The Emmy-winning filmmaker shares lessons learned in making his new documentary on healthcare in the U.S., The Waiting Room.
Documentary filmmaker Peter Nicks
Tavis: The issue of healthcare has been a constant conversation in this country over the past few years, amplified of late, of course, during this campaign season. But behind the politics of healthcare is the reality of what many Americans face, especially in inner cities.
Peter Nicks is an award-winning filmmaker who decided to chronicle a day in the life of an Oakland emergency room. The film is called “The Waiting Room” and is being talked about as one of the best documentary projects of the year; the film now playing in select cities across the country. So here now, some scenes from “The Waiting Room.”
Tavis: Why, Peter, would a hospital, public or private, let you in with cameras to see any or all of this? Why would they let you in in the first place?
Peter Nicks: They took a huge risk in letting a documentary crew into this hospital. I’ll give a lot of the credit to the CEO, Wright Lassiter, who I think understood that this moment in time in the debate and discussion around our healthcare system, that transparency was important, not just at his institution but around the country as we were trying to figure out what’s going on in our healthcare system as it relates to our communities, and how could we fix that.
I think he sensed in me the story that I wanted to try to tell. We were able to build a trust, and he kind of understood that I was more interested in telling the story of that community’s struggle and that institution’s struggle than I was at doing an expose on the hospital, per se.
Tavis: Tell me why, or what is a better way to put it, what you think he wanted you to see, he wanted, that is to say, the viewer to see through your work about this particular hospital and what they’re up against every day?
Nicks: The story that people are familiar with at Highland, and not just in Oakland but in communities around the country, west Baltimore and the Bronx and Boston, is news at 11:00, when somebody comes in shot, and that’s the only perception, I think that’s the dominant perception that the public has about our safety net system and our county hospitals.
We in the very beginning communicated to him that we wanted to tell a much deeper story, that we wanted to go beyond that headline and beyond that statistic, particularly as it relates to the uninsured and the community that represents the uninsured. That was really the starting point of that trust-building, I think.
Tavis: That’s what he – I asked a question about him – what do you want, what did you have in mind initially with regard to what you wanted the viewer to see about what these hospitals in inner cities are up against every day?
Nicks: Well, the antennae first went up for me, my wife and I came out of graduate school at the same time. I graduated from the graduate school of journalism at UC Berkley, and she came out with her masters in speech and her first job was at Highland.
She would just come home with stories of her patients that were quite remarkable and surprising to me. One of them I remember, I still remember, it was of this guy, and he was a drummer in this village in East Africa, and he was a legend. He was like the Bob Marley of drummers. He was in the hospital, and people came, they brought food, they brought their drums, they would break out into song, and this guy was just a statistic. He was just a headline.
He was somebody that nobody would ever get to know, and that got me thinking about how many more people were there like this guy at this hospital whose stories were never told, and outside of the context of the healthcare debate I was just interested in the story of this community and what they were going through day to day.
That began the exploration and the development of the idea that eventually became the film.
Tavis: Tell me more about the back story of how you got this done, because I was fascinated when I got a chance to look at it to see, and I’ll let you explain this, you basically follow four or five different patients throughout this 24-hour period.
It’s basically a day in the life of this hospital, and you’re following these patients as they come in, and what their experience and journey is like. How did you develop a rapport, a relationship with these patients for them to let you tell the story of their experience at Highland?
Nicks: So the film actually was preceded by this digital storytelling project. I workshopped the idea through the BVAC Producers Institute in San Francisco, which is a workshop and a lab that takes documentaries and re-envisions them as transmedia or digital projects.
The notion was that at this moment in time, when the healthcare debate was getting so noisy, that the people on the front lines, their voices weren’t really being represented in that conversation. I was getting emails from whoever, MoveOn.org or whoever, saying, “Share your story, tell your healthcare story, tweet it, upload a video.”
I suspect that the folks in this waiting room and in waiting rooms all over the country weren’t doing that and they weren’t participating in that. So we wanted to go into that waiting room and just sit down and talk with people, meet people. Our question was, “What are you waiting for?” That led to really profound and poignant moments of expression. The question wasn’t “What do you think about healthcare reform, what do you think about this hospital?”
