Spending time with The Waiting Room, a documentary on Oakland’s Highland Hospital

The Waiting Room is an upcoming feature-length documentary film shot entirely at Oakland’s Highland Hospital. The film follows a group of patients and doctors as they struggle through the realities of the public health care system—lack of insurance, the high cost of care, a shortage of beds, and extremely long wait times.

Highland Hospital, located in East Oakland at 31^st Street and 14^thAvenue, is a county-run, public hospital that serves as the major trauma center for the greater Oakland area, as well as providing the bulk of non-emergency medical care to uninsured patients in Alameda County. The hospital is the source of primary care for some 250,000 patients. Almost every adult in the area who suffers a traumatic injury is transported to Highland Hospital, whether or not they are insured. The emergency room sees about 80,000 visits annually. Doctors and nurses juggle 236 beds—balancing limited resources in a delicate triage system to provide care to a community desperately in need. The tension between trauma and acute care builds in the waiting room at Highland Hospital, resulting in long, frustrating periods—sometimes as long as twelve hours—spent waiting for basic medical attention.

CJ, a nurse at Highland Hospital, in a production still from the upcoming film, “The Waiting Room.”

Focusing on a handful of characters—a young girl with a serious bout of strep throat, a carpet layer suffering from painful bone spurs, a man brought in after overdosing on a number of drugs, an uninsured patient turned away from Kaiser on the day of his scheduled surgery to remove a testicular tumor—the film traces the entire course of waiting for, and receiving care, at Highland. These stories are juxtaposed with the struggle that doctors and nurses face everyday—managing a limited number of beds and supplies while providing prompt care. Shot over a two-month period in 2010, the film uses intimate access and a cinema verité approach to show a “composite day in the life” at Highland Hospital. In total, it took fourteen months to edit the final 79-minute film from 175 hours of footage.

Accompanying the recently completed film is an elaborate online, interactive “Storytelling Project” centered on social media and community engagement. The project is meant to share collective health care experiences in the hope of illustrating the needs of underserved patients. The film’s website, www.WhatRUWaitingFor.com, collects digital content—video, photographs, and text—and arranges it based on issues and emotions in a scalable framework that can be replicated in communities across the country.

Peter Nicks, the film’s director and an alumnus of the UC Berkeley Graduate School of Journalism (the school that produces Oakland North) sat down with Oakland North reporter Adam Grossberg to discuss the project.

Where did the idea for The Waiting Room come from? And how did the film get made?

My wife works at the hospital, so that was my entry point. The power of the stories I heard, in terms of what patients were going through on a day-to-day basis, that wall that they had to climb everyday—whether it was showing up in the waiting room or whether it was trying to make an appointment in a clinic or work through rehab. I first started thinking about this in 2001, well before the noise around the health care reform got crazy and ideological and political. I was attracted to the power of the stories. People coming to the hospital, taking three buses and a taxi and maybe walking the rest of the way and not having money to get home. African tribes rallying around their brother who got injured and he’s a star drummer in Africa and here he’s just an uninsured guy. Stuff like that piqued my interest.

There’s a complicated story parallel to that. I forgot about the idea. I moved to New York and was working at ABC for a few years. I moved back and my wife took her job back at the hospital. Her first month back at the hospital she came home and said, “Guess what? They’re making a documentary at the hospital.” And it turned out it was Rob Epstein and Jeffrey Freidman [Academy Award-winning filmmakers of Times of Harvey Milk], who I know very well. Jeffrey edited my first film The Wolf. So I called them up and they needed a producer, and I joined their team. It was a privately financed film about the uninsured. It was all about the uninsured, not the individual stories.

Then financing for Howl [the 2010 feature film about Allen Ginsberg’s famous poem] came through, and Rob and Jeff went and worked on that, so the project fell through. … I reconceived of the film as a social media and interactive project, and went back to Rob and Jeff and the original investor and said, “I want to resurrect this thing.”

Highland doesn’t have the best reputation. But, the film doesn’t really address that. Was it a conscious decision to show Highland in a positive light, or at the least, from a neutral position?

That’s the wrong assumption about Highland. If I had one regret, it’s that the film didn’t completely articulate that. … They will save your life. They are incredible at trauma. Their trauma center is incredible. It’s the number one destination for ER residents in the country. … If you’re a brilliant med student at Harvard, Highland is probably on the top of your list. You can go on their website and look at their residents, it’s like the very, very best. So that’s trauma.

