and there is so much i wrote in my book and you wrote in years, but the death of ben wilson, killed in 1984, all american basketball player, killed across the street from some eon high school. i might have been nine. that was my first understanding of violence in chicago. it was on the news. his mother mary weeping. the students weeping. jesse jackson. how did his death affect you? dr. fisher: i remember those same touchstones. i was a kid, but sports were central to the way i engaged the world. i sent a metronome for when the white sox were playing and when the bears were playing, when the wolves were playing. having a professional caliber player in the community, not far from us, getting coverage on the front page of our local newspapers, that was startling and amazing. and it really made tangible that these folks we see, like walter payton, he is very different. but, they come from somewhere. here was somebody that had the potential to reach those same heights. and he is like blocks away. simeon is a mile and a half from where i grew up, not far at all. when he was struck down, not only was it jarring that light, a celebrity was killed by a gun at school, but then, the outpouring. that same amount of morning was also approximate. the people upset workers of the community. the funeral processions. not only did it make real that violets was going to be an ever present part of my life and that was the first initiative, but, it started a pattern. we did not see this happening to the white stars emerging. we did not see this happening on the north side or in the suburbs. we saw these things. this was the initiation of a pattern that began to emerge where, not only was violence close, it was ever present. it was in my high school. when we would go out in high school and go to parties, one of the big things we would think about, are they going to shoot at this party? we did not just have to consider, is this going to be fun? what to my learning in school today? but, what is the right path home today, because, it seemed like there were -- wasn't some static in the hallway. a party at this place got shot up last week, maybe this week, we will keep it light. all of this began with ben wilson. talking about ben wilson in the book, that made clear that for a lot of black folks on the south side of our age, even a little younger or older, that was a seminal event that we all sort of sat on and learn from moving forward. natalie: the author of the forward opens the book in bronxville when you were at my condo. we were hanging out and if there was a murder across the street. we have talked about that many times. we have talked about seeing anybody just laying there uncovered for so long, bleeding. one of the things that tom has a goats -- that he wrote that i had not considered was, this is real life. can you talk about this arc between, benji has this mark on you, the fraud can -- the fraughtness of high school, then, what you see in the er? dr. fisher: i remember that night clearly. those gunshots were close. the next thing you know, it is so close and there is a body across the street. now that the university of chicago has a trauma center, i work in the busiest trauma center in the state. on a hot summer night we see tens of young men perforated by the bullets that fly through our community. men and women, in fact, that are bleeding and suffering. on one hand, it's really important for us to be there to stop the bleeding, to repair what we can. on the other hand, must've -- much of what we do is bear witness. we have no capacity to reshape the social and cultural framing that lead to these bullets flying through the air every saturday night on the south side of chicago. we can bear witness to the impact. we can stop them. but we know what makes a neighborhood safe. linkin park is a safe neighborhood. we know that's not about policing. that's about investment. that is about a racial hierarchy. that is about the way we prioritize profit over people. i cannot fix those things in the emergency department. i can only see the physical manifestations of an unjust society in the bodies of my patients. i can see day and night here after year, these patterns emerge. look, part of the point of the book is to bring that intimacy and understanding of how our bodies express our society and how they do so differentially. and, to recognize their shared humanity, even in those moments, even when it is difficult to understand what is going on. that the young man we saw murdered was somebody's brother. right? that is somebody's father, somebody's uncle. these sorts of things to even if they seem foreign and reduced, these are still human events we should not tolerate. natalie: the first sentence, the first page of your book is chilling. it takes us back to march 2020. we are living in this pandemic that is a lot different from where things started. completely unknown. you do not mince words. you thought you might die. you are getting your affairs in order. -- you were getting your affairs in order. i just cannot imagine what that was like, to be a doctor, to be giving care, then come hell -- and come home and decide to write. how did you construct this book? detail is incredible. where you journaling when you came home? wasn't this a way to release tension, sadness, whatever emotion you were feeling? where you always planning to write this? was this always going to be your book? dr. fisher: there are a few things in here worth picking up. i was already journaling to some extent. part of what i see when i am taking care of patients is complex and heavy. writing it down helps to alleviate much of the conflict, or at least, clarify what is going on in my head