People just wanted to share a little bit about who they were. They wanted a little bit of dignity in that moment. When you walk into a public hospital waiting room, you kind of lose your dignity and your sense of self. So we wanted to try to capture that. That really set the tone for the film, this notion that let’s allow this community a voice and try to step back ourselves and not editorialize, necessarily, and just allow the lives of these people to come forward.
Tavis: I ask that question because health is as personal an issue as there is. Health is personal, our religion, our faith is a personal issue, and people don’t often open up so easily about those kinds of issues. So I wanted to know what the process was and that’s why I asked that.
But in the answering of that question you made a statement that is worthy of going back to unpack, and that is this notion that people lose their dignity when they walk into a public hospital waiting room. Now for those, which would be I think most Americans, who’ve never sat in a public waiting room at a hospital, what do you mean when you say that walking in there oftentimes costs one his or her dignity?
Nicks: I remember the first time I went to Highland. I was with my wife and we were rear-ended on the 580 in Oakland. I got there and I remember sitting on a gurney and sort of looking at the ceiling, and just thinking that I’m going to be here for a while, because there are more pressing issues than me.
This feeling of being kind of forgotten – nobody’s really focusing on you. It’s not that the people don’t care; it’s that the system doesn’t have the resources to handle the volume of people.
So when you’re walking into a public hospital waiting room sometimes for low acuity primary care healthcare, you’re dealing with people coming in the back door who are shot, who are in car accidents, who have strokes, who have had heart attacks.
It’s that sort of dual resource problem of an emergency room trying to provide primary care to an entire community and deal with the emergencies that results in really long wait times and this sense that you’re just a statistic, a number. It’s like take a number.
So I think that’s disempowering for people. People feel helpless, people feel like nobody in the micro, in that moment. Then in the macro, it’s the sense that the system is not working for me. There’s an apathy and kind of a sense of nobody’s really looking at, nobody really cares about me.
We got to understand that in terms of talking to people and saying, “Would you like to share your story,” and people would ask us why we were doing it, and we were saying, “Well, if you share your story, somebody in Washington could hear you.” Sometimes people would say, “Nobody in Washington cares about me.”
So that sense of apathy and frustration really came through, and what we wanted to do is allow people, at least let people know that we were listening in that moment and that we wanted to connect their story to the outside world.
Tavis: Speaking of Washington, obviously Mr. Obama wants to return to Washington, specifically to the Oval Office. Mr. Romney wants to deny him the opportunity to return to the Oval Office. There has obviously been great debate about Obamacare, as it’s become – and I say that only because the president has now said he likes the name Obamacare, so if he likes it, I’ll call it Obamacare.
So there’s been great debate about Obamacare, and Mr. Romney, as you’ll recall, in one of these previous debates, which was shocking to some of us, suggested that we don’t need Obamacare. We have healthcare and we have emergency healthcare for those who can’t afford it.
He went on to suggest that if something happens to you and they rush you to a hospital room, an emergency room, they’re not going to turn you away. They’re going to be there for you in the emergency room. For those who actually see public hospitals or our system in that way, that if something tragic or traumatic happens to you the hospital isn’t going to turn you away, what do you say to Mitt Romney or others who actually view, persons who have, of course, healthcare themselves, but view our system in that way?
Nicks: Well it’s interesting, because when we started developing the approach to the film, and ultimately, the storytelling project really set that tone, that it was going to be an apolitical film, that we weren’t going to have any narration, we weren’t going to have any text, we weren’t going to give it context beyond what you saw, that decision turned out to be a powerful decision in a sense.
Because what we decided to do was just train the lens on the waiting room, follow people in their day-to-day navigating the safety net system without access to the healthcare that the rest of the country had, and get a real intimate sense of what that feels like, what it sounds like, what it looks like.
When Romney came on “60 Minutes,” of course I was looking for his number to say, “You know, I actually made a film about what that looks like,” not saying one way or the other, getting political about it, but that at this moment in time we need to understand what that really means.
