Adapting Joe Connelly’s fragmented, deeply psychological novel Bringing Out the Dead for the screen has given filmmakers Martin Scorsese and Paul Schrader the opportunity to once again create a purely subjective experience. The literal images that flash by are the broken pieces of consciousness and dreams. We do not know how much of what we’re watching is real or hallucinated. And many scenes have a foot in both worlds, creating what Scorsese calls the state of a "waking dream." All of Scorsese’s characters inhabit this purgatory. They are all descendants of the same tortured spirit.

Like the character of Jesus in Scorsese’s The Last Temptation of Christ, Frank Pierce (Nicolas Cage) is a haunted man. He is a medic for Our Lady of Perpetual Mercy Hospital who travels the streets of New York’s West Side in an ambulance. Every night he must consort with the city’s outcasts. Pregnant hookers, half-naked drifters, and doped-up gangsters float through his consciousness like characters in a dream. The camera doesn’t shy away from them; it brings us in close, sometimes shoving our faces in the filth, blood, and excrement. Frank can’t escape the ghosts of the night, and neither can we. His trauma is our cinematic experience.

In casting Nicolas Cage as Frank, Scorsese explained that his eyes alone convey the movie’s entire meaning. The opening shot is a tight close-up of Cage’s eyes focused intently, almost insanely, on streets ahead of him. There is something disquieting in the way they sit so deep in his face, as if they have witnessed too much horror and now want to recoil from the world. They communicate the world weariness of a suffering man who has grown tired of the ghosts who have become his only family.

Frank is haunted by the apparition of Rosa, an asthmatic girl who died when he incorrectly intubated her. He sees her face on every streetcorner. She is his constant reminder, his guilt albatross. But her angelic countenance suggests that she is also Frank’s spiritual guardian. She turns his rage against the city into a mortified paralysis. She reduces the hostility that courses through the streets into something not quite benign, but more understated in its menace.

For Frank, living in the city is an oppressive burden, like the voice of God that Christ endures, and throughout the movie his mission is to seek relief and to relieve others. "The city doesn’t discriminate," he says. "It gets us all." Frank finds escape in an assortment of drugs, ranging from caffeine to the nouveau chic Red Death, and as always, Scorsese finds the perfect visual equivalents for the narcotic high. The camera hangs upside down or lies on its side; the soundtrack blares REM ("What's the Frequency, Kenneth?") and The Clash ("I'm So Bored With the U.S.A."); the editing by the virtuoso Thelma Schoonmaker cuts directly into movement so that the flash of an ambulance light or the squeal of tires pierces our reverie like an alarm bell. But Frank can only anesthetize himself temporarily. The suffering always returns.

Offering relief to others proves even more difficult. Frank meets a fallen woman – his Magdalene – who keeps vigil by her father’s bedside in the ER. Her name is Mary (Patricia Arquette). She is genial but elusive, always ducking around corners, avoiding eye contact, stifling her emotions. Like Frank, she too suffers from a nameless urban affliction. They share something so fundamental that neither acknowledges anything. In a brief but brilliant scene set to the 10,000 Maniacs' "These Are the Days," they sit together in the back of an ambulance, exchanging neither words nor looks, only allowing themselves to be jostled together as they speed through the night.

Frank shares his ambulance with other medics, but he doesn’t connect with them. Played in broad comedic strokes by John Goodman, Ving Rhames and Tom Sizemore, they have learned to zone out the Hell they live in by engaging in vulgar behavior. But Frank isn’t part of their family; he is a street dweller by birth and must always return there. He is reviled and drawn to the lower depths of existence, and when one of his spiritual brothers cries out in pain, he answers. Whether it is Noel (Marc Anthony), a drifter with a rare kidney disorder, or Cy (Cliff Curtis), a sleazy but skillfully articulate drug dealer, Frank transcends his duties as a medic to ease their worldly suffering.

Bringing Out the Dead doesn’t resolve Frank’s turmoil. There is no dawn, no ascension to Heaven. But somehow, Frank moves on to another plane of being where things aren’t quite as bleak. In the climactic scene, he confronts the voices that have haunted him, and in an act of both mercy and aggression, he silences them. The voices will undoubtedly return, but for now, Frank has found a way to retreat from them. It is a just and well-earned conclusion. The pained existence of Frank Pierce will endure, spilling onto the enshrouded streets of New York.

[rating: 4 of 4 stars]