In Mexico City, the government operates fewer than 45 public ambulances to serve a sprawled-out population of 9 million. Director Luke Lorentzen gives us this information at the beginning of his documentary Midnight Family, but that's where the didacticism ends. The rest of the story—namely, how this dearth of emergency vehicles affects critically ill patients, and how the economics of healthcare in the city has changed as a result of the scarcity of public resources—unfolds entirely within the realm of the personal and the immediate.
Over the course of three years, Lorentzen embedded himself with a family, the Ochoas, that runs a private ambulance service. When the Ochoas catch wind of an accident through their police scanner, they rush to be the first to the scene, often neck-and-neck with other private ambulance companies. (These make for nail-biting sequences, almost out of a heist film.) If a government-run vehicle doesn't show up to the scene of the accident shortly after the Ochoas arrive, the family will transport the patient to the nearest hospital. This emergency service comes with a fee—after all, this is not a charity operation. It's how the Ochoas eke out a meager living.
Lorentzen's impressive one-man-band feat is a thrilling and often harrowing ride. Shooting stunning vérité with two cameras, he documents ethically complex, high-stakes situations that the Ochoas encounter, often as the clock ticks on their patients' lives. Among the choices the ragtag paramedics have to make are which hospitals to bring their patients to—some are public, others are private, and different institutions offer better care than others. Many of the Ochoas' patients cannot afford the emergency services, placing the family's leader, teenaged Juan, in the morally precarious role of asking for money from extremely compromised individuals. But when no other ambulance showed up, what options did that patient have in the first place? Midnight Family is a nuanced investigation of a broken health-care system, in which public and private interests compete, ultimately leave those that need their services most in the dust.
No Film School sat down with Lorentzen to discuss the merits of putting your camera in dramatic, high-stakes situations, how he managed to shoot as a one-person crew with two cameras, and much more.
"It's such an intense experience to really feel like you've embedded yourself into someone's life deep enough to make a film about it."
No Film School: This was a very emotionally affecting, all-compassing story, with a lot of societal and political implications. How did you stumble across this family in the first place?
Luke Lorentzen: I moved down to Mexico City with a close friend from college who grew up here shortly after graduating and was interested in doing a film here, but wasn't exactly sure what it would be about. I was actually [originally] developing a completely different idea. But through that process I met the Ochoa family, whose ambulance was parked on a street corner near the apartment that I was living. It was a fairly random encounter. I guess I was bold enough to ask them if I could just ride along with them for a night. And just in that first night, I knew that there was a film to be made about their life and kind of the work that they do.
NFS: So once you made that decision that there was a story there, how did you talk to them about agreeing to participate in the film?
Lorentzen: It was a process. I think it kind of always needs to be a process, especially with a film like this that is really playing with big questions about the work that they do.
I think when I started, I thought it would just be a film about this ambulance and Mexico City by night. But then I slowly started to learn about these much darker layers of the ethics behind it and that became more of the focus.
Lorentzen: Throughout, it was an ongoing conversation with them as I got to know them better and built trust. I would ask them what they were comfortable showing and what they were comfortable letting me film. It took several years before we had a very close relationship where they felt comfortable showing me everything. It wasn't like I showed up and in 24 hours had the access and informed consent on their behalf. But over the course of years, they started to understand what making a film like this would mean for them.
The project grew, too. I didn't know exactly the scale of it or the purpose of it when I started. And so it was just the matter of remaining in very close contact with them. I talked to them almost every day. Even now that the film is done, we brought them to the premiere at Sundance, so they got to see the world's reaction to it.
I think [the process of building trust] is very step-by-step. It involves being upfront and very honest about wanting to show the good and the bad. The press around private ambulances in Mexico is negative and one-sided. There are very few people that have spent the time to really see why these businesses do what they do. And so I think [the family] kind of saw an opportunity with me to tell a fuller story. They accepted that it wasn't all beautiful, but that it would be more balanced.
"I was kind of surprised by the percentage of people that were willing to let me film them. I went into this with the assumption that anybody in a difficult situation would want their privacy."
NFS: How much time did you spend, ultimately, filming with the family on ride-alongs?
Lorentzen: I spent almost 100 nights with them filming. This was, like, two in the afternoon to sometimes as late as eight in the morning. I would just be hanging out in the ambulance and filming them work. There's a lot of downtime, so we would hang out and get to know each other. And then there are also these really emotionally intense moments. I think that kind of built a bond between us. Once we kind of had experienced certain things together, we started to feel more comfortable with each other. Those 100 nights happened over the course of three years, so there's this level of trust that built when kept returning to film with them.
It's a strange process. The fact that anyone would give someone so much access and so much of their time...above all, my job is to create that space where these people feel good doing that.
