Spoiler warning: This essay contains spoilers for Bringing Out the Dead.
“After a while, I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply showed up.”
– Frank Pierce (Nicolas Cage) in Bringing Out the Dead
I can think of no better encapsulation for the actual role of an Emergency Medical Technician (EMT) than the quote above. You’re given an intense regiment of training to make what you do second-nature, a wide assortment of medical tools and equipment, and many medications with standing orders to follow. And yet I can’t tell you how many times all I’ve primarily done as an EMT-Paramedic is listen to a patient as we monitor their vital signs and transport them to a hospital. Less is often more.
The job is not what people expect it to be. Emergency Medical Services (EMS) personnel are indeed inured to chaos, violence, and death, but there’s more to it. We help people. While the job can entail “saving lives,” not all of it actually involves “saving lives.” Sometimes there is nothing that can be done. Sometimes all we can do is show mercy. Healthcare is about trying to make the best of terrible situations, the degree of which varies, and we are not always successful. This is a difficult lesson to learn.
Bringing Out the Dead is a fascinating intersection for me, as it’s a movie that I adore by people I admire about a profession that I’ve worked in for the better part of a decade. Stories set in the field of EMS tend to feel inauthentic and melodramatic and like things made exclusively by people outside of the healthcare industry. This is not the case with Bringing Out the Dead.
The 1999 film was directed by Martin Scorsese, written by Paul Schrader based upon a book by Joe Connelly that was inspired by his experiences as a paramedic, edited by the inimitable Thelma Schoonmaker, and featured the cinematography of Robert Richardson. That’s a damn fine ensemble of talent—all of whom worked together on Taxi Driver. And yet with more than 20 years since the movie’s premiere, Bringing Out the Dead appears largely underappreciated in Scorsese‘s oeuvre compared to Taxi Driver. The two share similarities, but are fundamentally different stories. Taxi Driver follows the disturbed loner Travis Bickle (Robert De Niro) and ultimately ends with the damnation of his soul, whereas Bringing Out the Dead follows the burnt-out paramedic Frank Pierce (Nicolas Cage) and ends with the salvation of his soul.
The opening of the film introduces us to the world-weary Frank with his partner Larry (John Goodman) on their way to a call. The first image is an ambulance whipping around a New York City street corner with its lights flashing, which is followed up by a close-up of Frank’s eyes tinged in the red of the lights. Nicolas Cage has the innate ability to command a scene with his eyes alone. This moment is no exception. Bringing Out the Dead is very much Frank’s story, and we stay with his point-of-view for the entirety of the movie. Cage makes an impactful entrance and finds a balance navigating Frank’s headspace throughout, from subdued to over-the-top moments, with dialogue and without it. He is unironically a great actor, and Frank Pierce is one of his most exceptional performances.
What ties the opening together is a voiceover from Frank that captures his internal struggle: “I was good at my job: there were periods when my hands moved with a speed and skill beyond me, and my mind worked with a cool authority I had never known. But in the last year, I had started to lose that control. Things had turned bad. I hadn’t saved anyone for months.” The song “T.B. Sheets” by Van Morrison plays throughout most of the opening sequence, and it connotes a feeling of weariness. Radio chatter breaks through to tell both the audience and Frank about the various happenings of the evening. We hear the sirens interspersed with the ambient noises of the city. It’s a compelling blend of images and sounds that entirely puts us in Frank’s POV.
Frank and Larry pull up to a complex with concerned neighbors and curious passersby out front. The ambient noises of the city continue, and they are joined now by the people out front speaking among themselves. The world doesn’t stop. The two follow the cries of grief up the stairs to the home of the Burkes. In a continuous tracking shot, they pass Mrs. Burke (Phyllis Somerville) being consoled in the kitchen and see Mr. Burke (Cullen Oliver Johnson) unresponsive on a bed with his daughter Mary Burke (Patricia Arquette) and son John Burke (Tom Riis Farrell) trying to tend to him. Frank and Larry—not missing a beat—size up the situation and get to work. Mr. Burke is in cardiac arrest. There simply isn’t time to waste.
