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Wed September 26, 2012
A Day In The Life Of An Oakland Emergency Room
Originally published on Wed September 26, 2012 1:49 pm
CELESTE HEADLEE, HOST:
This is TELL ME MORE from NPR News. I'm Celeste Headlee. Michel Martin is away. On television and in movies, the emergency rooms of big city hospitals are places of high drama, with doctors working furiously to save gunshot victims, those hurt in car accidents and people who are suffering a medical crisis, like a heart attack.
But that's just part of the story. The new award-winning documentary, "The Waiting Room," focuses on a day in the E.R. at Oakland's Highland Hospital, where many of the patients suffer from illnesses that become emergencies because they lack insurance and access to care.
DOUGLAS WHITE: There are times I have to admit people to the hospital, keep them overnight, just as much for their social conditions as for their medical ones. It's not ideal, but we're a public hospital. We're the safety net in society. We're an institution of last resort for so many people.
HEADLEE: That was Dr. Douglas White, one of the health care professionals featured in "The Waiting Room." The documentary opens today in New York, then it rolls out to other cities around the nation and it's the work of Emmy-winning filmmaker Peter Nicks. He joins us now from our bureau in New York. Welcome to the show.
PETER NICKS: Hey, Celeste.
HEADLEE: This has been a long time coming, so can you remember your initial motivation, what made you start this project?
NICKS: The genesis for it was really the late '90s. As I was graduating grad school, my wife was coming out with her master's in speech pathology and she took a job at this hospital and she would come home with stories about her patient population that really struck me and got me thinking that it would be a great place to tell a story about a community that's sort of struggling through, not just major health issues, but also economic and systemic problems that affect many inner city communities around the country.
HEADLEE: And you sort of cobble together footage that you took over a period of months, right, and then turned it into one day at this hospital with no narration. There's no expert interviews in here that you're featuring. Why does this best portray for you a day at this hospital?
NICKS: Well, documentaries take a long time to get off the ground. They're very difficult to fund and what we decided to do was actually begin by just filming small moments with people in the waiting room and our tagline for the project was, what are you waiting for? And this began as a digital storytelling project that we put on the Web. We set up a Facebook page and had a blog and these moments - small moments really allowed us to draw attention to not just this community, but sort of the issue of, you know, what was going on in public hospital emergency rooms.
And it also allowed us the insight that hearing from people on the ground level of our public health care system was especially important at a moment when the debate had become so noisy and dominated by, you know, media - no offense - media pundits and politicians and lobbyists and so forth and...
HEADLEE: It's OK. I don't think of myself as a pundit, Peter.
NICKS: And so we felt that, you know, the voices of these people really deserve to be elevated into the public conversation around health care reform. So we started with these small moments and that kind of evolved into what became a feature-length documentary film. And the style of the film was one that was observational and did not, you know, have a sort of angle, per se. It just presented the reality of what was going on in this one public hospital.
HEADLEE: And I have to tell you, Peter, you know, I've been watching some of these clips and the stories of these people from the beginning and I remember thinking to myself, I mean, some of them are just incredible, the stories that these people tell, the reasons why they end up in an emergency room with something that may have been just a really simple illness to begin with.
Tell us some of the stories that really struck you. Give us some of these compelling tales.
NICKS: More so than any one particular story, what struck me was the waiting room as somewhat of a metaphor for not just what we are going through in our health care system in terms of waiting for a better system, but also what our country was really all about. You know, here's a place where you have a - you know, the full glory of the diversity of America. It, you know, collects every day and people come together that normally would not ever come together, you know, cutting across race and class lines and having conversations and being joined together by one common thing, which is this vulnerability to illness.
And seeing those interactions and seeing the interactions between the patients and the caregivers really struck me, particularly this one nurse, C.J., who's sort of the star of the film, who really took the time to listen and to elicit story from people.
HEADLEE: And we actually have a bit of sound. This is one patient's family member speaking to certified nurse assistant Cynthia Johnson here.
(SOUNDBITE OF DOCUMENTARY, "THE WAITING ROOM")
UNIDENTIFIED WOMAN: I don't know the whole story, but I do know he got a bullet in him from - that they left in him two days ago when he was shot.
CYNTHIA JOHNSON: Well, I said...
UNIDENTIFIED WOMAN: And he don't feel good and he numb.
JOHNSON: I said I'm going to pass the word along to one of the nurses here and let them take a look and see what they can do, OK. There's just no place to put everybody. There's just not. I know it, but it just - no place.
HEADLEE: You watched these negotiations between the patients and the staff and some of these nurses, like Cynthia Johnson there. Is there a different discussion - is there a different tone in discussing our health care system between those who work in the medical profession and those who are seeking help?
NICKS: I think so. I mean I think what drew me to want to tell this story in the first place was the remarkable collection of humanity that is in this waiting room. I mean for me I have a private - I go, you know, to a private HMO in the Bay Area and the waiting room there isn't nearly as interesting as the waiting room at a place like Highland. I mean I think this is a place where when you're on the edge, when you have very little, when you're struggling, you can't help but reveal the full glory of your humanity. These are our neighbors, our friends, our relatives, they're us, you know, but for a life-changing circumstance like losing our job.