So it was a big serendipitous. As an independent filmmaker, it’s a big task to try to distribute your film and get it out there, and so we’re trying to do that. Nobody from the Romney campaign or the Obama campaign called me, because I don’t think people know about the film because the blinders are on, the boxing gloves are out, and they’re focused on getting reelected.
This film represents a sort of zooming out to say hey, behind these contentious debates and arguments, there’s actual people, and this is what they’re going through.
Tavis: I’m glad you said that. You’ve said two things I’m actually glad you said. One, I’m glad you mentioned “60 Minutes.” I said one of these debates; it was on the night, it was the night they both appeared on “60 Minutes” and not one of the debates.
Tavis: So I’m glad you said that for the record, number one, but number two, to your point now that the Obama people haven’t contacted you, the Romney people haven’t contacted you, and you’re trying to put faces to what this debate has been about with regard to healthcare in this country.
Why is it that you think that a film can make a difference? I ask that because Michael Moore is a friend of mine and we all know his project “Sicko,” and there are a number of projects where people have tried to advance the conversation about the healthcare debate in this country.
So what makes you think, one, that your project can make a difference in the debate, particularly given that your hospital is a public hospital that so often is there for people of color who live in these communities. I was glad in the piece, in the trailer that we saw earlier, I was glad that you saw a bunch of white patients in there as well, so it wasn’t just Black and brown folk.
But when we think of public hospitals, we tend to think color-coded, so against that backdrop, why do you think a project like this in this contentious debate matters?
Nicks: Well, there’s a couple of things that I was trying to do with the film, and in some ways I saw that it wasn’t just a film about healthcare, it was a film about this community and really revealing it in its full three dimensions. Because when you walk into the waiting room, it’s remarkable, it’s a remarkable stage.
It’s a turnstile of humanity, and it breaks – in my mind, it broke all kinds of stereotypes that I had, not just of the patient population, but also of the caregivers who are providing really remarkable care without enough resources.
I just really believe that if you – a story, intimately told without comment, can be a very powerful agent for change and can be actually a very powerful political statement in and of itself, particularly at a moment in the healthcare debate, where those voices of these people in waiting rooms in Oakland and all over the country aren’t being really represented.
I think polemic films that shake the trees are vital in our country too, and serve a purpose, but I felt like that film had been made and probably would be made, and the style of the filmmaking in terms of letting you in, in a way replicating that experience of sitting down next to someone in a hospital waiting room and overhearing their story, is important, because it is a step toward building empathy, which I think to some degree we’ve got a bit of an empathy crisis in this country where we divide ourselves ideologically, and we pit each other against each other.
We decide who the uninsured are, that maybe they’re sycophants and they’re taking advantage of the system and leaving the taxpayer with the bill, and they become stereotyped in that way. It was really important to try to remind people that we’re all in this thing together, uninsured or not. You can lose your job tomorrow, you can find – like that woman in the film lost her job, found herself at Highland. So that was definitely something that we were trying to accomplish.
Tavis: You think these people actually matter?
Nicks: I like to call myself an idealist, and I believe, of course I believe they matter. That’s why I have committed the last several years of my life trying to get this film not just made but distributed and heard. I think we’re distracted. I think we’re so distracted by the minutia of the battles that we forget about the soldiers.
These people are the soldiers. Not just the patients, but the caregivers on the front lines of our healthcare system. The premise of my film to some degree is that the system may be broken, but the people are not. There are people at the heart of this thing that we all know that are us, whether it’s ourselves or our neighbors or our friends, our kids’ bus driver, what have you.
In that waiting room, you’re going to see somebody that you love or you’re going to see yourself, and that, communicating that in an impactful and an intimate way can create change, because it can create emotion, it can create connection, it can create that framework. It can re-frame, I think, the discussion around healthcare reform that has in recent months, years, become so divisive and ideological.
Tavis: This project, “The Waiting Room,” your project, allows us to see the content of what happens or doesn’t happen, but we see the content of what happens in these public hospitals. The broader context of what these hospitals, public, are up against is budget cuts.