In a montage, we see the two medics with intense focus insert a breathing tube, push medications, defibrillate, and administer chest compressions. Mary stays close and ends up being enlisted to provide breaths to her father via a bag valve mask. Frank assures her and her family, “We’ll do everything we can.” It’s a statement used so often that it’s second nature. Intrinsically what you offer as grounded assurance. You can’t promise someone will be okay, but you can at least assure their loved ones that you’re going to do what you can to help. Mr. Burke doesn’t respond to Frank and Larry’s care. The prognosis is grim. It is at this moment that Frank shares in voiceover that despite his better judgment, he’s come to believe in spirits leaving the body. He feels as if Mr. Burke is watching them work right now, waiting for them be done.
Larry steps out to ask for permission to end resuscitation efforts while Frank continues CPR. He suggests the family play something Mr. Burke liked. So they do. Frank Sinatra’s “The September of My Years” plays as we see glimpses of Mr. Burke’s life embodied in the items around the home. The song thematically is about the way our lives pass by so quickly that we don’t realize it. Death leaves our lives in an awkward place, not in an orderly way we might hope. More often than not, before we know it, it’s over.
Larry returns and tells Frank he can stop. Unexpectedly, Mr. Burke’s pulse returns, and now they can’t stop. We transition to Our Lady of Mercy Hospital. It’s already packed wall-to-wall with patients with chaos unfolding all around. There is a cacophony that anyone who has spent time in an Emergency Room knows all too well. Mr. Burke is turned over to the staff, and Frank and Larry go back to the rig. This is part of the loop that is working in EMS. We see patients in a tiny window of their care and continue to repeat the same thing over and over. Healthcare providers can feel like Sisyphus, rolling a boulder up a steep hill, only for it to go back down and the process to repeat for eternity.
In an interview conducted with Roger Ebert in October of 1999, Martin Scorsese shared the following: “When you bring somebody back to life, you feel like God, you are God. But one has to get past the idea of the ego and the pride. Hey, the job isn’t about bringing people back to life, it’s about being there, it’s about compassion for the suffering; suffering with them.” This is the crux of Bringing Out the Dead. It’s not about saving lives, it’s about showing compassion and mercy. There is an unmistakable authenticity that’s present in every layer of the movie. A work of art doesn’t need to be hyperrealistic to be authentic. What matters is its essence.
Those who work in EMS are underpaid and overworked. The private sector agencies emphasize money and those on “top” while exploiting the workers on “bottom.” The public sector agencies are beholden to budgets that tend to overlook EMS, and this leaves departments stretched thin. The stressors of the job, increasing expectations, and the broken healthcare system of America all have created a cycle of attrition. The turnover rate in EMS is typically higher than in other industries.
Being trapped in an utterly broken system is demoralizing. Feeling as though you’re trying to accomplish a Sisyphean task with your job day after day, it’s no wonder why burnout is all too common. There is a sardonic sense of humor people in healthcare tend to adopt as a coping mechanism. Some recede into shells made of cynicism. Others go too far and lash out at those they’re supposed to help. They misplace the blame, for it’s the system and its many faults that cause our suffering, not the people suffering in the said system. We duke it out while those on top continue to siphon what they can from us.
When Frank turns the care of Mr. Burke over to Dr. Hazmat (Nestor Serrano), he crosses paths with Noel (Marc Anthony) restrained in a bed in the ER. Noel is a regular to the staff, suffering from brain damage, and struggling with addiction. His behavior is erratic, and he’s known to cause trouble. With the help of a patient nearby—who really just doesn’t want to listen to him anymore—Noel manages to escape the ER. Mary tells him that her father is sick, and in a profoundly human moment, Noel embraces Mary and tries to offer what comfort he can. The moment is fleeting, and he runs off, leaving Mary and Frank in the ambulance bay of Our Lady of Mercy.
