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The ER Pilot is a Clinic on How to Make Perfect TV

While there are many great shows out there, only a few of them have a perfect beginning—the kind that draws you in immediately and leaves you wanting more. In 25YL’s Perfect Pilots series, we will be looking at pilot episodes we think are flawless. This week John Bernardy looks at the pilot of ER on its 25th anniversary. Got a pilot you think should make the list? Let us know!


Before we knew John Wells was the big producer and showrunner of ER, and before the show even aired, all we knew was that the guy who wrote Jurassic Park was writing a doctor show for TV taken from his experiences in med school. And Michael Crichton wrote the two-hour pilot, reinforcing the idea. At the time I wasn’t sure about how his work would fare going from dinosaurs to an emergency room, but I read Jurassic Park and loved that book way more than the movie. I thought Crichton really understood how to tell a story so I was willing to try it out. And god damn was I glad I did.

Based on this pilot alone, I was hooked for over two years on this show. And today, having re-watched the pilot, it did it all over again to me. The ER pilot is even better than I remember. The pilot is built like a Swiss watch, and you can root for every single character in the ensemble. In its way I’d put it up against any pilot, even The Prisoner or Twin Peaks—and you folks who read my 25YL work how I feel about those—and ER would hold up admirably. This pilot is tied for first with so many greats.

The ER title card: green and black background with white letters ER in the center front.

They don’t make doctor shows like ER anymore. Grey’s Anatomy finally passed ER’s 15-season run this year with its 16th, but Grey’s has always been slick and soapy. ER did get there—death by helicopter coming back for more, anyone?—but it took a number of years for the show to get to that level of over-drama. In ER’s pilot, there’s a realism that gives me chills.

Instead of a cavalcade of scene-appropriate pop songs in the soundtrack like Grey’s, it’s mostly silent. The scenes and the stakes are mostly allowed to breathe. Sure, there’s dramatic music underneath every scene that involves surgery. Sure, the score comes in with that piano music when George Clooney’s Dr. Doug Ross and Julianna Margolies’ Nurse Carol Hathaway share a scene, and it returns when she comes back into the ER later, but mostly there’s only diegetic music like the radio at the nurses’ station. ER feels like a TV show, but its location also feels real. Maybe lack of soundtrack gives us cue dependency of when we were last in a hospital room. Every hospital visit I’ve ever made had a lot of heart in it and a lot of weight. This show is entirely in keeping with that.

Adding to the realism, there was no extreme star power on ER. Anthony Edwards was the most prominent cast member, and I only remembered him as Goose in Top Gun. Everyone else was as fresh on our eyes as Noah Wyle’s Dr. John Carter was to IVs and suturing. The biggest name I recognized was Miguel Ferrer, everyone’s favorite Albert Rosenfield, playing the part of a patient in a single scene. Everyone else, they could be your doctor or nurse or the person in the bed next to you, and you’d believe it. This show felt authentic as hell.

You can tell that every single character has a rich internal life, even the characters working the nurses’ desk routing patients to their rooms. Everyone has evident personality and point of view. Sure, you can’t not think that’s George Clooney in these scenes now, but even now you can say man oh man he’s so young. You could feel all of these stars beginning their journeys here. Part of the show is the characters growing in their careers, and part of it is the actors becoming themselves right before our eyes alongside their characters. It still feels just as authentic today despite the actor recognition.

A nice bonus is how—unlike today’s prestige television—no character is unlikable. They may not do everything correctly or they may have egos the size of a yacht, and they may not make the healthiest people to know in real life, but every main character on ER wants to make a difference. There’s no one who’s a villain, just a bunch of characters whose goals may sometimes be diametrically opposed with one another. You want to root for all these people, to save the day and save themselves. These days with all the ugly-inside mean characters on TV, this is absolutely refreshing.

The pilot itself, “24 Hours,” divides nicely into six acts, but it took me watching more than once to notice. When you get in the episode’s flow, it builds so organically it’s hard to notice how well the episode’s built.

6:30, Dr. Greene

Dr. Mark Green, asleep in an emergency room, is woken up by a nurse after bareley getting any sleep.