And then when you get into chronic care, continuity of care, the higher floors, that’s where it changes. If your knee hurts and you want to see a doctor about it and get into the orthopedic clinic—six months. If you don’t have a doctor and you’re not feeling well, you’re in the waiting room ten hours, twelve hours, because a trauma patient just came in and they’re all in the back working on him trying to save his life. Or someone got shot. That’s the reality of the waiting room. The waiting room is a manifestation of a ton of people coming in to seek basic health care competing with what urban hospitals do best, which is trauma. It’s that mixture that creates this dynamic in the waiting room that you see in the film.

Is that dynamic, aside from the fact that your wife works at Highland, why you decided to set your film there?

When we started, we started filming all over the place and saw this juxtaposition. People are there to seek basic health care and the hospital is trying to manage emergencies. Those two don’t mix well together.  Originally the focus was just the uninsured. Highland is where you go if you have no place else to go. That’s the story of every public hospital in the United States. The story of Highland is the story of many hospitals in many communities. So if we can tell this story, we’re also telling the story of a large swath of America. So that’s why we picked Highland.

Once you took over the project, how did the original idea change? How is it different from the finished film?

The original structure was different points of view. Different things are revealed about the health care system in the waiting room then are revealed in the upper floors, or are revealed in the dental clinic or in the administrative wing. Originally we had a patient, a caregiver, and an executive and we wanted to show those three different perspectives of each struggling in their own ways, juxtaposing their struggles. … Then we heard they were going to renovate the whole waiting room because they were trying to improve wait times. So then we had two months to film in the waiting room. We decided were we going to go all-in on the waiting room. Just two months, we were going to shoot patients. Shoot, shoot, shoot, and try to find the right patients.

You ultimately found a few characters that the film focuses on. How did you pick these people and what specifically were you looking for? On top of that, how did you get such intimate access to very personal and private scenes?

We were looking for people that were dealing with chronic health care issues, people that lost their job. All of these news stories that you hear about. People who were at Kaiser and they lost their job and now they’re at a public hospital for the first time. If you’re in a car accident, where are you going? You’re going to Highland. We were looking for that person who wouldn’t normally be there.

A frame from the upcoming documentary, “The Waiting Room.”

Then when we decided to hone in on the waiting room as the stage, and basically use the waiting room as a character. The method was just camping out there. When patients were queuing up, we would quickly go up to them and say, “This is who we are, this is what we’re doing. Would you let us follow you for the next 8-10 hours?”…

People are always surprised by that, because with documentary you have to spend weeks or months getting someone’s trust. Sometimes you spend weeks or months without the camera. We didn’t have that luxury. The dynamic that allowed us to do what we did is that when people are in crisis, it’s one of two reactions. It’s either, “Get away from me. I don’t want to talk to you.” And actually we didn’t get much of that.  Or it’s, “OK, fine, film me.” And they they’re on to their thing and they forget about you. That was what we found. People had issues to deal with. This kid in the film who has cancer, they have issues. They’re not thinking about us, they’re thinking about something else. Also, intuitively people understood what we’re trying to tell. We were trying to tell their story—that they didn’t have insurance, that they were struggling.

As far as the hospital itself, access was difficult on a whole bunch of levels. But on the big picture, they understand that we’re trying to tell their story—that they are trying to take care of this community without enough resources. That story needs to be told. The interests lined up in a way that allowed us to get access to these people.

What about medical record releases, HIPAA—the Health Insurance Portability and Accountability Act, a federal act to ensure patient’s medical privacy—and other privacy concerns?

There is a complicated legal reality. The deal we made with the hospital was we couldn’t turn the camera on, not just until we got our own release but also a HIPAA release signed. … We had two signs in the waiting room, saying, “If you didn’t want to be filmed, please leave.” But it’s a hospital, where are you going to go? So we weren’t sure that was going to fly.

To try and cover ourselves, we shot with a shallow depth of field, which originally was to protect the privacy of people appearing in the frame. We didn’t want to blur out faces because we thought that would take viewers out of moment. Then that turned into an aesthetical quality of the film and gave an intimacy that I don’t think you would necessarily have.

Can you talk about the structure of the film and the editing process? What were you hoping to show by stitching all of these characters’ stories together?

