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'A Year of Healing and Heartbreak' with Thomas Fisher: podcast and transcript

Chris Hayes speaks with emergency medical physician and author Thomas Fisher about serving his community through endless trauma.

Recovery from trauma and its emanations is a defining theme of this moment. Dr. Thomas Fisher has certainly seen his share of the effects of mass disruption as an emergency medical physician. He typically has about three minutes to spend with patients who come into the South Side of Chicago ward where he works. Throughout his storied career, he’s also served as a White House fellow in the Obama administration and as a healthcare executive. He writes about his experiences in “The Emergency: A Year of Healing and Heartbreak in a Chicago ER.” Fisher joins us to talk about how our country’s healthcare system often treats the poor as expendable, how the pandemic has exacerbated longstanding- and increasingly fraught- inequities in access to good healthcare and discusses the privilege of serving in the same community that he grew up in. This conversation is presented as part of NBC and MSNBC’s cross-platform “Inspiring America” series, which highlights stories of people who’ve made an extraordinary impact on their communities and industries over the past year. You can follow updates on Twitter by searching for #InspiringAmericaNBC.

Note: This is a rough transcript — please excuse any typos.

Thomas Fisher: Calamity falls like rain on all of us at some time. And I think at the end of the day, we all fall ill cyclically over the period of our lives, some sooner, some more severe. But there's really only one way out of this life at the end of the day. And so that actually speaks to the deep importance of our bodies, like it is only with our health that you're able to do things like play basketball, and imagine and do podcasts, and feel connected to one another, and love and inspire and be inspired. And only with our health do we have that. So the fact that we allow our social conditions to relegate some of us to early illness, to unnecessary suffering is a moral calamity.

Chris Hayes: Hello and welcome to a special Inspiring America edition of "Why Is This Happening?" with me your host, Chris Hayes.

New this year, WITHpod is part of a themed week across NBC and MSNBC, that highlights stories of people who have made an impact on their communities or industries this past year. Today's guest is definitely one of those folks. We're really glad to share this conversation with you. You can follow updates on Twitter with the hashtag “Inspiring America NBC.”

The defining feature of our age right now, or the defining feeling at this time as I speak to you in the spring of the year of 2022 is recovery from trauma or the emanations and continued vibrations of trauma, of mass disruption, of the wearing down of social bonds, of the dislocation of a once in a century change to social life, of the mourning and grief of people who no longer have loved ones with them, who fell victim to the plague, the hundreds of thousands of children who lost either parents or grandparents.

And the emanations of that trauma and that dislocation, the disruption through every aspect of our society. The increase in fights at youth hockey games, which was a recent article I read in a newspaper that it's harder and harder to get youth hockey officials because there are so many parents freaking out. The thing that we see with people losing their mind on flights, right? And part of it again, like every time I see that, I think, wait, is this just that we have cameras around to record it, or is there something happening here? And then when you look at the data and you talk to, say, flight attendants are like, “No, no, no, this is not just like there are cameras, they’re like people are acting wild. People are acting crazy.”

This is my own little personal thing; I take the New York City subway every day. I love New York City Subway, as much as I love any institution in American life. It's amazing. I've lived in New York most of my life. I'm born and raised here. Maybe once or twice I've seen someone smoking a cigarette on the subway platform or subway. In the last five or six months, I have seen it happen like five or six times. And I'm talking to my friends about it and they're saying the same thing.

And I'm like, to me, it's such a defining feature of this age where it's like, “Okay, let's set some wild infraction.” I'm certainly not going to call the cops over it, right. Like, they're not, in technical sense, hurting anyone. It's also like, it's just this violation. It's this taboo. It's just like the rules no longer apply. It's just kind of acting out. And you see it, I think, really society-wide. That builds all the way up to what we've seen in spikes of interpersonal violence, increased auto fatalities which are people have been driving insanely recklessly, right?

In the beginning, we thought that was because the roads were emptier during COVID lockdown. But then it turns, well, now, that was part of it, right? So the roads are empty, people started to speed, the speeding leads to more car accidents and more auto fatalities. But then as cars came back, we thought that would go down. But then people are still driving crazy.

We've seen a spike in overdose deaths, which again is not that surprising. We've seen a whole bunch of mental health indicators that show that people of all sorts of ages, particularly teenagers have been experiencing more acute mental health distress. Basically, the society is in the grips to me in a way that I don't think we've quite kind of grappled with holistically of this kind of collective emotional tumult, this psychological shock to all of our systems that came with the plague.

And today's guest is someone who is seeing this firsthand, who sort of life world and have this kind of firsthand what this looks like on the ground at all different kinds of levels. His name is Dr. Thomas Fisher, and he's an emergency medical physician. Now, I will tell you something funny, and I'm going to introduce him in a second. I was reading the book and I thought to myself, at one point, I had the thought, I was like, “They should make a TV show about this. This so dramatic.” And I was like, “Oh, right. Yeah. Of course, like the longest running most successful network show was about ER,” which again makes sense because it's a very dramatic place, right?

Like, the way that drama works is, you know, you can have 365 days in a year, and 355 of those are like fairly placid. But the 10 days of the year where like something crazy and unprecedented happens in your life, they happen in the ER every second, right? That's the whole setup of an ER. People in the ER are generally having either a bad day or the worst day of their life. They're in the ER because the worst kind of distress, the worst kind of disruption is happening. And they're there at the moment when the life is being broken into two halves before and after very often.

And so for that reason, you have a first person window into what this kind of disruption and trauma looks like, even in normal times, but particularly when the wave of COVID hits. And I thought this book is fantastic. And not every doctor is a great writer and storyteller, but Dr. Fisher is. He's also done a whole lot of different things. He was a White House fellow in the Obama administration. He worked as a healthcare executive.

The foreword of the book is by our mutual friend, Ta-Nehisi Coates. I actually met Dr. Fisher at a birthday party for Ta-Nehisi a number of years ago. And so, I think Dr. Fisher's view of this experience we've had collectively and the way that he's able to channel the book gives us a really unique perspective to kind of grapple with what we're all going through. And so, Dr. Fisher, great to have you on the program.

Thomas Fisher: It is great to be here.

Chris Hayes: Sorry. That was a long wind-up, a little longer than I wanted. But I do think when I was reading your book, it felt close to a thing that I feel like we haven't done a great job of articulating society-wide because we've been doing a lot of like the old, you know, folk tale about the blind man and the elephant, kind of like the different parts of it. Like, well, homicides are up, and oh, wait, this is happening over here. But something collective is happening in the trauma of the plague that you got to see firsthand. What made you want to write this book?

