Film Review: The Waiting Room

This vivid portrait of a public hospital’s emergency room captures in microcosm the current state of the American healthcare system. It ain’t pretty.

Five years ago, Michael Moore attempted to direct the public’s attention towards the various woes plaguing America’s healthcare system with his expansive, impassioned and typically inflammatory documentary, Sicko. In his new nonfiction feature The Waiting Room, director Peter Nicks hits on some of the same points Moore made in his movie, albeit in a more restrained—and therefore more persuasive—fashion.

For five months, Nicks embedded himself in the emergency room of Highland Hospital, a large public hospital located in Oakland, Calif., and filmed the hundreds of patients who entered the facility every day in need of aid, as well as the overworked staff of nurses and doctors attempting to deliver quality treatment in difficult conditions. Rarely venturing through the automatic doors that lead to the outside world, The Waiting Room turns Highland’s ER into its own self-contained universe and keeps its focus entirely on the men and women who populate it. It’s a small-scale story that nevertheless speaks volumes about the larger problems facing American healthcare.

Sifting through what must have been hundreds of hours of footage, Nicks devises a loose narrative that primarily follows four patients—whose stories were likely filmed months apart—during their extended stays in the emergency room. (We catch glimpses and overhear conversations from a number of other individuals as well, whose angry complaints and weary faces function as a kind of Greek chorus.) There’s Demia, a young girl whose worried parents are waiting to learn if her high fever and swollen face are the symptoms of an infection or something more serious; Davelo, a carpet installer with bone spurs that have resulted in debilitating back pain; Carl, a drug addict whose habit makes him a frequent visitor to the ER; and Eric, a man who was diagnosed with testicular cancer by the staff at a private hospital that then declined to perform the necessary operation.

While their conditions differ, what unites these individuals is that none of them can afford health insurance and are at the ER because they have no place else to go for care. Nicks’ camera mostly depicts Highland’s emergency room-dedicated medical staff as a cohesive unit, but two people do stand out—the eternally upbeat nurse assistant Cynthia Johnson, who screens every patient that enters the waiting room, and Dr. Douglas White, a sober physician who takes a special interest in Carl’s situation, particularly once it becomes clear that his patient will likely end up on the streets the moment he’s discharged. In a smart directorial decision, Nicks never cuts away to talking-head interviews with his subjects, instead recording their thoughts and feelings in the moment or layering voiceover from his private conversations with them on top of other scenes. (He also refrains from filling the screen with statistics-laden charts and graphs, which all too often simply act as visual clutter in documentaries.) This approach keeps the viewer locked into the immediacy of what’s happening in the ER, without a break in the film’s carefully constructed continuity.

Most movies and TV shows (even the reality-based programs like “Boston Med”) that take place in a hospital setting play up the drama surrounding the diagnosis and treatment of each patient. But The Waiting Room treats these elements matter-of-factly; what Nicks chooses to emphasize is the process by which visitors to Highland’s ER are seen and treated. And that process is the same for virtually every patient: After passing through the doors and registering with the front desk, they take a seat in the waiting room and wait…and wait…and wait some more. Some are there for a few hours, while others can expect to be there all day, depending on the severity of the cases ahead of them, not to mention the trauma cases (like gunshot victims) that can be delivered by ambulance at any moment and immediately take priority.

No matter how grueling the wait is, few of them leave, simply because, again, there’s nowhere else to go. Indeed, it’s telling that some of the patients in the film describe coming to the emergency room as “seeing a doctor.” Without health insurance—either provided by private employers or by the government, as in other countries—they can’t make an appointment with a GP or a specialist, which leaves the ER as their only avenue for a consultation even if their condition isn’t life-threatening. This fundamentally alters the nature of an emergency ward, turning a facility that’s intended to treat the most urgent cases into what’s essentially a general waiting room. Were we in a country where health insurance was publicly funded and provided to all residents, a significant chunk of the men and women in that waiting area would be able to make appointments with a primary-care physician, thus lessening the burden on Highland’s overcrowded ER.

Nicks doesn’t make this case overtly, just as he doesn’t go out of his way to underline the fact that the patients in Highland’s emergency room disproportionally belong to low-income and minority families. The closest the film comes towards editorializing is the inclusion of a pair of extended sequences in which two of the patients—Davelo and Eric—meet separately with the hospital’s financial advisor to discuss their bills. “This is going to be all free, right?” Davelo says half-jokingly, before the woman quite seriously gives him the rundown of what he owes and the complicated ways in which he can potentially reduce the final sticker price. It’s a bracing reminder that an ER visit costs you more than just several hours out of your day; you couldn’t ask for a better advertisement for the benefits of free healthcare than the look on Davelo’s face when he’s told he’s being billed as a “full-pay” patient. By couching this particular scene, not to mention the entire movie, in human terms, Nicks effectively moves the ongoing debate over America’s healthcare system out of the realm of budgets and taxes and instead asks viewers to consider the men and women whose lives would be improved by reform. In both its form and content, The Waiting Room echoes a comment made by former Speaker of the House Nancy Pelosi in regards to healthcare reform: “All politics is personal.”