If the soul and the ego were objects we could look at, the soul would be a translucent heart beating.
As both physician and filmmaker, Lilti discusses his recent hospital drama and the challenges of medical and artistic practice.
Last year, in 2014, Hippocrates played in Critics’ Week at the Festival de Cannes. This year, Thomas Lilti, the film’s director and co-writer, is back on the Croisette, having just finished shooting his third feature and taking a break from editing. That’s no mean feat for a filmmaker who’s also a primary care physician in Paris and has maintained a dual-career track since his salad days. Hippocrates, of course, refers to the Hippocratic oath and the challenges it faces in contemporary medical practice; in French, as Hippocrate (no “s”), the title is dangerously close to the word hypocrite.
Lilti has exploited to the full his own life experiences in this nuanced coming-of-age drama with strong political undertones. It is told from the point of view of twenty-three-year-old Benjamin (the emotionally supple Vincent Lacoste) as he starts a six-month internship at a large Paris hospital under the dubious tutelage of his father as head of the department. The public hospital, now run by corporate-style managers, is fraught with budgetary problems and ensuing staff and equipment shortages that strain priorities and patient care. The introduction of a second lead character, Abdel (Reda Kateb), an older, already qualified Algerian doctor who’s treated as an intern because of his immigrant status, greatly enriches the script’s dramatic potential as a solid collegial bond and friendship gradually develops between Abdel and Benjamin. Abdel offsets Benjamin’s inexperience and becomes the moral fulcrum of the film.
I spoke to Thomas Lilti via telephone, across the ocean from New York to Cannes, and translated our words from French.
Liza Béar I was struck with a simple scene at the beginning of Hippocrates. On arriving at the hospital for his internship, Benjamin asks the laundry room for a white coat, size 2. There is no size 2 in stock, so he’s given a size 4. This alerts us to the hospital’s financial plight and symbolically to the fact that Benjamin is not quite up to the job.
Exactly. It’s weird because in French we would say, le costume est trop grand pour lui (the costume is too big for him). It’s a symbolic expression, but here it’s concretized because in reality the uniform doesn’t fit.
>span class=”initials”>LB Well, practicing medicine in a hospital and making films have at least one thing in common—you have to get up at the crack of dawn.
TL That’s true.
LB Are you super well organized? How were you able to get two careers going at the same time?
TL When I finished high school I was rather young. I just wanted to make films. However, due to family pressure, I enrolled in medical school. But at the same time I tried to start making films with my buddies.
LB Super 8 or video?
TL Super 8. I’d bought a used Bolex in a Paris flea market. The little films I made with that camera were quite well received at student festivals, which gave me some confidence. Of course, I went to the cinema whenever I could to develop my taste in film. I wrote the script for my first feature film, Les Yeux Bandés, while I was a medical student and even managed to make the film while I was writing my graduate thesis.
LB It’s hard to imagine anyone doing that. Medical students have such a grueling schedule, as your film amply shows.
LB So how exactly did you pull it off?
TL I think, for me, film was a survival mechanism. Not only is studying medicine itself difficult but also, in the course of doing so, one experiences really complicated situations—
LB With the kind of judgment calls you portrayed in the film.
TL So filmmaking provided a breath of fresh air. I didn’t see it as overloading my schedule but almost as a pastime. When other students would go party or play sports, I would go shoot film.
LB What time period are we talking about?
TL It was during the ’90s—almost twenty years ago. I did my medical studies from 1992 to 2002. Super 8 was already an anachronism then.
LB In Hippocrates, during a scene in the hospital cafeteria, Abdel, the Algerian intern—played by Reda Kateb, an excellent actor—asks Benjamin why he’s following in his father’s footsteps. This is an autobiographical element?
TL Yes, my father is a doctor.
LB You mentioned earlier that gradually you became more confident as a filmmaker. But how did you feel about your development as a doctor? After all, a doctor has his own set of skills. Did you inherit some of these qualities from your father?
TL It’s true that my father was somewhat of a role model for me. But, at the same time, I think practicing medicine was a way for me to achieve a kind of peace: It was a way of telling my dad, Look, I’m capable of doing the same thing as you, so get off my back, and let me do what I really want to do, i.e. make films. Because I don’t come from an artistic milieu it was important for me to prove myself in the family tradition.
And when Benjamin tells Abdel that he doesn’t know what it means—to follow in his dad’s footsteps—I was the same at that age. It’s only now, in retrospect, that I can analyze the situation and say, Yeah, it was a way to buy myself some peace of mind.
LB What’s your medical specialty?
TL I’m a primary care physician, a family doctor. I like having direct contact with patients, and the idea of taking care of several generations of one family. That appealed more to me than surgery, for instance.
LB This must have served you well when you started directing actors.
TL Yes, actors and the crew—interacting with everyone in a film production. That sense of working as a team is definitely something that I acquired in medical school. Another is the capacity to work very long hours and to stay focused on specifics—you need that as a film director also.