Thomas Fisher: Writing the book was kind of something that was a long time and coming. And I think that what you articulate around how people come to the emergency department on their worst day, or at the end of a series of terrible days, gives us a unique perspective on society. Like myself and my colleagues see people whose bodies reflect either the wearer of a society that is neglecting them, and exploited them, and left them exposed to foods that sicken them and air that is poisonous, or they've gotten caught by that car accident, or finally had the stroke, or the complication from their pregnancy leads them to us.

And as a result, in many ways, emergency department physicians, nurses, and the rest of us who work in that environment, social workers, folks who really get an understanding of how our collective decisions get under our skin and are manifested in our health. And then we're also trapped within the healthcare system, one that expresses these very same slights and the racial caste that we see in our society is simply manifested in the healthcare system. We're trying to navigate that for our patients in ways that give us a very unique and sometimes frustrating vantage point.

Chris Hayes: You write about this in the book and it struck me that emergency rooms are a little like jail sometimes or night courthouses, where like the people on the bottom of society and the people most marginalized like end up when there's nowhere else to go. Like, there are two institutions that are there that kind of like do the processing of the human beings that are living under social conditions that put them on the precipice.

And sometimes that means they get booked by the cops because they acted unruly, or they broke in somewhere, or they tried to cop drugs. Sometimes it means they're in your emergency room because they’re in need. But they're similar spaces in certain ways because you really are seeing like one after another after another, a set of sociological phenomenon that are just unignorable.

Thomas Fisher: Yeah. There's a component to it that's also like trying to go pay an electric or water bill --

Chris Hayes: Yeah.

Thomas Fisher: -- where you have everybody who ultimately has to do this component of their life, right? You got to pay the bill.

Chris Hayes: Right.

Thomas Fisher: Maybe you fell behind, but you got to go to the office, and you just sit out there and wait. And the people like me who are working there, like, “Well, this is just an everyday.” I know you have to be here for some reason. But I still have a lunch to take, and I've got my internal jokes with my colleagues, and if that takes additional time for you, you don't take your ticket and wait. When your time comes, we'll take care of you.

But it's not a water bill, right? It is you're having chest pain, right? You're terrified. You're stressed. And like the water, when you're going to pay a water bill, there's certain people just have somebody to do that for them, right? Or they've had the capacity --

Chris Hayes: Or they're not going to do there, they got it on AutoPay and they're not showing up at the office in a million years.

Thomas Fisher: Right. They have the capacity to do it.

Chris Hayes: Yeah. Right.

Thomas Fisher: And if those people who are not accustomed to that environment actually are confronted by that tier, right, so much of this is healthcare. It has at least two tiers and probably more. But if you are facing that environment and you're not accustomed to it, you're like, “Get me out of here. I don't want to” --

Chris Hayes: Yeah.

Thomas Fisher: “I'm going to call the dean. I'm going to call the administrator. I want the fast track,” right? But that also leaves the conditions the same, right? We have an overburdened healthcare system writ large and even more so in our communities that are the most vulnerable, because then not only do they have an increased health burden, but they have less of a capacity to pay for healthcare broadly.

And therefore, fewer access points for the sorts of needs, the healthcare needs that they have, leaving emergency departments like mine on the south side of Chicago just chock-full, which is why I started writing this book well before the pandemic. And so many of the social issues that leave people sick often take half of a lifetime to manifest.

Chris Hayes: Yeah.

Thomas Fisher: We saw this social stratification leading to health discrepancies within a three-month period. It just compressed the time --

Chris Hayes: Right.

Thomas Fisher: -- of society into a really important example to describe --

Chris Hayes: There's a lot I want to sort of set the table on that, including the hospital you work at and when you started there. I's a fascinating place because it's the cross-section of a whole bunch of lines of race and class in Chicago which we'll get into. But just to follow up on that, I think I've maybe told this story before on the podcast, and so forgive me if I have.

But there's this moment that I always remember that we were at the hospital and my wife was giving birth to our first child. And as the non-birthing partner, you feel both anxious, but also ancillary. But you're also in this total admiration for the sheer will and strength being exhibited by your partner.

Thomas Fisher: Yeah.

Chris Hayes: You're stressed as hell for her and for the kid, and it's just a weird mind space. Obviously, nothing one one-hundredth of the actual birth giver. But at one point, we were very lucky to have this wonderful doula who came and she was there, and I was like, “I need to go, like, get some caffeine in me or some water.” So I walked out, and I walked through the nurse's station which is on the L&D floor in a great hospital, with great nurses. And there was just a nurse who was on her break. So she was at her computer, and she was just on break. And I see her, she's scrolling through UGG’s on Amazon, like the boots.

Thomas Fisher: Yeah.

Chris Hayes: And I just like had this thought of like, “Do you realize what's happening? What we're going through? Like, my wife is going to give birth to our first child.” It just struck me in this moment of, like, she's just at work. She has a 15-minute break and she wants to buy some UGGs. Like, it's the most normal thing in the world. But the weird juxtaposition of the banality and work of her experience of being an L&D nurse and your experience when you were there because you're about to have your spouse give birth to a child is so, in some ways, weirdly unbridgeable.

And my question for you is, I think it can make people who work in those situations, EMTs, nurses, doctors, cops, bailiffs in jails get really hardened and kind of misanthropic.

Thomas Fisher: I mean, there's a part of this where you kind of have to turn off certain things if you're going to deal with this component of life every day. Look, I had an experience yesterday, I worked in the emergency department where an older person came to the end of their life and we were unable to resuscitate them. And it seemed as though she had an amazing life, right? She was very old. She was independently living. And all of a sudden, a calamity from the heavens came and that was her end, right? That's not a bad way to go at the end of the day.

Chris Hayes: No.

Thomas Fisher: I met the family to tell them, right, this is something that I've done many times over the 20-plus years of my career. And there's sort of like a poem that I share, like I sort of “Help me understand about the circumstances,” and I describe what happened. And at the end of the day, I tell them that this person died. This family had met me before, right, because I had said the same thing about one of their other relatives who had died in my care --

Chris Hayes: Oh, wow.

Thomas Fisher: -- in the past years before it. They're like, “We remember. You don't remember me?” I didn't.

Chris Hayes: No. You're one of the most memorable people in their life because you were the person that delivered the news about the loss of a loved one, and that's indelible and it's just not going to be symmetrical.

Thomas Fisher: It's a transformative day for them.

Chris Hayes: Right.

Thomas Fisher: And it's one of 20 years of work days for me.

