Reviewed in the United States on August 11, 2020
21 years ago, Martin Scorsese and Nicholas Cage did a sleeper movie that you may not have seen - unless you are a paramedic or EMT. Interestingly, though I'm a lifelong paramedic, I have never seen it until today. I’ve been waiting for it to be included in my Amazon Prime “free to me” account. And now it’s over and I’m trying to understand why my EMS colleagues always say it is a must watch film.
Of course there are the shenanigans we got away with in the 70s and 80s - not quite Mother, Juggs, and Speed - and much more realistic. In fact, Cage, as usual, was phenomenal in his role. He plays a burned-out, seen-it-all, inner-city paramedic. Young, divorced, lonely, and on the verge of being a full blown and obvious alcoholic. Even the way he wears his uniform and sits in the back of the ambulance - both are portrayed perfectly. I’ve worked with each of the partners he’s paired with and at some level, I’ve been a part of those characters.
And now here we are 40 years later; 20 years after this film was made. What do I think?
It really comes down to the ending scenes and story closure. The first half of the movie sets us up for the closure. Many of the narrative lines are spot on, but the lack of professionalism - still rampant in many agencies even today - is bothersome to me. As our profession has grown, matured, and developed, our managers have stopped the shenanigans, but they haven’t taught professionalism.
In other words, they taught their medics to behave, but didn’t provide anything more than negative reinforcement. Some medics come from educated and emotionally intelligent backgrounds, and are naturally professional. However, many are so afraid of being “written up,” fired, or losing their license, that their whole career becomes wrapped into a fear of failure, rather than a pursuit of excellence.
There was something great about EMS in the early days - before multinational, investor-owned corporations took over. We were cowboys, but our patient care was centered on providing excellent patient care. We had fun, we didn’t always look like Clark Kent, but despite a few outliers, our care was really good.
In addition, we understood the streets and we knew how to build camaraderie with different people, in various neighborhoods, within different cultures. Sadly, we are now constrained by a desire to keep our jobs - even at the expense of not being patient-centered, or being an overly conservative caregiver.
Yet, this isn’t what really needles me about the movie. My question is, am I supposed to see ghosts? Or, to put it another way, am I supposed to feel guilty about the ones “I” lost? Is this what my friends in EMS are talking about when they say, “You have to see Bringing Out the Dead!”
Or are they talking about the uncaring supervisors, the burnout, the alcoholism, or the gritty reality of life in the inner city? And the lack of concern for drunks and sex workers? Or is it the cardiac arrest patient you know is dead (Maybe now, maybe later, but either way, they are dead) - and you know, in your heart or hearts, that much of the role of medicine is to run people through the machine - just prolonging their deaths. The inhumanity, the assault on their person-hood, and the loss of dignity through the whole process - it’s more obscene than incontinent drunks and barely clothed, anorexic, junkie prostitutes.
What is the reason other old school medics are enamored by this Scorsese film? I don’t know - we don’t talk about that stuff.
Which is what this movie is really talking about. Frank is sitting across from his partner, his supervisor, the doctor in the ED (I miss emergency departments like that!), or even his patient’s daughter, begging for help - and no one can hear him.
In the mid-80s, the average paramedic left EMS around 42 months into their “career” (we affectionately called it burnout back then). Cage, in this movie, is five years into his career and is trying to commit professional suicide. Some of us lasted longer - but we understand the price we’ve paid. Our divorce rate is high, substance abuse rates are high, and suicide rates are off the chart. We take care of others, but we haven’t taken care of ourselves.
And this may be the cause of our lack of compassion. Maybe we’re trying so hard to survive, that we have nothing left to give. We go through the motions. O2, IV, monitor, transport - rinse and repeat. “You call, we haul, that’s all.”
I’ve spent the last 25 years of my life trying to make this better. I’ve grieved over what our profession could have been. We had such a dream - we believed in that vision. We knew it was possible. And now, it no longer seems possible. Whenever I can, I try to steer kids away from a career in EMS. Stay away. Go to PA school, become an RN, do anything - just don’t become a paramedic.
Scorsese and Cage portray 1980s and 90s EMS very well - this film is adapted from a book written by a NYC paramedic and it is a story many of us who worked the streets understand. It's a very difficult profession - and one of the most dangerous in the country. Our suicide rate is higher than the rate of veterans, and our on the job death rate is higher than that of firefighters and police - but we are also paid poorly, with almost non-existent retirement benefits, and substandard management.
50 years ago, there were no paramedics - just a bunch of untrained ambulance drivers. Now, we have paramedics, offering the same care as one will receive in the emergency department and with education comparable to what RNs receive. It's not a sustainable model - and Cage portrays that well.