A Nerve-Shattering Day in ER

Film Review by Khalid Ali, Film and Media Correspondent

‘Le Fracture- The Divide’ (directed by Catherine Corsini, France, 2021).

Showing at the BFI London Film Festival on 7th, 9th and 14th October 2021.

The World Health Organization defines ‘Health’ as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. This broad definition of health is the focus of ‘The Divide’; the health of individuals and society are both influenced by the social and political milieu of the time. French actor, and director Catherine Corsini uses a busy emergency room (ER) in a Paris Hospital as a setting to reflect on turbulent times in contemporary France. The film protagonists are either seeking treatment or refuge in an overstretched ER where staff are struggling to care for an unprecedented number of casualties from a Yellow Vests demonstration raging outside. The police are using brutal force to stop the demonstrator’s anarchy and asking the ER managers to lock the hospital and turn away wounded demonstrators. Over the course of 99 minutes, the viewer is introduced to a myriad of people from different social backgrounds. The central characters are Raphaëlle/ Raf (Valeria Bruni Tedeschi) and her partner Julie (Marina Foïs). Raf fell and broke her arm in the street while trying to convince Julie that their troubled relationship deserves a second chance. A grumpy injured truck driver Yann (Pio Marmaï) argues with Raf over who is responsible for the failing French healthcare system. A collapsing rooftop inside the hospital adds to the number of casualties waiting to be seen by a medical professional. Here the film introduces its most endearing character, nurse Kim (Aissatou Diallo Sagna, a healthcare professional in real life). Kim is multitasking trying to decide which patient should be seen fist, delivering urgent care to demanding patients, while worrying about her sick little daughter left at home with her husband. The situation gets much worse for Kim when she is held hostage by a paranoid drug addict. In one of the most dramatic scenes, Kim uses her counselling skills and humanity to survive a near-death situation. The epitome of medical professionalism, empathy and commitment is embodied by Kim. However, this scene also symbolises a real crisis in a crumbling healthcare system delivered by burnt-out professionals.

While some critics may view ‘The Divide’ as an extended cinematic version of ‘ER’ or ‘Holby City’, the discerning viewer will recognise its compelling narrative around what it feels like to be in a stretched ER. Kim undertakes heroically multiple roles, a nurse, a health and social advocate, a team member, an educator as well as a vulnerable human being with escalating personal and professional demands. Tavares et al analysed these overlapping themes in a cohort of Canadian paramedics; maintaining patient safety, adaptability, compassion, and effective communication are always essential qualities. Tavares argues that “until these framing concepts, roles, and crosscutting themes are fully understood, tested, and operationalised, tensions between guiding frameworks and actual or intended practice may persist.”[1]

Kim feels guilty for leaving her sick daughter at home and reporting to work. During her shift, she is expected to provide empathy and compassion towards patients including those who assault her physically. Furthermore, she must tailor her caring style in response to patients’ wishes and preferences. Her competency and success as a good ER nurse are closely monitored by ‘satisfaction from patients and families’ as well as by local hospital and government targets. Maintaining high professional standards while being mindful to staff wellbeing is a challenge for hospital managers. Hooper at al interviewed a group of emergency nurses in South Carolina, USA, and found high levels of burnout and compassion fatigue. Hooper et al stated that “Understanding the concepts of compassion satisfaction, burnout, and compassion fatigue, recognising the signs and symptoms, and identifying best practice interventions, will help nurses maintain caring attitudes with patients and contribute to patient satisfaction.”[2]

Self-care, emotional intelligence, and social support were identified as protective measures against traumatic stress in emergency nursing.[3] The important social dimension of health features again; salvaging a failing, fractured social system should be a priority when supporting patients and the healthcare professionals who care for them.

[1] Tavares W, Bowels R, Donelon B. Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes. BMC Health Services Research 2016; 16:477 DOI 10’1186/s 129 13-016-1739-1.

[2] Hooper C, Craig J, Janvrin D R, et al. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing 2010; 36: 420-7.

[3] Barleycorn D. Awareness of secondary traumatic stress in emergency nursing. Emergencynurse.co.uk 2019, accessed 29 September 2021.

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