There are days as a healthcare provider that are easy, and there are terribly tricky days. My mantra is “People are people” (yes, like the Depeche Mode song), and it’s one I fall back on whenever I encounter the difficult days. People can be cruel, reckless, and selfish. But people can also be more than these things. They can be kind, sorry, and selfless. People can change. Some do, and some do not. No matter what happens, we can’t change people; they can only change themselves.
Over three days, Frank has three partners. The first is Larry, the second is Marcus (Ving Rhames), and the third is Tom Wolls (Tom Sizemore). Each of them has larger than life personalities, which is something anyone who has ever been in EMS knows is very much part of the job. For Larry, he makes ends meet for his family and takes pleasure in little things, like what place he’s going to grab food at while at work. For Marcus, he’s all about his faith and lobbing jokes around to co-workers and patients alike. For Tom, he’s all about chasing the adrenaline of the job and enacting his own twisted sense of justice. Of the three, Tom brings out the worst in Frank. One can argue he’s the jaded and angry future of Frank if something doesn’t change.
Mary connects with Frank over trauma, but the source of their own wounds are different. For Frank, it’s the utter helplessness of losing a patient named Rose (Cynthia Roman) despite doing everything he could for her. For Mary, we’re left to infer it’s from her difficult upbringing with her father. Frank drinks heavily and sinks himself into his job to cope. Mary uses drugs to cope, quits, and tries to keep it at bay with her new life, and then relapses. It’s during Mary’s relapse at the drug den of Cy Coates (Cliff Curtis) that Frank tries a downer to escape his trauma. But there is no escaping it, not for long anyway. It always finds its way to the surface.
In “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” psychiatrist Bessel van der Kolk discusses the nature of trauma, based on his research that furthered our collective understanding of PTSD. As Van der Kolk eloquently puts it in his book, “Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.” Maria Popova’s moving summation of Van der Kolk’s book delves into this further.
Trauma fractures the mind, and what we’re left with is a shell detached from everything around us. Our imaginations recede back into the deep parts of ourselves. Without creativity, we can not hope for anything better. It’s in this despondency that we seek ways to feel alive again through recklessness, substances, lust, and going back to the trauma. Much like Frank, I found myself drowning my pain with alcohol. It was easier for me than dealing with the underlying problem.
Dealing with the said problem is tricky. Revisiting the trauma in of itself isn’t an effective coping mechanism. You have to process it. Ideally, you have to expose yourself to it under a watchful eye. You have to ground yourself when your anxiety is unbearable with mindfulness. This means fully embracing what you’re experiencing at the moment. Because it will pass. Because not everything our brains associate with the trauma will lead to more trauma. But that takes conditioning and time. “The first step is love, the second is mercy,” as Marcus puts it to a bystander after Frank pushes the Narcan that saves a patient who overdosed on the potent heroin nicknamed “Red Death.”
During Frank’s trip facilitated by Cy and Kanita (Sonja Sohn), we follow a vision of Frank as he makes his way through the streets of New York. The entire movie is an awe-inspiring assembly of editing, but this is where the marvel Thelma Schoonmaker shines the brightest. Patients dissolve into the frame and become solid with Frank’s touch. It’s as if Frank “help” makes them fully materialize. “Help others, and you’ll help yourself” has been Frank’s mantra. He steps back and watches as those he has helped pay that good forward and continue to help others. It’s not long before we see a street full of people carrying on this goodwill. If you help others with no regard for yourself, what will happen when you’re the one who needs the help? Frank relives the trauma of losing Rose, and this memory triggers a “fight-or-flight” response. He loses it. He picks Mary up and gets them both out of Cy’s “Oasis.”
It’s then we learn the truth about Noel. He was hurt by Cy, and the incident left him in a coma for three months. It irrevocably changed the course of his life. Underneath the sardonic humor and the grim atmosphere of Bringing Out the Dead is a beating heart that isn’t there to judge and telegraph to the audience precisely what they should think. What the movie captures is the all-encompassing nature of the human condition.
