Directed by Ryan McGarry
Written by Ryan McGarry & Joshua Altman
Sometimes lost in the ideological weeds of health care reform are the unintended emotional consequences on the caregivers themselves. The documentary, Code Black, goes inside Los Angeles County Hospital’s emergency room to give as a frontline view of America’s overburdened health care system. What we see is less a stinging indictment of bureaucratic red tape and more a thoughtful re-assessment of the doctor-patient relationship in modern medicine.
Writer-director-physician, Ryan McGarry, takes us deep into the guts (and blood) of one of America’s busiest public hospitals. In scenes that resemble refugee camps, hundreds of ailing patients huddle in waiting areas for upwards of 10-14 hours. As one of the young doctors puts it, “Emergency rooms are the new church… a place of sanctuary.” These poor souls range from the mentally ill to the down-on-their-luck. Indeed, one of the film’s most powerful moments is a 58 year-old attorney who has lost everything, including her private practice, tearfully admitting she has no idea what to do with her shattered life. She is the human face on an issue too often reduced to catchy bumper stickers or public opinion polls.
While we get glimpses into the patients’ ordeal, McGarry wisely sticks to what he knows best. He and a crew of young, idealistic physicians are indoctrinated into the world of emergency medicine at L.A. County Hospital’s infamous ‘C-Booth’; a 20’ X 25’ space where the most critical patients are administered treatment. Doctors, nurses and attendants swirl around wounded patients like frantic stock traders, wildly shouting and gesturing to one another. But amidst the blood and chaos there is a churning humanity connecting doctor to patient. It is the ultimate proving ground for a breed of doctor who likes a dash of adrenaline in their coffee. As McGarry so eloquently puts it, “C-Booth forces you to rise to the occasion.”
Things begin to change, however, after an earthquake forces L.A. County Hospital into a new, state-of-the-art facility across the street. The intimate surroundings that pushed doctors and patients together are replaced by long corridors and reams of paperwork. Patients become numbers; the severity of their medical condition dictating whether their wait will be excruciatingly long or merely excruciating. Doctors question their ideals; openly admitting that the specter of paperwork often makes them dread caring for their patients. They wither under the stress of knowing that a waiting room packed at the beginning of their shift—a classification known as “Code Black”—will be twice as packed at the end of their shift. Understaffed and overworked, these doctors and nurses have watched the rules change before their very eyes. As one doctor questions, “What does it mean to be a doctor at this time in America?”
Surprisingly, McGarry is careful to not over-glamorize the glory days of C-Booth. By their own admission, it was a horrifying environment for patients, who often shared space with junkies and psychopaths. Personal dignity and reasonable privacy were non-existent, as patients were the main attraction at a 3-ring circus. Everyone associated with Code Black acknowledges that the new rights afforded by HIPAA laws (Health Insurance Portability and Accountability Act) are a very promising development. Such open-mindedness is refreshing considering the highly-politicized subject matter.
There can be no denying, however, that the new regulations have placed a buffer between patient and doctor. This is the crux of McGarry’s film, and he expertly uses his camera to document the seismic shift. The swirling chaos of C-Booth, cameras foisted into the action, is replaced by somber doctors pecking away at computer terminals, patients nowhere in sight. The intimacy is gone. Now there is only paperwork and endless lines of human suffering. We see the disheartening impact of a doctor losing that precious connection with his patients. It’s a side of doctors we don’t normally get to see, and McGarry portrays it unflinchingly.
Lest you think Code Black is all doom-and-gloom, the film ends on a more hopeful note. The crew at L.A. County Hospital has implemented a new patient care model that is yielding some promising results. Given that emergency rooms are ground zero for America’s health care system, perhaps that affords a ray of hope. McGarry’s film isn’t pointing fingers or furthering an agenda; it’s merely asking us to re-affirm the bond between doctors and their patients. Not as providers and customers, but as human beings united in a common goal to alleviate suffering.