Peter Nicks, The Waiting Room
If you’ve ever endured an hours-long wait at the emergency room of a city hospital— sick, injured, frustrated — or accompanied someone on an infuriating quest to find urgent medical help, then you’ve probably wondered aloud, why is it taking so long? In his enthralling new documentary The Waiting Room, winner of the Guggenheim Emerging Artist Award at the 2012 Full Frame Film Festival, Bay Area filmmaker Peter Nicks wheels us into the chaotic emergency room of a teeming public hospital in Oakland, CA, serving a mostly uninsured patient population. Adopting an immersive, all-in approach that owes a strong debt to the institutional studies of Frederick Wiseman, one of Nicks’s acknowledged influences, the film introduces us to a clutch of everyday people—a father with a distressingly ill daughter, a college-aged guy with testicular cancer who’s been booted out of a Kaiser facility—on their journey through a system under chronic strain. Inside, a continually embattled unit of ER clinicians deals with everything from gunshot victims and drug overdoses to fragile emotions and shredded nerves, all while striving to find beds and space for the throng of desperate, anxious people waiting to be treated in the lobby.
An ITVS Open Call Fund project that’s igniting debate and rousing strong interest in an election year, The Waiting Room captures a “day in the life” of a medical facility with engaging, at times humorous, often poignant immediacy, tracking marginal or destitute or out-of-work people in worrisome circumstances, attended to by professional caregivers who are, quite literally, in the trenches. In humanizing what’s at stake in the healthcare debate (see the cross-media project at www.whatruwaitingfor.com), Nicks has added something even more valuable to the conversation than a raft of statistics or an array of expert opinion: he’s given it a face.
Filmmaker spoke with Peter Nicks about institutional exhaustion, the lost art of documentary, and how storytelling can help illuminate the healthcare experience.
Filmmaker: Why did you decide that a vérité approach would be the best way to tackle this story?
Nicks: I went to the graduate school of journalism at Berkeley and chose film as a focus. I’ve always had an interest in making films. I came out of that environment of documentary filmmaking as journalism rather than as art. I used to work at Nightline. But the stories that interested me the most did not take a strong editorial point of view or use a polemic approach—[Frederick] Wiseman’s work—but was rooted in an issue we were struggling with as a nation. All of my work has dealt with some sort of social issue.
Filmmaker: Was that the case from the beginning, that you adopted a purely observational style?
Nicks: Well, I did one film that I had full control over, which was called The Wolf. It was acquired by Nightline and aired as a television documentary in two parts. It’s a personal story about me—I got involved in drugs in college and fell off the beam. I ended up in prison and had an overdose, and all kinds of crazy things happened, but I somehow got my life back together and recovered. The film looked back at [that time] through the eyes of all the people who saw it unfold, but it was still interview-driven. And I did some exposé work for Bill Moyers and PBS. With The Waiting Room, I had an opportunity to tell a story about big social problems but had flexibility with the co-presenter, ITVS. We had some good battles over whether you give the audience context or not—they initially did not want me to do a vérité film. Ultimately, to their credit, they did allow me the independence to take that approach. I don’t think anybody knew until we were finished whether it was going to be effective and satisfying for the audience. They took a risk, especially at a time when successful documentaries are the polemical ones, and have a very sharp part of view. I call them “disaster docs.” You know, a filmmaker identifies the problem and walks you through it. Our fears fell away as the film starting premiering at festivals and people reacted to it.
Filmmaker: Like major documentary filmmakers of the past—Wiseman, Leacock, the Maysles brothers, and others—you’re asking people simply to observe, and there’s actually a lot of drama in that. But at the same time, The Waiting Room is not quite equivalent in style or tone to High School.
Nicks: That’s right. We called our approach “Wiseman with words.” Iraq in Fragments and Hell and Back Again both did that, allowing some voiceover to come through, but you don’t ever see the character on camera. You sort of get inside the subject’s head. That was the extent of giving context. We did sneak some things in there, such as a few lines from the doctor about what they’re dealing with as an institution.
Filmmaker: At certain moments, it occurred to me that I was listening to voiceover, which was surprising because I’d been so immersed in what I was seeing.
Nicks: There was more voiceover in the beginning, which had a slight PBS-y feeling, but over time, that falls away and it does become somewhat hypnotic and immersive. Lawrence Lerew, who edited the film, did a remarkable job. He’s a young editor who co-edited The Most Dangerous Man in America: Daniel Ellsberg and the Pentagon Papers. He’d done some work with [Freedom Riders director] Stanley Nelson. I went through the Firelight Media lab with The Waiting Room, so Stanley’s a consulting producer and that’s how we found Lawrence. I really became an activist for our approach, the idea of going back to the “lost art” of documentary, and I got into it on a lot of panels. Debate arose about whether or not I was an activist, and what’s the role of a documentary storyteller. I’m not an activist but I do have a point of view.
Filmmaker: Those are two different things.
Nicks: Yes, I think so. A lot of filmmakers now are hooking up NGOs and other organizations before they’ve identified the story. And I think it’s dangerous to let the issue drive who your characters are and what your story is. I’m a huge believer that if you tell a story well, the stakeholders will rally around it. The Participant Media thing, that can happen—there can be an impact with a film that doesn’t take a strong editorial approach.
Filmmaker: How did you identify this Oakland public hospital as the one you wanted to set up shop in?
