“Is this expensive?” asks the distraught and bloodied young woman being ushered into an ambulance to be treated for injuries inflicted by her boyfriend. “Is this really expensive? It is, right?” The paramedics skirt around the question awkwardly, then try to gauge the woman’s financial circumstances by inquiring about her medical insurance (she has none) and family situation (she lives with her mother, who has no money). Juan, a 17-year-old paramedic, phones the victim’s mother and recommends that she be taken to a hospital for further treatment. There he tries to collect the ambulance fee (3800 Mexican pesos; approximately $300AUD) but the mother refuses to pay. Juan returns empty-handed to the vehicle where his father Fernandes, a fellow paramedic, grumbles his displeasure: “Cheap fucking people who won’t pay.”
The sequence demonstrates the practical and moral dilemmas faced every night by the operators of a private ambulance in Mexico City, the subjects of Luke Lorentzen’s excellent observational documentary Midnight Family. The Ochoas’ family business—comprised of Juan, Fernandes, 9-year-old Josué, and a rotating roster of assistants—is part of a cutthroat industry of unlicensed paramedics who race their rivals to scenes of emergency, hoping that the patient they collect is willing and able to pay. Their work fills an urgent need: an opening caption explains that there are only 45 government ambulances servicing a population of 9 million. The film goes on to show how the inadequacy of the city’s healthcare is compounded by poverty, overcrowded hospitals, and corrupt police, whom the Ochoas must bribe to receive tipoffs and prevent being shut down. It’s all a giant mess—but as Juan rationalises, the city would be in an even bigger mess without them.
Midnight Family belongs to a long and rich tradition in documentary, stretching from Robert Flaherty’s Nanook of the North (1922) to the films of Michael Glawogger, which pays tribute to the difficult work that ordinary people do to survive. It also taps into a current trend in fiction cinema—as seen, for example, in the two most recent Palme d’Or winners, Hirokazu Kore-eda’s Shoplifters (2018) and Bong Joon-ho’s Parasite (2019)—focusing on families whose members band together in unconventional ways to make ends meet. In the case of the Ochoa family, Juan has assumed a leadership role despite his young age, and is usually behind the wheel of the ambulance; his lethargic father is ostensibly the head of the family, but defers a great deal of responsibility to his eldest son; and Josué skips school to join them on their shifts—sometimes to help, but mostly just to tag along. Their ambulance is effectively their second home: a workplace which doubles as a space for hanging out in during periods of downtime, and a shelter in which they eat and rest (Josué is shown napping on the very spot where a pool of blood is earlier mopped up). As unusual as this life may seem, the casual manner in which Juan recounts the night’s events over the phone to his girlfriend reminds us that it’s unusual only to those who don’t need to live such a life.
The Ochoas never turn down patients and seem to genuinely care for their welfare, even when they’re unable to pay. However, their ethics become increasingly compromised as their financial pressures worsen. When Juan declares that “We need something good tonight,” having not been paid in three consecutive shifts, he appears to be wishing for an accident tragic enough that payment will be guaranteed. When the family suggest one hospital over another to an injured patient, their motives are left unclear, as are explanations of how the payment system actually works in this industry—troubling ambiguities which prevent an accurate read of the Ochoas and their methods. Meanwhile, the family’s quibbles about money, their frugal spending habits, and their relatively unhealthy lifestyle (their work involves little physical exercise despite its often frantic nature, the kids regularly gorge on junk food, and Fernando takes medication for a presumed heart condition) all remind us of the precariousness of their hand-to-mouth existence—and suggest that they might not be able to pay for their own services should they ever require it.
Lorentzen spent six months riding with the family and is well attuned to the rhythms of their work. Serving also as the cinematographer, editor and co-producer, he observes their routine—long stretches of waiting, punctuated by scenes of medical rescue that become progressively more serious—with clarity and empathy. When filming emergency situations that could easily slip into exploitation or sensationalism, he juggles the difficult task of conveying the gravity of each incident while maintaining the dignity and anonymity of the victims (their identities are obscured through framing and focus). Although some scenes are edited in a way that makes the family’s interactions feel stiff and unnatural—a problem often seen in observational documentaries that cut frequently, and particularly those where shooting continuous footage may not always have been practicable—Lorentzen succeeds in constructing a fluid narrative using the limited coverage options available inside the ambulance. The film’s signature shot is taken from a camera mounted at the top of the front windscreen, level with the flashing siren and looking into the vehicle. It’s over this shot that much of the drama plays out: one person drives, whoever rides shotgun directs traffic through the PA system, while another sometimes sits in between and gives directions or tunes into accident reports on the radio. Cutting between this wide shot and separately-filmed inserts pointed outside the vehicle or at the people seated inside, Lorentzen crafts some of the more understated—but nevertheless kinetic and thrilling—car sequences in recent cinema.
Such kinetic thrills take on a different dimension in a harrowing sequence late in the film. The Ochoas rush a young trauma patient to hospital, weaving through traffic with an urgency previously unseen, as the girl’s terrified mother sits in the front. It’s the first time the family are shown truly racing against time to save a patient’s life, not merely against other ambulances to score a job. None of this changes the fact that they must later chase up the victim’s mother for payment—and she too refuses to pay, accusing the Ochoas of taking her daughter to a private hospital rather than the closest one (“Can you help us with just 1500 pesos?” they try to plead with her.) It becomes clear that the Ochoas’ financial survival and a patient’s literal survival will always remain at odds within this broken system; one will always be compromised by the other. Tragedy doesn’t discriminate, and falls on rich and poor alike—but making an honest living with a clear ethical conscience may be a privilege available only to those who can afford it.