In Case Of Emergency

Code Black
Directed by Ryan McGarry
Playing July 23 at the Senator Theatre

There are moments in “Code Black” when it is easy to think you’ve tuned in to an episode of “Grey’s Anatomy” or “E.R.” The surgeries are primetime dramatic; the doctors are young and Hollywood-beautiful. Even the soundtrack has a theatrical quality. However, these seemingly fictional moments are counterbalanced by scenes of the less glamorous aspects of medicine: doctors filling out paperwork, patients languishing for hours in the waiting room, a janitor mopping blood from the linoleum floor. Between the overworked doctors and the overcrowded waiting room, “Code Black” shows the chaos of more than just a hospital. Despite the number of sick and injured coming through its doors, the film makes clear that the patient most in need of attention is the American health care system. 

Now an emergency room physician at the newly built Los Angeles County Hospital, Dr. Ryan McGarry began shooting “Code Black” while still in his residency training at the hospital’s old location. Inside its aging Art Deco walls McGarry captures a fleeting glimpse into what medicine resembled before bureaucracy took over: chaotic, but allowing more connection between physician and patient. It was at that hospital that the concept of emergency medicine as a specialty was born. In the 20-by-25 foot C-Booth (the origin of the name has been lost to history—the C stood for either cardiac or critical), “more people have died . . . and more people have been saved than in any other square footage in the United States,” one doctor proudly mentions. The limitations of the old building spared it from state regulations, but also resulted in severe lack of privacy and oftentimes dignity. Scenes of patients naked and writhing under scalpels mere feet from one another disturb, but even more troubling is one nurse’s emotional recollection of showing the body of a deceased patient to the relatives: With nowhere else to go, he showed them the body in a cramped storage room cluttered with bed pans and urinals. His tearful account would be over-the-top in a TV show, but the reality of his experience allows the scene to be poignant rather than corny. You feel the desperation of the situation.

The hospital’s move to a new, billion-dollar building in 2008 remedied those space-related problems but also coincided with an onslaught of different ones. McGarry and his colleagues’ primary complaint is that the connection between patient and doctor has been obstructed by a deluge of insurance policy strictures, safety regulations, and privacy codes, well-intended though they may be. Of course, this issue is not unique to just LA County: Hospitals across the nation are similarly burdened. With the onslaught of regulations slowing down the doctors’ work, the emergency room fills up quickly, especially since it’s a public hospital that doesn’t turn anyone away. The film’s title is the hospital’s euphemism for overcrowded and overwhelmed, a level it reaches all too often. Indeed, many of the most disturbing scenes of the film are of that shockingly crowded waiting room, filled with patients vomiting and crying, languishing in the hard leather seats for upwards of 10 hours before being seen. McGarry’s close-up shots of their destitute faces feels at times voyeuristic, but they do work to reinforce his point. 

McGarry filmed “Code Black” before the implementation of the Affordable Care Act, and since then the number of emergency room visits has only increased. A Harvard study published in Science earlier this year shows that patients who were randomly assigned to receive government-provided health insurance use emergency rooms 40 percent more than the cohort of people who do not receive insurance. Most of the increased use of the emergency room is for problems that are not true emergencies—rather, patients turn to the emergency room because specialists won’t take their insurance, and they don’t know where else to go for treatment.

One bright spot in the otherwise-dismaying account that “Code Black” offers is the sincere devotion that the hospital staff has for its patients.  McGarry and his young colleagues make far less money working at LA County Hospital than they would at a privately funded hospital. Having invested untold thousands of dollars on medical school, it would certainly be understandable for them to seek employment in a more lucrative setting. Their commitment to “doing the right thing” by serving the city’s poor and forgotten thus becomes all the more inspirational. Watching them interact humbly with their patients makes it clear that they are not in the business for the glory. In one telling scene, McGarry kindly calms down a delirious patient who repeatedly screams that the nurse is trying to kill him. 

Seated interviews with the doctors aim to provide further insight into their choice to work at the public hospital, but these scenes feel somewhat scripted. One doctor speaks of his pushy parents demanding excellence from him as a motivator for his career choice, and it’s almost impossible not to roll your eyes. McGarry sympathizes with the patients in the waiting room by telling us about the frustration he had felt as a young man awaiting test results between chemotherapy treatments for his stage-IV lymphoma, but the analogy feels forced. McGarry was waiting on results; these people are waiting just to be seen.

For the most part the documentary is engaging and sensitive, but despite providing a panoply of troubling diagnoses, it offers no treatment plan. After watching Dr. McGarry and his colleagues tend to the medical needs of countless sick patients, it remains uncertain how—if it all—we as a country are to heal our ailing health care system.

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