Nicks: It’s a convoluted story. [Laughs] My wife came out of grad school at the same time I did with a master’s in speech pathology. And her first job was at this hospital. She’d come home with all these stories and my antennae immediately went up. This was in 1999, a little before the healthcare debate became what it is today. But I never approached them to get access. We moved to New York and I went to work at ABC, and then we came back in 2005, and she went back to work there. She said, “Guess what? They’re making a documentary at the hospital,” and I thought I’d lost my chance. It turned out that Rob Epstein and Jeffrey Friedman [The Times of Harvey Milk] were making the film. Jeffrey had edited my addiction film, and I called him up and said, “You guys stole my film idea!” I came on as a producer and the investors wanted to do a Michael Moore–style polemic about the uninsured. They wanted to get it in theaters before the ’08 election. Then Rob and Jeff got pulled away on Howl and the whole thing fell apart.
Filmmaker: Except you didn’t let it go.
Nicks: I couldn’t get it out of my head. In 2009, I approached everyone and said I wanted to take it over. I’d done some consulting at Internet start-ups and was watching what was going on in media, so I conceived of The Waiting Room as a big interactive media project. It started off as a very simple video storytelling [concept] where I went into the waiting room and asked people “What are you waiting for?” I wanted to hear what people had to say and what they were going through. The online storytelling piece started to attract a ton of attention and then I applied to ITVS Open Call. The next thing you know, we got funding and we were making a film.
Filmmaker: What was that process like of working among the clinicians and ER staff, and navigating the sea of people in the waiting room? How did you find your characters?
Nicks: Because it’s a big public hospital in a major American city, there were so many potential ways to approach the film, which is about putting a human face on the millions of uninsured. Early on, when we were meeting with the hospital executives, we had to walk through the waiting room. Hours later, I’d notice some of the same people were still there. At first we were shooting in the diabetes clinic, the heart clinic, the inpatient area, finding amazing stories and caregivers, but the waiting room kept pulling on me. We’d already shot about 50 hours of footage, and it dawned on me that the waiting room was a very contained space where not only amazing people were assembling every day, but that it was also a metaphor for our healthcare system and state of being. That’s when it got a sharper focus.
Filmmaker: What kind of schedule did you keep?
Nicks: We had to shoot very quickly because of continuity. The hospital was planning renovations to improve waiting times. The film is a composite “day in the life,” but we had only a month to shoot. Our approach was to meet people who were queued up, and we’d never spend more than a day with any one character. We wanted to capture what it was like for the patient on that one day.
Filmmaker: I’m sure the down-and-out patient we meet who’d been on a dangerous meth binge, Carl Connelly, resonated pretty strongly with you, given your personal history.
Nicks: Yeah, that was my story. One question raised early on was how can we make a film about a population that is going through really difficult times? We wanted to present it in an accurate way, but we also didn’t want to alienate the audience, who we knew would be more privileged. How would they be able to connect with these people’s lives? The reality is that a lot of people who assemble in public hospitals are just like you or me, but maybe they just lost their job—maybe it’s your uncle or brother. But a lot are indigent or addicted to drugs. We decided we wouldn’t shy away from representing them but would work really hard to allow people in the audience to be sympathetic toward them.
Filmmaker: You also show us how the Highland clinicians themselves show incredible compassion, even though they deal with frustrating situations like drug overdoses and shootings day in and day out, sometimes with the same individuals.
Nicks: The caregivers are truly some of the most unique people I’ve ever met and they’re a big part of the story. They are dealing with such difficult circumstances, working without enough resources, dealing with people who yell at them and who stink, and people who are sometimes physically threatening. And they still show up. It’s a self-selecting group of people and I think they have a bit of a mission. They’re very compassionate. One of the attending [doctors] there donates his time. Every doctor has a bad day, and we witnessed some of that, but we represented them in the most honest way we could.
Filmmaker: Cynthia Johnson, the admitting nurse, is absolutely fascinating—she’s so cool-headed and sharp and witty. She’s a psychologist, almost, who really handles people beautifully.
Nicks: Some people describe C.J. as a customer-service genius. What she’s doing is managing people — and she can handle anybody. I think she’s a big part of the reason the film is resonating with people. She’s not just a character in the film, she’s a symbol for what we all want our healthcare system to be. We all want that kind of respect when we walk into a hospital—that kind of love, really. She’s remarkable.
Filmmaker: What are your thoughts on the current debate over healthcare?
Nicks: My research is more around the human condition than public policy. I will say that public hospitals like Highland are trying really hard to provide better customer service. But when you look at the realities they have to deal with, the challenges go well beyond any ideas that an industrial designer might have [to improve] waiting room times. We’re trying to remind people these hospitals are cogs in a system with bigger problems that we need to address. Little victories, like the way C.J. deals with people and how doctors can be resourceful in helping patients, do add up.
Filmmaker: Since you’re more interested in exploring the human condition, tell me briefly about the transmedia storytelling project The Waiting Room is connected to.
Nicks: It really gave birth to the film. When we started talking to people, what we found is they didn’t want to talk about Obamacare or politics, they wanted to talk about who they were and what their journey was. “I’m a comedian,” or “I lost my son in this hospital.” That put me in the frame of mind of using the project to reframe the conversation. We will continue to collect stories and moments over the next several years as reform laws are implemented. How is the system working? How are people doing? It will segue into an interactive, user-generated platform where [hospital visitors] can record video, take a picture or audio, Tweet or use text—it will give people something to do while they’re in the waiting room. That’s my goal, to give people a new way to talk about healthcare as opposed to it being a boxing match.