Physician Filmmaker Documents One of America’s Busiest ERs in Code Black

By Sarah Sonies

There are few places of such constant drama and excitement as a hospital emergency room. Crowded with patients awaiting urgent care, Los Angeles County Hospital’s ER is one of the busiest.

Code Black, a documentary directed by ER doc and first-time filmmaker Ryan McGarry, MD, highlights the physicians fighting to save lives in one of the largest public hospitals in the country.

The center and inspiration for the film is “C-Booth,” which served as Los Angeles County Hospital’s trauma bay in historic downtown Los Angeles. Referred in the film as only “C-Booth,” the term referred to a 20-square-foot resuscitation area in the center of the main ER, reserved for the hospital’s sickest patients. It was the first stop for major trauma patients—anyone in immediate danger of losing life or limb—at LA County Hospital (officially Los Angeles County + USC Medical Center).

McGarry began documenting C-Booth as a first-year resident in order to capture the raw nature of patient and clinician experiences in this very compact space.

Code Black director, Ryan McGarry, MD on set in LA County + USC Medical Center
Code Black director, Ryan McGarry, MD on set in LA County + USC Medical Center

“When I first walked in as a resident, I saw all these mind-blowing traumas for the first time,” McGarry said. “C-Booth was overwhelming, with an incredible amount of pathology and volume. The issue really became what was happening in the waiting room, capturing the incredible burden placed on the emergency rooms and patients.”

The initial shock of the crowded but powerful nature of C-Booth inspired McGarry to start filming daily in the trauma bay and on rotation in the hospital.

“I thought, this is all historic, there is just an incredible amount of intensity and volume of patients and it’s just incredible,” said McGarry. “It all needed to be captured since we didn’t ever think people would believe how intense it was.”

Named for the term used when a hospital waiting room is completely full to the point of overflowing, Code Black reveals the complex relationship between the hospital, physicians, and patients. McGarry documents daily life through the eyes of his fellow emergency physicians. Their commitment, passion, and frustration are palpable as they fight to treat as many patients as possible.

Residents and physicians treating a trauma patient in LA County + USC Medical Center’s C-Booth
Residents and physicians treating a trauma patient in LA County + USC Medical Center’s C-Booth

Code Black is, above all, an experiential documentary. I went to great lengths to capture the noise, the adrenaline, the commotion, and the fear of what life is really like in the ER,” McGarry said. “We wanted to show the human side of medicine organically, in order to give the physicians who work with these often underserved patients a voice.”

As McGarry evolved from a rotating med student, to matching at USC, to working full-time as an ED physician, a story began to evolve through his experiences at LA County.

“My initial inspiration for the film did not match the final one. As my time at the hospital continued, I was filming bits and pieces, and I realized that the real problem is not the trauma, not the shock and awe of the injuries and sickness, but what happening in our waiting rooms, the access problems,” said McGarry. “It was wanting to show the incredible amount of burden placed on emergency rooms and the creativity physicians need to properly treat the patients.”

As the largest single provider of health care in Los Angeles County, Los Angeles County + USC Medical Center is often the only option for a large, underserved population in Los Angeles and provides treatment to more than half of California’s AIDS and sickle-cell anemia patients.

During McGarry’s tenure, the old Los Angeles County Hospital closed and a new facility was constructed to meet updated earthquake regulations. The new hospital was built with a newer waiting area, and private ER trauma bays for greater patient privacy, eliminating C-Booth. The film chronicles the soaring ER wait times post-construction, sometimes as much as 30 hours for some patients, and the ER docs’ attempt to address them. The loss of C-Booth meant a lost sense of teamwork, of treating patients collaboratively. They developed a plan to open up the waiting and treatment areas of the hospital, literally breaking down the walls between doctors and patients to make a central area where numerous patients could be treated simultaneously.

“The benefit and problem with our experiments on waiting-room time was that they worked, but in the end weren’t sustainable because we do owe our patients privacy and a dignified experience,” McGarry says. “The theme of the film really centers on the clarity and the creativity physicians have to show in treating many patients in urgent need simultaneously. When there is an onslaught of really sick patients, in those moments you will only see what matters, which is how health care should be.”

Code Black, trailer below, was named Best Documentary at the Los Angeles Film Festival and the Hamptons International Film Festival, and Audience Award Winner at Denver Starz Film Festival and Aspen FilmFest. The film opened in New York on June 20. A list of upcoming screenings can be found here.

 

ssonies1Sarah Sonies is associate editor of Wing of Zock. She can be reached at ssonies@aamc.org or on Twitter @ssonies.

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