A review of the film The Death of Mr. Lazarescu by Cristi Puiu
Some things shrill as they are about to cross a threshold. But it is strange how the ringing becomes melancholy; like a knell, when it heralds departure…
Walter Benjamin The Arcades Project(c3,5)
Every cultural artefact both internally records and externally actualises passages between different states. The artefact’s content records threshold transitions and border skirmishes: from life to death; from drunkenness to sobriety; from love to indifference; from revolt to acceptance; from one formal tone to another. At the same time it records the failure to traverse the connection between any, or all, of these – every passage closes. It also records those passages which do not manifest as oppositions or serial developments but which are purely associative in nature (As beautiful as the chance meeting on a dissecting table of a sewing machine and an umbrella). And without reference to any content, the artefact opens (inviting palynology) passages between its production as a historical object in the world and its subsequent receptions. That is to say, the artefact becomes a means for mediating social relations through multiple channels.
The film The Death Of Mr Lazarescu records the rapid passing of a man who has been living day to day an impoverished lonely life of drunken stalemate in a decrepit Bucharest apartment. The logic of his decline ends with his death on a trolley in a hospital’s operating theatre prep room. Mr Dante Remus Lazarescu has liver cancer, but he also suffers a bleed on the brain following a drunken fall into his bath. After a long initial delay, he is eventually picked up by ambulance following the intervention of neighbours. From the outset, he is evaluated as a low medical priority. His type, as an old single male, with chronic alcoholism and a terminal illness, triggers every latent hostile reaction in the nightshift clinicians who attend upon him. No cure is possible in his case; within the discourse of medicine there is no answer to Dante Lazarescu’s problems; and where there is no hope, levels of care also dwindle. Therefore, in the logic of the film, Mr Lazarescu must function in his own story as Dante without a Virgil. His descent into non-existence, without hope of redemption, appears simultaneously in the domain of his own biology and in the register of institutional process.
From a paramedic’s first contact and filled in questionnaire, the responsibility for Mr Lazarescu’s existence passes from his own capacities, and that of the care of interested others, to the discretion of the ‘healthcare provider’ apparatus. At this point, the communist critic reaches for the theoretical term Biopower in his attempt to describe the absolute technical capacity for scrutiny of the individual’s existence by the institutional apparatus which seems always to be coupled with the delivery of that intimate indifference which such power engenders. As soon as he embarks on his long journey, Mr Lazarescu experiences the exacting procedures of institutional dehumanisation by which his person is deconstructed into his component organs. And each of his organs being the responsibility of a different departmental specialism.
Mr Lazarescu is also plunged into the internal politics and resource scarcity that consume the greater part of the health system’s energies. He is shunted between four different hospitals as a low priority case and receives no care over a 6 hour period whilst his condition steadily worsens. The structuring of the system ensures, rather than militates against, the neglect that he receives. That which appears as a right to the individual person, in this case the right to an appropriate and standard level of hospital care, is supplied, in the interest of the institutional service provider, as a secondary product of the healthcare apparatus.
The cybernetised institution prioritises the delivery of ‘rights’ (individual packets of care) in the form of a quantifiable output of its engineering of life processes at a population-wide scale, and responds not to individual claims upon it but only according to modifications of its written targets and protocols. The delivery of its product to individual consumers proceeds from the rationalisation process of its technocratic structure, that is to say, it manufactures a standard product for society-wide distribution, it does not enter into a nuanced patient-centred relation. Any subsequent discrepancy between individual expectation and the system’s actual delivery may only be recorded within the system as an inevitable, if anomalous, consequence of standardised procedures. It monitors its effectiveness solely in terms of successfully meeting a mean distribution for achieved minimum thresholds. There is no inbuilt corrective feedback of, no interactivity for, complaint.
The patient is subject to, and has no capacity to rectify, a layered hierarchy of system management, the great accumulated force of which is only delivered by ‘front-end’ staff to patients at the end of a very long cycle of strategic intervention at the population level. State targets and programmes are strategically planned by the designated departments and delivered on an integrated province wide scale according to assigned resources; tactical implementations and administration loops are effected on an institution by institution basis; and the priorities and limits placed on patient to patient decisions are made through a window on clinical intervention as that appears to medical staff under enormous topdown directive pressure (proceeding always from abstract planning to individual case). That the optimum window, as far as the patient’s interests are concerned, is often missed is a direct consequence of the character of such ‘provison’. Institutionalised services in the end, and at the beginning, always serve as a matter of priority the programmed requirements for the processive reproduction of the systems themselves as distinct from any stated goal of the service; which becomes just one measurable output to be set against others. This means that the tolerable level of patient mortality is indexed to cost thresholds.
Within this, already weighted, environment, the patient becomes subject to those twists of fate and luck which highly rationalised systems seem to generate as decisive components of the apparatus. At the level of individual experience, what might be called, after Chekhov, ‘Ward Six’ phenomena, immediately come into play. These are the extremely capricious variables in both care and outcomes which transform individual experience within rationalised environments but which register as statistical exceptions for the systems’ monitors: one might, by stroke of life-enhancing luck, encounter the good nurse on the ward with a terrible reputation; one might, unluckily, have had a swab sewn into the wound; a norovirus outbreak might lead to the shut down of wards, having a ‘knock-on’ effect on operation timetables: or one might be reduced to a sort of football kicked between departments, none of which wishes to pick up the cost of treatment at a time where cut-backs are imminent and cost-cutting efficiency measures are demanded. The patient always appears within an institutional circumstance defined by its tumultuous turnover (of staff, of material, of patient flow, of money) which leads him to understand that if he had been taken ill one year, one month, one day earlier (or later) then his case might have turned out so much the better (or worse).