It begins when Dr. Greene (Anthony Edwards) gets woken up in the dark ER room by the “that nurse!” Lydia Wright (Ellen Crawford) an hour and a half before he was scheduled because Dr. Doug Ross (George Clooney) needed assistance because he rolled in drunk.

Greene sleeps at the hospital, not with his wife and daughter. Ross leans into irresponsible ladies man territory on his off nights.

Dr. Greene tries to get more sleep, is woken up by the nurse one more time for medical orders, then again right after the door closes at what’s now 6:30. You can feel the zero time Greene feels he slept. Dr. Lewis (Sherry Stringfield) and Dr. Benton (Eriq La Salle) are arriving, and you see the TV in the lobby that is showing a building collapse in the Loop, anchoring the show in Chicago. Then the ambulances with patients start rolling into the hall along with the crazy surgery music.

Ross wakes up to help. Benton acts like the big guy in the room but the orthopedist shoots down Benton’s desire to do the necessary surgery. “You’re a resident, Peter. You’re years from a case like this.” Greene has to go to the lobby and give the “we were unable to revive your father” news to a guy in the lobby. Lewis diplomatically shoots down a patient hitting on her while being proficient at her job. The music score’s gone again by now. The doctors are together in the hallway. One asks “that’s it?” Nurse Hathaway (Julianna Margulies) nonchalantly says “yeah, last two are DOA.”

Next we’re in the doctor lounge afterward. Benton’s pissed because the coffee’s gone. Greene cops to getting an hour total of sleep the night before. Someone asks if the new students are there today, and they hope they’re better than the last batch. Then Greene meets his wife and daughter in the cafeteria. His wife Jennifer (Christine Harnos) is trying to get him to take a meeting with Dr. Harris. “You’re not going to forget or get too busy?” All the while their daughter is cute but not saccharine. The gist is the couple never sees each other anymore, and she hopes he likes Harris’ offer. Whatever that is.

End act one. That was just fifteen minutes, and the conflicts and character traits are organically well on display. Built like a watch.

Welcome to the emergency room

Doctors Greene, Ross, Lewis and Benton look offscreen towards the student doctor's extremely white coat.

We meet Dr. John Carter (Noah Wyle) who knows how to dress—the first tailored white coat the doctors had seen in an emergency room—but not much else as Benton takes him around the ER showing us viewers around the landscape as well. Carter meets Dr. Morganstern (William H. Macy) who says mostly glowing things about Benton. “Learn everything you can from him, except attitude.” Carter’s a mess. He’s never given anyone an IV or stitched a suture.

Ross’s student Tracy Young (Holly Gagnier), on the other hand, is all business and has no interest in crumbling to Ross’s smiles or charms. We don’t get to see much of her this episode but there’s promise of more.

We also don’t get to see much of Hathaway but we see her here having questions pelted at her by anyone and everyone, and she has a correct answer for all of them. You know she’s liked and respected, and you know she’s capable. And Dr. Ross comes up next to her and we realize they have a) history that didn’t end well and b) chemistry that remains to this day. Their quick chat is when we get the first piece of non-surgery music from the score—“Doug and Carol,” by show composer Martin Davich. That song murders me. It leans towards Young and the Restless, but I don’t give a shit. That song got in my heart immediately. Almost ten years later I finally broke down and bought the ER Soundtrack just so I could have it.

“24 Hours” uses its score like a surgical tool rather than wallpaper, and every time it does its job well. Thanks to “Doug and Carol,” we knew that the melancholy, heartbreak and longing between those two characters is where we’re to find our soapy One True Pairing. Message delivered.

After that, we get small vignettes to prove that even without a building collapse an emergency room never gets too calm.

