State of Emergency

“You gotta love the widgets.”  So states Jim Anderson, the victim of a car accident stuck on a gurney, his loving wife by his side.  The attending physician, Dr. Joe Novelli, can barely manage a wry smile yet in this moment a connection is made.  It is the start of the personal redemption of an emergency room doctor, whose cynicism has been honed over 12 years.  He has come to hate the people who populate the emergency room, and now he has been reminded that he must love them.  They are why he is there.

State of Emergency documents a night in a public emergency room.  The patients are stashed in every conceivable corner, the CAT machine is down, there is no neurosurgeon on call, and the hospital is about to be merged into a health care company.  Dr. Novelli’s priorities are his patients.  The business executives’ priorities are prestige and the bottom line, which is awash in a sea of red ink.  The answer:  close the clinics and open a surgery institute.  An institution founded to serve the underserved is about to be transformed into yet another slick health mecca for those who have the insurance to pay the fees.

What is worse, the lack of a working CAT scanner, let alone no neurosurgeon available, requires the emergency room to downgrade to a Level 2 Trauma Center, yet Raoul Hernandez, the hospital administrator, will not do it.  His personal commitment to keep the ER at Level 1 outweighs all other considerations.  The decision will have tragic consequences.

When Anderson suddenly goes into convulsions, the only choices are to let him die or perform risky surgery, literally ‘by the book.’  It is a risky choice to attempt surgery, for if it fails Dr. Novelli will become the scapegoat.  The surgery at first appears to be successful, but Anderson goes into cardiac arrest, and dies.  As expected, Dr. Novelli is held responsible for the death of his patient, and no consideration is given to the many variables that led to that moment.  In a passionate speech to the executive board Dr. Novelli describes the many shortcomings of the ER, and the pennywise yet pound foolish decision to close the clinics.  It does not matter for this is his swan song.  He counsels his successor that having just one patient still alive because of the efforts undertaken in the ER is worth it.  Crucified on the altar of expediency, he will be resurrected at another clinic where he can be the doctor he wants to be.

The movie details the problems of the ER in an ‘in your face’ fashion, much like Dr. Novelli’s bedside manner.  The good doctor is jaded, angry, and frustrated.  His emotions break forth at a critical moment, convincing Anderson’s wife that he is rude and possibly incompetent.  He is not incompetent, but he is stuck in a system that does not support the efforts of the staff or appreciate their special understanding of what is needed.  It has sapped his strength and his humanity, and is never satisfied with the efforts that have been given.  The staff fights the system as much as they fight the trauma and illnesses that bring the patients into the ER.

The face of the system is Raoul Hernandez.  Dapper and self assured, he cares more for prestige than medical realities.  If a scapegoat can be found that will protect the system, and him, he is willing to accept that alternative.  The lack of a functioning CAT scanner is less important than Level 1 Trauma status.  The loss of a good doctor is insignificant when balanced against the financial realities plaguing the hospital.  Hernandez wants people to believe he is with them, but the staff knows the difference between the cosmetic rules governing ties and the real problems that prevent them from giving the care they want to. 

The staff meeting after Dr. Novelli leaves says it all.  The slouching bodies and bored looks come from people who have heard it all before and aren’t buying it.  They will give what they can, but the pep talk from the head of the service has all the bite and excitement of paint drying.

Dr. Novelli reclaims his humanity in that night, but at a huge cost to his professional prestige.  His willingness to stand up to the system, even though he knows he must lose, speaks to the principles that have always been a part of him.  His passion, long dormant, has been reawakened.  He leaves behind the hospital but he also leaves behind the shell of the man he had been.  Dr. Novelli has relearned how to “love the widgets.”

A Word About Robert Beltran’s Performance:

As I watched Robert’s portrayal of Raoul Hernandez I could not help but wonder if he disliked the man as much as I did.  Raoul Hernandez is a walking example of the bureaucrat slavishly caving to his executive masters in the expectation of acquiring prestige and power.  His decision keeps the ER open at Level 1 when it should close, and he has the power to demand Dr. Novelli’s resignation in lieu of firing.  The hospital merger can only help him, and he is not willing to move from his safe spot, even though he knows he has contributed to the events that led to Anderson’s death.  He does not work in the ER, so his hands are clean.

Elena Walker speaks to the gold pen and the way the character uses it to punctuate and manipulate his encounters.  The gold pen is more of a nervous twitch, a reflection of Hernandez’ deep-seated discomfort, unspoken, with the man he has become.  No matter what he says his soul knows what his mind refuses to accept:  he has sold himself to the corporate devil.  Robert’s use of that pen is so unselfconscious that I have to wonder if he felt the darkness that shadowed the character.  It’s frenetic movements made me think of a soul desperate for release from a bargain that offends the true self.  Raoul’s desire for power, and the opportunity for self-gratification, results in a trapped soul.  It expresses itself in the nervous energy released through the gold pen, and the character’s physical mannerisms.  In its own peculiar way, the pen becomes a Marconi device, tapping out a desperate SOS.

I don’t know if Robert ever reflects on the characters he plays, but if he does I would love to know what he might think of Raoul Hernandez now.