"Bringing Out the Dead" recalls the first collaboration between Martin Scorsese and "Dead" scripter Paul Schrader, "Taxi Driver." It's a quintessential New York nocturnal tale of the occupational hazards, joys and sorrows of a paramedic, splendidly played by Nicolas Cage, as he "routinely" goes about his job of saving people's lives. Dark humor, visual pyrotechnics and bravura acting help make more palatable a movie that's intense and full of gory details.

In a radical departure from his last picture, “Kundun,” a historical epic that was basically an arthouse film, Martin Scorsese teams for the fourth time with scripter Paul Schrader for “Bringing Out the Dead.” In many significant ways, pic recalls their first collaboration, “Taxi Driver.” Based on Joe Connelly’s pulp novel, it’s a quintessential New York nocturnal tale of the occupational hazards, joys and sorrows of a paramedic, splendidly played by Nicolas Cage, as he “routinely” goes about his job of saving people’s lives. Dark humor, amusing moments, visual pyrotechnics and bravura acting from the entire ensemble help make more palatable a movie that’s intense and full of gory details and which mainstream viewers might not find appealing or entertaining. Domestic distrib Paramount should expect a moderate theatrical run, likely in the underwhelming B.O. vicinity of Scorsese’s “Casino.”

The British director Michael Powell once fondly described Scorsese as “the Goya of Tenth Avenue,” a label that perfectly applies to his new effort. Though not as resonant or brilliant as his landmark New York trilogy (“Mean Streets,” “Taxi Driver” and “Raging Bull”), “Bringing Out the Dead” is a decent, well-made movie that displays admirable balance among the dramatic, comic and absurdist elements that define paramedics’ highly demanding jobs.

Schrader, whose last script for Scorsese was “The Last Temptation of Christ,” improves on the source material, a dense stream-of-consciousness account based on Connelly’s experience as an ambulance driver. More shapely than the book from a dramatic standpoint, the taut script is punctuated by much-needed romantic and comedic interludes that modulate what’s fundamentally a hysterical, if dynamic and vibrant, yarn, epitomized by a speeding ambulance as it charges from one pressing assignment to another. Quite effectively, Schrader reduces the novel’s first-person narration to a minimum and eliminates its heavy religious symbolism.

Though this is a more mature work, critics will likely perceive it as “Taxi Driver” a generation later, and not only because of the protagonists’ similar professions. Like the earlier film’s Travis Bickle, Frank Pierce (Cage) is a man on the edge, an insomniac loner who works the graveyard shift and, in the midst of his work’s hustle and bustle, undergoes a severe spiritual crisis that may lead to either self-destruction or redemption, two motifs that run throughout Scorsese’s three-decade oeuvre.

There are also echoes of Scorsese’s “After Hours”: Like that 1985 noir comedy, new pic is a nocturnal journey structured in terms of brief encounters that progressively get more desperate and hilarious.

Story is set in the early 1990s, when New York City’s Emergency Medical Service was in disorder; in 1996, EMS was put under the jurisdiction of the fire department, which introduced some organizational improvements. This background conveys the chaos and wilderness in which Frank and his associates operate: urgent calls, heavy traffic with screaming sirens and flashing lights, overcrowded hospitals, hysterical victims. The streets are populated with pimps and prostitutes of various colors, drug dealers, crackheads, homeless people, innocent pedestrians, arguing Russians and religious Jews.

The film follows Frank over the course of two days and three nights (56 crucial hours, to be precise), as he threatens to collapse from exhaustion. Haunted by visions of Rose (Cynthia Roman), a girl he failed to save, Frank knows there’s nothing like the joy of preventing a death. Indeed, in the first scene, he rescues an older man, Mr. Burke (Cullen Oliver Johnson), who was presumed dead, and brings him to the ER.

As soon as he meets Burke’s sensitive and distraught daughter, Mary (Patricia Arquette), a former druggie whose character recalls Jodie Foster’s teenage prostitute in “Taxi Driver,” he falls for her, determined to help her face the ordeal.

The filmmakers dwell on how paramedics come face-to-face with the dead and the dying on a daily basis. Burned out by their demanding jobs, they are broken, both physically and spiritually. What keeps them going is a caustic sense of humor reflecting a worldview that is at once humane and acrid.

