‘ER’: The room itself was the real star

Perhaps because of its longevity or because its inventions became conventions or because anything with such broad appeal is likely to invite disdain from some quarters, “ER,” which of course concludes tonight after 15 seasons, never seemed to be as highly regarded as, to mention a few, “The Sopranos,” “Six Feet Under,” “Hill Street Blues” or “St. Elsewhere.” Most people I know viewed it as a formulaic medical soap opera with the requisite life-affirming uplift -- a verdict that became even more pronounced as the seasons passed and diseases, situations and character types were recycled.

Yet for those of us who kept watching it, and I have seen every episode, “ER,” far from declining, actually gained a cumulative power and, more, began to purvey a vision that would surprise those who gave up the show for dead. With its interlarding of medical triumph and personal angst, “ER” may have begun as a show about salvation, in the operating room and in the doctors’ own lives, but it became a show about the near impossibility of salvation -- a show less about healing than about damage. Those holiday episodes notwithstanding (“a very special ‘ER’ ”), the show may now be the darkest, bleakest program on broadcast television and the one with the most sophisticated take on life.

The seeds for this vision were planted early. The nurses and doctors performed heroically (surprisingly few patients have been lost over the years), but from the outset they all bore their own stigmata. Many of these were physical. There was AIDS, Alzheimer’s, a rape, a double amputation, death in a helicopter crash, an emergency hysterectomy, a deadly aneurysm, a knife attack that seriously hurt one doctor and killed another, and Dr. Greene’s (Anthony Edwards) fatal brain tumor. In short, the patients had nothing on the people who attended them.

But it was the emotional wounds that bit deep. Virtually every doctor bore some psychological scar, whether it was Dr. Kovac’s (Goran Visnjic) memory of his family killed in Croatia, or Dr. Greene’s paranoia after he was beaten by an unknown assailant, or Abby Lockhart’s (Maura Tierney) alcoholism, or Dr. Benton’s (Eriq La Salle) emotional frigidity, or Dr. Ross’ (George Clooney) self-destructive womanizing, or Dr. Rasgotra’s (Parminder Nagra) paralyzing indecisiveness. Patients survived. The doctors barely did.

The effect of these personal torments in any single episode or even over any single season might be negligible -- just more soap opera bathos. In the course of 15 seasons, however, the unrelenting bombardment cohered into something in which the miasmic whole is much larger than the sum of its parts. Many of these doctors may have had preexisting conditions: traumatic childhoods, strained family relations, internal demons, etc. Still, it is the emergency room that exacerbates them, as one might expect. They work in a place where every single person who busts through the doors is diseased, hurt or hurting. It is a hell of constant suffering, which is why their own suffering is heightened. In “ER,” the entire world is reduced to people’s pain.

Indeed, as its stars kept departing the show and replacements took their slots, it became more and more apparent that the real star of “ER” was the ER itself and that the room had been transfigured from a literal emergency room into a metaphor of crisis where every triumph is temporary because it is inevitably followed by another disaster -- actually dozens of disasters. It also became apparent that those who stayed in the ER and kept facing the carnage there were condemned. The only way to survive was to move on -- a case in which the program cleverly used its departing cast members (and their characters) to make a point. To heal the damage to yourself, you have to remove yourself from the hell. Or put another way, in a world of sorrow, you must rediscover hope.

The character who may have most embodied the damage inflicted by the ER is Dr. John Carter (Noah Wyle), who early on was the audience’s primary point of identification and whose tenure on the program neatly traces the thematic trajectory of “ER” from its early nobility to its later futility. When the show began, Carter was a wealthy, fresh-faced intern, an idealist who cared so much about each and every patient that he could barely cope with tragedy. As seasons passed, Carter not only honed his medical skills, eventually becoming a great technical doctor, but he also learned how necessary it was to inure himself to much of what he sees. He is a great doctor because he feels. But he can function as a doctor only when he ceases to feel so much.

Carter’s journey includes the knife attack by a psychopathic patient who kills a medical student and damages his kidney, a lapse into addiction, relationships marked by his icy indifference, an abrupt and cruel breakup with Abby, and a recognition, through it all, of his own growing emotional narcosis. The feeler has lost the ability to feel. To regain his idealism and recalibrate his feelings, he leaves the hospital to work in sub-Saharan Africa and even falls in love and gets married, but there is a sense that he has been so brutalized by the ER that he will never be what he once was. Unlike so many other denizens of the ER, he cannot move on.

This was painfully evident when Carter reappeared on the program this season for five episodes after three seasons away. His once boyish face was now weary, battered, sad-eyed, hard, as if he were bearing some irreparable wound and racked by some ineffable pain. Though the show is smart enough not to identify a particular source, it is clear that Carter has seen too much. It is his life that afflicts him. Carter says as much in a brief monologue this season on an episode titled “What We Do,” which recalls an episode of “MASH” in which a documentary crew interviews the staff. “You see it all. You see the whole spectrum of human experience,” Carter tells the camera, reinforcing the metaphor of the ER as a microcosm of life. “Whatever you can imagine, it happens here.”

Later, Carter gives the camera what is likely to be as close to a valedictory as “ER” will deliver. He says he left years ago because “I started to feel that every day was the same thing, and I’d had enough.” But he’s been through a “lot of stuff since then,” and now “I try to embrace the idea that everything that happens has never happened before.” As for the ER, he says, “I can’t imagine ever finding it boring because right at the moment that you’ve seen it all, something happens that you never could have expected.”

It is a lovely idea -- that life continually renews itself with surprise and wonder. But Carter is fooling himself, if not the viewers. After 15 years, we know that “ER” is not a string of surprises but exactly the opposite: a series of ongoing crises that bleed into one another with little relief. Indeed, Carter’s formulation, which is betrayed by his eyes, is also betrayed by the series itself. At the beginning of “ER,” the world was wondrous, and there was the sense that we could defeat its ailments. By the end of “ER,” the world promises never-ending agony and heartache, and it defeats us.

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