relating to, usually the gap between what i wish we could do and what we actually could do. so, i have been journaling for a while. when covid fell on us all, i had been watching it since january. i write this in the book. i had been watching foreign press. i still do that to better understand when viruses are emerging across society dressed like i want to know when there are shootings under the community, when there is new heroin on the street. i need a pulse of what is coming. i watched this emerge from china and circumnavigate the globe from italy to new york to seattle to chicago. i saw doctors getting sick and dying. one of the first deaths in china was one of the doctors discovered the virus. we did not know what this would do. all i knew was i had been training for this. this is what emergency medicine does. we stand in the face of pandemics and we interface with medical centers across the world and their hospitals, trying to take care of people in these moments. so, i knew all of a sudden this distance between what it meant to be a physician and patient would be collapsed. normally, we are working in teams taking care of very sick people, even in life and death situations and we can be clearheaded knowing at the end of the day we will go home and have dinner. we are not sick, the patient is. but having seen what happened in china, in italy, in new york to our colleagues, i assumed i would be sick. did i know i would die? no. but it was on the table in a way it never had been before. the book was originally about describing an unjust society and its human impact and health care system that then adds insult to injury if you are poor and you are black. then, covid laid bare those parameters, laid bare that situation in a way that was always present, and will probably always be present so long as we have a society ordered by racial cast and unchecked capitalism. but in this crucible, one where we are all all of a sudden vulnerable, where everybody all has the potential to fall ill, these figures were broadened. it became not only an opportunity to describe a society rot -- rocked up by these variables, but it was also catharsis. here i am being challenged every day in ways i had not been. here is a way to document what i am seeing. this also forced me, it forced me to slow down. like, what am i actually saying? what are the barriers i have erected between myself and my patients that are self protective or lazy. who is in the room with me and why? where is my team? what are we working on? this became even more important as covid started getting folks sick. nurses starting to fall ill. my colleagues. security. this reminded me that everybody on the team is necessary. all of a sudden when they are not there, it is a jarring experience. it is light, i think i might have shared this with you or somebody in passing, it is like in a zombie movie where there is a group of teenagers in the woods that should have gone left but they went right anyway. looking around, all of a sudden, where is johnny? thought -- johnny is gone because the zombies picked him off one by one. it is like that in the emergency department. i have not seen so-and-so in a couple days. they are sick, they will be back in a couple weeks. some people did not come back. it was a very, very challenging time. natalie: paint for us all -- what the er was like on a day-to-day basis during covid. you have a line in their. you said "i am a short order cook flipping burgers at lunch hour." part of the reason you chose to write letters to your patients is because you only had three minutes with them in the er. dr. fisher: i think that is from the chapter right before covid when i was working in a special section of the emergency department where i was sorting through all the sick people in the waiting room. i think it was a 45 people when i got there. that was not uncommon at the time. in those moments my job was to identify the sickest people, get their workup done and send them back to the waiting room to continue waiting. because usually there is nowhere to put them. in those moments when i only had three or four minutes, i don't really have a chance to ask more than critical questions. where does it hurt? how long has it been there? do you have any fever or similar challenges? then, start the work up. draw blood. send them for radiology. maybe give them tylenol if i have it. there are other parts of the emergency department as well. the resuscitation area turned into the covid area, with negative pressure rooms. there is a fast-track for ankle sprains. there is a trauma area where all of our car accidents and shootings and falls go. then, there is sort of a moderate specialty area where people who have chronic bonuses and cancer did managed by a team. the team is usually an attending physician like me, a number of residents that are physicians in training, a bunch of nurses, respiratory therapists, technologists, housekeeping, who keep everything safe and clean. security. they make sure we do not get run up on if there is a shooting. when we are moving, it is a very smoothly orchestrated flow. all of that changed during covid. all of a sudden we had to wrap ourselves in plastic and cover our eyes and read -- breeze -- breathe through a filter, and everything that was normal that was just unconscious execution, we had to start thinking about and that slowed us down. what was interesting that was between waves. we had that first weighs in march. we did not have any tests. they did not exist anywhere in the country. we had no idea who had what when. certainly it seems like we had vaccines forever. but we did not have treatments. we did not have vaccine. we didn't know