Chris Hayes: But how do you hold on to your humanity though? Because I know people and I've reported on people, and I see this with cops a lot --

Thomas Fisher: Yeah.

Chris Hayes: -- who I have a lot of empathy for. I mean, you're around disordered people. You're around violent people. You're around people calling you horrible names. You're around people acting terribly to each other. And there's this like crust that builds up, the shell, and it's both adaptive and necessary, but it can really be insidious.

Thomas Fisher: I can tell you what works for me. Part of it is I work in the same community that I grew up in. That keeps me honest in really important ways because the context in which my patients emerge are the same ones that I came from. And so, when they describe circumstances, they're very familiar. I'm often taking care of people who I know, either literally or figuratively. Sometimes I've taken care of the parents of my friends. Sometimes I've taken care of my friends, old teachers.

Things of that nature remind me that, like, look, this person across from you, even if you don't know them, you do, right? This could easily be your aunt, your grandmother, your nephew, your brother. And at the end of the day, that extends even beyond people you know, and it is important to hold on to no matter what. But having that reality check by being in a familiar context, in a familiar community, in a community that can point at me and be like, “You need to check yourself,” right?

I mean, there are components in the book where I act callously. Like, look, there's no heroes in this at the end of the day. And my patients will check me about that. Like, actually, that's not a fair thing to say. I think that two-way street of communication is a reflection of what a real physician-patient relationship is. It's two people.

Chris Hayes: Well, and that gets to something profound that is woven throughout the book about race, class, hierarchy and the medical system, right? So let's talk about where you're from, where did you grow up, and where do you practice now.

Thomas Fisher: I grew up in Hyde Park. The University of Chicago is an anchor in that community, like many universities that has town-gown conflict like Penn, Columbia, all of the rest of the places. And so I was on one side and I'm on the other, right? The south side of Chicago is often vilified also for its notorious violence and for its notorious machine politics. But it is a warm and vibrant community of hundreds of thousands that spans a massive geography and it's an anchor for black folks, both locally and nationally.

Chris Hayes: Yeah. I mean, just to give people a little context. I mean, Hyde Park is a fascinating and one of the most distinct places I've ever been. I've spent a fair amount of time there. You may remember that's where Barack Obama was a state senator. It's a very racially integrated, diverse. Well, diverse, although its integration can sometimes be tenuous.

Thomas Fisher: Yes.

Chris Hayes: It's also got the University of Chicago campus. And then it is a neighborhood that on all four sides of it are essentially entirely African American communities.

Thomas Fisher: Absolutely.

Chris Hayes: And then broader out, when you zoom out to the south side of Chicago, what you had was racial segregation that produced a south side that was racially homogeneous. It was essentially almost all black. But lots of different levels of class --

Thomas Fisher: That's right.

Chris Hayes: -- inside that. So you had the sort of the doctors and lawyers and business owners of black Chicago lived on the south side. You had people who were very poor and struggling people in public housing, all of that. So you have this very fascinating fabric of black life that is there for a hundred years, 150 years, and has its own dynamics. And then you have the effects of modern sort of post deindustrialization, and urban hollowing out, and disinvestment and things like that.

And now a situation where the hospital that you practice at is both the hospital for the folks in that neighborhood, but then also the trauma center for people from around the south side of Chicago, in neighborhoods that are way, way more poor, violence-prone, et cetera.

Thomas Fisher: Yeah. And you have neighborhoods like Hyde Park, which are racially integrated. But just west is Inglewood --

Chris Hayes: Yeah.

Thomas Fisher: -- which is one of the most violent neighborhoods in the city, but it is also kind of empty. It's being emptied out for a lot of different reasons. People are moving and leaving. 12.5% are uninsured, 25% are unemployed. You also have Beverly, which is mansions on the south side. You've got South Shore, which is a different sort of community that is urban dense, and mostly black, and middle class. I mean, Barack Obama was living in Kenwood, just north of Hyde Park.

Chris Hayes: Farah Khan's mansion is there.

Thomas Fisher: Farah Khan’s mansion. I mean, look, you can be anything in the black community on the south side.

Chris Hayes: Yeah, exactly.

Thomas Fisher: There's exactly there's Farah Khan. There's Jeff Fort.

Chris Hayes: Yeah.

Thomas Fisher: There's Barack Obama. It is a very, very vibrant community. And having black middle class parents anchored us in one where we were shown that there are a lot of ways to be black in this country, and they're all kind of normal. And I don't think I realized until I was an adult that that was an unusual experience.

Chris Hayes: It's a really rich, incredible place for people that have not been there. And if you ever have the opportunity to spend some time in the south side of Chicago, and there's a bunch of different neighborhoods you can go to, and a bunch of terrified white people will tell you like, “Don't go to south side of Chicago.” You generally ignore them.

I mean, the other thing is you can't downplay the fact that there are places that are just profoundly violent. I mean, there's just very high levels interpersonal violence. So talk about the year you write about starts pre pandemic. So you undertake this not to write a pandemic book, you undertake this to write a book about the disparities and complexities of American society as seen through the eyes of someone who's at the kind of point of the sphere.

Thomas Fisher: That's right.

Chris Hayes: And tell me what those themes are, what you see in the November 2019 to February of 2021 when the world is going to change.

Thomas Fisher: I mean, I wrote the book in order to describe how a society stratified by racial caste and one that elevates profit over people with unchecked capitalism is manifested in the bodies of its citizens, particularly those who are being subverted and exploited in order to transfer wealth by segregation or through employment.

Chris Hayes: Yeah.

Thomas Fisher: And what that means is the emergency department where I work is overburdened, right? You have tons of people who are injured at work, who don't have places to live, who live in a food desert, who are subjected to violence because of a struggle that leaves them outside the mainstream economy and contracts are then adjudicated with violence.

Chris Hayes: Right.

Thomas Fisher: They come in the emergency department, they tell you stories, right, that first reveal their humanity, and remind you that so much of your position is fortune, a function of how you were born. And they also reveal the way society has trapped them, and how those traps then lead to their injuries and illnesses, and then lead them to be stacked up in an emergency department because our healthcare system reflects those same racial caste strata and that same prioritization of profit over people.

And so what I wanted to do was write a book that made it intimate, right, that brought you into the room with me and revealed that the folks who come into the emergency department with these struggles, even if their lives are very different, their humanity is identical. And so, if you fundamentally believe like I do, that if we have a shared humanity, we owe something to one another when we're ill… Then these traps both inside and outside the healthcare system must be addressed. Like, you can't look away from this.

