Who hasn’t done time in the ER: with a sliced lip, chest pain, a child with a broken bone or a fever? It’s not an experience anybody is eager to relive. Yet for millions of Americans, the ER is the first and only source of medical attention, whether it’s for gunshot wounds or a cough.
Those experiences, but from a physician’s point of view, are what Ryan McGarry set out to document in “Code Black.” McGarry is an Assistant Professor of Emergency Medicine and an alumnus of the Los Angeles County Hospital’s emergency room, one of the busiest in the country, where waiting times can last up to 18 hours, and where the crowd of patients can be so overwhelming that the condition is known as Code Black
The film is shot from the doctors’ and nurses’ point of view. Patients are wheeled in and immediately surrounded by medical personnel. Abdomens are cut open. Blood is mopped up (literally, though not by the doctors). Decisions are made fast. Sometimes, one of the doctors has to give bad news to waiting family members.
McGarry and some of the other featured doctors started their careers in the LA County Hospital’s legendary C-Booth (“C” for “critical”), a small area for the most seriously ill patients–where, it’s said, emergency medicine got its start. In 2008, when the hospital moved from its magnificent (though outdated and seismically unsafe) Art Deco building to its new quarters, it gained space and privacy for the patients, but, according to McGarry, it lost the intimacy between doctor and patient that the old building provided. Furthermore, the times have brought requirements for more and more paperwork–50 to 60 forms just to get a patient registered, McGarry points out. All of which “kills the passion for saving someone’s life.”
It takes a special kind of doctor to be an emergency room doctor, a job that “challenges you to be the best you can be,” says one of the doctors we get to meet. These doctors (and one nurse) are sensitive and dedicated. Practicing medicine, says one, is “much more important than pushing paper or making money.”
But they’re frustrated not only by the time they have to spend filling out forms and sitting in front of the computer but by the inadequacies of the American health care system, which, in an early scene, we see being debated by rival TV commentators. Emergency departments in all hospitals, including private ones, are required to treat any patient who comes in, with or without insurance. But private hospitals and physicians can refuse further treatment for an uninsured patient–such as a patient referred to a specialist who won’t treat him or her because that doctor takes only a certain level of insurance. Money, or the lack of it, is at the root of the patients’ and the hospital’s problems: a diabetic who can’t afford prescribed meds may land in the hospital with a diabetes-induced heart attack. And the hospital itself depends on funding from the county, vying for money with the schools, the Fish and Game Department, the Department of Parks and Recreations, and the rest.
Director Ryan McGarry, who himself had extended dealings with the medical system when, as a teenager, he was diagnosed with advanced-stage bone cancer, is philosophical: the hospital, he says, has replaced the church as the place where people come for sanctuary.
Well–maybe. What “Code Black” shows us is people desperate for care, and a system that has a long way to go before it satisfies that need.