what to do. did that abated and we had this lull between waves. during that time the emergency department was empty because we were still somewhat on lockdown. people were like, i am not going to the er because if i don't have covid, i will catch it there. we went from being mad and crazy and scared to like in an eight hour timeframe, seeing people. it was an unusual time. >> can you talk about some of the patients. they are all compelling. i will let you choose if you want to read and search or just tell us about a couple of the people you write about. dr. fisher: jerk. -- dr. fisher: sure. towards the end of the book, i talk about working in an area of the emergency department that was sort of like a field hospital. it was reclaimed -- a reclaimed ambulance bay that we used to expand our capacity to care for as many people as we could as fast as we could. that ambulance bay was basically like a big garage, right? it had open piping. it had garage doors we sealed off. we changed into hvac to try to make it warm in the winter and cool in the summer. we rolled out temporary room dividers and gurneys and monitors in order to serve people in this reclaimed garage. one in that chapter i described taking care of a couple of people. those people are composites. they are based on real people, but they aren't entirely real people because i wanted to make sure i protected people's identity and wouldn't have any situation where people were concerned that coming into the emergency department would be unsafe. one of the people i described was somebody who had caught covid in the first wave. like so many people who caught it that wave, this person had chronic illness, was a black woman on the south side, lived in a multigenerational family, and got so sick that she ended up being on a ventilator in the icu for multiple weeks. that wasn't uncommon on the south side. we saw that regularly. she came back to us having recovered, having gotten through that episode, but having left over medical conditions. she had amnesia. she didn't remember any of it. all she remembers is waking up in a skilled nursing facility for rehab. it also impacted her family. her multigenerational family was fragmented once she was gone. her daughter had to move out of state. some of that disrupted some of the others in her family. and now not only was she dealing with these ongoing medical problems as a result of this illness, but her social situation became complicated in ways that also impacted her health. indicative of so many people on the south side. your health is a function of where you live and work and play it what happens at home is what ends up being in your physical body. in the book i write that across the hall from her was not an older gentleman, but a gentleman who was usually too old for violence, late 30's, early 40's, who had been shot in the abdomen a few years ago and was coming in with a wound infection. and spent so much time dealing with physicians that he knew our lingo and exactly what was going to happen. like so many folks on the south side, and lingering medical and psychological issues from being violently assaulted even though it was many years ago. when you have a violence rate as high as ours, it leaves the scars not only on the body, but on the mind and on the community. there is collective ptsd that is occurring when you have tens on people being shot. i wanted to eliminate that even though -- i wanted to illuminate that even though we get folks through these acute issues, the health impacts stay. each of these stories demonstrate that there is a very rare and unusual intimacy between physicians and patients in the emergency department, where these are total strangers. intimacy between total strangers. somebody i met 5 minutes before hand and they are telling me about some of the most intimate details of their lives and some of the most harrowing experiences they have ever had and trusting me with the information and to do something important with it. if nothing else, i want to honor those relationships with the letters i was writing to the patients in the book, but also bring into those intimate experiences the reader so that they see the patients on the south side and therefore humanity, their hopes and dreams and fears and wants, and have an understanding that the conditions that led them to us can't stand. we owe something to one another, and if you can see the humanity in these folks, you can see that anyone of us could end up in the situations with a different role of the dice. -- different roll of the dice. so much of this is fortune. natalie: how do your patients respond to you as their doctor? dr. fisher: you know, that is an interesting question -- natalie: i mean, you have been set up they try to introduce you to granddaughters? [laughter] dr. fisher: that doesn't happen quite as much now that i have all this gray hair. it feels like family. sometimes it is family. i definitely take care of people who i know and have known, people's parents and pulled teachers. -- old teachers. but i am able to recount shared experiences. this happened at this place during that time. i may have had a very similar experience at that place and at that time. i know where some of the lines of demarcation and resources are. and so that allows for a much more rich conversation. and i think that i have a lot of colleagues who worked alongside me who have the capacity to do those same things, establish rapport. but it is very -- it keeps me honest, it is a very humbling experience, because not only do i know them, they know me. and so i can't front. i can bring airs into the room, because we see each other. i think it might lower barriers that keep