If you then see your aunt and the woman who has been waiting in the waiting room four or five hours with organ failure and suffering with pain, and there's no end in sight to that. Or if you can relate to the physicians like me who see that waiting room full of 40 people, many of whom are sick, like that elderly person, and we have no place to put them because the healthcare system is prioritizing other things… Well, once a bed opens up, it's somebody like me who decides who comes next.

What if you have to do that every day? You're making a decision about who of these similarly deserving and similarly ailing people is the next to be served, and you never have enough resources to solve those problems and rarely have enough time once you do see them. Like, these are the sorts of moral dilemmas that we've set up in our society and healthcare system. And we turn them in to statistics and vague terms like health inequities and disparities.

But in fact, there are people at the end of that. There are people who are suffering, and then there are providers like me and the nurses, respiratory therapists and techs who are struggling against these waves of humanity, and we all need relief. And that was happening before the pandemic.

Chris Hayes: Right. That's one of the things that's striking and you're buckling when you describe the pre-pandemic pace of the ER, the pre-pandemic capacity. Just to follow up on that a little bit like, so one of this viral tweet the other day that just said the most obvious, profound thing that was just like I think a lot of people are coming to understand what a blessing it is to have good health.

Thomas Fisher: Yeah.

Chris Hayes: The way I've described it before is that I play basketball and if you ever like have a bad injury, rolled an ankle or bust out a knee, and then you're on your crutches for a little while or you're on a cane, there's this period right after where you get well enough, where you can walk. You have about a week where you're like, “It is a miracle to walk.”

Thomas Fisher: Yeah.

Chris Hayes: It's a miracle because you had just gone through this six-week period of like, “I can't get anywhere else. I got to go to steps.” And then you have a week where you're like, “Oh my gosh,” you just appreciate just simple basic human mobility. And then, of course, it fades the background because that's how we operate.

Thomas Fisher: Yeah.

Chris Hayes: But one of the things that comes through in the scene setting of the situation here is just like the level of chronic illness, the level of untreated illness, like just the background, ambient difference in class and race of who is healthy and who's not is so striking, even though we know that like, look, a brain tumor could come for anyone at any time. I have a beloved cousin who literally just passed away at 53 from a heart attack. I mean, again, like one of these, it feels like lightning striking, horrible tragedy.

A layer on top that, like we know there's that. But it really comes through in your description of how class and race-driven this is when you're in a situation like the emergency department you work at.

Thomas Fisher: Well, first of all, I'm sorry for your loss, Chris.

Chris Hayes: It is very sad. He's a great guy. I was not that close to him. I'm sorry to bring it up on the podcast. But it was a very sad situation. And again, it was like one of those, just like struck by lightning, right?

Thomas Fisher: Yeah.

Chris Hayes: It wasn't someone wind up, it wasn't this thing. It's just like sometimes God calls you.

Thomas Fisher: Yeah. I mean, calamity falls like rain on all of us at some time. And I think at the end of the day, we all fall ill cyclically over the period of our lives, some sooner, some more severe. But there's really only one way out of this life at the end of the day.

Chris Hayes: Yes.

Thomas Fisher: And so that actually speaks to the deep importance of our bodies. Like, it is only with our health that you're able to do things like play basketball, and imagine, and do podcasts, and feel connected to one another, and love and inspire and be inspired. And only with our health do we have that. So the fact that we allow our social conditions to relegate some of us to early illness, to unnecessary suffering is a moral calamity.

Chris Hayes: It's medieval. I mean, that's the thing. It's like when you take a step back and you look at it, I mean, I know this. Obviously, you know. But even reading your book, it's like if you saw this through the lens from another society or in a history book, where it's like, “Well, yeah, there's all the poor and working folks, and their bodies are breaking.” And then there's the people on top, they're doing pretty well.

Thomas Fisher: Living till 95. Yeah.

Chris Hayes: Yeah. And it shows up in life expectancy. It shows up all these things. Like, that's sick. That's really sick and futile.

Thomas Fisher: I mean, in many ways, the book is about how do we really measure injustice, right? One of the ways we see it regularly is like the wealth differences across society, income differences, employment challenges, educational attainment. But none is more intrinsic than our health status and our longevity. I mean --

Chris Hayes: That's the thing, like how many years you get on this planet.

Thomas Fisher: That's it.

Chris Hayes: It's sick.

Thomas Fisher: That's it. And so, we've got to look at the genetics. We've got to figure out why is it that we have this life differences, these differences in life expectancy. Well, this is society. Like, we've chosen some people to pay with their lives very early on. Like, you will only get 67 years. If you're born in a different place and are a different race, you get 76 years. That's just the way it is and we've come to accept this. And in fact, we blame the victims.

Chris Hayes: We'll be right back with more of our Inspiring America WITHpod conversation after we take this quick break.


Chris Hayes: Will you talk a little bit, we're going to get into COVID, but I've been intertwining race and class a lot in this conversation, and partly because they're both operating in these places. But I want to sort of take a second to let's say, and this is just a sort of empirical fact, right, so when you control for a class, you control socioeconomic status, you still end up with profound racial disparities --

Thomas Fisher: Absolutely.

Chris Hayes: -- in American health outcomes. And they are really striking. So it's like black folks with college degrees, with higher incomes are still lower life expectancy, higher degrees of chronic illness, all of these things, worse outcomes once they enter the system?

Thomas Fisher: Absolutely.

Chris Hayes: I mean, the easy answer to that is to say, well, I mean, the right answer is we're a white supremacist country and we have a set of racial hierarchy and caste that produces the outcomes. But at the ground level and as a black man who is a doctor, in the position of being a care provider --

Thomas Fisher: Yeah.

Chris Hayes: If I'm a completely naive white person and I walk up to you and I say, “Why are health outcomes for black folks, even black folks who are not in lower socioeconomic situations worse than for white folks,” what is your version of that answer?

Thomas Fisher: So I want to be really careful because it's important to disentangle health status from health outcomes, right? So there is both the case that black folks at all socioeconomic status, when paired with white folks at all socioeconomic status have worse health status. They have higher burden of disease. They have worse birth outcomes, so low birth weight babies, prematurity, things of that nature. They have shorter lifespans. That's health status.

The flip side of it is what are the health outcomes? Once you go to a healthcare system, why do you get different care? And so much of that has to do with both interpersonal discrimination, right? So there's a lot of implicit racial discrimination studies that demonstrate that providers give differential care and misinterprets experiences when relayed to them because of the racial lens. But probably the bigger toll is the system challenges, right? We have organized our healthcare system towards one that is yielding and generating profit, one way or another, right? It might be margin as opposed to profit or surplus depending on if you're a nonprofit.

