The institution of last resort: The Waiting Room ***

By Dennis Hartley

(Originally posted on Digby’s Hullabaloo on March 23, 2013)

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We’ve established the most enormous medical entity ever conceived…and people are sicker than ever. We ‘cure’ nothing! We ‘heal’ nothing!”

– George C. Scott as ‘Dr. Bock’, from The Hospital (screenplay by Paddy Chayefsky)

There are two questions that get asked again and again throughout Peter Nicks’ film, The Waiting Room: “Do you have a regular doctor?” and “Do you carry health insurance?” And the answer that you hear over and over to both questions is a simple “no.” After watching this extraordinary documentary (which somehow manages to be at once disheartening and life-affirming) I had to ask myself a question: “Does this country have a completely fucked-up health care system?” To which I answer with a simple “yes.” Not that Nicks has set out to make a self-consciously polemical statement on the health care crisis. Quite simply, he allows the  filmed record to speak for itself.

The premise is straightforward: document a “typical” 24 hour period in the life of a bustling public ER (in this case, at Oakland’s Highland Hospital) and compress it into a 90-minute film. And as you would expect, all forms of human misery are on display, in a microcosm of Everything That Can Go Wrong with these ridiculously fragile shells we inhabit for “…eighty years, with luck-or even less” (if I may quote my favorite Pink Floyd song). A sweet little girl with a severe case of strep struggles to communicate as her loving parents take turns at her bedside. An uninsured 20-something couple (a man who has just learned he has a tumor, and his concerned wife) desperately confab with hapless and over-taxed attending physicians about how he’s supposed to arrange the “emergency” surgery recommended by a private hospital that has palmed him off on Highland’s ER.

Every time a trauma case arrives, there’s a ripple effect on the pecking order for the huddled (and understandably frustrated) masses in the waiting room proper; for obvious reasons nearly all available ER staff have to pitch in and focus on stabilizing the patient. When these efforts prove to be for naught, it’s heartbreaking to watch (in the film’s most emotionally wrenching scene, a 15-year old gunshot victim is pronounced DOA after attempts to resuscitate fail).

Not all scenarios are life and death. Some  patients are “regulars” who use the ER for primary care. One of the “regulars” is a homeless man (initially brought in for breathing problems) who has ongoing issues with drug and alcohol abuse. He has become a handful for the shelter he has been staying at; his attending physician is told over the phone that they don’t want to take him back anymore. Now the doctor has to decide whether to let the pleading patient stay the night (and take up space that may be needed for more medically needy patients) or in essence toss him out into the streets. “Sometimes,” the frazzled doctor confides with a resigned sigh, “I have to admit people…for societal reasons.” Then, he delivers the film’s money quote: “This (the ER) is the institution of last resort.”

The filmmaker can’t be faulted for not asking the million dollar question that arises from that statement, because any viewer with a heart and a functional brain will begin to ponder why emergency rooms have become “the institution of last resort” for America’s uninsured. Why are already overextended medical personnel who staff these facilities getting saddled with responsibilities more appropriate to PCPs, social workers and mental health professionals? And why is this even up for debate? How and when did the fundamental right to receive decent health care transmogrify into a political football?

Of course, we can wring our hands and debate health care issues until the cows come home, but in the meantime there are sick people who need help yesterday and who certainly don’t have time to hang around waiting for an act of Congress in order to get it. For their sake (and for yours and mine when the time comes, and that time will come) all I can say is thank the gods for the tireless and dedicated men and women who staff these facilities. That’s the takeaway I got from this film (and it accounts for that “life-affirming” part I mentioned earlier in the review).

Nicks, whose utilization of the observational mode recalls the work of documentary film maker Frederick Wiseman, has fashioned a narrative that is wholly intimate, yet completely unobtrusive. I never once got the impression that anyone was playing to the camera; consequently there is a great deal of humanity shining through, from doctors and patients. And the next time a family member or co-worker starts ranting about the “tyranny” of universal health coverage, don’t argue. Calmly take their pulse, ask if they’ve been eating right, exercising and getting regular check-ups. Then, invite ‘em out for dinner and a flick-preferably this one.

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