Code Black. Directed by Ryan McGarry. Oley, PA: Bullfrog Films, 2015. 81 minutes.
The Waiting Room. Directed by Peter Nicks. Oley, PA: Bullfrog Films, 2013. 82 minutes.
Code Black and The Waiting Room are documentaries about emergency departments (ERs) in large public hospitals located in two California cities, Los Angeles and Oakland. While they provide very different perspectives into the complexities of emergency room care, they condemn America’s healthcare system, especially as it affects its under- and uninsured members.
Code Black is an intimate portrayal of a team of young doctors over the course of several years of their residency training at Los Angeles County-University of Southern California Medical Center (County-USC), the birthplace of emergency medicine training and, arguably, one of the best trauma medicine locations in the United States. The action is intercut with clips of members of the team at different stages in their training with additional narration provided by their mentors, the attending physicians who developed the procedures adopted by trauma medicine specialists the world over.
The film begins in the “C-Booth”—the trauma bay—where a scrum in scrubs clusters around a man with a gunshot wound. We soon learn that the chaos is more apparent than real—this personnel is operating as one, like cells in an organ, working together to save the life of the man at the center. They pride themselves in their ability to function as a whole, and the individual interviews interspersed throughout speak to their desire to make a difference and to their belief that they do this daily.
About one quarter of the way through, we learn that the C-Booth has been replaced by a new emergency department in a brand new County-USC hospital (built to comply with updated and stricter earthquake codes in Los Angeles). It’s different; it feels cold and remote. Racks of forms cover its walls, forms that must be filled out before any patient care begins. The patients, once at the center now wait on the peripheries. The members of the team are dispirited by these differences. As they figure out how to come together and make this space theirs, serious complaints about and critiques of the healthcare system surface. For example, the HIPAA (Health Insurance Portability and Accountability Act) forms—among the many that the residents must complete—are just one example of governmental requirements (federal, state, and local) that come between the residents and their patients, wasting precious minutes before life-saving efforts can begin.
Large public hospitals must take all comers (and their emergency departments are the dumping grounds of private hospitals). Since they depend on decreasing government funding, the situation frustrates the narrators. It is in this setting that we finally learn what “code black” means. Code black signifies an emergency room in an overflow state—with some people waiting fifteen hours or longer to receive care regulated by a triage system groaning under the burden of patient numbers and without adequate staffing.
The story of The Waiting Room unfolds over a shorter time span—more like “a day in the life.” The camera tells the story, focusing on the interactions between the staff—nurses, medical assistants, and doctors—and the patients who come in to be treated. A central figure is an intake nurse whose joking manner and soothing tone put patients at ease. This is Highland Hospital, the county hospital in Oakland, California, where every day is code black in the emergency room. Instead of documenting the dramatic efforts involved in saving the lives of trauma victims, this film focuses on the everyday health problems of people with nowhere else to go. Vignettes highlight the narrative. For example, we follow the events surrounding a feverish little girl with a throat so swollen she can’t speak; her father (a laid-off blue-collar worker who’s lost his health insurance) has brought her in. In another scene, a 58-year-old lawyer who saw her business implode during the crash of 2008 cries as she explains the economic plight that left her with the ER as her only source of care.
In health policy classes professors teach that overuse of emergency rooms by people with non-emergent health concerns is a problem whose solution involves getting patients to other sources of care. The Waiting Room asks, “what other sources?” The people coming to Highland are rejected by private physicians and hospitals. Discouraged, they attempt to “tough it out,” eventually arriving at the ER much worse off. The man whose leg wound wasn’t healing because he had diabetes and had run out of medicine provides a startling case in point. Unable to afford the generic drug controlling blood sugar that cost only pennies a day, his worsened health situation will now require thousands of dollars of medical care.
Neither documentary provides solutions; that’s not their point. Instead, both offer richly textured stories with emotional intensity, coincidentally damning the state of the system. They bring reality to textbooks about medical care. What kind of classes would benefit from these movies? I think the length of Code Black (81 minutes) is best for a meeting of a pre-med group, since it is very doctor oriented. The main protagonists are mostly white men and include only two people of color—an Asian man and an Asian woman. Moreover, because the focus is mainly on heroics, the film could be accompanied by a text that soberly considers the causes and cures of urban violence.1
The Waiting Room has short and long versions (62 and 82 minutes, respectively) and comes with discussion questions. The staff and patients are far more diverse in gender, race, and class. Its focus on the quotidian lives of people with common chronic illnesses that go untreated reveal the untold struggles of those living without access to regular medical care. Accompanied by a book such as Mama Might Be Better Off Dead by Laurie Kay Abraham, it would encourage discussion and critical thinking in classes in health care policy, medical anthropology, medical sociology, American studies, or political science.2 Though I loved Code Black, I’m not confident that it would as useful pedagogically. The Waiting Room, by contrast, is both absorbing and highly teachable.
1 Deborah Prothrow-Stith, Deadly Consequences: How Violence Is Destroying Our Teenage Population and a Plan to Begin Solving the Problem (New York: Harpercollins, 1991).
2 Laurie Kaye Abraham, Mama Might Be Better Off Dead: The Failure of Health Care in Urban America (Chicago: University of Chicago Press, 1993).