Each night, Frank teams with a different partner, and his distinctive interactions with each paramedic provide the film’s texture — and most entertaining elements, for ultimately the narrative is about survival, or how these pros cope with the miseries inherent to their chores.

Unlike the emotionally involved Frank, who does not separate himself from the suffering around him, Larry (John Goodman) endures through cool detachment — and his varied nightly meals. In contrast, Tom (Tom Sizemore) is as savagely dangerous as some of his patients, a borderline sociopath whose sense of justice is demented. Fatalism and Christianity seem to be the guiding principles for Marcus (Ving Rhames), who has found a way to deal with death, convinced that every man has his own predetermined biological clock.

With the exception of Arquette, who gives a merely adequate performance, rest of the cast is first-rate. In his best role since the Oscar-winning “Leaving Las Vegas,” Cage is suitably cast as a tormented, empathetic man in desperate need of salvation and sleep; pic’s closing image of him achieves a poetic, quasi-religious tone.

As much as “Boogie Nights” and “Out of Sight,” this film has been blessed with a large and superlative ensemble of secondary characters, with standout turns from Goodman, Sizemore and Rhames as the three radically different partners.

Also hitting high notes in small roles are Mary Beth Hurt, who shines as a cynical nurse; Arthur Nascarella, as the captain who refuses to fire Frank; Marc Anthony as a pathetically crazed homeless man; and Afemo Omilami as a cool hospital guard who never removes his sunglasses.

Arguably the most surreal and psychedelic picture Scorsese has made, “Bringing Out the Dead” benefits from its mostly nocturnal on-location shooting (primarily in Hell’s Kitchen). Ace lenser Robert Richardson has successfully devised elaborate lighting techniques and camera rigs for the dialogue scenes within the confined space of the ambulance.

The masterfully staged climactic sequence, involving drug lord Coates (Cliff Curtis) achieves the kind of dazzling effects (and literal fireworks) that recall the climax of Leos Carax’s “Lovers on the Bridge.”

Also making distinguished contributions are production designer Dante Ferretti — particularly his garish, pink-lit design of “the Oasis,” Coates’ refuge for those suffering in the real world — and longtime editor Thelma Schoonmaker, who accomplishes wonders in her seamless, often hypnotic montages of street scenes.

Although Scorsese and Schrader may not have pulled off alchemy by transforming an undistinguished piece of literature into a great film, “Bringing Out the Dead” is still the best adaptation imaginable of its source material, and a mature reworking of many of their longtime preoccupations.

Bringing Out the Dead

Production

A Paramount release of a Paramount and Touchstone Pictures presentation of a Scott Rudin-Cappa/De Fina production. Produced by Rudin, Barbara De Fina. Executive producers, Adam Schroeder, Bruce S. Pustin. Co-producers, Joseph Reidy, Eric Steel. Directed by Martin Scorsese. Screenplay, Paul Schrader, based on the novel by Joe Connelly.

Crew

Camera (Deluxe color, Panavision widescreen), Robert Richardson; editor, Thelma Schoonmaker; music, Elmer Bernstein; production designer, Dante Ferretti; art director, Robert Guerra; set decorator, William F. Reynolds; costume designer, Rita Ryack; sound (SDDS/DolbyDigital/DTS), James J. Sabat; supervising sound editor, Philip Stockton; special visual effects, Industrial Light & Magic; associate producers, Jeff Levine, Mark Roybal; assistant director, Joseph Reidy; casting, Ellen Lewis. Reviewed at Paramount Studios, L.A., Oct. 13, 1999. MPAA Rating: R. Running time: 120 MIN.

With

Frank Pierce - Nicolas Cage Mary Burke - Patricia Arquette Larry - John Goodman Marcus - Ving Rhames Tom Wolls - Tom Sizemore Noel - Marc Anthony Nurse Constance - Mary Beth Hurt Cy Coates - Cliff Curtis Dr. Hazmat - Nestor Serrano Nurse Crupp - Aida Turturro Rose - Cynthia Roman Griss - Afemo Omilami Mr. Burke - Cullen Oliver Johnson Captain Barney - Arthur Nascarella
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