Here in Los Angeles, where this show emanates every night, great debate some years back about a hospital here in Watts and whether or not it would – King Drew – whether or not it would -
Nicks: King Drew, mm-hmm.
Tavis: – come back online or stay online. In Chicago, they’ve had this debate, as you well know, I’m sure, doing your research on this. Your project is about a particular waiting room in a particular hospital in Oakland, but across the country in inner cities, these hospitals are up against the wall and again, the budget cuts and other political decisions are closing some of these hospitals, and others are on the brink of being closed.
I say all that as background to ask this question – what happens, with all the drama and all the difficulty of what happens inside Highland every day, what happens if these waiting rooms no longer exist? What happens if they aren’t there? For all the drama we’ve got to deal with to navigate the waiting room, what happens if they disappear?
Nicks: You’ve seen a little bit of this with how society has dealt with the mentally ill in closing down a lot of facilities that care for the mentally ill. They’re out on the streets. So they’re going to show up on your doorstep on some level, and that’s the thing that’s always baffled me with sort of how some people approach this idea of well, people who are going into these public hospitals are just wasting taxpayer dollars.
Well, if we didn’t care for them, where would they go? Vulnerability to illness, we all are vulnerable. We’re all human. We all share that in common. So this notion that you can brush aside that reality seems like something that you cannot do.
I think clinics, I was just in Houston, at the San Jose Clinic in Houston. It’s a private, it’s a nonprofit run by the Catholic Church, and they provide free healthcare for the uninsured. Those would have to pop up, but you can’t just create those overnight.
When entire states, Texas, Florida, are talking about shutting down the safety net system, something’s got to rise up. I’m not an expert in sort of that world, but it would be certainly a crisis, given what it already looks like in our public hospitals today with the volumes that they’re dealing with, with the complexity of providing continuity of care to entire communities, that juggling between primary care and emergencies that you see unfolding every day in “The Waiting Room.”
They’re already at capacity, and so I can’t imagine how that would be a good thing.
Tavis: Let me, as I see this footage on the screen now, let me circle back and close our conversation by talking about the caregivers. How do these caregivers, knowing what they are up against every day, knowing that the dignity and the humanity of these patients is challenged and contested every day, how do these caregivers sustain their hope? What’d you learn about that?
Nicks: One thing I learned is that this is a really remarkable place, and it’s a self-selecting group. A lot of the staff, a lot of the certified nurse assistance, LVNs, support staff, are actually from that community.
A lot of them were born at Highland. They have a very deep connection to that community. When people come in, they’re their friends, their neighbors, their loved ones. So that’s family, and you care for your family. The residents who come from some of the best medical schools in the country because you get the best training at a place like Highland, so you’re getting people from Harvard, Stanford, Yale, who come in.
They grow not just as people but as doctors there, and you see it really unfolding. In just the three years that we were there, Dr. Doug White, who was in the film, we saw him grow as a human being and a doctor, and it’s a profound transformation. They believe in what they’re doing. They believe in providing care for a community when they know that that community has nowhere else to go.
It’s hard, it’s like a sport. It’s like you imagine getting hit, these linebackers and quarterbacks are getting hit, well, these doctors and nurses and staff, they’re getting hit emotionally every day with the weight of this entire community, whether it’s a young child being killed and the family having to be informed, or whether it’s seeing someone repeatedly coming back, the frequent fliers, they call them, the drug addicts, coming back over and over and over again.
But not giving up, because you don’t know where that person’s been maybe the day before, you don’t know where that person’s going to be the day after, but you’re going to give them that one more shot, that one more hand. They believe that. They internalize that.
The institution, the community, engenders, I think, that sense of purpose and it was quite remarkable and actually surprising for me as I got to know a lot of the caregivers there.
Tavis: The project is called “The Waiting Room.” Remember the name. I suspect as the award season gets closer, you’ll start hearing that name time and time again, and you might want to check it out in the process. Peter, good to have you on the program. Congratulations.
Nicks: Thanks, Tavis.
Tavis: That’s our show for tonight. You can download our app in the iTunes app store. I’ll see you back here next time on PBS. Until then, good night from L.A., thanks for watching, and as always, keep the faith.
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