Chris Hayes: Right. All these nonprofit hospitals, but it's dollars and cents. Yeah.

Thomas Fisher: But it's dollars, right? We have sorted society in order to already distribute those dollars by race, right? So discrimination in the workplace, higher income workers, and those who are more likely to have good insurance are more likely to be white, right?

Chris Hayes: Right.

Thomas Fisher: We've sorted that. We've also sorted our society by segregation to ensure that those wealthy, well-insured individuals are more likely to live together and far from black people.

Chris Hayes: Yes.

Thomas Fisher: The healthcare outlets that then pursue those well-insured individuals are also therefore likely to be in those white communities.

Chris Hayes: Right.

Thomas Fisher: And so if you look at Chicago, one of the most segregated cities in the country, and you overlay race with insurance status, and then lay on top of that where the health care outlets are, it looks like a racial segregation. They're on the north side. They are where there are more wealthy folks, and folks who are white, and folks who have insurance status.

That means that those fewer providers who are less likely to be well paid tend to be concentrated or sparsely concentrated on the south side and in these black communities. So your wait is more likely to be long. Your capacity to get surgery as a follow-up option for your injury takes a longer time, and you have fewer options for that. Your capacity to get the specific resources you need in a timely fashion are just harder to get.

And therefore, because we have done all this social selection already, because of segregation and the way our employment works, all of these other unjust allocation of the goods, services and protections of our society already followed race. The health care system doesn't have to do anything. It would actually have to go against society in order to ameliorate.

Chris Hayes: Yeah. Right. If it were just entirely neutral, it would produce wildly disparate outcomes because all the inputs are wildly disparate, right?

Thomas Fisher: And we don't have that. What we have is a healthcare system that reflects the same social racial caste, and one that prioritize profit over people.

Chris Hayes: The geographical point is really profound. I hadn't quite thought about it, but it's so striking. Like, when I moved back to New York, Kate and I moved back here in 2011, she was pregnant with our first kid, and we were like looking for provider, like an OB-GYN, which is a little tricky actually if you're mid pregnancy and you move. New York is a very big city. There's a lot of money in New York, and there's a lot of money in New York and a whole bunch of different neighborhoods.

Thomas Fisher: Yeah.

Chris Hayes: And yet, even in the year 2011, the concentration in like the Upper East Side of providers, like the most old school, wealthy neighbor in a city where there's lots of money and lots of places. Like, even in this sort of weird geographical location of where the hospitals are, where the sort of “best providers are” is so bound up with socioeconomic status, money, capital, that I hadn't even thought of that.

But then when you move down the scale to like, “Okay, how many doctors are there? How many hospitals? How many providers are there in these huge swaths of neighborhoods that are relatively poor, underserved?” Like, that geographical aspect has a huge effect on people's health. Like, are you able to walk to a doctor or go see a doctor easily?

Thomas Fisher: Yeah. I mean, it's not only what sort of care do you get, right, where you receive care. Well, the people you receive care with is as impactful as like your specific case. Like, are you able to go to competent, high quality accessible outlets easily? Like, that is not really a function of whether you individually have insurance or can pay for it. It's more function is do those things exist in your neighborhood because your neighbors and those around you have that.

Chris Hayes: Right.

Thomas Fisher: Similarly, your health status is also dictated by your neighbors more than it is you. “Are there healthy grocery stores?” is not a function of whether or not you personally can pay for it, right?

Chris Hayes: Right.

Thomas Fisher: “Is there a lot of interpersonal violence in your community?” is not really about whether or not you personally are packing a gun.

Chris Hayes: Correct. Yes. Yeah, you can't choose. You don't get to choose whether there are gunshots on your block.

Thomas Fisher: So the impact of segregation on our health individually, but also on our capacity to get high quality care and care that is the best in the world, which is actually what we have in some places in this country, segregation influences all of that. And all of that was constructed.

Chris Hayes: So there's two aspects of this. We talked about health status and health outcomes. And what I'm hearing from you and this is reflected in what you write that the status and the hierarchies of racial caste in America, the legacy of how it's been constructed, the social and geographical spatial element of it, the economic element of it, those are producing these inputs. But just to talk first, which is the bulk of what's happening, right?

Thomas Fisher: Yes.

Chris Hayes: But to talk about and this will nicely, I think, segue to COVID in some ways, I mean, I have talked to you and read the accounts of and had many conversations with black folks about their interfacing with a medical system they feel is racist. And there's some studies on this. I mean, there's a very notable study about pain, which was the way that white doctors estimated what the pain threshold does for people based on race. They basically were medicating white people with much lower levels of pain than black people because they thought they could take it.

Thomas Fisher: Yeah.

Chris Hayes: And what I'm hearing you say is, look, the bulk of what's happening is systematic. It's not happening in the confines of the delivery system itself. But if you could just speak a little bit about that particularly because you are in position to be not only a black man who is a doctor in emergency department, but from the neighborhood you're serving --

Thomas Fisher: Yeah.

Chris Hayes: -- where I think some of the like, fraught, almost colonial relationships can kind of manifest themselves in the room.

Thomas Fisher: Yeah. I mean, look, I work in a resourced setting, relatively really well resourced setting.

Chris Hayes: Yeah.

Thomas Fisher: We have all of the trauma resources. We have all cath lab resources. If you have a stroke, we're a certified stroke center. We can do everything. But people's healthcare doesn't read the book. And there's so much judgment that goes into every single case because our bodies are unique, and our presentations are specific. And when you see people take ownership of care as though it is your aunt, it is the sort of pace and intensity of care that is hard to argue against.

I write an example in the book where judgment comes into play, where there's somebody who came in and is breathing heavily because they're having a heart attack, and we need to rapidly intervene. What intervention that is, is up for debate between myself and one of my consultants in the book. And it turns out, this person finally got to the care that they received and didn't have a good outcome anyway.

And I contrast that to what happens when a VIP comes in. And all of the specialists come to the emergency department to do whatever, to convene and quickly make decisions about moving people through care. Those judgments are hard to argue against, right? There's rarely a right answer. But what is the one that is fastest and is going to lead to the best outcome for the individual? And is that free and clear from all other ancillary considerations? Like, am I just too tired to do this right now?

Chris Hayes: Right.