  • We see Carter in the single scene that didn’t age well at all: Carter’s trying to get an IV in a cop’s leg, and doesn’t say a single word to the patient who is repeatedly talking about beating his wife. This was supposed to be comedy in juxtaposition, but we’re even further away from “one of these days, Alice, bang, zoom, to the moon” than we were in 1994 and there’s no more Jackie Gleason “cuteness” left to recall. Thank God.
  • Greene  has a race relations issue when he initially tries to not put a guy through an expensive test, but then orders the neurology report to show respect when the patient says it was “because I’m black.”
  • We next get a baby delivery that couldn’t wait. Greene delivers the baby in the hallway with Lewis, Ross, and Carter looking on. There’s a purely-soundtrack spiritual song that plays when the baby is born, and you can tell Carter is overwhelmed with happiness for what he just witnessed, even with Benton telling him to get back to his list of sutures that are backing up.
  • Next we get Green explaining to a patient pressing hard for workers comp for his ankle “the diagnosis is you’re still alive,” while the next bed behind them Lewis just lost a patient.
  • In another room, Ross prescribes amoxicillin for a crying baby and leaves the room. The mother says “he’s very handsome.” The nurse, missing no beats, says “he knows it.”
  • At a station, Greene chews out someone over the phone for not having test results done, then goes out to the lobby to find a Mrs. O’Rourke who isn’t there. The emergency room is always in motion.
  • Carter asks Benton if there’s anything he could help with and is told to go to lunch. We get the whole explanation from Benton to not be a hero and eat when you can, because later you might not be able to leave. Take your lunch because you can. Be back in a half an hour.

All this, from the minute we first meet Carter until now, took place in fifteen minutes and gave us a fantastic introduction to what it’s like in the emergency room when a major crisis isn’t happening, all while learning a ton about how each character deals with their workloads. And none of it drags or is boring. This is the way to mask exposition.

Mark, We’d Really Love to Have You

Dr Greene ushers a drunk Dr. Ross by the arm towards a spot where he can help.

While Greene is getting his coat and leaving the emergency room, there is total chaos, complete with dramatic piano music in the score. The implication is that he understands how to help, and that the room is calling to him to help. He knows he’s needed, and he understands his role there.

Dr. Harris’ private practice office, on the other hand, has empty synth music playing through speakers and it seems like a calm lawyer’s office. It’s all decked out in browns and wood, and it feels like an absolutely sterile alien environment. The next associate office, meant for Greene, has glass doors. The salary is almost a full hundred thousand a year more than Benton quoted earlier for his salary. The ER, according to Harris, is a young man’s game and Greene needs to think about getting his kids through college and traveling to conferences in Maui and Rome. Harris tells Greene Morganstern says he’s the sharpest guy they’ve got, trying to woo Greene, but it all feels so superficial. Even the office is redesigned every couple of years. “It keeps us looking fresh,” because the people that work there aren’t going to feel fresh.

Back to the ER, Benton appears to have lost a patient. “I must be crazy,” he says. Hathaway says “that’s a very good insight.” At the same time, Greene’s in the lounge talking with Ross. They glancingly get into Greene’s misgivings about Harris’ private practice offer, but Ross asks about the cute tech on surgical floor. Ross has no qualms about a married man cheating but Greene says he’s faithful to his wife. The two guys have a good working relationship but you can tell they’re two different kinds of people.

After that we move onto Lewis looking over X-Rays with her patient. This is the Miguel Ferrer scene, where he plays chronic smoker Mr. Parker. Lewis sticks to the scientific explanation as long as she can, but he keeps at her about what she thinks it means. She eventually says signs point to cancer, but still won’t confirm it. Not until he asks her “how long do I have?” After a long number of seconds she says “six months to a year.” The piano score is here as well so you know it’s an important scene. Parker talks about how it’d probably be good to take those trips then, see the world. It’s intense enough already, but then he gives her a long hug. Lewis is a straight arrow and you can tell this was hard on her. The scene gives her a few moments after Parker leaves and she takes down the X-Ray. End of act.

We gotta go

We start with some needed comedy as the nurse staff changeover happens and Hathaway goes home.