information away. all of us have shame about some things, but when you -- when they feel as though i am a part of them and their community, some of that dissipates and we can have a more honest conversation. i have gotten good -- better at asking questions. i'm not sure if i am good yet. you journalists are really good at asking questions, when people tell on themselves. one of the things i like to do is say "did you sleep well last night?" people tell me their hopes and dreams, fears from that question. they don't usually tell me about sleep. i'm getting better i just sitting and listening. natalie: i want to pick it away from the -- i want to pivot away from the personal, because the book isn't only a click and of stories from the er--collection of stories from the er, which itself would be a terrific book. i want to talk about public policy and what you saw. tell us about -- well, one of the letters you wrote, you create a composite of, i will just call him a suit doctor in the er. the university of chicago really almost did something so egregious that early in your career that you were willing to quit the er. tell us about that time. dr. fisher: this is a chapter-long story about how early on in my career i was a junior faculty member during -- and doing research on health and equity. and i was very interested in crating community medical center -- creating community medical center projects to address disparities in chronic management of congestive heart failure. if you are black and you were poor, you would end up in the er with heart failure. i did all this research. i done a fellowship, i was ready to go. the economy turned down, and that meant a lot of people got laid off and lost their health insurance, and that changed everything for hospitals and medical centers around the country, including ours. and number of things were done. one of them was going to be creating a two-tiered health care system in the emergency department. a wall was going to be built, and on one side would be what was called patients of distinction, people with chronic or acute medical illness that required a high-leveled care, but in order to be selected as one of the patients of distinction, you add a certain type of insurance, you had to have private insurance. on the other side would be a broadly selected population of patients. not only -- so, at the time i was shocked. i was young, early in my career, and naive, and just astonished that all of these things that we knew would create health disparities was being implemented in real time. we knew that the two-tiered health care system was unjust. we knew that the way we delivered health should be the sickest first regardless of their ability to pay. new that doing something like this on the south side would be dangerous. but because of the city's segregation, if you were to say the insured go on one side and the uninsured on the other, the insured's is going to look much whiter and the uninsured side. they were reconstituting brown v. board of education right in front of my eyes. that is not why i went into medicine. i knew i could not tolerate that at the time. it was a challenging period. a lot of people stood up in opposition, i was one of them. in the end, those plans did not happen. but what i saw was the danger of bystanders. what i wrote about in particular -- this was a composite, because in number of my mentors and leaders stepped down rather than be a party to this plan. those who are selected to be in their stead wasn't one person, it was a collection of people. that is why i made them a composite into an individual. their effective approach was this is going to happen, we ought to make the best of it. and sort of stood by while a great evil was being deployed. it didn't require that they even agree. he required that they not stand up in a moment and lead towards a moral solution. in the end one of them did help to support the changes that were necessary. but leadership means courage, doesn't it? health care means centering humanity, not profit. in those moments i learned of these parted truths in the worst possible ways that going along would be hurting people, if i were to stay in medicine in the same way that i am. that is kind of why i left academia, why i started going on this eclectic professional career to understand, how do you better understand how the system works, what was i seeing in those moments, and how do you deploy resources, leadership, and experience to create a more moral and just health care system, with the recognition that it was unlikely that we would ever have a moral and adjust health care system until we have a moral and just society. natalie: the university did not do the plan because of all the moral outrage? dr. fisher: it was. and it wasn't just me and the other folks inside. it was in "the new york times." emergency medicine physician organization was standing up and upset. there were senior members who were upset. there were a lot of people who were like, who were worried and deeply concerned. not and mouth but it didn't still become the official plan- -- not enough that it didn't still become the official plan. this was a socialized and accepted plan that was ready for deployment pit you know, i'm thinking about a couple things come let's get some feedback -- no, it was the plan, until a small but vocal group of folks raise the alarm. no, we can't go back to the 1950's. keep in mind, segregation is a meaningful part of our society everywhere. we have an implicit two-tiered health care system across our nation -- not explicit, but implicit. there was a period where black folks could not come to the university of chicago at all. it was going back to a place