Thomas Fisher: Will I get paid if I do this in the middle of the night? Should I come in? If a VIP comes in and is like, I don't know, on the board and gets bad outcome, like a whole lot of people have ramifications for that. And all of a sudden, things start being mobilized. Some places, and we don't have this, formally tier their care, right, where there is a VIP floor for these special people so that when there is a judgment call to be made, they always get heaped more on top. Now, you can argue more isn't always better.

Chris Hayes: Yeah. There's a little bit of cooks in the kitchen situation that happens with VIP care, where it's like the VIP sitting there in the bed and be like, “Oh, I talked to my buddy Morton and he says to give me ivermectin.”

Thomas Fisher: I mean, in fact, if you look at some of that pain data, while black folks suffered needlessly in extended periods of time because they weren't getting sufficient pain medication. It might have protected a lot of black folks from that first wave of opioid addiction.

Chris Hayes: This is the other outcome.

Thomas Fisher: Right.

Chris Hayes: Yes.

Thomas Fisher: So more is not always better.

Chris Hayes: Yeah.

Thomas Fisher: But when you're in a community that never gets more, rarely even gets enough, certainly you can add to their care.

Chris Hayes: When did you realize COVID was coming for you, for your life world?

Thomas Fisher: Yeah. I am sort of a lurker on Twitter. I mean, I have more presence now than ever because the book has both changed a lot of things, but also there's an opportunity to sort of convey to folks what's coming. But my lurking involves scanning international press for pandemics, for virus emergence. Like, I've been following the avian flu that's been sweeping the world for the past couple of years and wondering whether or not that's going to leap to humans and it hasn't yet.

I was watching Twitter and I noticed that there was a new respiratory virus in China. Probably at the end of 2019, it was actually Christmas Eve when it first hit my radar and I remembered texting friends, including our mutual friend Ta-Nehisi Coates that this may not be the next pandemic. But when we get the next one, it will look like this.

And I watched it marched, it first started shutting down China. And there were indications that factories were closing even though was weren't being publicly described. I watched doctors die in China who were taking care of those folks. I watched it marched across Europe, shutting down Italy. I think that's when most Americans really woke up and said, “Oh, this is big,” right? We saw both lockdowns in Italy. We also saw their healthcare system overwhelmed. And we saw again, doctors get sick and die over there.

And so the next thing you know, it's in Seattle, and then it hits New York. And that's when they pretty much became clear, this is coming for all of us. This is an inevitability. Even though I don't think that we had this sort of honest public health conversation coming from the highest levels yet, we were still saying, “This will pass over.” We saw at that time, right before it got to us and society really shut down in March, there were some cruise ships that were impacted, and we were debating what to do about that.

Look, in the emergency department, we prepare for this. This is one of the things that's sort of central to our training is that we know infectious diseases that sweep through a community will come to us first. And we prepared really carefully for things like Ebola when that came, right?

Chris Hayes: Yeah.

Thomas Fisher: We knew how to don and doff our protective equipment, and that came in handy as we prepared for this respiratory virus. We also had similar preparation way back when anthrax was a threat. Remember when those mails were being sent to our elected officials with anthrax spores in them in --

Chris Hayes: In 2001.

Thomas Fisher: There you go, 2001. And all across the south side, people saw white powder like, “I've been exposed to anthrax.” Fortunately, those things didn't expand. But those just speak to the sort of drilling and preparation that we on the frontlines are accustomed to. I knew it was coming. I don't know that I was ready. But I've seen it for three months before society actually closed down.

Chris Hayes: What was that period? What changed for you? I mean, I think Chicago had a pretty bad early outbreak. But it wasn't ever quite the New York level, like lines of freezer trucks.

Thomas Fisher: Right.

Chris Hayes: And I've spent a lot of time talking to New York ER docs, they were really profoundly messed up by that.

Thomas Fisher: Yeah.

Chris Hayes: And one of the things that one of those ER docs said to me that stuck with me, he said, “Look, I lose patience all the time. I mean, I'm an ER doc, I have to go make this speech that you just referenced.” He's like, “But it doesn't happen that often. Like it's a big deal when you lose a patient. Most of the people I care for get well.”

Thomas Fisher: Yeah.

Chris Hayes: Being in a situation where you are, you have five or six people dying on you on a shift. I've never been through that. No one's been through that. Like, we were just not, in some ways, emotionally, spiritually prepared to deal with it. Like, the personal level of failure and impotence, but also just the grief and the trauma of dealing with that much death, which we really hadn't done, even though you would think, as an ER doc, that I'm pretty used to it. And it turned out, I was not.

Thomas Fisher: Totally. So it's that. And then you add to that, we feel like Swiss Army knives, like we have tools for all kinds of environments.

Chris Hayes: Right.

Thomas Fisher: We've seen it all before, but we've never seen this. Like, we don't exactly know how to treat this. We think you're supposed to intubate people when their oxygen saturations are low. We think these sorts of steroids might work. We don't really know, right? And I know some of the interventions we were trying at the beginning were not effective. I don't know if they were actually detrimental. But we certainly weren't helping people because we had no idea what to expect.

We thought it was droplet at first, right? There were a lot of indications that it was airborne, but that data wasn't clear yet. We were flying blind. Then we were seeing people die. And then on top of that, now we're in the equation, right?

Chris Hayes: Right.

Thomas Fisher: All of a sudden, our own health is complicated. Even on the worst days of trauma, like it's not always the news, but we have trauma nights in the summer where multiple people will die in a shift and it's just horrendous. But at the end of the day, we go home. We might have a fitful night of sleep, dinner might not taste as good, but we go home, right? And we know we're going to go home.

All of a sudden, we don't know if we're going to go home. Our colleagues and ourselves are all of a sudden not only flying blind and trying to care for people in the best way we can, not knowing what tools and resources are the best in order to serve our patients. But we also might get sick ourselves and become patients.

And through my time as a White House fellow, I became acquainted with a lot of people in the military, including folks who had operated overseas. And it was one of my very close friends who I spoke to, who helped me sort of understand how to interpret that component of risk, where he also might not come home at the end of the day. So how do you deal with the fear, right? It was terrifying.

And his advice was like, “Look, once you actually get in the environment and start moving, your training kind of takes over and you're not really afraid all the time.” But that had nothing to do with like what about the night before, right? What about once you get home and you're like, wow, that was close? And the emergency department is not like anywhere else. Like, it's unselected. We often didn't know if somebody had COVID, right?

Chris Hayes: What do you mean unselected? What do you mean unselected?

Thomas Fisher: Everybody comes in, right? You --

Chris Hayes: Oh, right. Right, I see what you're saying, Yeah, you have no idea because someone might be in for a broken arm, and that they also might have COVID.

