This is the seventh in a series of articles on the recent Berlin International Film Festival. Part 1 was posted February 20, Part 2 February 27, Part 3 March 2, Part 4 March 6, Part 5 March 9 and Part 6 March 10.

Two films, the drama Late Shift (Heldin) and the documentary Palliative Care Unit (Palliativstation), featured at this year's Berlin International Film Festival, addressed the current situation in German and Swiss hospitals. The sold-out festival screenings reflected the burning public interest in this topic. This is particularly remarkable bearing in mind that Palliative Care Unit has a running time of more than four hours.

The COVID pandemic starkly revealed the consequences of hospitals being unprepared and overburdened. Under such extreme conditions, triage is unavoidable. This means doctors are forced to decide which patients should be saved and which should not due to insufficient capacity. Both films make clear that this can happen and not only under the extreme conditions of a pandemic.

Palliative Care Unit

The documentary Palliative Care Unit by Philipp Döring, shot at the Franziskus Hospital in Berlin, literally makes time stand still. The camera quietly observes the daily routine, staff consultations and the constant empathy of the head of the ward towards employees and seriously ill patients, who usually spend their last weeks here.

The very calm, always discreet images emphasise the necessity of sufficient time for care and reflection when making life-critical decisions. Is surgery advisable when the patient is weakened, or is chemotherapy preferable? How can the highest possible quality of life be achieved? The high ethical standard of treating incurable patients as active human beings, meeting them at eye level, recognising they can make their own decisions while the doctor makes recommendations, is admirable and makes a lasting impression throughout the film.

Until the film’s scene of a staff meeting, one has the impression of an ideal hospital and even wonders: wouldn't it be admirable if this level of care and respect for life were part of our normal daily work, instead of all  the stress, rushing about and impatience? The palliative care unit, however, is also no paradise. 

One employee points out the calm is deceptive. During the work consultation, things come up that shock the viewer. The increased number of beds cannot be managed. “Leased workers,” as temporary workers are called here, are sometimes not suitable for the special requirements of a given department. One employee complains that the palliative approach (the progressive concept stemming from the US in the late 1970s) has not been properly implemented for some time. The quality of work is seriously at risk.

One small scene lasting only a few minutes makes an impression on the viewer that endures for the rest of the lengthy film, as conversations take place with patients and relatives, along with staff discussions and the distribution of tasks and daily plans. In the second part of the film, one senses that the staff are walking on thin ice. The question arises: what happens when the pressure increases and at what point does constant shortage lead to a different assessment of the value of life?

Late Shift

Late Shift by Petra Volpe, which had its world premiere in the Berlinale Special section delivers what the German-language title (Heldin, or “Heroine”) seemingly promises. It transports us fictionally into the world of a “heroine,” undertaking an everyday but at the same time almost superhuman task. It is about the late shift of a nurse in the surgical ward of a Basel (Switzerland) hospital. Floria Lind (Leonie Benesch) has just returned from vacation, freshly rested. But in no time at all, she is not only back at the highest level of stress, she is on the verge of a crack-up.

Floria begins her shift motivated, attentive and in a good mood. From the start, her state of mind starkly contrasts with that of her older and somewhat more cynical colleague Bea Schmid (Sonja Riesen). The two of them have to look after an entire ward with 25 patients, i.e., almost full occupancy. The third worker is trainee Amelie, who, however, is regarded by Bea more as a nuisance and disruptive factor. Floria criticizes Bea for this, but in the course of the shift also admonishes Amelie for her alleged slowness. In reality, there are simply too few hands for too many problems.

Late Shift follows Floria everywhere she goes. It impressively shows how this consummate professional handles every task. She takes vital signs, selects medications, coordinates transfers to and from the operating room on the service phone, comforts patients and their relatives. At the same time she has to document every step of her work. In addition to disinfectant and disposable gloves, a ballpoint pen is one of her standard tools.

Floria seems to be pulled in a hundred directions, rushing from one patient to the next. Her rounds are repeatedly interrupted by the ringing of a bell or buzzer, sometimes it is her office phone, sometimes another patient who needs help. Floria seems to be a conductor in the midst of chaos, solving everything calmly. But it doesn't take long for the first crack to appear in the routine perfection. She is distributing painkillers to two patients who have just been transferred to the ward from surgery. Once again, the duty phone rings—and that's when it happens. Floria mixes up the painkillers, and due to an intolerance, one of the patients has an allergic reaction.

The doctor on duty easily defuses the situation with an antidote. But it is only the beginning of a downward spiral. Battered by excessive demands, bitterness, anger and self-doubt, Floria ends up with a nervous breakdown after the death of a patient—a patient to whom she has not been able to pay a routine visit during her shift.

Volpe's film manages to create a toxic mixture for Floria using normal, everyday patients and hospital procedures. In doing so, she communicates a state of normality on the brink—so typical in the healthcare sector.

Late Shift also warns against the emergence of grey areas. Floria sends Amelie, who has already failed to fully stock the nurse's trolley, back and forth to do errands she cannot do herself. When, due to stress, will trainee Amelie perhaps be encouraged to do something she is not yet allowed to do?

Under these conditions, tensions are also provoked among the hospital staff. This is shown in an ambivalent scene with a female doctor who, after an eight-hour surgical marathon, refuses to give a patient the overdue results when asked to do so by Floria. The behaviour of the seriously ill, mentally unstable patient, who flees the hospital in severe disappointment, seems to prove the nurse correct. Should the doctor have taken these extra ten minutes, or was her behaviour justified? The question does not arise, however, and this is where the film becomes superficial. Volpe's film ignores the increasing shortage of doctors.

The film vividly portrays the trend towards two-tier medical care. The only private patient is by far the most annoying for Floria and costs her more nerves than the senile Mrs. Kuhn (Margherita Schoch), who doesn't know where she is and can only be calmed down by the singing of a children's song.

At the point where Floria angrily throws the private patient's watch out of the window—the watch he uses to pedantically measure how long she takes to deliver tea—she has won the audience's sympathy. But a shock follows immediately, and she is punished for her unprofessional behaviour: the watch is worth 40,000 francs [$US45,000] and cannot be found at first. In reality, an actual nurse would be unlikely to respond in such an extreme manner.

The Swiss director was inspired to make the film based on the book by a Berlin nurse (Our profession is not the problem. It's the circumstances [Unser Beruf ist nicht das Problem. Es sind die Umstände, 2020], by Madeline Calvelage).

Late Shift is a stirring tribute to an important layer of the working class that takes its work seriously despite adverse circumstances and is committed to the lives and health of patients—true “heroes,” in other words.

It dramatically shows the consequences of massive cost-cutting in the health care system, staff shortages, privatization and the establishment of a two-tier system—but without fundamentally questioning such tendencies.

“A society saves money with good care,” Volpe declared in an interview with the Rheinische Post. ”The individual hospital may not make as much profit, but from an economic point of view, it makes sense to have enough nursing staff.”

Volpe's comments in the press stressing the negative conduct of male doctors toward female nurses also distract from the extent and causes of the crisis in the healthcare system. Fortunately, they were not included as a plot element in the film.

At the end of Late Shift, texts are displayed warning that by 2030 there will be a shortage of tens of thousands of nursing staff in Switzerland, hundreds of thousands in Germany and 18 millions worldwide, according to the WHO.

The contrast between the “heroines” in the hospital and official politics is striking. Governments are not focusing on health, but on “cost efficiency.” They are ruthlessly continuing their policy during the COVID pandemic, i.e., profit takes devastating precedence over life.

To be continued