Most of us have waited for care in an emergency room at some point, whether to get our own injuries treated or to seek urgent, late-night care for a child or parent. But with the swelling of the nation's uninsured population to 48 million in recent years, these clinics of last resort have become the only option for more people than ever before.
Now, as the political debate over health care reform rages in Washington, The Waiting Room, an acclaimed 2012 documentary about a big-city ER, comes to PBS as part of the Independent Lens series. (The film premieres on many PBS stations on Monday, October 21. Check here for local listings.)
Two Months in a Hospital's ER
Director Peter Nicks and his crew gained extraordinary access to Highland Hospital, a public facility in East Oakland, Calif., over a two-month period in 2010. (Nicks' wife works in the hospital as a speech therapist.) They met a range of patients, including a gunshot victim, a drug addict, a twentysomething with testicular cancer and a carpet layer with chronic bone spurs.
Each landed in the waiting room because, lacking health insurance, they could not get appointments elsewhere. The hospital's ER treats about 80,000 patients a year, or more than 200 a day. All are triaged by the nursing staff on arrival and the film shows several patients protesting that the staff does not see them on a first-come, first-serve basis, but instead takes the most acute cases first.
Above all, the film is about understanding, patience and humor in the face of illness and frustration.
The Waiting Room offers no voiceover to set the mood or ratchet up the drama, no statistics on the state of health care in America and no updates on what happens to the patients after they pass through the ER. This approach makes the film all the more engrossing. The Waiting Room doesn't make a Democratic or Republican case for reforming health care. Instead, it puts viewers from both camps inside the ER, where they meet patients without means, who look a lot like our neighbors, waiting for care and hoping everything will be OK.
Navigating the Safety Net
"It's a big leap to throw a film out there about a big public policy question, at a critical moment in the evolution of that policy, without that context," Nicks says. "People have heard about the uninsured in the abstract sense, in the context of the political fight over health care. This was an opportunity to bring people to a more intimate understanding of what it is like to navigate the safety net system on a given day. We felt like Americans had not gotten that intimate, close-up feeling of what it's like to navigate that system when you don't have insurance. We felt that the voices of the people who are on the front lines deserved a voice and a human face."
(MORE: The Healing Power of Empathy)
The film's portrayal of the emergency-room staff will be, for many viewers, a revelation. ER crews are often assumed to be uncaring and unskilled, viewing patients as little more than names to be crossed off a ledger. The Waiting Room shows that the stereotype does not hold, certainly not in East Oakland.
"To be honest, people who are living without insurance — not all of them, but many of them — bring with them lots of challenges," Nicks says. "If you have people coming into a waiting room who are yelling or who smell bad or look terrible or are difficult to deal with, that can create a problem in creating empathy between the caregiver and the patient.
Proving the Stereotype Wrong
"The stereotype of people who work in a public hospital is that there is a lack of empathy and we discovered that it's exactly the opposite," he says. "People come to the table with remarkable stores of patience and empathy and a sense that they are doing something beyond themselves. That's what you see on the screen. We didn't have to look hard to find doctors, nurses and administrators who care."
One certified nurse assistant, Cynthia (CJ) Johnson, manages patients with particular efficiency, humor and compassion, but not judgment. (You can see her in the trailer, below.) "CJ gives the film a resonance that people really carry with them," Nicks says. "She's the star of the film. She's a symbol of what we're all looking for in our healthcare system — a listening, hearing human connection, a human touch."
Emergency room doctor Doug White, another staffer whose calming presence helps carry the documentary, is seen tending to a number of patients, including Carl, a drug addict whose church shelter is reluctant to take him back, delaying his release from the ER.
At a recent question-and-answer session following a screening of the film, Nicks says, someone asked White how he approaches such patients, knowing they may just land back in the waiting room a few days later.
"His response was profound," Nicks says. "He said, 'I don't really think about where he was yesterday or where he's going to be tomorrow. I'm going to treat him today.'
The Director's Personal ER Story
"Many years ago, I was the guy on that gurney," says Nicks, 44, who had a severe drug problem during college that landed him in the ER after an overdose. "It's hard to think about people's humanity separate from their situation. Somebody who's got it all today may end up in a waiting room tomorrow. It's hard for most people to see that, so we tend to judge. We wanted to try to get people thinking about that."
The Waiting Room's patients include entrepreneurs, musicians, artists, people who just lost their jobs, independent contractors and small business owners. "It's a mix of humanity, all gathered in that one space, forced together and talking to each other," Nicks says. "Anybody who watches the film will see themselves or somebody they love in there."
The documentary has gained momentum and attention since its release last year. "You go into a project hoping that you get the thing finished and maybe play some festivals, because there are so many great documentaries fighting for attention," Nicks says. "And then audience response was really profound and the critical response started rolling in and it was positive." To date, the film has a 100 percent positive rating on the Rotten Tomatoes website, which collects movie reviews nationwide.
"We started thinking, Wow, this thing is resonating," he says. "The health care debate had become so political and nasty. Our film came along at the right time and presented an antidote to the way the issue had been discussed. What's really driving interest in the film is this notion of storytelling as part of the clinical experience."
The Film Is Now a Teaching Tool
The Waiting Room is now being used as a teaching tool in a number of medical schools and Nicks has launched a national campaign to collect the stories of patients in emergency rooms, starting with Highland Hospital. "That's pretty darn exciting," he says. "It's been incredible watching this film hit these different audiences."
The film, its teaching component and the storytelling project are all crucial to the national conversation about health care because day after day, new patients keep arriving at waiting rooms like Highland's. "They may clear that waiting room overnight," Nicks says, "but it's going to fill right back up the next day. They're shoveling sand against the tide."