Thomas Fisher: But they might also have chest pain.

Chris Hayes: Right.

Thomas Fisher: They're drunk and out of control, and here for some mental health issues. They're not wearing a mask.

Chris Hayes: Right.

Thomas Fisher: They're not like, “Excuse me, sir. Hey, buddy, let me negotiate with you so that I can keep my entire team?” Like, no, they're out. It is a very uncontrolled environment. And so --

Chris Hayes: Yeah. Right.

Thomas Fisher: -- it's not as though everything stopped when COVID happened. Things did change the dynamics of who came in changed. But like there was still a lot of out of control situations that could have exposed me and my colleagues, and many of my colleagues did get sick. Both at the beginning and then throughout all the way through Omicron, folks were falling ill and there was a component of it…

I've shared this story in other settings and certainly with friends, where it felt like being in one of those slasher movies where like teenagers are walking through the forest in an ill-advised way. And like, all of a sudden, they look around, there's like, “Wait, where's Johnny? They got Johnny.” We would be at work, and all of a sudden, you'd wonder like where's Mark? I haven’t seen Mark in a couple shifts. Did we just not coincide? They're like, “Mark got sick.”

Chris Hayes: Right.

Thomas Fisher: “He's not back yet.” And then just there was a cadence to that, where all of a sudden, we were very much in the equation for catching illness at work, in ways that our colleagues who could be elective in their procedures, or make sure that everybody was tested before they filled their appointment. It never worked. And that both made it a very interesting perspective on the way our society came together, and in fact, did not around COVID. But also just a crucible for understanding what is it that we really do mean to one another?

When everything is stripped away and people are in these moments where they are facing these fundamental existential challenges, and all of their culture is stripped away. They're at their most human, and we saw so much of that, both between peers and colleagues, but also between us as providers and our patients. That’s a reminder that we owe something to one another, much more than what we've decided to invest.

Chris Hayes: What have you come out of that experience with? I mean, you're not out of it and people are still I'm sure presenting with COVID symptoms because it's indefatigable.

Thomas Fisher: Yeah. I mean, COVID is going to be here for quite some time. I think we're going to be facing waves of this for the foreseeable future. And I'm old enough to remember there was a life before we even had things like HIV, and now it's just a part of our society.

Chris Hayes: Yeah.

Thomas Fisher: I think the way in which our society and its injustice creates illness in people particularly begins in our childhood, in the nutritious food, in the safe environments or not safe environments, and the way we're educated and the way we're reared, and whether or not we go to the sort of workplace that allows for us to work behind the screen, safe from the pandemic, or whether or not we actually have to stock shelves and work in warehouses and deliver goods.

Chris Hayes: Or even independent of COVID, which you note in the book, it's like whether we work with our bodies that then get injured --

Thomas Fisher: Right.

Chris Hayes: -- because our back gets screwed up.

Thomas Fisher: Our hand gets caught in a press.

Chris Hayes: Right.

Thomas Fisher: Usually, that takes a lifetime and we saw that in just months.

Chris Hayes: Yeah.

Thomas Fisher: And it's a reminder, I guess my takeaway is we not only need to respond in such a way that allows to protect us to protect everybody, given our shared humanity in moments of crisis. But why can't we do that all the time? Why aren't there a random or at least even distribution of protections, goods and services that allow everybody to be healthy? Even if you can't make everybody rich, I mean, I don't even know if that's actually a good goal, but we should be able to make everybody healthy so that they can explore, they can love, they can hope. They can play ball, right? They can make art. They can create.

Chris Hayes: And I mean, talk to me a little bit about your policy vision here, which I think is the policy vision that I and many people share, which is that you need a universal system that is outside the boundaries of the market, that is a fully public system. No system is ever going to be outside of resource cost questions, where they're going to be omnipresent. Everywhere you see the NHS. What is the NHS being funded? Where are those funds going?

Like, no one is ever going to be able to escape questions of resources because those will always be even in a public good. But it's a different set of questions and a set of questions around the market and around what will be covered and what won't, and who can pay for this specialization in this neighborhood.

Thomas Fisher: Yeah. I mean, I think that some things shouldn't be run like a business, right? If you perceive of running as a business and not everyone else, if you perceive that that is finding profit no matter where it lies at any cost, and not everybody runs their business that way.

Chris Hayes: Right.

Thomas Fisher: But if that is the underlying premise, I think that things like the way we teach our children and the way we take care of our bodies ought to be liberated from that. One way to do so is with a democratically guided system of finance and care that looks like a lot of different things. And I think that when I stepped back, I realized that there are more than enough technical solutions on the table that have been thought through and published by the wonkiest of the wonks that can work to solve some of these problems.

But unless we step back and have a commitment to elevating humanity over all of these principles, it won't matter, right? There was a time where we had de facto and de jure segregation of our schools, and we passed laws in order to desegregate those schools, but we hadn't reshaped our commitment to humanity. And guess what, schools are just as segregated now as they are then. So even if we were to do something universal --

Chris Hayes: That's a good point.

Thomas Fisher: -- whatever that might look like, and we do not address this fundamental commitment to one another, it won't matter.

Chris Hayes: Right. Universal healthcare, which if you gave me a magic wand, I would have us have Medicare for All tomorrow. But even if you got that, you got Medicare for All tomorrow, okay, grafted onto the American system of racial, geographic, spatial, socioeconomic segregation and caste, it would be better than now --

Thomas Fisher: Yes.

Chris Hayes: -- I think definitely. But there would also be a lot of inequities in that system because it's going to be built up on top of the inequities that are again in those inputs.

Thomas Fisher: And if you didn't safeguard one another through dismantling and abolishing this racial caste, over time, as you tinkered with this universal system, you would simply arrive at the same sort of tiering because that's the fundamental insult of our society, right? When it comes to these issues of injustice, you will have to stare at that and be uncomfortable with it until it goes away. You can't just simply say, “Well, if we just address this payment structure, that tiering will go away.” It will not.

And in the meantime, you can still be a moral leader in your own place. You can, in your place, elevate people over profit and look at systems rather than individual solutions in order to create better healthcare in every organization, in every setting. But you could do that today.

Chris Hayes: One of the things that was so striking during the first several months of the pandemic and extending actually through the summer when there's another outbreak, and then it's the winter, the snapshot of the economics of hospitals, which I think a lot of people don't have a lot of insight into. The fundamental paradox, it was all like everyone is cheering for the healthcare workers, the hospitals, the place where all the care is getting done, and the hospitals are bleeding money at an unprecedented clip because they have canceled surgeries.

