‘Code Black’ documentary a sobering look inside ER system
September 27, 2013
The opening scenes of the documentary "Code Black" are ones of chaos and confusion. There are too many people and too many voices as critically injured people are wheeled into an area no bigger than an average bedroom.
At this time, it's nearly impossible to decipher what exactly we're seeing. The Los Angeles County Hospital emergency room is a hub of horrific and life-threatening injuries, but in the midst of the adrenaline-pumping scene, the voices of the doctors take over.
Viewers are getting their first look at the C-Booth trauma bay at the Los Angeles County Hospital, which the film refers to as as the "hurt locker of American medicine." The hospital, located on the University of Southern California campus, is considered by some as the modern birthplace of emergency room medicine.
Viewers also are seeing some of the most dedicated and courageous doctors constantly battling life-and-death situations.
One doctor put it this way: "This is a place where you get to work twice as hard for half the price, deal with a lot more difficult day but sometimes enjoy a lot more gratifying outcome."
"Code Black" is alarming, disarming and intriguing as it takes the viewer into a place most only get to see from a patient's perspective. Unless you're in the medical field, access to a working emergency room is private business.
First-time director Ryan McGarry is also a doctor at the hospital and gives people a much different look at the reality of dealing with critical situations that seem to come nonstop during a so-called "Code Black" emergency room status where the waiting room is overwhelmed far beyond capacity. At the Los Angeles County Hospital, wait times for non-life-threatening injuries during a Code Black can reach 18 to 24 hours.
McGarry also provides personal accounts of the residents who train and work at the county hospital and shares his own personal experiences that led him on the path of becoming an emergency-room physician in Los Angeles.
The residents are young, genuine and full of optimism. They're attracted to the energy of the emergency room and bond as they work together toward a common goal.
"There's nothing that brings people together more than struggling for something worthwhile," one doctor says.
McGarry was also a resident at the hospital when he began making the film in 2008. His initial goal was to capture and document footage of C-Booth, the notorious trauma area that was scheduled to close once a new, code-compliant hospital was completed.
"There was an organic path to making this movie," McGarry said during a phone interview. "There came a shocking moment for me when I realized I was beginning to make a film with no real plan on where it was heading. It was scary, but it also took courage to start this project without knowing fully where it was going."
The scenes from C-Booth are some of the most compelling in the movie as one sees the trauma firsthand. It isn't the physical space that makes C-Booth what it is; it's what happens in the cramped 20-by-25-foot area. It's controlled chaos in the hands of doctors and training physicians.
"When I first saw C-Booth, I knew it was something unique," McGarry said. "It seemed so Third World, but they had it right. C-Booth was really a well-oiled machine with its own personality."
Just when the successes and dedication of the doctors working in C-Booth become obvious, it all changes.
McGarry leaves the county hospital for one year as part of his training. When he returns, he finds the old county hospital is closed and the new ER facility is up and running.
With the new facility comes changes — or as McGarry called it, a "new culture." The energy of C-Booth is gone, replaced by paperwork, bureaucracy, seemingly endless policies and a disconnection from the hands-on teamwork that made C-Booth so compelling.
It's 2012, and the students from 2008 are now the senior training doctors at the new facility. The ideals of helping the common man are still there, but they're dampened by so many new regulations and protocol that keep the doctors from actually helping patients.
"We're a generation (of doctors) starting out totally immersed in protocols, policies, rules, checklists and forms," another young doctor says.
They also have to deal with a waiting room that sometimes has a wait list of as many as 500 people. It's so bad, they have to use a numbering system that rates ailments from non-critical to life-threatening.
Inspired by the spirit of the doctors who trained them in C-Booth, these young physicians decide they need to do something to decompress the waiting room and break down the doctor-patient barrier.
They introduce a system of taking the patients in most need from the waiting room and making a space to treat them within the ER. They skip most of the patient intake system and the paperwork, getting back to helping those in need in a hands-on way.
Their system works. It drops wait times without any increase in costs. The energy felt from the C-Booth days returns and ideals seem to be reinvigorated.
As quickly as the idea comes to fruition, it goes away. A shortage of nurses forces the hospital to make cutbacks and run at less than full capacity. The new waiting area now sits quiet, but the volume of patients in the Code Black waiting room remains unchanged.
McGarry is now an assistant professor of emergency medicine at Weill Cornell College in New York. He finished his four-year residency at Los Angeles County Hospital in July.
"I really enjoy teaching and feel I can offer some interesting background from my experiences," McGarry said. "There was a real attraction to working with such a motivated and highly skilled group of young ER doctors. ER is really blue-collar work. It's the only area in a hospital that staffs physicians 24/7. We were a safety net for so many people. It was both a burden and an honor. "
A Q-and-A with McGarry will follow the movie showing.