But from the caregiver perspective, I became interested in wanting to know what was it like trying to care for this community without really enough resources and at a moment where you have this collision between people coming into the waiting room seeking basically primary care for low acute issues and also people coming in like in the last clip - this guy had been shot. Because when those high acuity crises come in, the people who are sitting there, you know, getting their prescription medical meds refilled are going to go to the end of the line and have that long wait. And so that tension, you know, really manifests itself in the struggle of the caregivers trying to manage the flow of these patients in the waiting room.
HEADLEE: If you're just joining us, this is TELL ME MORE from NPR News. I'm Celeste Headlee. We're talking about the award-winning documentary, "The Waiting Room," and our guest is director Peter Nicks.
It's not just that tension that causes issues, but of course there's this larger issue - especially in a place like the emergency room - of mortality. And let's take a listen here of doctors trying to save a 15-year-old boy.
(SOUNDBITE DOCUMENTARY, "THE WAITING ROOM")
UNIDENTIFIED MAN #1: No pulse. I hear nothing up here.
UNIDENTIFIED MAN #2: Let's roll him before we call it, make sure there's nothing back...
So, go ahead and call it?
UNIDENTIFIED MAN #1: Yes.
UNIDENTIFIED MAN #2: Time of death?
UNIDENTIFIED MAN #3: That is 20:16.
HEADLEE: So throughout this film we seen patients like you've talked about with chronic illnesses and some real pain. But interspersed are these stories, these cases, victims of crime and violence, sometimes they don't make it. How does the health care system deal with that kind of pressure?
NICKS: In communities like East Oakland and similar cities around the country, violence is a public health issue and that's why we wanted to your show, you know, how that revealed itself in this one particular hospital. And this is what's at stake. It's what's at stake for young people in these communities who are caught up in this violence. And it weighs on caregivers who have to see this on a fairly regular basis. We were really surprised by the amount of violent injuries that came through the waiting room. And when these shootings happen, everything, all the resources swarm around that injury - around that gunshot - and then that pushes the wait of the people in the waiting room that much longer. And so it wasn't just the, you know, telling the story of the violence per se, but it was showing it in the context of this larger system of the hospital trying to manage primary care for an entire community.
HEADLEE: So after years of covering this, you must have a deeper understanding of what the issues are facing our health care system and how to solve them as well. I mean what do you take away as sort of the bigger themes in health care that perhaps the politicians are missing?
NICKS: Well, you know, a lot of documentary filmmakers these days make films that identify a problem and actually offer a solution within the film. We didn't set out to do that. What our goal was from the outset and the take away for me early on, in spending time in the waiting room, and also observing the debate, the health care debate nationally, was that the folks in this particular waiting room - and by extension waiting rooms all over the country - their voices and their experience were not being heard, and that there was a problem, we sort of had a crisis of empathy in our country where if you were uninsured, you were - depending on what side of the political aisle you came on - it was, you know, relatively easy to dismiss and malign people who either weren't taking care of themselves or involved in crime or drugs or what have you. And we wanted to try to present our film in an apolitical way so that people could come together around the realization that we're all connected on this journey, this health care journey, and that in our communities we have a mixture - and in these waiting rooms - we have a mixture of people who are classically uninsured and have been for generations, but also people who have just lost their job and have found their situation altered. And you know, we are bringing the audience in and allowing them that seat next to the person in the waiting room and have that conversation and, you know, hopefully that can move the ball forward toward building more empathy.
HEADLEE: You know, you're an optimist, Peter, after all that you've seen over the past few years. I know that about you. But you also have sat back and watched the discussion. You watched the Republican primaries. You've seen the discussions from both President Obama and Mitt Romney. You see how toxic the issue of health care is in this country. Do you really believe at this point we can have a substantive discussion about health care without getting politics involved?
NICKS: I think so. And I think in larger, more public forums, that's much more difficult. But I think in intimate settings - and our plan with the film is to have it travel around the country at film festivals, theaters, community screenings, medical schools, universities, house parties, and we're not just going to be taking the film the choir, so to speak. We, and we have already taken the film to places where there are different opinions on, you know, how to fix the health care system.
It is frustrating to see some of the comments, for instance on our blog, on our Facebook page, on YouTube, when we present what we believe is a very human moment of somebody struggling in crisis and sometimes the reaction is less than human in response to that person. I think that's just a symptom of the tone that a lot of policy issues have taken in our country and as a result of social media and the way we - new ways of communicating that, allow anonymity and allow people to vent, you know? But what we're planning to do is, you know, use the film to try to re-frame and bring people together who do have differences of opinion on how to solve the problem, but also recognize that common humanity as it's represented in this one particular waiting room and by extension waiting rooms all over the country.
HEADLEE: Peter Nicks is the director of the documentary "The Waiting Room." It opens in theaters in New York today, then rolling out to other cities around the country, including Los Angeles, Houston, Washington, D.C. and several more.
Peter Nicks, thank you so much. He joined us from our bureau in New York. Nice to talk to you.
NICKS: Thanks, Celeste. Transcript provided by NPR, Copyright National Public Radio.