we had been, place we should never go back to. not considering that i come from the place. my patients are keeping me honest. how can i show up and talk to them and say i accepted this? no. natalie: even though we are talking about the university of chicago, they are part of a system in which this can exist. they were not some sort of outlier. dr. fisher: they were not an outlier, no. natalie: here you have this research one university, karen discovery, brilliant minds, studying, caring, healing. and then you have this er that is mostly poor black folks. and you describe in a digestible overview for people who are not going to be entrenched in health care policy that this boiled down to how medicaid, medicare, and private insurance does reimbursements. tell the audience the cliff notes. that undergirds all of this. this is why the university is doing this. i'm sorry, not just of them. dr. fisher: look, to their credit -- i shouldn't say "to their credit" -- there are other institutions that have whole vip floors that they can access if they are willing and able to pay for it. and these are nonprofit institutions in other cities that are explicitly saying if you have the money, we will build it for you. the challenge is that if you are privately insured, internationally wealthy, and can pay cash for your health care, you provide a margin against what the health care you receive costs. if you get medicare, you might pay about what health care costs, but if you are on medicaid, the amount of money that you pay an institution for your health care is below what it costs to give health care. institutions have organized themselves in order to ensure as many people can pay have access compared to those who are medicaid or unable to pay. that is nationwide. what that leads to are things like vip floors and special services. that means plans that ensure you have conduits for special cardiac care or oncology care, advertising campaigns that are in the communities. where there is a plethora of clinics where folks who are insured exist compared to those who are uninsured and on medicaid. inglewood is one of the least- insured neighborhoods in the city's, mostly medicaid and medicare. about 12% of folks in inglewood are uninsured altogether, compared to about 2.5% in lakeview. if you were to overlay where our health care resources are, doctors offices, clinics, hospitals, and lay them on top of the city, you would see that all densely located on the north side compared to the south side. you would also see that is where our health status is. 30-year life expectancy givens for men between inglewood and lakeview. most of that is not a function of the actual health care they get. most of that is a function of living in a community where there is violence, where there are food deserts, where there are not options to work outcome where you work in a job that requires you go double shifts and might be dangerous. those -- all of those things track along the segregated racial cast lines that have been instituted in our city for decades. in all that is required to keep that going for more decades is that we sit back as bystanders and not stand up and say this is on acceptable, and heat -- this is un acceptable, and here are the human costs to that. in the book i describe clearly how the economics lead us to structure our health care system in the way that it is. there are a million solutions, but what is required is that we no longer see this as an economic challenge, but one that is human. there is a human manifestation of this caste system. there are years lost that are being transferred from a porta and from black to white-- poor t o rich and black to white. if you believe that we are similarly human, that cannot be tenable. you cannot accept that transfer of years, the unjust and unnecessary suffering. and we created all of this. none of this was bestowed by god. segregation was built, these financial motives were built. we can unbuild, if you believe we are all human in the same way. and nowhere do you see that more clearly than in the emergency department, that we are all the same. natalie: you reference your eclectic career. even if you take another job, you still keep your er shift. but you work for an insurance company. you have gone to the business side. you became a suit, although you didn't wear a tie. symbolically. [laughter] but he found that even if you were in the system, had to try to make changes, that you were -- you couldn't affect that change you are looking for. can you talk about that phase in your career? dr. fisher: and i'm still working in those faces. i'm still try to understand how can i better shape the system towards one that doesn't put people and profits in conflict. i had success and failure. the biggest challenge is that we have an entire culture that believes that profit matters more than anything else. that health care is simply a business. and in fact, you hear slogans like "we have to run this like a business." yeah, but you know, businesses sell ice cream. businesses make shoes. but we are dealing with the something -- what we are dealing with is something more precious and different. you can always close an ice-c ream store and no one is worse off. but here we have to think differently about that. when you have slogans like no margin, no mission, that put people and profit in the same sentence and recognize that the people are in service of the profit and not vice versa, as roundly accepted and a normal conversation, as opposed to recoiling at the thought of that this is bigger than one person. there are no heroes here. this is not going to change because the right leader came in. it is going to change when we