Can a Martin Scorsese movie be considered truly underrated? Scorsese has produced one well-regarded film after another for the majority of his career, and his bonafides remain untouchable. But nestled within Scorsese’s impressive filmography might be one truly underrated gem: his 1999 effort Bringing Out the Dead. It’s a wild, energetic, but ultimately compassionate work. It was also a major box office flop that barely made a blip and still hasn’t been released on Blu-ray. Twenty years later, Bringing Out the Dead is overdue for a reappraisal.

Here’s how Paul Schrader‘s Bringing Out the Dead script starts:

After World War One it was called
Shell Shock.

After World War Two it was called
Battle Fatigue.

After Vietnam it was called
Post Traumatic Stress Disorder.

Frank Pierce drives an EMS vehicle for
Our Lady of Mercy Hospital, New York City.
He has been a paramedic for five years.

Schrader appears to be partially quoting a George Carlin stand-up bit, but he’s also setting the stage for what’s to come. Frank Pierce is a man at war. His enemy is death itself. Not his own death, but death as a driving force stalking the mean streets of New York, taking the lives of the unfortunate. Frank is a paramedic, and to say he’s suffering from shell shock (or battle fatigue, or PTSD) is an understatement. He’s a haunted, hollowed-out man.

Nicolas Cage plays Frank and turns in one of the best performances of his career. Cage had yet to tip over into self-parody mode in 1999, but Bringing Out the Dead allowed the actor to blend both quiet poise with manic madness. Frank is overtired – he just can’t sleep, and he keeps pulling nightshifts. It’s left him with heavy, corpse-like circles under his eyes and a slow, drawling way of speech. But every now and then Frank will be in the midst of an experience that increases his adrenaline and sends him over the edge. Scorsese heightens this with sped-up montages – Cage behind the wheel of the ambulance, moving in fast motion while bathed in flashing red lights while The Clash’s “Janie Jones” screams across the soundtrack.

“He’s inventive and he goes from an expressive style, almost like silent film, like Lon Chaney, whom he adores, to something extremely internal,” Scorsese said about Cage, adding that the first thing he thought about when he read the source material – Joe Connelly‘s novel of the same name – was Cage’s “face and his eyes.” Those sad eyes and that hangdog face take up the center of the frame more than once in Bringing Out the Dead, and we can feel the weariness – the bone-tiredness – lurking behind it all.

“Help others and you help yourself,” Frank’s narration tells us. “That was my motto. But I hadn’t saved anyone in months.” People keep dying on Frank, and it’s thrown off his entire life. One death in particular – a young girl named Rose – haunts him the most. He sees her face on nearly every corner, looking at him, judging him, asking him why he couldn’t save her.

There’s a selfishness in Frank’s outlook – he’s saving people’s lives as a way to make himself feel better. The conflict within makes him feel God-like. “Saving someone’s life is like falling in love,” he says. “The best drug in the world. For days, sometimes weeks afterwards, you walk the streets, making infinite whatever you see. Once, for a few weeks, I couldn’t feel the earth – everything I touched became lighter. Horns played in my shoes. Flowers fell from my pockets. You wonder if you’ve become immortal, as if you’ve saved your own life as well. God has passed through you. Why deny it, that for a moment there – why deny that for a moment there, God was you?”

For Frank to get beyond this twisted hell he’s trapped himself in he’ll have to evolve. He’ll have to, as Scorsese said, “get beyond the tremendous ego to get to the heart of what [he’s] doing – which is compassion.”

Bringing Out the Dead marked the reunion of Scorsese and Schrader for the first time since 1988’s The Last Temptation of Christ. Before that, Schrader penned scripts for Scorsese’s Taxi Driver and Raging Bull. Like the protagonists of all three of those films – and like protagonists of virtually all Scorsese films – Bringing Out the Dead‘s Frank is tortured, and in the midst of a spiritual crisis. But he’s also perhaps the kindest of the Scorsese/Schrader characters. Yes, even kinder than Willem Dafoe’s tempestuous Christ in Last Temptation.

bringing out the dead anniversary

Schrader structures Frank’s saga over three nights, giving the narrative a perfect three-act structure. Each night sends him out into the dirty, dangerous streets in an ambulance. Each time he’s paired up with a different partner: the lackadaisical Larry (John Goodman), Bible-quoting ladies man Marcus (Ving Rhames), and finally, downright psychotic Tom (Tom Sizemore). Each of these partners brings out the best – and worst – in Frank, and he grows more harried in the process.

During the course of these nights, he encounters Mary (Patricia Arquette), the daughter of a heart attack victim Frank hauled off to the hospital. Mary is a recovering drug addict, and Frank finds himself drawn to her again and again as if she were some sort of lighthouse beacon calling him across choppy seas. There’s a sense of potential romance here (Cage and Arquette were actually married at the time, but would divorce soon after). But Frank is also kind of sexless. He doesn’t seem to want to sleep with Mary in the sexual sense, but rather just literally sleep with her – lay down beside her in a bed and close his bleary eyes for a good night’s sleep. “You have to keep the body going until the brain and the heart recover enough to go on their own,” he tells Mary in relation to her father, but he might as well be talking about himself.

Frank’s sleep deprivation and caffeine-induced bursts of energy are highlighted by stunning, oversaturated cinematography courtesy of Robert Richardson. Anyone who has ever suffered from insomnia will find familiar sights in Richardson’s imagery here – streetlights that seem to bleed and blur, and darkness that almost seems cognizant. Richardson’s trademark top-down light – lights literally mounted above people’s heads and beamed down on them – adds an almost saintly halo to Frank.

But is Frank a saint? He’s certainly a good person, but that eternal, internal struggle is real. His long night journeys into day take him to the darkest, dankest parts of the city, forcing him to encounter the unwashed masses and the downtrodden. “I grew up with the homeless, and the alcoholics, and derelicts, and I was sort of split between a decent family and the bottom of the barrel,” Scorsese said. “The dregs. They become non-persons. They just wait to die. There was a conflict in me, and probably still is, about how one feels compassion towards a person like that, but is also repelled by it. And that’s one of the reasons I did the picture.”

Scorsese is often lambasted for his portraits of violent, destructive men. But here is a movie with a man learning to heal. Indeed, it’s a destructive act that finally triggers a massive change in Frank’s life. While riding with the dangerous Tom, Frank loses his grip on everything and proclaims that he wants to get into a fight, or break something. Tom talks him into attack a homeless man (Marc Anthony) who is clearly suffering from mental problems. But Frank has a change of heart. He comes to his senses and helps the afflicted man instead.

He saves a life. But he takes one, too. Mary’s father has been hooked up to respirators and other life support systems in the hospital for days – being artificially kept alive well past his expiration date. Frank fancies he can hear the man’s thoughts in his own head – pleading to let him die. So Frank does just that. He gives the man a peaceful send-off, and the night finally ends: daylight arrives. And with it comes a moment of forgiveness. When Frank staggers over to Mary’s apartment to tell her her father has passed he has one last vision of Rose. He begs her to forgive him. “It’s not your fault,” Rose’s ghost tells him. “No one asked you to suffer. That was your idea.”

“You can’t forgive yourself,” Scorsese said of this ending, which wasn’t in Connelly’s book, but rather something Schrader came up with. “You want everybody else to forgive you.”

In that moment of self-forgiveness, Frank’s long battle against death halts. The war isn’t over – this is merely a ceasefire. You can’t defeat death, after all. But at least you can try to finally find sleep, rest up, and head back out into the fray. And keep the body going until the brain and the heart recover enough to go on their own.

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