  • Greene takes care of Mrs. Radkin, an older woman who likes the attention of being taken care of. He removes her hangnail when Dr. Lewis comes in and asks Mark if he can take a coffee break. Though with that one interaction Radkin’s more observant that Greene. She tells him “you be a good boy and go home to your wife.”
  • Carter gives sutures to a girl who wrecked her dad’s car. “It was the Caddie??” It played well for comedy as we tried to figure out exactly how he’d react.
  • Ross has a laugh with the kid who swallowed his mom’s only key to the house.
  • Then we’re back to Carter who’s being stonewalled by a girl trying to hide a pregnancy. Benton has to be called in and he solves the problem with two questions.

Then we have a scene in a coffee shop with Greene and Lewis. They have an easy rapport. They actually care about each other and know their significant others by name. And Lewis knows that Greene will hate that private practice role. They’re professional, but they’re close too. This isn’t somewhat superficial like with Ross. Looking forward, I can see how the seeds were planted for these two, even if it’s not at the front of either of their minds. As a teenager, I shipped these two hard. I’m glad to know it was because they were genuinely good for each other rather than just being interested in getting together.

Except in the pilot, we don’t have a chance to ponder their relationship too long because Greene’s pager goes off and they’re called back to the hospital. Next thing we see is the camera in the hallway behind Ross’ head, going around to the front of him as Greene and Lewis arrive. “She’s on her way.” Ross asks, “how could this happen, to her of all people?” By now that piano song has started in the score and the ambulance pulls up. Greene, the consummate professional rallies everyone. “Hey! Let’s get back to work!” And as the camera finally gets to her face, a nurse says “it is Hathaway.”

They need our help

An almost sick Dr. Carter is outisde the hospital doors with his head down. Dr. Greene sits across from him offering encouragement.

When the show comes back from commercial break, the team has Carol Hathaway on a bed and they’re preparing her, for pumping and whatever else is necessary. Nurse Lydia asks why’d she do it, and Greene keeps his eye squarely on the care. “Doesn’t matter why she did it, we don’t ask it for any ODs that come through this door, we don’t ask it about this one.” And he keeps trying to get things back on track. A lot of “what are you people standing around for” and the like. He’s in charge of the whole floor right now and he’s easily up for this challenge.

We get a quick interaction in another area where Benton has a conversation with an X-Ray doctor, who says this of Peter: “man of many talents, all unproven,” thus setting up the climax of his episode arc.

Then it’s right back to the floor where Morganstern’s arrived. He’s talking with Greene, who says “for the morale of the unit, we have to try everything.” Morganstern has the tone that he thinks Carol’s a goner, then says “We take care of her, then we go on with our jobs. You set the tone, Mark. You get us through this.” First order of business, to Dr. Ross: “Go get a coffee, Doug.” Then he does the work of checking on Carol.

After that, Benton’s wounded patient shows up and it’s a nasty knife wound. This is when Carter has to step outside, and Greene follows him out to have the thematic conversation of the episode.

This scene combines the two parallel threads of Greene and Benton’s stories this episode, even though it only includes Benton’s student. But we all understand by now Carter is the third of three focus characters for this episode. And it’s the breakthrough point of the episode’s theme. This whole episode focuses on Greene’s “is it time to make a change” and Carter’s “can I really do this.” And this scene is when they realize their answer. Everything that happens after this scene is what they choose to do with their answers.

Carter apologizes for being sick, and Greene tells him not to apologize. “There’s two kinds of doctors. There’s the kind that gets rid of their feelings, and the kind that keeps them. If you’re gonna keep your feelings, you’re gonna get sick from time to time, that’s just how it works.” Greene goes on: “People come in here, and they’re sick and dying and bleeding, and they need our help. And helping them is more important than how we feel.” A pause. “But it’s still a pain in the ass sometimes.”

The two doctors share the moment and the space between words, and before Greene goes back in he says “by the way, I was in medical school with Benton, and he used to get sick all the time. So don’t let him give you any crap. You’re gonna be fine.”

The very next scene, Benton arrives in the doctor lounge, followed soon after by Carter. They shortly talk about the basketball game on the TV, then Benton says “don’t worry about what happened out there, just don’t make a habit of it.” They’re now on the same page.

We get a few more vignettes leaning into the comedy vein.

