A gurney crashes through a set of swinging doors as emergency medical technicians bark out a barrage of vital statistics. Doctors and nurses scurry about as the injured patient is rushed into a trauma room. On a three-count, the patient is lifted onto the examination table. Clothing is stripped off, an IV needle inserted and blood pressure measured. "Get an ABG, CBC and ERG!" shouts the doctor in charge. "The lungs are filled with fluid! Call OR and tell them we're on our way up!"
Joe Sachs, MD/MA '85, watches the action from behind the trauma room window. He looks concerned, but not about the patient. Sachs is monitoring the doctors and nurses. As medical technical adviser on ER, NBC's hit series now starting its third season, he is responsible for making sure the show is as technically accurate as possible.
Each week, Sachs carefully choreographs the trauma scenes, coaches actors on their pronunciation of difficult terms and rehearses them in the medical procedures they perform. It might be difficult for the 48 million viewers to believe, but until a few minutes before the scene, Dr. Greene had no idea what a CBC (complete blood count) was, let alone how to do one.
It takes Sachs about five hours to stage a five-minute trauma scene that might involve up to a dozen actors frantically rushing in and out of the room and working around the examination table. The writers give Sachs the script the week before it is to be shot. Opposite every page of dialogue, he writes columns of blocking that detail exactly what each character should do throughout the scene. On the day the scene is shot, he gives each actor his pages of instructions and then goes over them briefly. He assembles all the actors in the trauma room, oversees two walk-throughs and then is ready for the director to watch. Next, the cameras roll. "It's like the New York City ballet getting its choreography instructions for a performance the same night," Sachs says. "There's tremendous pressure to be fast and prepared because 15 minutes of shooting cost about $10,000."
Nurse Carol Hathaway (Julianna Margulies) is assisting Mark Greene (Anthony Edwards) as he inserts a catheter into a (dummy) newborn baby's umbilical vein. "Pick up the syringe, squirt it out a little," Sachs advises, "dangle it for Tony to hook into. Be sure to wipe the end with alcohol before you stick it in." Margulies follows orders, and looks over at Sachs pleased that it worked. "That's cool, Joe," she says.
"Joe is the archangel of ER. When you get a procedure right, it's exhilarating," Margulies says. "But if I were in a real situation, there'd be trouble." Sachs is the "most talked to man on the set," according to Edwards. "I compare what we do to dancing and singing at the same time, and Joe is instrumental in making the scenes look as real as possible."
One look at Sachs's resume suggests he's been preparing his whole life for ER. Raised in Connecticut, the son of a physician, Sachs, 40, studied biology at Yale before coming to Stanford Medical School. On the first day of orientation, the dean advised him to diversify his studies. "He didn't want us to just go through medical school on a conveyor belt and come out boring people," says Sachs, who took the advice and decided to take film classes in the communication department. Six years later, he graduated with a medical degree and a master's in motion picture production.
As a graduate film student, Sachs wrote, directed and produced Between a Rock and a Hard Place: Values, Ethics and the Physician-in-Training, which is now shown in medical schools around the country. He completed the sound mix for the film just before starting his internship at UCLA. He also served as writer, director and producer on a number of medical shows for the Lifetime Network.
If Sachs and ER seem the perfect fit, it was sheer coincidence that brought them together. Two years ago, Sachs was an emergency room doctor at Northridge Hospital Medical Center, when some writers doing research for the show called with technical questions. Sachs happened to answer the phone. He shared his experience with the writers, who began to rely on Sachs's expertise. Halfway through the first season, he was hired and ever since has worked on the show up to 100 hours each week.
Sachs still does a weekend shift in the UCLA emergency room to keep himself current. He takes as little dramatic license as possible on ER, but acknowledges there are some limitations. Doctors don't wear masks on the show -- after all, viewers need to see George Clooney's smile -- although actors do don glasses, gowns and gloves. Medical procedures take less time than they do in real life, and drugs work their magic in record time.
To ease the grueling pace of his ER schedule, Sachs has trained another doctor to advise the actors every other episode this season. He hopes to dedicate more time to writing and teaching and hanging out with his real ER buddies. "They don't watch the program because they say it's too much like being at work," Sachs says. To him, that is the ultimate compliment.