Emergency medicine is a relatively young field, but its role in the American health care system – as the first line of last resort for our country’s poor and uninsured – shows the specialty to be a victim of its own success. Hospital ERs and their waiting rooms are overwhelmed and overpopulated with patients who believe they have nowhere else to go. There’s a failure in the system – in other words, a Code Black.
Ryan McGarry is an unusual hyphenate: a filmmaker/physician. McGarry shot Code Black over several years, while completing his residency at Los Angeles County General, a public hospital also known as County/USC. Here the system is so overloaded that it’s not unusual to find patients sitting for 18-24 hours in the waiting room before ever being seen by a member of the medical staff. Code Black has points to make about the triumphs and inadequacies of America’s health care system. (Any updates to reflect the present-day reality in the post-Affordable Care Act era would likely reveal little change.)
The finished documentary (which has won several festival awards) is remarkably vivid in capturing the sights and sounds of the ER. There’s a wonder to the organized chaos of the treatment bays, where the sight of spurting blood and guts mix with the din of stainless steel instruments, barked orders, and curdling shrieks of pain. Viewers will come away with a you-are-there perspective: It’s not always pretty, but it’s always amazing.
A great deal of the film captures County General’s shift from its old ER theatre into a spiffy new building mandated by updated earthquake building codes. While in their original space, the doctors and patients were all crammed together in an area called C-Booth. Spoken of in reverential tones by the doctors who trained there, C-Booth also had the effect of cosseting the doctors from various rules and paperwork that just weren’t feasible in that outdated location. Add to that the cowboy culture that’s been endemic in this field of quick-fire medical practice, which only became a board-certified specialty around 1970, and you’ll see some idealistic young residents complaining about the brutalizing amount of paperwork that’s now required in the current age of HIPAA laws. Code Black indeed follows a half-dozen or so residents as they go through their paces and intercuts some of this footage with some after-hours gab that humanizes the steady erosion of ideals among a group as telegenic as any you might find on any hospital drama on TV.
For the most part, Code Black is a riveting document despite its tendency to jackrabbit around in its themes and personalities. Since being in the ER with a personal emergency is not an event you’d wish on anyone, watching this film allows us another kind of up-close access – through a protective layer of film, if you will.