During the introduction to his documentary “Code Black” at its world premiere at the Los Angeles Film Festival, director and ER doctor Ryan McGarry warned the audience about the graphic imagery in the film, which documents the emergency room at LA County Hospital. However, McGarry justifies these images of people suffering because his film is largely about the way that the U.S. healthcare system isn’t doing enough to help alleviate this pain. And yes, there is imagery in the film that is extremely graphic, something that ER doctors and nurses have seen before, and in which they remain calm and unflappable. But it’s especially poignant that much of the carnage is obscured by the numerous hands and bodies of the doctors and nurses crowding around the patient -- it seems an apt metaphor for the story of the ER itself, pain and suffering and injury obliterated by the caring and healing hands of these doctors, who are dedicated to a type of medicine that isn’t the most glamorous, but is becoming more and more crucial in the wake of the health care crisis in this country.
The film opens with a gunshot wound victim being brought into the “C-Booth,” the emergency department at LA County Hospital, where director McGarry was just beginning his training in 2008, and the birthplace of emergency medicine. As a student, he and his fellow training doctors were in awe of the knowledge and skill of the doctors in this unit, and felt drawn to the camaraderie and spirit of helping others in any way, and McGarry as a filmmaker is drawn to capturing the unique qualities of this place -- a small, cramped room, with patients and doctors crowded on top of each other. It wasn’t glamorous or private or pretty, but the patients brought in were immediately treated by the team of highly skilled doctors, led calmly by Drs. Edward Newton and Billy Mallon, completely unflappable in this world, and with two distinct approaches. We’re introduced these doctors, and what it means for them to work in the ER (Dr. Mallon calls it “blue collar work”), all while we are seeing them operate feverishly on the gunshot wound patient. Despite their heroic team efforts, the patient dies, and the moment the death is called is rendered in stunning fashion; the soundtrack silent, the busy, bloodied hands suddenly idle, the body still on the table. These doctors have seen it all, but death and horror still affect them.
“Code Black” jumps from 2008 when this group starts out, to 2012, when they are the senior training doctors in the ER. The hospital has been rebuilt because of an earthquake and the ER revamped completely. Gone is the cramped, but intimate space of the C-Booth, replaced by pristine and sterile hallways filled with computers and racks of forms. The physical changes in the building reflect the structural changes in health care, which are now less concerned with immediate care, and more with covering their own liability. The idealistic young doctors are frustrated that more of their time is spent filling out forms than seeing patients, and wait times in the ER are now stretched to 12 hours long (or more). Because of health insurance premiums, the ER is often the only access to health care for many working poor (and undocumented immigrants, and the homeless, and the recently uninsured, etc, etc.) so these doctors are family physicians, psychiatrists, counselors, surgeons, dermatologists (and the list goes on and on). Also, because it’s a public hospital, LA County receives the overflow of patients that are turned away from other ERs and hospitals if they don’t have a life-threatening condition. It’s a sad and desperate state of affairs, and the waiting room, most often at Code Black (which means it’s at full capacity), is a poignant representation of the sorry state of the state of the health care industry.
So what do they do? The doctors decide that if what they came to this profession to do is to treat patients, treat patients they will, going into the waiting room and putting patients first and paperwork (and profits) second. In doing so, they reduce the average wait times by almost half, and bring the sense of adrenaline and urgency that was lost in the shuffle of computers and paperwork back to the ER. They aren’t necessarily able to change the whole, broken system, but they follow their ideals and put care and treatment first, which is the one significant thing, they as doctors are able to do.
The footage captured and access granted to McGarry in “Code Black” is completely unique and only possible because he was often just shooting with a camera by himself, and because he was a medical student, the team just learned to ignore him. The fact that it’s made by one of their own makes the film as remarkable as it is, but there are certain times when a bit more objectivity or restraint could serve the film as a piece of documentary filmmaking. Scenes where the group of good-looking young doctors talk about their opinions and feelings over a table of brews at a local restaurant feel a bit too “Grey’s Anatomy,” and many of those discussions are better served in the interview format. Additionally, the comparison between C-Booth and the new ER isn’t quite as objective as it could be, as it doesn’t focus on the wait times or more minor injuries or waiting room there, which is the focus of the main problems in the new ER. C-Booth is shown to be this sort of magical and heroic place, where teams of people are always working on catastrophic injuries, so the comparison feels a bit lopsided.
Regardless of these few issues, “Code Black” is a special documentary with unprecedented access to the ER, depicting a truly amazing place that we hope we may never have to visit. The personal stories of the doctors who work there add layers of emotion, meaning and investment to this portrait. While tracing their journey through this ER, “Code Black” manages to encapsulate so much of what is wrong with our health care system, but also to point out what’s right, and to posit an attitude shift not just about health care but about how we as a society treat those around us who are in pain or suffering. A heartbreaking but hopeful message within this important film. [B+]