We are left in no doubt that Mr Lazarescu would have received different and better care, if he had not encountered those doctors at that moment under those conditions. His situation is openly compared unfavourably with that of the victims of a coach crash who arrive at the hospital at the same time. From the perspective of those attempting to deliver an impoverished service, coach crash victims appear as innocent patients whereas Mr Lazarescu has nobody to blame for his misfortune but himself. He is an object of barely disguised disgust and revulsion. Medical staff criticise and mock him. He is incontinent of urine. There are never sufficient staff available to adequately attend to him. He is at the back of the queue until he is moved to the back of another queue. There are not enough operating theatres or MRI scanners. He is refused an operation because he cannot give consent to it. He is incontinent of faeces. He passes into an acute confusional state and his words make no sense. Doctors pull rank over the paramedic accompanying him and refuse him treatment even as she insists on it. They send him back out into the night. There will be no consequences. There will be no inquest. There will be no protest. Every decision has been made according to the protocols. The ambulance’s progress through tunnel-like streets of the Bucharest night is uncertain and directionless. By the time the paramedic has located a hospital which is prepared to treat him, he is in a coma, and it is too late.
The process by which Mr Dante Remus Lazarescu becomes neglected, is also that by which the film connects him to a dying potentiality which could only be realised through him. This flickering potential, a shadow in his shape, a shadow that is the image-object to which the care of others might be attached, and which has hitherto only appeared within a set of relations defined by his insignificance, is both realised by the film and closed out unrealised by the institution which it portrays.
Biopower forecloses on all discourses of redemption and seeks instead to realise, or manufacture, the tangible potentials which it identifies in individuals. Where no useful, achievable, measurable potential is identified its institutions find no purpose, nothing to work on – the shadow, the potential that is care for care’s sake, is dispersed. Mr Lazarescu’s lonely fate is also the fate of the potential that is his alone and which he might have realised in a life lived otherwise. At the end of his life he carries his shadow down into the void. And a potential for society, with him as one of its centres, an alternative circumstance structured on other relations, and other procedures, other means of caring and prioritising, dies with him.
So the tiny woman closed the shutter of the cottage window and fastened the door, and trembling from head to foot for fear that any one should suspect her, opened a very secret place and showed the Princess a shadow… It was the shadow of someone who had gone by long before: of someone who had gone on far away quite out of reach, never, never to come back. It was bright to look at; and when the tiny woman showed it to the Princess, she was proud of it with all her heart, as a great, great treasure. When the Princess had considered it a little while, she said to the tiny woman, And you keep watch over this every day? And she cast down her eyes, and whispered, Yes. Then the Princess said, Remind me why. To which the other replied, that no one so good and kind had ever passed that way…
Dickens Little Dorritt
As is often the case with people in his position, Mr Lazarescu has effectively ceased to exist long before the moment of his death. All that is left of him, at the end, is a poor, bare, fork’d animal, trapped somehow in an arbitrary and unhomely place; head shaven, naked, alone, lying under a thin sheet on a trolley in the company of unfamiliar others for whom he is little more than the pretext of their work. He appears before them, in the crepuscular glow of their non-recognition, at that threshold between the night and morning shifts, in the prep room adjacent to the operating theatre, as nothing more than their work. They attend upon him because they are paid to do so.
Mr Lazarescu, as an individual, has lost his autonomy (as this is paradoxically defined by the caring intervention of others). He has nobody at the end to carry forward his identity, his uniqueness, the memory of him. He has become absolutely subject to his environment. It is no accident that two other characters of the film are named Virgil, as the importance of the witness, the companion, the guide, the one who will plead the case, is demonstrated throughout the film by his absence. Dante is an alcoholic. He lives alone with three cats in a dirty flat. He has no wife. He has a daughter but she lives in Canada. His neighbours are ambivalent. He has nobody who will accompany him in the ambulance as it descends into his purgatory.
Benjamin writes problematically, So difficult is it for man to relinquish his place and allow the apparatus to take over for him (S5a,2). And yet, also so easy. The communist critic assigns himself the task of reopening those meandering passages to the question of the difficult individual as an end in himself, precisely those passages which have been progressively filled in by apparatus-rationale as it pursues frictionless operations at the macro scale. The critic’s purpose is not only to subject capitalist instrumental rationality to critique but also to problematise the use-value based assumptions of left ideology as expressed in the advocacy of workers’ self-management of production.
Within the field of his commitments, every critic illuminates passages between the internal opposites that are belonging to his field; he is an anarchist to the communists and a communist to the anarchists; he connects the profusions of spectacular wealth to the abject reality which sustains it. He seeks to open passages to the real world from the fantastical and to reveal passages to the fantastical, the life lived otherwise, from works of social realism. But he is not merely a mining engineer of latent social connection. He also explores the passages that lead to answerlessness, that come to a dead-end, the labyrinths of the mute and immobile; the very non-passages and disconnects which thereby threaten the project he has undertaken.
At the end, at the very end of a long row of booths, as if — ashamed — he had exiled himself from all of these splendours, I saw a poor mountebank, stooped, decrepit, leaning his back against one of the posts of his hut, a hut more miserable than that of the most most brutalised savage, and whose poverty was illuminated yet all too well by two dripping, smoking candle butts.
Everywhere joy, success, debauchery; everywhere the certainty of bread for tomorrow; everywhere the frenetic explosion of vitality. Here, absolute misery, misery decked out – as a crowning horror – in comic rags, upon which need rather than art had introduced contrast. He didn’t laugh, this poor wretch! He didn’t cry, he didn’t dance, he didn’t gesture, he didn’t shout; he sang no song, either happy or sad; he didn’t plead. He was mute and immobile. He had renounced, he had abdicated. His fate was fixed.
le vieux saltimbanque Baudelaire