A real-life ER pulls back the curtain on public health care

A screaming ambulance. Dramatic music. A man is taken to the emergency room on a stretcher with a 10-inch blade still in his chest. Close-up of the knife – serrated edge, the paramedic explains – while medical staff discuss how to handle the case.

This is the opening of a new TV series – not a fictional ER drama, but a documentary series filmed for British Columbia public broadcaster Knowledge Network. Emergency Room: Life and Death in the VGH was filmed over six months at Vancouver General Hospital in 2013, tiptoeing through an ethical minefield to deliver what its creators firmly believe is important. a look behind the scenes of the hugely pressing issue of public health care.

What we see on screen are real patients, doctors, nurses, and other medical staff, and real life and death issues that people are most at risk of – sick, scared, and dying. The series is graphical without blinking and shows worst-case scenarios. And unlike reality TV, say the makers, there is no game with facts that perhaps goes beyond a certain time compression.

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“We made it clear from the start: This is a documentary series,” says Rudy Buttignol, President and CEO of Knowledge Network. “It’s not reality-based entertainment … nothing is made up.”

A crew of four from Lark Productions was given unprecedented access to the emergency room for up to 12 hours a day, five days a week, keeping the cameras out of the way as much as possible while looking for additional cases – with the patient’s consent, of course .

“That was often the challenge, because obviously someone who comes to an emergency room might come on the worst day of their life,” director Kevin Eastwood said during a recent tour of VGH’s emergency room. “We didn’t film anyone until we got their approval, but sometimes it was kind of a juggling game. Really, the story is mostly about the staff and what it’s like to work in emergency medicine. So we focused on that. And then, when there is a suitable moment, we try to reach out to people. “

Signs were posted in the emergency room so patients and their families knew what was going on. In the end, Lark collected more than 2,000 approval forms. People were often eager to tell their stories, says Eastwood.

So that doctors and staff could also be involved, they had to give their consent. At the beginning, about a third have unsubscribed.

“At first I shared some of the concerns a lot of people shared about what this would be like, the confidentiality of people’s experiences,” says Deborah Allman, a social worker at VGH ER.

“And the other part,” she adds, “was even if patients weren’t addressed or weren’t part of the film, how would the presence of cameras in the department affect people’s experiences? I was quite concerned.” about the.”

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Allman met with Eastwood and had a very strong instinct from an early age, she says, that she can trust him, so she agreed to attend. After watching the first three episodes, she is confident the show was “very respectfully” produced.

Buttignol got the idea for the series while visiting his elderly mother in Toronto, where they made several trips to the emergency room.

“As I sat there with a lot of time, I realized that all of humanity was stumbling through the emergency room,” he says. “And I realized the emergency room would be a great place to locate [a health-care series]. “

Buttignol called production companies and put his money where his mouth went and provided the equivalent of an annual startup budget to produce the series’ six hour-long episodes. He went with Lark, the producer of The Real Housewives of Vancouver.

The first hospital they approached – St. Paul’s in downtown Vancouver – turned them down. “People were concerned about patient confidentiality for a reason, really very concerned,” says Buttignol. “And secondly, ethical representation.”

While officials from Vancouver Coastal Health (which governs the VGH) shared these concerns, they trusted the public broadcaster and ultimately decided it would be a worthwhile project.

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“The purpose of this company, in my opinion, is to showcase our work because I think we are doing a fantastic job,” says Dr. Doug McKnight, director of emergency medicine at the VGH. “It really shows the teamwork and how a place that looks messy actually works pretty smoothly.”

The already intense shoot took an unexpected personal turn five weeks later. During a break in production, Eastwood, then 36, was flying to Los Angeles and trying to rent a car when he suffered sudden cardiac arrest. He had no pulse for 10 minutes and was shocked eight times by paramedics before responding. He was in a coma for four days and in the hospital for 10 days. In less than three weeks he was filming again in the VGH, with a defibrillator in his chest and a new perspective.

“I think if that hadn’t happened I don’t know how I would have dealt with all of the trauma I was subjected to. It just made me believe that life is so precious and valuable, ”he says. “After something like that happens, after you’ve died and come back, you’re usually just happy to be around.”

It remains to be seen whether the good intentions of the creators of the series will live up to the privacy concerns of patients and viewers alike. Last year there was an uproar over another BC Shot series, Border Security, with the BC Civil Liberties Association and others arguing that the Canada Border Services Agency-sanctioned series violates federal data protection law. There was outrage that people with immigration problems were asked to sign consent forms in very stressful situations.

Buttignol says he wasn’t worried that the excitement about border security made him fear the same problems would break out via the emergency room.

“I think there is the benefit of being the British Columbia’s public broadcaster,” he says, adding, “We don’t have to dress up, we don’t have to do fake drama, we don’t have to chase ambulances.” . Ultimately, we want to inform people. “

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An advisory board made up of conflict-free medical professionals has been appointed to address ethical concerns that may arise throughout the series. But there were no such problems and the committee never met. There was an odd time when McKnight had to suggest the best way to leave a particular case alone, but the hospital had no control over how the episodes were handled.

People can still feel uncomfortable with it. Take the man with the knife in his chest: his face is blurred so that he is never identified per se. But even if faces are never shown, imagine you are that guy, turn on the TV one night and see what you know is your chest with the knife in it; or being the drunk guy who berates the medical staff; or the patient with bed bugs.

Viewers are encouraged to use the series’ interactive website to respond to questions raised by the show. And the creators certainly have the strong feeling that they have made an important, groundbreaking program with good information and an important message.

“The subject of [the show] is simply the unpredictability of life, “says Eastwood.” Life can turn quickly and end without notice, and I think that is valuable to be cherished. “

Emergency room: Life and death at VGH Premiere on January 21 in the Knowledge Network and at www.knowledge.ca/er.

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