Code Black's Dr. Ryan McGarry on What Really Goes on in Hospital Emergency Rooms
From left: Dr. Danny Cheng, Dr. Dave Pomeranz, Dr. Ryan McGarry, and Dr. Billy Mallon in Code Black.
As an ER physician, Dr. Ryan McGarry is probably the only filmmaker Cultist can forgive for calling in for a scheduled interview five hours late.
Speaking via phone from New York City, where he moved last year to work at Cornell Medical Center at New York-Presbyterian Hospital, the 32-year-old doctor apologizes for the delay. He says he wanted to make sure a patient he had admitted on his shift two days earlier made his way to the right doctor for treatment around a complicated hip injury. "It's nothing sexy, but it is what it is," he says.
Code Black is McGarry's directorial debut, and the things he captures on camera at L.A. County's trauma bay will illicit great sympathy for this young crusader, his patients and his colleagues, whose greatest adversary nowadays seems to be paperwork.
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Today's doctors have to make the extra effort to ensure their patients get the best care. The maze of paperwork that came with HIPAA laws almost 20 years ago has created many complications for physicians, and as the movie makes clear, it's often why you have to wait so long in waiting rooms before you are tended to. The title of the film comes from the warning status that the ER waiting room is at capacity, and doctors need to prioritize patients for treatment, including some with life-threatening issues.
It's ironic that the film will screen exclusively at the Cosford Cinema at the University of Miami. University President Donna Shalala was one of the architects of HIPPA (the Health Information Portability and Accountability Act). McGarry agrees she, as well as the physicians and med students at the school, should see it, but he also emphasizes that anyone who has ever been a patient should do so as well.
But don't expect a simple lecture on the state of healthcare from a doctor's standpoint. This award-winning documentary made Indiewire's list of Best Documentaries of 2014 So Far. From the intense scenes at L.A. County's "C-Booth," featuring life-or-death cases that are not for the faint of heart, to the emotionally-charged doctors who present desperate cases for patient-doctor relations without bureaucratic duties tying them down, this film is made with passion and driven by it.
Cultist: You don't hold back from the start. Why do the doctors have to cut that 21-year-old man who came in with bullet wounds practically in half to reach inside?
Dr. Ryan McGarry: That's a pretty darn extreme measure. It's something that we do effectively if you arrive just almost without a pulse, and you're hoping sort of to get to the heart as fast as you can to sort of patch up any holes and possibly save it [the heart]. Yeah, it's pretty intense, but it's not gratuitous. What we're trying to show is that there's a sense of teamwork. There's ... this overwhelming sense of what looks like a medical complication, yet that's not actually the hardest part of the job. That's actually doable. We get through that stuff pretty easily. What's really scary is the waiting room.
This is how we get to know C-Booth, the former trauma bay at L.A. County Hospital. A child could be wheeled right next to him in a different situation. Their only divider would be a curtain. There was an advantage to this from a physician's perspective, even though it removed privacy in a way.
I would say it's a tradeoff. It seems to be an imbalance either way. Most patients I know don't really care about their X-ray being protected in the hospital hallway. I mean, who's gonna look at it other than doctors or nurses? What patients want is their pain medicine, what they want is one of us at their bedside. The problem is you can't have this extreme level of privacy protection and huge amount of regulation and at the same time have us right there with you. And it's not even just privacy rights. As physicians, we're totally judged and being monitored on many metrics, and actually some of them make a lot of sense that are actually for the patient's benefit. For example, if you come in with a heart attack you're measured for how quickly you get aspirin or how quickly you get to the cath lab. But what's crazy is that we are asked as doctors to actually be the ones to record that data. It's like watching a Miami Heat game where the players are being asked to do their own stats.
So what is the solution?
Everyone wants a quick answer to that, but here's the deal: I think it's really got to be a shifting of the dialogue. Right now, major players and major voices are not doctors and patients and nurses. They're really administrators, politicians and insurance companies. These are the people who sort of run the show, and I think at some point the responsibility is 20 percent on the patient and 80 percent the physicians who long ago lost control over their own industry.
In the film, we see doctors trying to save a grandmother's life, the vote to call a time of death, and then a doctor has to walk over to the waiting room to tell a relative she has passed. The encounter with life and death I'm sure is quite profound for someone like you.
We try to make Code Black an action film in some ways. I brought on people with narrative experience from the film world (our producer, our sound designer) to really make those action sequences work. But I've got to tell you, some of the most powerful moments and my favorite of the movie are the quiet ones, and it makes for a pretty intense, varied ride.
These are young doctors, and the doctor that has to deal with this sudden death says it is the first time he has to deal with this, and he doesn't expect it to get any easier.
I think the hard part about that is your instinct to want to take a full afternoon with those people and to really translate that news into something to start to really process, and instead you gotta go to your next patient. That's where there's this direct clash of motivations. Most of the counselors I've talked to stress that you should never try to bottle it up or put it away inside. You should really try to deal with it right there and then, but obviously that would make you a really poor physician if [for] the next patient you went to, you were emotional (laughs). You need to focus on them. They need your help too.
What made you pick up a camera to make this documentary?
It was always my intention to combine the arts and visual storytelling at some point. Not really combine them as far as outright subject matter, but to be exposed to the human drama at one point in my life and to be able to write about it and shoot stories about it on the other. I didn't expect it to happen so early as a resident, but the situation in front of me was once-in-a-lifetime, and I think that five years later, it seems to be easy to write an evaluation of it. I mean C-Booth was crazy. There's this insane pace and cadence of life, death, and everything in between - every five minutes, it seems - and no shortage of characters. And on top of that, [C-Booth] was gonna close, so everything was there for a film.
Code Black opens on Friday, August 1, exclusively at the Bill Cosford Cinema, 5030 Brunson Drive, Coral Gables. 305-284-4861. www.cosfordcinema.com. Tickets are $9 and $7 for students and seniors. UM Students have free admission.
Follow Hans Morgenstern on Twitter @HansMorgenstern.
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