Emergency medicine pioneer Robert Slay, MD, recently discussed his emergency medicine career and his acting with ACEP Now.
Explore This IssueACEP Now: Vol 39 – No 07 – July 2020
ACEP Now: How did you get your start in emergency medicine?
RS: After completing an Army residency in internal medicine, I passed the internal medicine board exam but functioned as an internist for only one year. In 1976, I was assigned to Brooke Army Medical Center in San Antonio, Texas, as an internist. Brooke had more than 700 beds and an ER that was a major trauma center and saw around 60,000 patients a year. There was no recognized EM specialty and just the beginning of a few fledgling training programs in emergency medicine nationwide.
The chief of internal medicine at Brooke gave me an alternative to being exiled to the eternally boring abyss of the clinic. “Bob, we have a real problem with our medicine residents running amok in the ER with no supervision—they are killing patients,” he said. “Would you be willing to go down there and stop the carnage and maybe even teach them?”
I snapped up the offer. I and several other atypical internists began supervising while learning emergency medicine, with the residents rotating in the ER. Two years later, we got approval and started the first EM residency training program in the armed forces.
I was able to grandfather in to taking and passing the newly established EM board exam. I finished a 20-year Army career as a colonel, residency director, and chief of the department of emergency medicine at Brooke.
While assigned at Brooke, I had the privilege of becoming a member of the elite antiterrorist, super-secret Delta Force. I participated in the ill-fated hostage rescue attempt in Iran in 1980. The debacle of Desert One and failure of the hostage rescue mission haunt me to this day.
After retiring from the Army, I have worked in emergency medicine as an emergency physician and continue to work in a community hospital in San Pedro, California. I also had the good fortune to become an oral board examiner for the American Board of Emergency Medicine.
ACEP Now: How did you become involved with the TV show Untold Stories of the ER?
RS: I was working in the Los Angeles area in 2005 and had gained some notoriety as an EM storyteller. I have always liked to perform, and I found that stand-up comedy is fun but a real challenge and requires lots of practice. I did better just telling real ED stories. As all emergency physicians know, there are some real stories we tell each other that are not just unbelievable but often funny.
During the first year of the show, one of the show’s producers had seen me perform in a storytelling contest and contacted me to do the show. I had a funny story of moonlighting in an ED in a small Texas town and dealing with a pseudo coma patient, a local football hero, a crusty old ED nurse, and an old-school local doc who taught me how to really practice medicine. The story was called “Coma Cowboy.” It is still one of the most popular stories of the series to date.
Since then, I have been lucky enough to write for and act in 16 shows over 14 seasons. I continue to perform, both as a storyteller and in stand-up. My YouTube channel is “Dr. Bob Slay, ER Story Teller.” When you see my performances, you will understand why I keep my day job.
ACEP Now: Why should emergency physicians consider doing the show?
RS: I know all emergency physicians out there have a story. It should be told. The producers want drama, humor, truth, and a formula. The story should include a mystery diagnosis, an “aha” moment, and a great conclusion.
An example is a story I did with a pediatric patient with a suspicious long bone fracture and a positive total body X-ray for multiple fractures. Child protective services were called for obvious child abuse, and the child was taken from the parents. The “aha” moment was noticing the child’s blue sclera and confirming an osteogenesis imperfecta diagnosis. The parents were absolved, and we concluded with a tearful, warm, and fuzzy ending.
Do it for your legacy. We are all toiling away in the ED, seeing incredible human suffering, salvation, and hope. We need to tell the world. Do your kids know what you really do? Do the show, and you can show them, your grandkids, and the world.
ACEP Now: Do patients recognize you from the show?
RS: Yes, about every other shift. They recognize my voice and ask me if I am on the show. Usually, it is a young girl around age 9 because almost 80 percent of the viewers are female and between the ages of 7 and 32 years old. I take a lot of selfies with 11-year-old girls.
ACEP Now: How can emergency physicians become part of the show?
RS: I assume the show is going to have a 15th season because it is the longest-running reality-based medical show in television history. I will be submitting my ideas, and I hope other emergency physicians will as well. Send show ideas to the producer, Bob Niemack, at
firstname.lastname@example.org. Bob will get back to you—he loves a good story.
Take a risk and send a story idea. These stories need to be told. You know you can act; you have been acting your entire career!
An On-Set Prank
by Robert Slay, MD
On the first day of my eighth season writing for and acting on Untold Stories of the ER, I decided to have a little fun on the set.
The show was always filmed in Vancouver, British Columbia, on a set scavenged from a defunct mental hospital on the outskirts of town. All of the crew were Canadian locals, and the same people were always on the set, except for the director. Every season we had a new, insecure, fledgling, itinerant director—easy prey.
If your idea for an Untold Stories show is accepted, you will be offered the opportunity to tell your story on camera and to reenact it as yourself. Amateur-actor doctors playing themselves—every director’s nightmare. Untold Stories is a scripted, reality-based show, so the doctor-actor must recite dialogue, hit their marks, and perform procedures, all with cameras and lights in their face and 30-odd people (the crew) watching.
The director and crew are wary of new doctor-actors because some have been incredibly bad. A bad doctor-actor means it may take 12 or more agonizing hours to get an acceptable 10-minute reenactment on film.
The crew is glad I am a veteran of multiple previous shows. Now we have a reasonable chance of moving through the production on time. Then I let them in on what is about to happen to our unsuspecting new director, Hugh.
Day one, scene one: After an hour of setting up, we are finally ready to roll cameras. Hugh starts directing.
“OK, Dr. Bob, let’s rehearse this scene,” he says.
“You know, Hugh, I think we should just roll film and do the scene extemporaneously, without a rehearsal,” I say. “I think it would be fresher and more energetic that way.” (All directors love the word energetic.)
“I wrote the script, and I have already run lines with the actors,” I continue. “This Code Blue scene is a resuscitation. I do this all the time. I can do this in my sleep. This is simple. Trust me, Hugh.”
This is a monumental power struggle, but Hugh reluctantly concedes because I am the principal of the production and he can’t really fire or replace me. One way or another, we have to get this done.
With palpable sarcasm, he gives in. “I guess we’re going to do it Dr. Bob’s way.”
The filming begins: “Quiet on the set, places, sound rolling, frame cameras, background, and action.”
That’s when I make my move. I suddenly become stiff, with terrified, widened eyes. I slowly shuffle to the wrong spot, then stare straight into the camera. On your first day on set, the director will tell you there is one thing an actor must never, ever do: look into the camera.
I start reciting my lines. “Please call respiratory,” I say haltingly. “We have a Code—line please—oh, yeah, Blue!”
“Cut, cut, cut!” the director screams. He charges from behind his stack of monitors, red-faced. “Please tell me this is not happening,” he says eye to eye, neck veins distended. “I simply cannot work with you. They told me you had done this before. Oh my god.”
“Hugh, just kidding,” I say, and the crew starts cheering.
We got Hugh that day and several other directors over the years. The director and I always became friends after that, and we then would shoot the episode with a newfound equilibrium.
Dr. Slay is a practicing emergency physician in San Pedro, California; emergency department residency director; and board examiner for ABEM. Contact him at email@example.com.