TV Unspooled: ER, "Hell and High Water"

Taking a look at a classic medical drama.

Hello and welcome back to this feature where I watch and write about an episode of a television series I’ve never seen before. Previous editions of this looked at Seinfeld and The X-Files. Today, I embark on my first taste of ER, with the (I’m told) iconic episode “Hell and High Water”.

One of my favourite TV series of the first half of this decade was the Jason Katims family drama Parenthood. The show had the lowest concept of premises, which one could only describe as “there’s this family”, and they go through the kind of basic trials and tribulations one would expect on TV. Marriages hit the rocks, teenagers fall in love for the first time, kids have conflicts with their parents, that sort of thing. As a commenter once said in Emily VanDerWerff’s reviews of the show, “It's like any recycled storyline you can think of that has ever happened in a TV show was shit and Katims just decided to fix it. There isn't anything original about this show, but it's the best unoriginal thing to happen to TV”. Parenthood made no attempts to reinvent the wheel. It simply wanted to hit all the classic TV notes in the genre, and execute on them beautifully. It had no ambitions to be anything other than a family drama show. It was, in the truest sense of the phrase, pure television.

Based on “Hell and High Water”, I feel like ER might have the same quality.

Let me lay out the central story of the episode so you see what I mean. Talented but loose cannon doctor Doug Ross (played by a young George Clooney, who gives a performance that seems like he really might have a future in this industry) is on his way out of the County General Hospital emergency room. He interviews for a job at a pediatrics ward, despite not seeming a great fit for the day to day care of kids, and looks all set to take the plunge into a normal, low pressure career where “nobody dies”. That evening, when driving to a fundraiser (another example of the more relaxed life he could have), a young boy runs over to his car to tell him of terrible news: the boy’s brother is caught in a tunnel, and as a flash flood is coming, is in serious risk of dying if he isn’t rescued. Doug puts everything he’s got into getting the boy free from the tunnel, but the force of being flushed out in the flood sends him unconscious. As Doug tries to resuscitate young Ben, a TV news helicopter arrives on the scene. Doug, knowing that there might not be enough time for the ambulance to get the boy to the care he needs in time, takes the risky move of putting him on the helicopter and flying to County General. After doing all he can to keep the boy alive on the chopper, when arriving back at the emergency room, Doug still wants to do it all by himself. He is forced, though, to take a step back, clean himself up, and work as part of a team effort to save Ben’s life. The medical work is a success and the boy lives. Two important lessons are learned: that Doug can do more work helping kids at the ER than in a pediatrics ward, and that he’s best as part of the team.

If you haven’t seen the episode, all of this may sound astonishingly cheesy. And it is. It’s a quattro formaggio pizza served with a side order of baked camembert and mascarpone cheesecake for dessert. This isn’t a mistake. The show was produced by Steven Spielberg’s company Amblin Entertainment, which doesn’t always have a great record of translating the filmmaker’s success to the small screen, but in this case it feels like a quality genuinely made it across. In “Hell and High Water”, at least, the show is finding the most straightforward, core emotional beats and building everything around hitting them. What’s being attempted is not complexity, but resonance. And boy does this thing know how to resonate.

What helps is how perfectly the thing is structured. Like all American broadcast network dramas of the time, the obvious constraint was ad breaks, and the need to shape the episode around them. You start with a “teaser”, a pre-credits cold open that runs for around four minutes, then the rest of the episode after the opening titles is split into four acts of ten minutes or so. In an ideal world, the people who made ER probably wouldn’t have asked for this. Not all stories are going to suit the shape of a teaser and four act structure, and acts certainly aren’t naturally going to hit equal lengths. And I’m sure there were episodes of the show that were just that little bit too long or short, and had to suffer in the edit to hit the runtime. But what these “impediments” lead to is a strong skeleton to work from. Every act break has to hit an action beat and end on a dramatic reveal. The story has to conform to a five-ish part structure. With every moment building toward these climactic breaks, the show has to consistently rise the tension. This isn’t right for every story, but for such a pulsating show as ER, it feels like a blessing more than a curse.

“Hell and High Water” specifically takes advantage of the structure. The teaser drops us into Doug’s job interview, showing him as a fish out of water but nonetheless emphasising that he’s keen on making the move. Act one really plays up the ensemble drama, showing us plenty of an average day at the hospital, before act two makes an abrupt turn and focuses entirely on Doug. Going an entire act without cutting to a B-plot is something that really tells the audience this isn’t the usual hijinks, while also feeling entirely reasonably paced. If a show like this without ad breaks suddenly went from intercutting storylines to over ten minutes in one setting, it would feel strangely structured. This way, it’s something the audience notices, but an entirely natural time to switch gears. And it makes sense when the show returns to cutting between Doug and the hospital in act three, while building to the storylines coming together in act four. This all flows properly. It meets all its marks at the exact moments it needs to, helping ensure the audience feels all the emotions they’re supposed to feel. And it’s all thanks to an artificial act structure forced upon the show by the demands of commercial television.

And that’s the thing I got most from ER. This episode was so many specific qualities of television turned up to eleven. Of course, I’ve only seen one episode, so I’m stumbling in the dark here, but it felt as though the show was trying to ensure you got as much TV as possible in the hour of ER you watch every week. Everything about the modern TV landscape cuts against a show like this. The combination of binge watching and no ad breaks means there isn’t an incentive to pack every scene with incident, with the mode instead being about dragging things out to keep you watching, or just because the show doesn’t have the guts to cut a scene they like. The mode now is that a show should only be satisfying over a whole season. ER seemed to be making every *scene* feel satisfying. It’d be nice if we could get that back one day, but I’m ok for now, because I have another 330 episodes of this show to work through.