LB Let’s talk a bit about the political and economic background in France, as it concerns your film. There’s national health coverage, right, but what about hospital ownership?
TL The hospital in Hippocrates, is like all major hospitals in Paris and throughout France, which are public institutions attached to a university. They’re teaching hospitals whose doctors are at the cutting edge of French healthcare.
LB What’s the role of the men in suits who show up near the end of your movie when the hospital staff threaten to go on strike?
TL For the past few years, French public hospitals have been in financial trouble and racking up large deficits. Successive administrations have argued that hiring management types from private enterprises, people with a profit-making corporate mentality, to run the hospitals might solve the problem and close the budget gap.
However the experiment, which was tried in a few groups of hospitals, was considered a failure.
LB Budgetary issues are certainly one of the root causes of dramatic conflict in Hippocrates.
TL Yes, and I wanted to show many others, too. There’s the treatment of foreign doctors, who come to work in French hospitals because we’re not training enough of our own doctors. Because of visa issues, though qualified doctors in their home countries, these foreigners are treated as interns. Then there’s the training of young doctors itself, represented by Benjamin’s character in the film. He’s portrayed as much too young, too isolated and solitary, and this affects his practice. The budgetary deficit translates into lack of supplies, equipment, and staff.
Then, very important to the story, is the dilemma posed by terminally ill patients, represented by Madame Richard’s character, who doesn’t want to be on life support, doesn’t want to be intubated and resuscitated, doesn’t want to be kept alive if she can’t maintain a certain minimum quality of life. This is an overall societal problem—what to do with very old people in the hospital, for whom there’s no cure, and how best to take care of them at the end of life.
LB And there are interpersonal conflicts between father and son working in the same department, and also between Benjamin and Abdel, with whom Benjamin has a push-pull, contradictory rapport. But then there’s a genuine moral issue over and above medical practice.
TL Are you talking about whether to keep Madame Richard on life-support?
LB No. To me the basic moral question that drives the script is the mistake committed by Benjamin.
TL At the beginning of the film?
LB Yes. And the cover-up.
TL What happens is that one night, when he’s on duty, Benjamin thinks that he should get an electrocardiogram for a patient with a bad pain. But, because the EKG machine for that department isn’t working, because he would have to go look for another one, and because no one is too motivated to help him get this EKG done, he says, Well, let’s just drop the idea.
The next morning the patient is dead. We understand that had the EKG been done, certainly the source of the pain would have been diagnosed and the patient’s life might have been saved. But Benjamin, out of laziness and lack of judgment, didn’t do it.
He feels extremely guilty about the death of a man on his watch, even though his guilt is possibly debatable. When he admits his error, instead of being told, “Let’s talk about it, maybe you should be punished,” he’s told to hush it up, to pretend the EKG was done—both by his supervisor and by his own father, who’s head of department. It’s this impunity, this law of silence, this protection, which Benjamin hasn’t sought, but that is imposed by the medical hierarchy, which doubles his sense of guilt and creates his malaise. I strongly believe that’s true in general; and it’s particularly true in a hospital context.
LB The film has four screenwriting credits and one of them is Julien Lilti. That’s your father or your brother?
TL He’s my younger brother.
LB Did you consult you father while you were writing the script?
TL No no no. Not at all. He had nothing whatsoever to do with the project.
LB Is this something that happened to you while you were an intern, committing a medical error?
TL Yes. It happens to all young doctors. It wasn’t too hard to search my memory for an example. What you do after the mistake is what counts. This starting point for the story came to me very quickly.
LB Did you shoot the film in hospitals where you had interned?
TL The film was shot on a reconstructed set and also in a currently functioning hospital where I had been a student. For the cast, we used about two-thirds professional actors and one-third working nurses and medical personnel, a significant contribution.
LB Are you working on another film?
TL I just finished shooting a feature, and now I’m in postproduction. It’s another medical story but set in the French countryside, not in a hospital. Because we haven’t trained enough doctors, we’re beginning to see a shortage in the rural areas. The story is about a sort of old-school French country doctor, a solo practitioner, who discovers that he’s sick and has to find someone to help him, a woman doctor. We shot it near Normandy.
LB The doctor does his rounds on a bicycle?
TL Oh no! He has a car.
LB What have you seen at Cannes this year that blew your mind?
TL I only arrived this morning! Now I’m about to see Mateo Garrone’s latest film, The Tale of Tales. It’s his third.
Hippocrates opens nationwide theatrically on June 19, 2015
Liza Béar is a writer, filmmaker, contributing editor at BOMB, and the author of Beyond the Frame: Dialogues with World Filmmakers (Praeger, 2007). Her film Jackie Winsor: Work in Progress (1975-1978) has just been acquired by the Museum of Modern Art and Homeward Bound, a short, is currently being shown in Not Yet: Re-Inventing the Documentary at the Museo Reina Sofia, Madrid.
If the soul and the ego were objects we could look at, the soul would be a translucent heart beating.