A doctor made a movie, and it’s a powerful one. Indiewire calls Code Black one of the “Best Documentaries of 2014 So Far” (see article). Speaking via phone from New York City, where he currently works at Cornell Medical Center at New York-Presbyterian Hospital, 32-year-old Ryan McGarry, M.D., spoke about what inspired him to make this documentary, both cinematically and circumstantially. His ultimate message, however: Our health care system is super messed up and something needs to change.
Code Black presents a very human portrait of doctors concerned that their passion for patients is being lost in paperwork. The ER doctors McGarry presents are his colleagues, and his intimate access allows for an unfiltered look at these people who clearly seem invested in the human connection between doctor and patient, a luxury that has been compromised by the famed patient privacy laws of HIPAA. The briskly-paced film is far from a lecture piece. It opens with the stark image of doctors and nurses working to save a 21-year-old gunshot victim by cutting him practically in half and digging through his guts to reach his heart in a desperate attempt to revive him. Above this scene, a window allows doctors in training to watch how the group take almost instinctive roles to work as a unit.
McGarry said it was scenes like this, of intimate cooperation, which actually dates back several years, that compelled him to pick up his camera. That trauma bay, known as “C-Booth,” was about to close at L.A. County Hospital, which was actually the birthplace of emergency medicine. “It was now or never,” he said about deciding to make this film and document the last moments of what would become history. “You’re not gonna get a constellation like this again. This is pretty extraordinary.”
The pace of the film is dynamic and McGarry’s influences will not come entirely as a surprise to some. “I love Danny Boyle,” he said. “I think he’s got such a frantic and loud and clangy style that I like.”
Other influences also include the doctor-turned-director and creator of the Mad Max series of films, George Miller and another documentary filmmaker who knows how to respectfully present difficult subject matter. “I think that George Miller, who’s a physician, has done some great work, but for the sake of documentary, I think I’m lucky that Mark Jonathan Harris, who executive produced the film, is someone I really admire.”
His other heroes include his colleagues. While working at C-Booth, he got to know Billy Mallon, a physician with at least two decades of emergency room experience. Mallon is clearly presented as a bit of a maverick who has never lost touch of his humanity in the face of HIPAA laws that require doctors to jump though many hoops while trying to treat patients. The mantra of the film emphasizes the paperwork that takes up valuable time from doctors having to treat patients. “One thing I can say about Billy,” said McGarry, “and this is not the case for all practicing physicians of that many years, is that there is something about him that is not cynical. He’s not dead to everything, and I think it would be easy in private practice to get that way. Ultimately, you worry about the bottom line, and as a sort of a physician/businessman or woman it would be very tough to keep that youthfulness and that rawness too.”
Mallon’s specialty is charity care at one of those rare public hospitals, like L.A. County that takes care of patients regardless of their ability to pay. The equivalent to that hospital in Miami would be Jackson Memorial Hospital. “I think he’s been at a university hospital his whole career, and I think he still feels that it’s very difficult,” McGarry continued. “We all do. One of the benefits of being at a county hospital like that, is that we’re not worried about billing or money. When you’re totally separated from those things, it’s probably mostly conducive to be present with what’s in front of you.”
McGarry, who does not associate himself with a political party and calls himself a “moderate,” emphasized that his film is not political. “I think for a lot of millennials the troubling aspect about American politics is that you have to pick one or the other. That’s bullshit … Ultimately, I think it’s less of a political movie and more of a philosophical one,” he said. “What we’re saying is ultimately the equation is fairly simple: the providers want to treat people and patients just want to be treated. For that basic exchange there are a heck of a lot of spokes in the wheel that are often not even related to that moment.”
He said he has hope his generation can change things and does not write-off his peers as egotistical and oblivious to the greater good of humanity. “The good news is I think that this generation of doctors, as millennials, can kind of reverse the criticism of the millennials that we’re very entitled. The good news is that we’re all very motivated to fight for an entitled patient-doctor relationship. We think it should be more than just paper pushing or just a 10-minute Medicare moment.”
If the movie does its job right it will make audience members want to do something for the sake of medical care, if not for the doctors or their patients, then for themselves. “I think it wound be good if there were more editorials from patients saying, ‘Look I care about my privacy but what I care about the most is the 20 minutes I get with my doctor,” said McGarry. “‘I don’t want my doctor to be buried in a computer the whole time, and I don’t want to have my nurse have to re-chart something we’ve already charted just because of legal redundancy.'”
He said activism to change the laws are a long time coming, and he feels quite passionate about it. “I mean, the trouble with this whole situation is that we are really far into a lot of bad habits, and it’s kind of like how do you backtrack from that? Everyone keeps asking us but what our opinions about Obamacare, and we kind think we’re going, ‘Well, I think there are things about Obamacare that are definitely good when it comes to more access. I think most of us are feeling good about that. But the things that we’re talking about in Code Black are almost pre-Obamacare. These are things that are sort of industry foundations that we kind of feel have become imbalanced around the way, so as a patient, I think there are a few things here that are fair for the picking of what’s just no longer acceptable, but I think it’s just starting a large national discussion about what we are all fighting for, which is that moment when you walk in, you’re not well, and there’s somebody motivated to help you. Well, we have to be protecting that experience and elevating it. Right now it just seems like it’s been slowly eaten away by all these other things that we’re not saying don’t matter but certainly are not as important as they’re made to be.
“I think like all things in America, when it comes down to these kind of things, it is all about a consumer-based world … I think to ultimately think of patients as customers is bullshit… The only thing that’s unique about that versus any other aspect of our economy except for education is that you wish it didn’t need to be that way. It sucks that it is sort of locked into profit margins and like a capitalist view and everything else. They’re strange bedfellows. Ideally, you don’t want to think about money and everything else when you’re healing somebody.”
You can read more of my chat with McGarry at the Miami New Times art and culture blog Cultist. He talks about some of his filmmaking choices, including his decision to not hold back from the visceral moments that capture life and death so powerfully in this film. Jump through the blog’s logo below to read more:
Code Black opens on Friday, Aug. 1 exclusively at the Bill Cosford Cinema, 5030 Brunson Drive, Coral Gables, FL 33124. (305) 284-4861. Tickets are $9 and $7 for students and seniors. UM Students have free admission.