as a democracy say there are certain things that are important, that are bigger than this business endeavor. and that it won't be about one person. it will be about everybody making a demand that we owe health care to one another, we owe a society that does not make some people sick at the expense of others. until then, the best thing we can do is stop the bleeding. just like in the er, the best thing i can do is to keep these young men and young women who have been shot safe, these folks who have chronic illness, i can help them. i can fix the sprained ankle and treat the -- but until then, you can create a moral institution, you can be a leader that tries to keep people and profit out of conflict and work on a system. even that will only be stopping the bleeding in your institution. natalie: i know many people are probably wondering, how do you keep your head in the game. journaling has been helpful. you talk about cocaine use -- dr. fisher: no, i don't do that. natalie: not you, but how er doctors cope because of what you are seeing. so how do you manage your well-being? dr. fisher: well, i'm fortunate to have plenty of love in my life. family and friends, friends who are like family, who have supported me -- you are one of those people, thank you very much. i have a strong meditation game. i workout regularly. i cook. and if nothing else, i think that part of this -- even the writing experience has helped me to understand what matters. i am not confused by the transient nature of our time on this planet. and there really isn't much else besides each other. all the other material things are here today and gone tomorrow. and so that understanding came later. i don't know if i always had that understanding. but that makes it easy to invest in the people, whether they are my patients with the people around me -- my patients or the people around me. i shared with you that i'm not really reading the reviews or things like that, because i'm not sure what that helps for me. i know what matters. i know what is here. i'm very happy it is being well received, because it is honest, and i think honesty ought to be well received. but what keeps me sane is the realization that it's the people that matter. natalie: did you have that clarity before covid? dr. fisher: i was coming into it, yeah. i think so. but nothing clarifies the world for you like having literally everything stripped away. there aren't restaurants, there is no travel. i had to be careful about how i spent time with my family, because i did not want to infect anybody, assuming that i was always going to be infected. while it was an extra me difficult time,--extremely difficult time, it also made clear, why am i doing all of this, what is this about, what is life. that sort of helped in many ways. it was a challenge that crystallized many of these notions. natalie: we have a bunch of questions coming in. i'm going to turn it over to lonnie to manage that part. >> actually fascinating conversation--absolutely fascinating conversation. i know such great value has been offered to the community not just in this moment, but when people watch this video later. really powerful, so impressive. thank you so much, natalie and thomas, for your engagement with each other and with this topic. just brilliant. dr. fisher: thanks for having us. >> i want to remind folks that we have been putting links in the chat of purchasing a copy of "the emergency." it is a fabulous book. fast read, i might add. it's a page turner, i couldn't put it down. we will be doing a buy one, get one free. fan is going to underwrite the cost of a book giveaway. if you buy a copy, when you get the link to come to after hours, starting 8:05, we will give dr. fisher a five-minute break between these two zooms, register for after hours, come to after hours, and you will get a second copy of the book. what a conversation. i have my own questions. let's turn to some of these here. natalie, you did cover what is a popular question both before the event of the zoom registration form but also right now, which is i find it touching and not surprising, dr. fisher, that folks want to know, are you taking care of yourself. they are worried for you. they want to make sure you are doing self restoration. i appreciate that natalie asked that. a question that lucy is asking is what are two or three things that health care executives and policymakers could do to bring more equity and justice into medicine and healing. it is definitely the question of the hour. you address it somewhat in the book. maybe a couple tidbits. dr. fisher: well, i think, first of all, it is important to note that there is an extensive body of work that demonstrates solutions that improve health equity. everything from collecting and using data to guide interventions to paying for equitable outcomes rather than just hoping that they come into play. to community-based resources and extending services outside the medical center. i think so many of those are founded on some three similar premises that i talked about more in the book. those are moral leadership is imperative. there is nothing but influences -- there are myriad influences that are telling you that your balance sheet is the most important component of your health care system. that is not true in health care. that cannot be true in health care. there must be a moral imperative that what you're are doing is something bigger than a profit loss. the other thing is creating systems, anything that is dependent on reeducating, whether it is an employee or patient population, will fail. or that is requiring that a villain is removed or a hero put in place, that will also fail. we need system solution