The film covers two days in the life of Frank Pierce (Nicolas Cage), a burned-out EMT (emergency medical technician) working the socio-economic underside of Manhattan. From the beginning, Frank is upset because recently all his patients have been dying on him, and he is haunted throughout by the hallucinated ghost of Rose, a young woman who collapsed on the street and died, apparently because he could not intubate her correctly.

Frank is highly stressed, he has no life outside his work, and he is self-medicating with alcohol. He tries to quit, but his boss keeps him on by promising time off in the future. In the film's first action, Frank does manage to miraculously resuscitate Mr. Burke, a heart-attack victim, but the patient winds up in the hospital with a very bad prognosis, so even that "saving" works against Frank.

Frank has encounters with numerous patients, many of them street people whose lives are out of control, some of whom are ER (Emergency Room) regulars, such as the demented young Noel (Marc Anthony). He also deals with (and is dealt with by) several highly idiosyncratic EMT partners in his ambulance rounds (John Goodman and others). Frank gets to know Mary Burke (Patricia Arquette), the daughter of the heart-attack victim, and they tentatively move toward being a couple who might help each other survive their lives.

Near the end, Frank, who knows Mr. Burke had tried to tear out his tubes during a brief moment of consciousness, and who feels he has been getting pleading messages from him to end his agonies, surreptitiously takes him off life support long enough for him to die. The physician who responds to the code decides not to attempt resuscitation of this patient who had already been resuscitated 14 times that day. Frank goes to tell Mary that her father has died (but not how), and exhaustedly falls asleep on her breast, apparently having forgiven himself because he has in some sense finally "saved" Mr. Burke.


This gritty film is a rich source of images and scenes from the life of an overstressed caregiver in a harsh urban environment. While the central focus is Frank's state of mind, Frank's world is full of characters and events that could be the starting place for discussion of many topics, from the appropriate treatment of repeat medical "offenders," to the role and conduct of emergency rooms in urban hospitals. (The institution in this case is tellingly named "Our Lady of Perpetual Mercy," as if mercy were sometimes the only thing that could be offered.)

The camerawork effectively portrays New York at night as fragmented, disorienting, malign, entangling, and infinitely needy--all emblems of Frank's growing distress. One striking image is Frank's own face and uniform remaining bloodspattered (from a difficult patient encounter) through several scenes, a particularly grisly sign both of the primal nature of his work and of his inability to escape its terrors.

Frank's voice-over at one point tells us he has found a way of looking at his work that makes it easier to take: "My role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply showed up." However Frank is keeping score, the stress builds up, and his behavior gets increasingly erratic. His euthanizing Mr. Burke at the end, of course, raises huge ethical questions--particularly since he does it completely on his own.

Like Chief Bromden at the end of 0001, Frank seems to have the best interests of the patient at heart--but (a voice cries from the real world) what about procedures? And what is the role of Frank's own interest in this mercy-killing? How do we distinguish Frank's act from criminal real-life mercy killings by medical attendants? It is highly paradoxical, of course, that the mournful Frank finds his first relief of the film by killing a patient. The film is full of provocative paradoxes, but its individualistic and somewhat romanticized ending slights obvious professional ethical concerns.


The film is based on the novel of the same name by Joe Connelly, who worked as a medic in New York City. Director Scorsese appears briefly as an ambulance dispatcher, and Queen Latifah is the voice of another.

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