Dr. Ryan McGarry knows what it’s like to be a patient — he’s been one.
Dr. McGarry was running NCAA Division I track and field as a Penn State undergraduate when his times inexplicably slowed. He saw doctor after doctor, but left them only with a diagnosis of training burnout. And then they found the real reason: non-Hodgkin’s lymphoma. Stage IV.
"Statistically, I was not in a good place for survival," said Dr. McGarry, now 32, an instructor in medicine at Weill Cornell Medical College and an attending emergency physician at NewYork-Presbyterian/Weill Cornell Medical Center. "I went beyond protocol on treatment with four additional rounds of chemotherapy and happily things turned around. I have a permanent patient's perspective."
His experience not only inspired him to go to medical school, but to also combine his commitment for patient care with his passion for storytelling. The result: a documentary that makes its New York City premiere on June 20 at the IFC Center. The film, "Code Black ," follows a group of young doctors during their residencies at Los Angeles County General Hospital as they grapple with their idealism and the realities of practicing medicine in an overburdened system.
"Code Black," which Dr. McGarry filmed during his own four-year residency at the hospital, has won numerous accolades, including the 2013 Los Angeles International Film Festival Jury Prize for Best Documentary Feature, Best Documentary Feature at the 2013 Hamptons International Film Festival, Audience Favorite Documentary Award at the 2013 Aspen Film Festival and People's Choice Award at the 2013 Denver STARZ Film Festival.
We sat down with Dr. McGarry to learn more about the film, the motivation behind it and how his experiences shaped his perspective on the American healthcare system.
Q.: What did you hope to achieve with the film?
Dr. McGarry: Documentary is unique in that you start with certain goals and a certain vision of how the story’s going to be. By the end of it, the film tells you what it’s going to be. This became a film about idealism and protecting your ideals. You are a young physician in America today and you have certain expectations, but once you get involved you find out that it’s none of those things. When do you become a skeptical physician versus someone who protects those things and fights for them?
Q.: How did you initially conceptualize “Code Black”?
Dr. McGarry: When I started at LA County Hospital, it was in a much older facility — it was 80 years old — and it was about to move into a new facility. I saw this emergency room that looked like a war zone. The amount of trauma, sick patients and chaos was completely not what we would expect in modern America. To my surprise, everything was actually working really well. I thought that would be an interesting point for a before-and-after story of American healthcare: What happens when you take a cultural institution that’s been there for 80 years and change that environment? What I found was that we lost patient-doctor connections, intimacy and the ability to manage multiple cases at once. Following filming, additional nursing staff were added to the ER and additional improvements for patient flow continue to be implemented.
Q.: What’s in the name? What’s "code black"?
Dr. McGarry: Code Black is an official code for “internal disaster.” At this institution, it meant overcrowding, that there were no beds upstairs, no beds in the ER, and so it’s gridlock. We found ourselves in code black up to three-fourths of an entire year.
Q.: You made this film in one of the largest and busiest hospitals in the country. How did you manage to pull that off?
Dr. McGarry: We certainly had to work with the hospital and county administration, and I was very lucky that they saw the silver lining in this project. You can shoot a commercial and show doctors and nurses smiling and being great, but it’s quite another thing to show them being challenged, compassionate and putting patients first, because that’s authentic to people. Another challenge was obtaining patient consent and permission. We wanted to make sure that patients involved not only had a chance to give their permission on the spot, but also sometime later after whatever they were there for had a chance to diffuse. We found them after the fact, showed them the footage and asked, 'Do you still want to be a part of this?'
Q.: How did they react?
Dr. McGarry: A lot of patients who were really sick at the time or their families were really traumatized at the moment watch this with some amount of awe and gratitude, that they couldn’t believe the effort that went into their resuscitation.
Q.: What did it take to produce this film?
Dr. McGarry: After shooting 50 hours’ worth of material with a skeleton crew, I made the risky call of cold-calling a professor of documentary at University of Southern California’s cinema school who’s a three-time Oscar winner in documentary, Mark Jonathan Harris. He felt the footage had feature film potential and he decided to come on board as an executive producer, and that led to other producers and funders coming on.
Q.: Your film provides insight into the harsh realities of America’s faltering healthcare system. What are the biggest challenges that you see?
Dr. McGarry: In the film, we’ve tried to highlight the idea of reconnection, that a lot of well-intended regulations are sometimes not evidence-based and often prevent doctors, nurses, etc., from doing the right thing. Given a 15-minute exchange, you’ll spend almost 10 of that just keeping up with the documentation. If two-thirds of your time is spent away from the patient, how quality can that exchange be?
Q.: How can we fix this?
Dr. McGarry: I’m a young doc so I’m not an expert. I think that the physician voice has to return to the conversation. I hope as a filmmaker I can contribute to that.
Q.: How do your experiences at LA County Hospital compare to NewYork-Presbyterian/Weill Cornell? How do the lessons you learned during your residency affect your practice in medicine here?
Dr. McGarry: I’ve been lucky in both places. People should know that NYP/Weill Cornell nurses, as well as physicians, are world-class. I’m struck by how the patient experience here is truly patient-centered. I am so thankful to everyone in the emergency department here.
Q.: What made you come here?
Dr. McGarry: When I was on the job market coming out of residency, Dr. Neal Flomenbaum , Dr. Wallace Carter and Dr. Jeremy Sperling were incredibly supportive of the film and its contributions to our specialty. And Weill Cornell and NewYork-Presbyterian have such an incredible reputation, I couldn’t turn down such a great opportunity.
Q.: What’s next for "Code Black" after the premiere on Friday?
Dr. McGarry: It opens in theaters nationwide and then it’ll be available through Netflix and iTunes. It’s been optioned for a fiction series by one of our executive producers who comes from television and I hope to write and direct for that. In the meantime, I am shooting commercials and other projects for television and film.