Thomas Fisher: Elective surgeries, yeah.

Chris Hayes: Elective surgeries, so-called elective surgeries, which again is a little bit of a misleading category because sometimes it's like cancer treatment that you can put off for a month. But it's not like cosmetic surgery.

Thomas Fisher: That’s right.

Chris Hayes: I think people heard elective surgery and they felt like, “Oh, it's a facelift.” Like, a lot of elective surgery is like pretty important and serious stuff.

Thomas Fisher: No, you need it done, just maybe not today.

Chris Hayes: Today. Right. But it was such a fascinating moment where it was like, wait a second, now, why are the hospitals going bankrupt? You saw the kind of fundamental perversion of the market incentives, which is like we all agree at a societal and human level, these are the sites right now. These are the most important places in our society.

Thomas Fisher: That's right.

Chris Hayes: But, literally, they're also leveraging money because they're doing the thing that's most important, like most focused, but they make all their money from this other stuff and they have to do them both. And it was like, wait a second, how does that work in normal times? And then it sorts of moved on, the hospitals got bailed out, I think, correctly.

Thomas Fisher: Yes.

Chris Hayes: That was the right policy move, for sure. But I keep coming back to that, as I was reading your book, when you talk about how we're ordering value in these places like that was the ultimate sort of reductio ad absurdum contradiction in those months.

Thomas Fisher: And then what's even more insulting in some settings is that our nonprofit hospitals are also like these are public goods. The fact that they are not paying taxes on either the real estate or revenue is because you have a community supporting it. Like, they can use that tax revenue.

Chris Hayes: Right.

Thomas Fisher: The training of the residents, that's taxpayer money, right? Those are Medicare dollars. The NIH funds that keep our academic medical centers afloat, those are further tax dollars. So the fact that you have all of these collective resources being invested in the delivery of care, but then that care is not being similarly democratically and equitably allocated --

Chris Hayes: Right.

Thomas Fisher: -- it's a fundamental challenge we have to face.

Chris Hayes: How long do you think you'd be a doctor?

Thomas Fisher: I mean, forever. It is one of those, the intimacy of strangers, the way people tell me things that they don't tell their closest people, the privilege of being with people in these moments that are turning points in their lives, is just an incredible privilege and one I won't just easily give up.

Chris Hayes: I was talking to someone the other day, and the work that I do is so much less important than the work you do, so let me just stipulate that straight up. I was talking to someone the other day about doing my job, hosting this television show, and I said the thing about it, it's hard every day. But like there's different problems to solve. There's different things to talk about. There is a kind of freshness and dynamism to it.

And I would imagine that every patient is a new mystery. I mean, there's some stuff that's wrote, like, you know this is the treatment for this. Like all jobs, you get good stuff. But I imagine there's something both sort of intellectually and emotionally dynamic and enlivening about the fact that you have a new set of problems with each shift, with each patient.

Thomas Fisher: Yeah. And I also get to use my hands, right?

Chris Hayes: Right.

Thomas Fisher: I get to do procedures. I get to meet strangers from walks of life that I would never come in contact with. All my colleagues are pretty cool. Like, it's a lot of very smart people who are also technically gifted and have a lot of education. And we work in concert, in a very integrated and interesting team fashion, from nurses to techs, to custodians, our housekeeping and security. All that stuff is really cool. And then we see a section of humanity that nobody gets to see. Those components make it very interesting. And so --

Chris Hayes: What do you mean by that? What do you mean by that section of humanity no one gets to see?

Thomas Fisher: I mean, I get an opportunity to ask very probing and interesting questions of titans of industry and the homeless.

Chris Hayes: Right.

Thomas Fisher: Sometimes right after one another.

Chris Hayes: Right.

Thomas Fisher: An open-ended question like, “Hey, how did you sleep last night?”

Chris Hayes: Right.

Thomas Fisher: People tell you their fears and hopes. They don't usually tell you about how they're sleeping. And when you ask all these different people from all these different walks of life, these open-ended questions, they show you society in a way that it's just a very unique and special opportunity. So I'll do this as long as I can.

I am also fortunate because I do it in the community where I work for, and I have those sorts of checks. Like, I'm not as burned out as many, right? And that burnout is real, particularly when you look at in 2020 when we were bending the curve, and healthcare workers were heroes, and pots and pans were being banked compared to when Omicron hit and folks like, “Hey, you're on your own.

Chris Hayes: Yeah.

Thomas Fisher: We were crushed. Half of the docs got sick. I can see why people left, and I can see why people continue to leave. Like, there was this deal. There's this deal where doctors and nurses and folks work harder and longer because there's this social like --

Chris Hayes: Yes.

Thomas Fisher: -- reinforcement. Like, you guys are heroes or whatever. Once that goes away, doctors and nurses are like, “Well, why am I giving all this?”

Chris Hayes: Yeah.

Thomas Fisher: I can see more folks leaving.

Chris Hayes: Dr. Thomas Fisher is an emergency medical physician. He's also the author of a really great book, “The Emergency: A Year of Healing and Heartbreak in a Chicago ER.” He’s healthcare executive and served in the White House fellow in the Obama administration. And I'm in no position to judge technically, but I would imagine that any patient would be lucky to have him providing their care. So it's really such a treat to talk to you Dr. Fisher. Thank you very much.

Thomas Fisher: Chris, it's been a pleasure. Thanks for having me.

Chris Hayes: Once again, great thanks to Dr. Thomas Fisher, an incredible guy really I got to say, who I find inspiring I got to say. The book is really, really well done. You should definitely check it out.

For more inspiring stories of people like Dr. Fisher, you can watch the primetime special Inspiring America, the 2022 Inspiration List, celebrating extraordinary individuals making an impact, on Saturday, May 7th, on NBC, MSNBC and Telemundo, or catch it on-demand starting Sunday, May 8th on Peacock.

We always love to hear your feedback. Tweet us with hashtag WITHpod. Also join the conversation this week using the hashtag Inspiring America NBC. “Why is This Happening” is presented by MSNBC and NBC News produced by Doni Holloway, Tiffany Champion and Brendan O’Melia, engineered by Bob Mallory, and features music by Eddie Cooper. You can see more of our work including links to things we mentioned here by going to

Tweet us with the hashtag #WITHpod, email “Why Is This Happening?” is presented by MSNBC and NBC News, produced by Doni Holloway, Tiffany Champion, Brendan O'Melia, engineered by Bob Mallory and features music by Eddie Cooper. You can see more of our work, including links to things we mentioned here, by going to