because it is systems that are creating an equity, and that all points in every decision, there must be humanity at the center. so much of what happens in this crucible i described early in my career where a wall was being built is there wasn't any race in that conversation. there was no "we want to harm this population." but once you center humanity and ask, if we do this, what will this impact be on people, you can get out of that trap on your own. centering humanity in all of your work is the third thing. i want to reiterate that as i said earlier, until you create a just society, we are not going to get there, because these are not economic or even leadership questions. these are moral questions. this is about what we owe one another. do we see one another as fully human? none will we allow our -- will we allow our racial caste system to dictate outcomes, or will we dismantle that? until we bring that into our conversation, we will be stopping the bleeding, which is important, but that won't solve this. >> the question of how do -- today do people keep the notion that we are an interdependent species, is this front of mind or not? does it matter to people or not? it is a key moral question, because if you believe you are interdependent and that you need and you are needed, how do you -- it forces morality just the front of that thinking. i wish i could feel super confident that everybody felt that way, but i'm sure you can speak way better than i can on that topic. dr. fisher: what is funny is that people intrinsically know it. when you are sick, as everybody falls ill at some point, the last thing you are thinking about is your social status or your financial status. when your niece, nephew, daughter, parent is critically ill, you know that what we are is beholden to one another. you know it. you know it in your heart. the challenge becomes what about when they are on the south side. what about when they are on the border? what about when they are in ukraine? do you see their struggle as your struggle? are we all similarly human? i see it all the time when people are in these moments when they are shutting all of these social structures and they reveal the quietest and most shared components of themselves, the things that make the most human. but most people don't have those opportunities that i do in the emergency department. i try to show them in the book. >> you see people with extreme vulnerability and precariousness. i will get to a question -- given that emergency medicine has been a source of neighborhood primary can't, and yet it is a facility where you are essentially doing triage to make sure you are available for the most critical trauma cases, how do you determine the resources were primary care is not available in your community and many communities? dr. fisher: this is a big challenge. take a step back and look at the biggest picture, the most important contributions to our health have nothing to do with the health care system. do we have jobs? is the water safe? is there the opportunity to be gainfully employed and walked -- those other the things that matter most to our health -- those are the things that matter most to our health. are we investing to make sure those things exist? right now and most of the communities that need the most, what we are investing in are not the businesses and the built environment that would allow people to have intrinsic help. we are investing in hospitals and health care centers and the police. that is where the majority of our social investments are. and so people come to us in the emergency department for all kinds of things. we let folks in the winter sleep in the waiting room with a warm sandwich and a blanket. we help people who have been kicked out of their home find a place to live. we do all sorts of things that certainly could be done with primary care or another health care outlet. what we need our resources in the community so people are not using any health care because they are healthy. the way we better allocate our health care dollars is very important and largely a function of the economic conversation that we already began. but i would much rather reinvest in our communities. -- much rather we invest in our communities. >> i want to give you and natalie a chance for closing thoughts here. we will close in about two minutes. we will give dr. fisher a five-minute break before we open after hours. please join us because we scratched the surface on a norma's topic on which a lot of people have a point of view. natalie, would you like to offer anything in closing? natalie: nothing for me. just grateful to be here in conversation with my friend and so glad that this book is getting the attention that it deserves. dr. fisher: thanks, nat. i really appreciate our ongoing dialogue that continued tonight but that has been going on for 20 years. thank you so much for having us. this has been such a pleasure. oneworld world has been such an amazing home for this book helped see that i was a writer before i was a writer. i just feel really thankful for my patients who for 20 years have reminded me what matters, and reveal to me what is going on in our society in a way that no other -- that i couldn't see in any other way. thank you for having us. it's been a wonderful conversation. >> thank you, thank you, thank you. i'm grateful to one world as well. they do extra mary -- we work with a lot of publishing houses and we love them all, but oneworld did an extraordinary job supporting their authors and content. it feels so mission-driven. when we are presented with a one world author, we know it is going to be great and we know it is solid support. bravo. prejob. hi, i'm carl