A health-care emergency in the ER

The Waiting Room at Highland Hospital in Oakland, CA The Waiting Room at Highland Hospital in Oakland, CA Photo: International Film Circuit, Inc. Photo: International Film Circuit, Inc. Image 1 of / 12 Caption Close A health-care emergency in the ER 1 / 12 Back to Gallery

Peter Nicks' documentary "The Waiting Room" is forceful but never ostentatious in presenting a blunt approximation of one day in the emergency room at Oakland's Highland Hospital, which one doctor in the film describes as "an institute of last resort for so many people." ... "Unfortunately, we see a lot of patients coming in with very treatable conditions," says the doctor. "I know I can make someone better in the short term, but the ER is not the place to manage someone's overall health."

The film is primarily shot in a vérité style, void of talking heads nattering about the flaws in the American health-care system. Instead, the camera follows numerous patients with ailments that require treatment that ranges from emergency surgery to Tylenol. Highland, which sees some 80,000 patients a year in its emergency department, has unwittingly been transformed from an ER into a general clinic for an uninsured multicultural community that routinely outnumbers the ER's beds and exam rooms. (As context, doctors at Ben Taub General Hospital in Houston, a city with a population more than five times that of Oakland, see more than 100,000 emergency patients each year.) The ripple effect of a patient being treated for a gunshot wound can be a seven-hour wait for another Highland patient who could've bought the necessary medicine over the counter at a pharmacy.

The caregivers in "The Waiting Room," which actually was shot over a two-month period, are quietly heroic, berated by and lied to by patients at times, yet committed to a Sisyphean task that steers the film away from cynicism and toward something resembling hope. It's a moving and at times darkly humorous film full of little barbs meant to provoke thought rather than judgment. Nicks, who will be in town to introduce the film Wednesday at Sundance Cinema - followed by a Q&A - talked about his time in Highland.

Q: One of the toughest segments follows the addict who gets bounced from a shelter by his pastor, who is fed up with him. Something about it reminded of the "let him die" moment from the (Republican) primary debates earlier this year. I'm sure there will be some viewers who will feel that way.

A: I have very strong feelings about that. I was Carl. I suffered a serious addiction in college, losing everything and ending up in prison. My first film was about that and what happened to me through the eyes of the people who watched it happen: my attorney, the judge, family and friends. I've met Carl and people like him. And what I think has happened in our country is we have a bit of an empathy problem. When you have something secure in your life, it's difficult to empathize with others who have fallen down. I wanted thematically in the film to present the idea that we're all connected and vulnerable. And life is unpredictable. You can slip down. Carl was in a tough situation there. It was something I wanted to get out there without inserting myself into the film. Some of these stories were challenging to put into the film. I want the audience to sympathize with the characters.

Q: The feeling conveyed was that this was a day in the ER. Was it really shot that way? Or was it a composite.

More Information 'The Waiting Room' Q&A with director Peter Nicks following the screening When: 6:15 p.m. Wednesday Where: Sundance Cinemas, 510 Texas More information: 713-223-3456 or www.sundancecinemas.com

A: It was a composite of a day. We had to do that to give the film some structure. At first I thought about filming multiple days with 12 cameras per day and pick the best day. But that was expensive. What we did, was we didn't spend more than 24 hours with any one patient. And we spent eight weeks collecting these vignettes. And we hung out for several months with the doctors and staff watching their work dealing with beds, all the negotiating. The 24-hour structure was important, though, because I wanted to show how the hospital has to work so hard to clear the waiting room just to have it fill back up again. It's like shoveling sand before the tide.

Q: With the one fatality in the film you chose not to show his family. Was there any temptation to do so? It could've come across as powerful but also manipulative. And the aftermath had its own chilling quality without that.

A: You know, one of the first things I saw when I started my time there was a family being notified that a loved one died. I've never seen anything quite like it. The sound of it, the look of anguish on the faces and the range of emotions. You talk about the seven stages of grief, but those first moments are really something profoundly human. I think most people are vulnerable in that state. We didn't want to exploit that and add to the trauma of that moment. ... We also thought it would be more powerful to leave something unspoken. It was difficult enough to watch these doctors deal with life and death. A lot of these guys were young. The one guy, it was the first time he'd seen one of his patients die.

Q: In other hands, this film could've ended with a death and carried a more cynical message. Maddening as the film is, you seemed to want it to end with a note of hope.

A: I definitely wanted people to feel a measure of hope. That our communities are made up of people going through some very trying circumstances, but they're strong. That the safety-net system cares about them. We didn't want to shy away from the very stark realities we're facing. So hopefully people will leave with complicated feelings. It's hopeful, dark, funny and sad. All of that, but that's the human condition. What I saw right off the bat in that waiting room was a remarkable kaleidoscope of humanity.

andrew.dansby@chron.com