The film Code Black is a thrilling glimpse into the work of the Emergency Department at Los Angeles County Hospital. The documentary centers on the legendary C-Booth, the hospital’s trauma bay and the birthplace of emergency medicine. Dr. Ryan McGarry, the filmmaker, began shooting footage of the C-Booth when he was a medical student and then captured the transition to a new facility when the hospital was forced to upgrade its facilities to comply with seismic standards in 2008.
Code Black, which received Critic’s Pick reviews from the New York Times and Los Angeles Times, introduces viewers to a talented and passionate group of resident physicians, attendings, nurses and other team members as they grapple with unwieldy patient loads, excessive wait times, and ever-increasing paperwork burdens. The film raises questions about how to balance patient privacy and accountability from providers with the loss of intimacy and teamwork that accompanied the transition away from C-Booth when the hospital’s facilities were upgraded.
CIR Vitals had an opportunity to interview Dr. McGarry at reception and screening co-sponsored by CIR in Los Angeles on June 28, 2014.
What inspired you to make this film?
It was the idea of a C-Booth, which was one of the first things I saw when I started my rotation as a medical student. I saw that it was a 16 by nine-foot space, almost a theatrical ratio, and with all this drama. You see all facets of the human condition coming in every two minutes, plus amazing characters, and then this idea that the C-Booth was going to pick up and move during the upgrade. Well, those are three things that would make an incredible film, in my mind, and so I thought, “This trifecta may never happen again. I’d better get on this!”
Were you active with CIR during residency? Were you aware of the union?
I was definitely a member of CIR and most of my class was. During the second half of the film I was a resident there, so of course I was a CIR member, which we all thought was pretty cool.
What themes do you hope people will take away from the film?
The first is that we have to protect and value our county public hospitals. The other is that it’s always better to discuss healthcare in a disarmed fashion. Audiences seems to leave less polarized [than when they came in].
What most surprised you during the shooting of the film?
I was shocked at just how difficult it is… when you’re directing a documentary, your instinct is to have a vision for the story, and of course your expectation as an artist is to be true to that vision. But really, the greatest skill in documentary filmmaking is flexibility, the ability to see what the story is, not what you want the story to be.
Did it take turns you weren’t expecting?
I thought the whole film would be confined to the old county hospital. I never thought I’d be a character in the film, for example. But narratively we found that the bridge between the old and new place had to come from someone who had seen both, and my voice had to be included in that, although reluctantly.
What advice would you give to resident physicians who have a story to tell?
The biggest thing that our patients need right now is for physicians to take back control of the patient-doctor interaction. Doctors should be policing ourselves, evaluating regulations, deciding if it’s in the patient’s benefit. If it is, great; I’m for that regulation. If it’s not, why are we doing it?
The public should see the physician voice as the commanding one again as far as who’s leading healthcare. Right now we’re not leading it, at least in the media. Our voices are drowned out by politicians, by lobbyists, and by insurance executives. And those people didn’t drop $300K to go to med school. They didn’t lose their 20s to residency.
Have you found that the film has opened people’s eyes to the role of residents?
People leave the film feeling a bit more informed about what the front lines are like. Residents are the front lines, and in many ways that was the ultimate task for us in telling the story without getting into politics. Residents are effectively pulling the weight, and it’s hard to argue with that. We didn’t choose what society has given us at the front door, but we’re the ones literally dealing with it.
Anything else you’d like people to know?
What was really encouraging to me was how good an experience it has been to actually step up and say something. People are listening, and for change to happen, you have to speak up first.