Bringing Out the Dead was shot in New York City mostly at night with Panavision’s anamorphic lenses, which gives the lights captured a “stretched” out looked. The lighting of the movie in more than a few instances has such an intensity to it that it washes out parts of the frame. The color palette, by and large, has a cold tone to it with red used to accentuate things. What this effectively captures is a gritty, chaotic atmosphere of the streets of New York and the cold, sterile mood of healthcare facilities. True to the profession, practically a third of the movie takes place inside an ambulance. Vehicles very much are an extension of ourselves, but EMS crews spend the majority of their time on the clock inside an ambulance. It’s an ER room on wheels that handles about as well as you could expect, which is not very well. Many shots feel as if we’re in Frank’s seat of the rig, looking out at the city and night.
On the third and final night, Frank and Tom take out of their frustrations on a homeless patient with the chief complaint of suicidal ideations. The scene has a pitch-black sense of humor to it, but underneath the surface speaks volumes about how we collectively treat the less fortunate. Frank and Tom are chasing that adrenaline, and they view this patient as not worthy of their time. But this is a fundamental misunderstanding of the job. Frank, earlier in the film, describes his profession as “bearing witness,” and this is accurate. It’s bearing witness to suffering. To people on their worst days. To people, no matter who they are or where they’re from. Your job is to help.
The evening takes Frank back to Cy’s Oasis. The gang distributing the new batch of “Red Death” heroin both seen and mentioned on multiple occasions strikes against Cy. Kanita is killed in the ensuing chaos. In his desperation to escape, Cy jumps from his patio and ends up skewered on a metal post of the balcony below. Frank takes Cy’s vitals and holds his head up for comfort as first responders work on extricating him. Cy had asked Frank about what it was like to be a paramedic, and he learns about it firsthand as a patient. It’s a sequence that’s achingly human. After a long stretch of death, Cy ends up being the first patient Frank saves. But this doesn’t stop Rose’s ghost from continuing to haunt him. She keeps appearing to Frank, unraveling him more and more throughout his shift.
It’s here that Noel and Frank’s paths cross for a third and final time. Tom hatches a plan to enact his own sense of justice on Noel, and this escalates to Noel being beaten to a coma by him. It’s at this moment that the need for mercy crystallizes for Frank. He intervenes and screams at Tom to grab the equipment. Frank provides mouth-to-mouth rescue breaths to Noel (something he had only done for newborns up to then) while he waits for Tom. They insert a breathing tube and bring Noel to Our Lady of Mercy ER. The story has come full circle.
Mr. Burke, after being defibrillated over and over by the ER staff, has been transferred upstairs to the ICU. Mr. Burke is the embodiment of Frank’s own trauma. He’s still caught in the past, trying to save Rose and can’t process it. Mr. Burke, through visions, tells Frank to let him go. This culminates with Frank taking matters into his own hands. Sometimes there is nothing more that can be done. Sometimes all we can do is show mercy. He terminates Mr. Burke’s life support by placing all of the equipment on himself and waiting for Mr. Burke to pass. The ICU staff aren’t surprised to find Mr. Burke in cardiac arrest yet again and decide to terminate resuscitative efforts once and for all.
In the final moments of the film, Frank stands at the door of Mary’s apartment. He gives her the bad news. “You have to keep the body going… until the brain and heart recover enough to go on their own,” Rose (standing in Mary’s place) says to Frank, repeating his words back to him. He said this earlier to describe Mr. Burke’s potential recovery, but maybe this wasn’t about Mr. Burke. Perhaps this was actually about Frank’s own detachment.
Frank begs Rose for forgiveness. “It’s not your fault. No one asked you to suffer. That was your idea.” It’s been said and will be said that we have to forgive ourselves. In my own struggles with trauma both at work and at home, the hardest part was forgiving myself. It wasn’t until I did that I was finally able to start to become reacquainted with life. Healing is a process. No amount of adrenaline or chemical substance can replicate what it feels like to truly be engaged with the living. The first step is love, the second is mercy. The next step is life.