It was an odd process editing the film. It was a puzzle where pieces had to talk together. There’s no one scene that really jumps out. There are scenes that are dramatic, but no one scene tells the whole story. But when you see the film as a whole, there’s something about it. We used time-lapse shots to show sand against the tide. It’s this collective mass of humanity, turnstile of humanity, and it never ends, and I was moved by that. That’s what we tried to do. We just compressed it to a day, and just tried to show that after that it’s just going to repeat and do it again with no end in sight. … It’s like going to battle everyday. The next day kind of resets and we wanted to represent that.

Each character we followed, we only spent at the most a day with. I’d say 50 percent of the footage in the film was from one day. There was just one day we got all this stuff. It was remarkable, just a magical day that all this stuff happened. I think it’s three days total, the bulk, like 80 percent of the film.

Talk about the goals of the social media and interactive side of the project. What do you hope the online aspect of the project accomplishes, and how do you view it working with the film?

What I wanted to do with the community engagement piece and the interactive piece helped me raise money for the film. I’m convinced of it. We got a video blog online before we got any money for the film. It was just a project in the waiting room talking to [patients]. Letting them express themselves and putting these small pieces of content online, organized by emotion. People really responded to it. …

[It’s] a journalism project that will use the film and use the path the film will take naturally around the country—using community screenings to gather content around it, that sort of thing. In each location, we will interview stakeholders in that community—experts, CEOs of public hospitals, activists, educators—who can talk about how the Health Care Reform Act is working in that community. We will aggregate that content and be a specialized health care reporting outlet.

What do you think the main value of this kind of project is?

It’s a rallying point. It’s a conversation starter. I didn’t want to make an essay film with talking heads and people telling me what to feel and what to think and what to do. I wanted people to experience what it’s like to sit down in that waiting room and have to wait ten hours for basic health care. The assumption was that if we gave the audience enough of an intense experience and did it in such a way that you remind them that that could be them or their father or the sister or their uncle, that could be a rallying point to really talk about what is going on with our health care system, what needs to change, what needs to stay the same. Get that conversation started in all these different communities. We’re trying to leverage the film, use it to spark those conversations.

The underlying thing was to give the audience an immersive experience in the least politicized way possible. That’s not to say its not politicized, because whenever you turn your camera on you’re making a political statement. But we really wanted to try to have it not be in a style of what has become a fairly standard style of talking heads, fancy graphics, and action.

Will the film be seen in theaters?

I don’t know yet. We’re going to a few festivals and we’ll kind of know after we do that gauntlet. Distributors are really finicky and it’s really hard to predict what’s going to make money at the box office. But it’s a special interest health care film. People are interested in health care, so that’s what’s going for it. I wouldn’t describe it as your typical theatrical release. Maybe a very limited art house release. … But people are responding really strongly to it because it’s heavy. It’s a really blunt look at our health care system, at least our public health care system. It’s getting a lot of attention in that context and not as a crowd pleaser.

Now that the film is complete and you’re getting some distance from the actual production phase, how would you describe the process personally? What was it like making this very emotional, intimate film? What did you learn?

On a personal level, I felt as if I had experienced the movie well before I first set foot in the door. Because my wife works at the hospital, I had already felt her telling of the myriad heartbreaking yet somehow inspiring stories. I had lived with the idea of this film for so long that I had already started telling it well before I rolled on the first footage.

Peter Nicks filming “The Waiting Room” at Highland Hospital in Oakland.

But being up close with your subject is a unique experience. And sometimes the experience was unsettling. After all, this is a population that ranges from solid working class to dangling from the last rung of a social ladder that is suspended high in the air. The sheer scale of the challenge they face everyday was draining at times. But what always made me look forward to the next shoot was the anticipation of that unexpected moment of beauty, that great character, that terrific nurse. My days were filled with lessons about life, about being a documentary filmmaker, about being a dad, a neighbor. I met people like me, like my parents, my friends. I could make another film in that same location, spend another six months shooting, because I know I would find my gems, make new friends and get more perspective on my own life.

That said, it is hard being exposed to an environment that at times can have a hopeless smell. I guess that’s what being a cop or an emergency department nurse is like. After a while you put up your guards, you place an emotional shield between yourself and the people you witness. In some ways, I don’t want that to happen. I certainly do not want to lose empathy.

The Waiting Room will screen as part of next year’s PBS Independent Lens schedule. To learn more about the film, and to view additional content shot in Highland Hospital’s waiting room as part of the interactive Storytelling Project, go to http://www.whatruwaitingfor.com.