Code Black: An Emergency Hospital Situation, A Documentary, A New TV Series

By Beth Weinhouse

While most residents are desperately trying to find time to sleep and hoping to remember everything they’re supposed to be learning, Ryan McGarry did that. . . plus created and directed an award-winning documentary. Code Black is a first-person reflection of McGarry’s residency at Los Angeles County Hospital, one of the birthplaces of emergency medicine and still the busiest emergency department in the country. The title of the documentary, for those who don’t know, refers to a situation that occurs when hospital resources cannot meet the needs of waiting patients—a condition that happens with alarming frequency at Los Angeles County Hospital. The documentary premiered as Best Documentary at the 2013 Los Angeles Film Festival, and earned a Critics’ Pick from The New York Times and The Wall Street Journal.

How did McGarry find the time? As he told Physicians’ Life, it wasn’t easy. “Residency has to take 110 percent of your effort, and so should film,” he says. “You have to be completely invested in both. If the subjects were not in overlap, it would have been impossible. But the film subject was also my life in residency.”

Even so, sacrifices had to be made. “At the end of the day I probably made some unhealthy decisions—I wasn’t sleeping,” admits McGarry. “I didn’t take vacation for about four years while I was doing residency and making the film.”

But the subject matter was irresistible to the young filmmaker. “The emergency department is like a secondary drama lab,” he says. “There’s the privilege of seeing people go through life’s incredible spectrum, from the happiness of birth to the tragedy of death and everything in between.”

In the documentary, Ryan and his fellow residents reflect upon their choice of specialty, their desire to help patients, their frustration with the increasing incursion of policy and administrative oversight into a specialty previously celebrated for daring “cowboy medicine” tactics to save lives. The young residents in the documentary both understand the intention of the new legislation but also recognize what they’re missing in an era of endless regulation. The documentary obviously has a much larger purpose than merely entertainment. There’s a strong message about the mission of medicine and how that clashes with the current political and legal/litigious climate. It’s almost a love story from a new generation of doctors to an era of emergency medicine that has mostly  disappeared.

McGarry says both young doctors and old have enjoyed the film. For doctors just starting out, “it’s a generational lament,” he explains, “something about the simplicity of health care and why we can’t get that back.”

More experienced doctors find the film nostalgic. “I’ve had physicians write and say, ‘It’s been a while since I’ve felt this way about medicine. Thanks for bringing me back,” says McGarry.

That sense of nostalgia lives on in a new CBS series of the same name, inspired by McGarry’s film and created by Michael Seitzman. Code Black stars Marcia Gay Harden as Dr. Leanne Rorish, the ED’s residency director. She’s joined by a cast playing first-year residents, the senior ED nurse, an attending. . . and other ED staff. In the TV series, Los Angeles County Hospital has become Angels Memorial Hospital, and the real hospital’s  “C-Booth”—the area of the ED where the most serious cases are taken--is dubbed  “Center Stage.”

The network has retained Dr. McGarry as an executive producer of the new series, to help make sure the show stays true to its inspiration and its medical facts. “My job involves a little bit of writing, a little bit of directing, coordinating education, business. . . wearing multiple hats, which happily feels like the ER,” he says.

There’s very little politics in the television show, which focuses on the human drama of the ED staff and the cases they are presented with. Politics isn’t the only thing missing from the scripts; there’s also little evidence of the endless digital paperwork that doctors must provide for each patient. Obviously doctors typing into a keyboard wouldn't make for compelling television drama.

But the spirit of the documentary, the sense of purpose of the doctors and staff, the strong feeling of teamwork, the feeling of order in seeming chaos, the struggles of young ED residents working in challenging conditions to save lives, all remain. “The show highlights the experience of being an ED doctor—the terror of it, the total rush,” says McGarry, adding, “The TV show is fun. We’re so rigidly authentic on this show that I think a lot of physicians will enjoy seeing just how far we’ve gone to make it accurate.”

In addition to his role as executive producer on the show, Dr. McGarry is now an assistant professor of emergency medicine at the Weill-Cornell Medical College of Cornell University in New York. His own back story, revealed in the documentary, is a compelling one. Running track and cross country while an undergraduate at Penn State University, he became concerned when his running times started worsening dramatically. Tests revealed the reason why:  Stage 4 lymphoma. The experience was at least partly responsible for his decision to attend the University of Pittsburgh School of Medicine. Healthy now, Dr. McGarry still enjoys running.

Code Black airs on CBS Wednesdays at 10 p.m. Eastern time, 9 p.m. Central. Catch up on episodes you've missed at CBS.com. You can watch Code Black, the documentary, on Amazon or iTunes.