Lorentzen filming 'Midnight Family' in the Ochoas's ambulanceNFS: When you were filming, did you come across any situations where you were forced to kind of make decisions about the ethics of filming certain things or not filming them at all?
Lorentzen: Yeah, 100%. I don't have the exact ratio, but I think a good half of all accidents that we would show up to ended up being things that I couldn't or didn't feel comfortable filming. And it took weeks before I built that muscle of being able to make those decisions on the fly. Eventually, I set certain ethical barriers that felt right. But for the first two and a half weeks in the ambulance, I actually just filmed through the front windshield. I was only filming the EMT core team. I wasn't even trying to film the patients. And then, eventually, I was like, "Okay, how can I go about telling more of this story?" You know the intensity of what's going on, and while the film doesn't make that the focus, the emotion of their work needs to be a part of the movie. It can't be kind of sugar-coated or overlooked.
"Getting the dashboard cam to work was a fairly complicated thing. You're dealing with windshield reflections and different lighting situations."
It was a process of figuring out how to get consent from patients when they're capable [of giving it] and making the call not to film if I don't feel like I have that permission. And then in some instances, it was connecting with these people after things have calmed down and explaining to them what the film is and what the goals of the project are. The last accident in the film, where you see the mother riding in the front of the ambulance—that's somebody that I connected with six months later and had a long conversation with. So it was case by case. I kind of needed to accept going into the film that there would be moments that might be really important for the movie, but they were things that I could capture.
I was kind of surprised by the percentage of people that were willing to let me film them. I think I kind of went into it with the assumption that anybody in a difficult situation would want their privacy. And that wasn't really the case. You know, there was definitely a good chunk of people that felt that way, but there were some that were totally comfortable with [being filmed].
NFS: So you were constantly refining your standards of what you deemed ethical to film.
Lorentzen: Yeah, definitely. They kept changing. I think they started off very, very rigid. Maybe too rigid. And then with each shoot and with each night in the ambulance, I was able to get a sense of how these things would unfold, and at which moment I could make the call. The Ochoa family was also really helpful with that. They would often be the first ones to interact with the patient or a family member of the patient and let them know that there was a film being made. This will probably be one of the more complicated ethical films I ever make!
NFS: So it was just you with the camera, then, inside the ambulance? A one-man-band?
Lorentzen: Yeah. I was a one-person crew. That was how I shot my other films, so I was kind of familiar with it. But it was necessary. There just wasn't space for more people. And it's more difficult to embed yourself with more people around. But it was also insanely complicated to pull off.
I was actually shooting with two cameras. There was one that was mounted on the hood of the ambulance, and then there was another camera that was with me in the back. And these are full-size professional production cameras—not like a GoPro or something smaller. And then the sound! Everyone was wearing microphones. I had a sound mixer that was attached to one of the cameras.
NFS: That sounds really stressful.
Lorentzen: Yeah, it was. And it didn't always work. Getting the dashboard cam to work was a fairly complicated thing. You're dealing with windshield reflections and different lighting situations. And even just getting it to be perfectly square—it's like a seven-part bracket strap clamp. I would have a bottle of Windex in my pocket the whole night and be cleaning the windshield like every hour, 'cause there'd be dirt that would show up on the windshield that would make the shot look dirty. It was a very, very hands-on shoot. But when it worked, it created these really dynamic scenes where I could cut between spaces. That felt necessary to the final film.
NFS: The cinematography looks very intentional, but I can't imagine you had a lot of opportunities to think about framing on the fly. How did you manage?
Lorentzen: I was thinking a lot about framing. I think one of the saving graces of the subject matter was how repetitive it was. I wasn't getting the framing right the first week I was there, but night after night, things would unfold in an almost identical way. So I could really be intentional about where I would be and how I would shoot it. In that sense, I had several takes. I mean, I didn't have several takes when the moment actually came at me, but I was prepared [having had other similar situations].
You know, there were moments that were totally chaotic and crazy, but I felt like those were happening within the space that I had already kind of understood. And then there were moments that were very calm, between accidents, where I could really think about how I wanted to shoot things.
"There was a moment [in editing] where I wasn't totally sure if I could show everything without completely throwing this family under the bus."
NFS: How do you navigate that objective distance when it comes to keeping your human reactions, or your human responsibility, at bay in service of getting the shot?
Lorentzen: I think there are multiple steps to that. There's the process of shooting the film, and then there's the process of editing the film, and then there's even the process of talking about the film. Different levels of objective and subjective perspectives are at play in all of the above.
I think it was most complicated when we were editing it. In the process of shooting, you know, obviously, I'm a subjective presence there. I'm shooting it from a perspective of mine even though it's observational. But my job while shooting is to try to be as invisible as possible and capture things as they would be happening were I not there. There are a few moments in the movie where I kind of prod, and get Juan to talk about stuff. But for the most part, I'm very much trying to be a fly on the wall.
