Emergency room visits are a reality, whether you have insurance or not. Odds are you, or a friend/loved one, will end up in one–my parents who were fully insured were told by their doctors to go to the ER when they needed a hospital bed, that it was the fastest way to gain admission to their overcrowded hospital (I though it was a waste of ER resources, as well as their own). A friend of mine used the ER for a paracentesis (a draining procedure relieve abdominal pressure from ascites caused by Hepatitis C/cirrhosis) at his hepatologist’s suggestion because he didn’t want to wait until Monday–his usual appointment, he had a date. WTF? (That guy ended up being readmitted to the ER for abdominal bleeding, because seriously, the ER, where they are used to trauma and acting quickly, is not the place for a non-emergency procedure usually done in a lab setting!). These were people with insurance who simply wanted an end run around hospital and lab procedures. But not everyone has that luxury–or the insurance to cover the cost of an ER visit.

For the uninsured, ERs are the only resort for last minute health care as well as being the go-to place for major medical emergencies, and tonight’s film, The Waiting Room–along with with its smart website featuring extra storytelling footage–takes us inside 24 hours at Oakland’s Highland Hospital,  where the dedicated staff handles everything and everyone–the majority of whom are uninsured–with dignity and care, despite overcrowding, lack of beds, and trauma cases which pull staff away from the “routine” emergencies–sore throats, back and chest pain, patients running out of medication–and into life and death situations of gunshot wounds. (And for a doctor confronting his first time loss of life in the ER, it’s a trauma for him that must be put aside in order to continue his work with the living).

The ER also sees a lot of follow-up from gunshot wounds, as patients they have patched up come back with additional health problems. A divorced dad brings his ailing daughter–along with her siblings and ex-wife–into the ER, and explains to the camera  that he didn’t have enough money to make the visitation trip the day before. He apologizes to his daughter for spending their visit in the hospital–but no doubt his care and the respect both parents show each other during her ordeal will make a lasting impression on the child.

A carpet layer with spinal bone spurs explains his pain and his frustration with his employers who won’t give him a raise, and with the hospital system than won’t get him an appointment with a doctor until next March. He leaves with a Vicodin prescription, a short term salve with long term repercussions.

The ER is a rotating door for some patients. One man with substance abuse problems, found passed out on the street, is brought in. The ER doctors, familiar with him, stabilize him, but his faith-based residency program won’t take him back, and the staff is loathe to release him onto the street without a place to go. He is filling a bed that could be used by one of the waiting patients, but he can’t be released, since he would end back in the ER immediately, or worse yet, die.

One couple arrives, sent by Kaiser. They don’t have insurance, but paid Kaiser for the husband’s exam, tests and MRI. Kaiser stated he has testicular cancer and needs to be operated on immediately, so they told him to go to Highland Hospital to have the growth removed. Confronted by the cost,  the man debates using the funds friends donated to them for use at a sperm bank, since their last pregnancy was a miscarriage.

A 44-year old man who has suffered a stroke was kicked out of his last hospital and turns up in the ER. Resident Dr. Douglas White pulls favors and finds a neurology clinic that will take him–in a few weeks.

Dialysis patients, diabetics, children, elderly, all needing care are seen by the ER: 241 patients in 24 hours. This is not what health care should be. Without making any partisan arguments, and simply showing events as they unfold, tonight’s guest director/cinematographer Peter Nicks opens our eyes and sheds light on the failure of the health care system, the unraveling of the safety net, and those who try to catch the patients as they fall. The staff is amazing, compassionate, cheerful, and strong–with the tone set by warm and efficient Certified Nurse Assistant Cynthia Y. Johnson, who wrangles patients, sweetly  scolds them for swearing, tracks down snacks, and even escorts one lady to the bus. There are no egos on the staff,  just the desire to do the best for the endless wave of patients who flow in, all needing care–in some cases care they should be getting a doctor’s office, but lack the resources to do so.

As Dr. White says about the ER:

We’re a public hospital. We’re the safety net in society. We’re an institution of last resort for some many people.

The Waiting Room is on the short list of Academy Award nominees for Best Documentary.