Chris Knipp Writing: Movies, Politics, Art

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PostPosted: Sat Jul 12, 2014 9:17 am 
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The adrenalin rush of work in a major ER trauma center, and the downsides of US medicine

Ryan McGarry's documentary feature debut Code Black takes us to Los Angeles County Hospital's trauma bay, which attracts doctors who are both intensely dedicated and adrenalin junkies. Here, the pressure is always on. While Peter Nicks's 2012 The Waiting Room was made by a documentary filmmaker with social concerns, Ryan McGarry, whose film also focuses on ER action, is a doctor, and the spotlight shifts to the doctors, though they couldn't perform their medical miracles without patients to work on whose needs are dire. Nicks's film especially depicts the struggle, the long waits and the patience, the poor's efforts to get treatment. He begins with patients sitting around waiting to be seen. McGarry's goes for the drama. He starts out right away with a 21-year-old found on the street with multiple gunshot wounds to the left and right chest, rushed to the hospital in a helicopter. This is the kind of case that can only be handled by a big hospital emergency room. It's also the kind of case that makes everybody else in the waiting room outside (at least of a less specialized ER than LA County's) have to wait for hours while all the staff focuses on saving a life. Both films present the American "health care crisis" at its point of greatest stress, but their approach is different. The new film has doctors lecturing us face to face. Waiting Room listens more to patients, and the humble but dedicated intake person, Cynthia Johnson.

McGarry is a senior resident county hospital ER physician. Like his colleagues, he's selfless, tireless, and idealistic. To the naked eye Code Black appears flashy and too full of itself, but this is the nature of the viewpoint. The action in the trauma bay is spectacular. As he points out, it seems chaotic to the naked eye, a crowd of twenty people pressing in upon a patient with tubes and gadgets in every direction; but the physician in charge sees the order and purpose of it all. Furthermore, this film provides a brief account of the history of emergency room medicine, which they say originated, at least for the US, at LA Country Hospital. There, in a room called C-Booth, doctors learned to practice this special craft, and the ER was no longer just staffed by whatever doctors were available at that moment but by ER physicians. McGarry shows up close some of the action that goes on in C-Booth today. Warning: some of it is not for the squeamish. But it's also exciting and might make you envious of lives lived on the edge, saving people's lives, and somehow having a great time. The analogy with life in wartime is given and makes sense. The staff are working at the top of their game. And because it's a teaching institution, they're learning at breakneck speed. (Think of the rapid advances achieved during wartime.) It's also a democratic world, where everybody counts and conventional status doesn't matter so much. I got some of the same rush and inspiration from McGarry's film as I got from my first youthful glimpses in magazines of the Olympics and their athletes.

But the trouble with the film is, paradoxically perhaps, its enthusiasm. As Justin Chang wrote in his Variety review, Code Black "might have benefited from a less earnest, more distanced approach." This begins to read like a very flashy and colorful love letter from McGarry to his coworkers; like a moving picture yearbook for young graduates enormously proud of what they do but, by the same token, lacking the perspective needed to best interpret the subject for curious and intelligent outsiders. There are too many fresh-faced, good-looking young doctors. Not that McGarry doesn't present downsides. First of these is the new LA County Hospital that greeted him when he returned from a year of internship elsewhere in 2008. The hospital was built due to earthquake requirements. "State of the art" turns out to carry disadvantages. It proves overlarge, over-compartmentalized, and worst of all, more bureaucratic. Doctors find the intimacy and the passion of C-Booth are lacking in the new hospital.

Later McGarry gets to the related material dealt with primarily in The Waiting Room. This includes the fact that the poor who can't afford regular medical care, come to the ER when it's not exactly an emergency, like appendicitis or chest wounds, but it's too painful or worrying to ignore. This is where the privatized, profit-based medical system fails to serve the US population. At LA County, they have a code rating system for how busy their waiting room is. Code Blue is "like Christmas and we're giving out turkeys," i.e., uncrowded. Code Black is a madhouse. Patients too are rated from 1 to 4, and a 2 is serious but not about to die if not treated immediately. With a Code Black room and a Code 2 patient, the patient may be in danger, if he or she waits 18 hours. And so on. The Waiting Room gave a little more up close and individual picture of such situations, but McGarry and his colleagues -- still getting a lot of face time as opposed to The Waiting Room's narration-less and talking head-less approach -- do explain how it all works quite well, perhaps even better from the administrative and doctors' point of view. And here we see the young doctors finishing their residencies fighting to restore the feel of C-Booth, cut past the paperwork and get to the neediest patients in ER.

The young doctors' point of view continues to dominate throughout Code Black, making one sometimes wish for that more detached perspective Justin Chang called for, and showing the virtues of Peter Nicks's recent parallel film. But there is passion and a personal knowledge in Code Black that nonetheless make it a powerful and valid statement. And if its flash and charisma bring more attention to the need to improve funding and organization of US health care, more power to it.

Code Black, 78 mins., debuted 18 June 2013 at LA Film Festival and won documentary feature awards at LA and the Hamptons. Opening theatrically 20 June 2014, it arrived in Bay Area theaters (Opera Plaza in San Francisco and Rialto Elmwood in Berkeley) 11 July 2014.

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