Lorentzen: We went into post with so many different feelings towards the footage. There were scenes where I felt that [the family] was saving people's lives. And then there were scenes where I thought they were seriously putting people in situations that weren't ideal. I had such a specific memory of these moments and had such a close relationship with the Ochoa family. It was hard to figure out how to show the whole picture—the good and the bad—but still keep them as empathetic characters. Because throughout all of it, I really still liked them and enjoyed being with them. And, to a certain degree, I trusted them, despite certain things that they were pushed into doing.
To become more objective, I showed cuts to other people and saw how they were reacting to these things. There were versions of the film where people hated the Ochoas and thought they were totally horrible. There were cuts where people thought they were saints and saving everyone's lives. So it was kind of swaying back and forth between those two versions to find something that felt right. And when I say "right," I mean something that matches how I felt about this family. You know, it's not objective. It's very much me trying to recreate my experience of being in this ambulance.
For the first six months of post, we worked with a Mexican editor who came into the footage with a completely fresh perspective and really taught me a lot about how this material was playing for people who hadn't experienced it, or didn't know the context, and didn't know the Ochoas. It's a lot of trial and error and a lot of small tweaks. Like you can add one scene—one little human moment—before something happens, and it can totally flip the weight of that scene. The film is really, really delicate in terms of how it balances the ethics of their business.
"There's a certain element of dumbness that comes with good filmmaking, where you're not overthinking everything."
NFS: Definitely. What you saw in the ambulance was a contextual picture, but the audience comes in with their own preconceived notions and experiences with different healthcare systems.
Lorentzen: Yeah, totally. I didn't want to make something that imposed these morals on this family. I very much wanted it to come from them.
There was a moment [in editing] where I wasn't totally sure if I could show everything without completely throwing this family under the bus. And that wasn't something that I felt comfortable doing. It was a really complicated edit to get it right. Especially because people come in with such a range of values themselves. Like some people have just a greater tolerance for certain things. Or some people are just more empathetic than others. And so the film needed to be built in a way where it could kind of accommodate all of that.
I'm not saying that everyone who watches the movie should love this family. That definitely hasn't been the case. But I think the majority of viewers have come away with an understanding of this systemic pressure on this family's shoulders that put them in this tricky situation. It's kind of like this staircase of victims. Starting with the patients, then the Ochoa family, the police officers, the government...everyone is getting kind of screwed and trying to figure out how to survive in this horrible system.
NFS: Looking back on the entire process, if you were to talk to a filmmaker who had a similar idea in the sense that they wanted to make a film in a very high-pressure situation as a one-person crew, what advice would you have?
Lorentzen: It's hard to sum up. But a really important piece was the relationship that I had with the Ochoa family. I knew my limits with them and I knew that I could trust them to be there with me through all this stuff. They were concerned about my safety. I knew that they would warn me or tell me not to film if something was getting sketchy. I just physically felt safer around them because they were aggressive people who would protect me.
I also spent a lot of time with my equipment. I was very comfortable with my camera. I had worked as a camera operator and a cinematographer for several years on other projects, and had built up enough of a muscle memory of like basic shooting that I was able to be a little bit unconscious about the cinematography and a little more conscious about the ethics and my own safety and the Ochoa's safety. I think it would have been difficult had I been trying to figure out how to shoot while juggling all these other things.
NFS: No kidding. It kind of has to be second nature at that point.
Lorentzen: Yeah. It's very much a physical thing that you learn with hundreds and hundreds of hours. It's about being able to shoot something without it taking over your whole brain. There's a certain element of dumbness that comes with good filmmaking, where you're not overthinking everything. You're kind of just listening to the conversation and letting that guide your movements. It's a bizarre craft, but an interesting one to learn.
I found the best stuff that I shot came from shorter shoots. I did these two to three-week segments that gave me really good material—much better material than I had gotten from this six-month shoot that I had done. I think there's something valuable about coming fresh and giving it my all for a short period of time, and taking time to reflect and process before going back. So I think that's something I'll probably try to do in my next film.
I was filming a football show [at the same time I was filming this], which was also extremely high pressure and was another situation where if you didn't get the shot right on one go, you were totally screwed. I think you need to be in those moments in order to create an exciting film. Your camera needs to be in very high-pressure situations. Obviously, a football game isn't the same as a car accident, but there's a similar pressure there that you'll always have in a dramatic moment.
It's such an intense experience to really feel like you've embedded yourself into someone's life deep enough to make a film about it. It took three and a half years. I feel like my whole world has bent and twisted. The way I see everything is different. It's just a totally immersive experience. It isn't just filmmaking; it's totally life-changing. That's what's so complicated about documentary filmmaking--in order to really do it properly, you just have to completely give yourself over to a story. I'm still processing it all.
For more, see our ongoing list of coverage of the coverage of the 2019 Sundance Film Festival.