Indy Film Fest: The Invisible Patients

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“Sometimes I feel like it’s third-world medicine, and you just go out there and do what you can. And that’s OK because they would otherwise end up in the ER in a total mess.”

Those are the first sentences you hear in “The Invisible Patients,” a documentary about nurse practitioner Jessica Macleod and several homebound, limited- or low-income patients to whom she delivers in-home medical care in southwest Indiana.

It’s just the opening salvo in her barrage of blunt talk. Macleod says she scans the newspaper obituaries every morning for patients’ names and to avoid the embarrassing indignity of knocking at doors of the bereaved. She openly admits there have been, and will be, promises she makes to her husband and her kids that her job will force her to break. She suffers no fools who would threaten her, however lightly inferred.

There has likely never been a spoonful of sugar in Macleod’s bag. But she is neither abrasive nor cynical. In fact, her bedside manner is unfailingly humane. She simply works, by and large, with medical issues where her realism is often confused for pessimism and she refuses to peddle the fiction of a comforting alternative.

Macleod is the fascinating, tenacious center of this debut documentary from Patrick O’Connor, a screenwriter and former healthcare marketing professional in Evansville, Indiana. Indeed, O’Connor’s list of former clients includes the same hospitals of whom the film's subjects often speak ill. “The Invisible Patients” neither plays like sour grapes for client relationships gone south nor a preferential puff piece for MD2U, the company that employs Macleod. Neither she nor the film discounts wholesale the value of hospitals but understands that for the people under her care, they offer very definitive, palliative limitations.

Instead, “The Invisible Patients” follows the compromises, workarounds and shortcuts Macleod employs to keep those she’s treating at least a step ahead of the reaper … or perhaps not, as you see in the story of her most dramatically compelling charge.

Hearing Jessica discuss her vast, worldly healthcare experiences before joining MD2U in 2013 would be preferential to reading them in onscreen text. But it’s the only real bugaboo in the story of a woman who, by necessity, compartmentalizes her experiences to carry on, and “The Invisible Patients” peeks into four such chambers.

Wink and Patty Sherrill are married seventysomethings for whom arthritis is just the start of maladies they suffer. When Patty somehow screens negative for pain medication she’s prescribed, their care is red-flagged – the prescribing doctor’s suspicion being that she is selling pills rather than taking them.

The more we see of Wink and Patty, and their side-table skyscrapers of prescription medication, the less likely it seems that they are pushers in disguise. “I’m not naïve, and I know people are capable of anything,” Macleod says while choosing to follow her instincts. Rather, O’Connor follows Wink and Patty through the insurance coverage shell game forced upon many elderly people scraping the poverty line.

Ron Riordan is an artist who years ago suffered a debilitating brain injury in a motorcycle accident. Although his body is confined to a wheelchair, Ron’s mind and motivation remain unbound. “I have so much more to do!,” he says, in a hopeful tone with which no reasonable person could argue. But then there’s his "mother-brother" Louis, content to sleep off his latest heart attack on the floor of Ron’s home and bark insults at Macleod. We wonder whether Louis might be a bizarre form of comic relief until we see him tower over Ron – even from a prostrate position – in a power play of resentment and expectation that also ensnares Macleod.

The brunt of Macleod’s and the movie’s focus falls on Roger Brown, a 30-year-old who has already exceeded his best-case scenario by 10 years. Even before kindergarten, Duchenne muscular dystrophy began eating away Roger’s muscles and has now turned toward his heart. Roger is permanently bedridden, an oxygen mask obscuring all but his knowing, probing eyes and a pair of fans cooling his body for a small measure of physical comfort. He prefers lucidity and presence over the haze of pain medication; “I think you’re the only 30-year-old who doesn’t (like pain medicine),” Macleod quips to Roger.

As his condition worsens, Roger’s story hinges on his agreement to unconditional Do Not Resuscitate terms as he transitions into death. We understand the flickers of hope from Roger and his mother, Shirley; after all, he has fought longer than anyone could have predicted. But death’s imminence is never in doubt. With patience and peaceful insistence, Macleod persists on the issue – “an honest conversation more families should have” at any stage of wellbeing, she argues. It’s here that O’Connor boldly, and without exploitation, asks viewers to question a will to live asserted in defiance of irreversibly deteriorating conditions – complete with the long-agnostic Roger’s brief embrace of prayer as a potential full-healing power.

All the while, Macleod wrestles with legitimacy, or lack thereof, in her station – namely perceptions that she’s somehow “lesser than” because she is not a doctor by label or accreditation (and, it’s implied, a female in the healthcare industry). She certainly embodies the rare skill set required to dole out hard math and difficult advice daily. But O’Connor never lets soft-focused nobility creep in. However gently she breaks it to them, Macleod helps her patients recognize that death is the only equalizer with those on the other side of the economic gulf.

Alarm-sounding healthcare documentaries tend to plateau at the level of functional lecture. That’s not the case for “The Invisible Patients,” which illuminates the challenges of healthcare for the home-bound while elevating itself with a delicate balance of gallows humor, observant composition, artful pacing and the grace with which we would all hope to face death.

“The Invisible Patients” screens at 11 a.m. EDT on Saturday, July 16, and 7 p.m. EDT on Thursday, July 21, at the Indianapolis Museum of Art’s Toby Theater as part of the Indy Film Fest’s Hoosier Lens Feature series.