  • Carter gets a patient dressed as a French maid.
  • Greene gets a man who cries as if he expects the cancer diagnosis no matter what Greene says, but when he finally hears Greene instead giving him an ulcer diagnosis he shifts into “quit smokin’ and drinkin’, what, are you kiddin’ me?”
  • Then a girl with burnt legs attempts to seduce Green but Nurse Lydia is in the room. The girl says “are you afraid of me?”  Greene replies with “you’re gonna be fine in a few days.” And then after she’s gone he says “thanks, Lydia.”

We get back into it with Ross making a phone call to child services once he realizes the child had been beaten, and then Benton talking with a patient, Mr. Harvey, who appears to have a burst aortic aneurysm bleeding into his stomach.

Benton talks with Lewis about who’s here to take the surgery, and when the answer is no one, decides to open up the patient himself and “keep him alive until Morganstern gets there.” Lewis makes the phone call to get Morganstern.

This act, we shifted from one unthinkable situation the whole floor had to deal with, into an impossible situation where no one can do surgery except for the guy not allowed to do surgery. With only fifteen minutes left in the show. Well played, Crichton.

I can’t give up on this

Uptight Dr. Carter tries to take notes behind Dr. Benton who is sharing information quickly.

After centering himself, Benton goes to an operating room—with a surgery already in progress—to ask for anyone who could help. The doctors in the room provide a moment of humor: “That’s a joke, isn’t it? Please find out if that’s a joke,” setting up the nurse’s “it’s not a joke.”

In the operating room, Benton has control over the scene and makes the cut, before Jimmy from the other surgery room comes aboard to help. There’s a tense minute of not being able to find the leak but then they do, and right after that is when they hear Morganstern is on his way.

When Morganstern eventually arrives, he gives Benton crap about the ugly incision, but right as Peter almost walks out he says “Peter, you did a good job. You were lucky as hell, but you were right to open him up.” Benton walks out, decompresses by doing that punch in every credits montage for years, and then we’re onto Dr. Ross because nothing ever stops in an emergency room.

Ross lays into the mom of the battered baby, explains that child services are involved, storms out of the room and lays into Tracy for misplacing a file. He finds the babysitter who brought the child in and lets her know the baby will be okay. It was a good way to give Doug an actual arc, as well as to show him bouncing back after Carol’s arrival.

As far as Carter and Greene, their arcs recede into the background in this act because their answer was to do the thing. Carter’s old hat at the sutures by the end, and Greene says “I can’t give up on this” right in the middle of caring for a patient. Green also hears twice that his wife called. “I’ll call her in the morning.” There’s Greene’s future conflict in a nutshell.

Benton’s epilogue was in Mr. Harvey’s room after the surgery. Mrs. Harvey was all happy at the good job Dr. Morganstern did, then says Benton was given credit for doing a lot. Benton’s response? “I just helped out a little.” Which thankfully Morganstern heard because he happened to be standing in the doorway. Humility looks good on Peter and I like that he instinctively went to that mode.

After that we had some small events, because the emergency room never stops completely.

  • Ross apologized to Tracy for yelling and they go get a coffee.
  • Carter is yawning after finishing up stitches on the head of a charming older man who didn’t feel a thing.
  • Lewis wakes up to talk radio that’s complaining that doctors should be ashamed of themselves for the price of healthcare.

Then Benton picks a room for a nap, Carter lays down on three lobby chairs, and Greene goes to room 8. “Wake me up at 6:30.” The nurse responds, “gives you almost an hour and a half, you’re lucky.”

The door closes. And the door opens right back up. “6:30 Dr. Greene.”

Dr. Mark Green, asleep in an emergency room, is woken up by a nurse after bareley getting any sleep.

“Wow. Wow.

Wow indeed. On top of everything else, having the episode go full circle at the close was perfect. Now I just need to decide: do I re-watch the pilot, or do I go on to the next episode?


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Written by John Bernardy

John Bernardy has been writing for 25YL since before the site went public and he’s loved every minute. The show most important to him is Twin Peaks. He is husband to a damn fine woman, father to two fascinating individuals, and their pet thinks he’s a good dog walker.

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