By Nathan Duke

Director Ramin Bahrani’s acclaimed films (like Man Push Cart, Chop Shop, and 99 Homes) focus on people struggling to survive due to economic challenges or failing to achieve the mythologized American Dream. His latest, the short documentary If Dreams Were Lightning: Rural Healthcare Crisis, is a startling look at the challenges facing rural communities in which hospitals are closing and leaving residents without options for care. The film incorporates themes from Bahrani’s previous work, but its subjects’ struggles are far from fictional. 

Bahrani interviews people who lack healthcare resources—a combination of financial woes and a lack of access to hospitals—but its central protagonists are two women doctors operating a healthcare wagon that visits rural communities without a hospital and, to the best of their ability, serving the needs of the populace. 

Bahrani spoke with me about the documentary and how it fits into his overall body of work.

Why did you want to make a nonfiction film about rural health care? 

I had been reading a lot about hospitals closing in rural America. In my research, I came across the health wagon and was captivated by the female doctors in the film. They were so charismatic, lively, and funny, and dedicated their lives to something difficult and inspiring. 

I also had a personal connection. I was born in North Carolina, my dad is a physician, and I recall as a child going into Appalachia. He was seeing rural patients like in the film. I thought it was an opportunity to interview those same patients I saw in the waiting room as a kid. I’m Iranian by heritage. My dad became a doctor in Iran. He went to the big city and became a physician. The first thing he did was go back into the rural areas [of Iran] where people had barely seen a doctor. He’d drive into these communities with a jeep and medicine and provide free healthcare. I thought this was what these women in the health wagon were doing.

It is mentioned in If Dreams Were Lightning that the communities you visited have been “left to fend for themselves.” This could describe many of the characters in your films. What draws you to these stories?

You never know why it is you do what you do. My father’s background, I feel, had something to do with it—his upbringing and the patients he saw were of a similar, working-class nature. Maybe that led me to want to tell stories about working-class characters, immigrants, or characters struggling to survive. 

The question could be: Why are there not more films about people like this? These types of stories can be funny, surprising. 
More people are living precariously these days. Fiction filmmaking seems to ignore the majority of people in this country. When people say they feel left behind, they’re talking about a lot of things—access to medical care, jobs, education, sanitation, or representation in media and film.

Your films also focus on systems that aren’t working—for example, the housing crisis in 99 Homes, or corruption in At Any Price. This documentary focuses on a failing system, too.  

I think that’s accurate. It’s something most of us experience. It puts people in tight, tough situations, which makes for good storytelling. Characters are forced to do things they might not normally have done. I think day-to-day life is so captivating. It’s a rich source for great characters and stories.

How did the topic of dreams come into play? Most of your subjects’ dreams here border on desperation. What do you think it says about our healthcare system that so many people’s dreams are merely those of survival?

I think the sobering one was the person who didn’t even have a dream. She couldn’t even conceive of a dream. This was so sad and disturbing. When I meet people, I’m interested in hearing what people’s dreams are. This illuminates people to me. A lot of people don’t dream now, maybe because they can Google everything or they’re just overworked and stressed. 

People who were nice enough to allow me into their lives provided answers that were poetic, beautiful, and haunting. I thought it would be better to feel something rather than read a statistic. I wanted [viewers] to feel the crisis, not just hear about it.

And the title references dreams as well; what is the origin of that?

The title comes from a John Prine song [“Angel From Montgomery,” which plays over the closing credits, and the line is “If dreams were lightning, and thunder were desire/This old house would have burnt down a long time ago”]. I love John Prine’s music and went to a tribute concert, after he died from COVID-19. That’s where it occurred to me for the title.

How can viewers find hope in such a bleak, crisis-level situation in these rural “healthcare deserts”?

The subjects themselves are often humorous and resilient; they’re great storytellers, and they have a great sense of community. 

They’re also very proud, which can be a detriment if they don’t want to ask for help. That’s a nationwide syndrome. People feel like they’ve not succeeded in this country. It’s almost impossible for people to succeed anymore, but it’s a stigma. The health wagon itself is definitely a source of inspiration. 

[But] it’s hard to have hope. The political situation in this country is a mess.

The line that finance is a “judge, jury, and executioner” is startling. One subject says he struggles to pay the 20% he owes toward medical bills and works in an environment that is detrimental to his health. Do you believe this sort of problem is more widespread than people realize?

The first comment was from one of the doctors in the health wagon. The second was from a coal miner who has a litany of medical issues—such as black lung disease. As soon as he got sick, they got rid of him and cut his insurance off. These problems aren’t just in rural Appalachia. You could go to any urban center and bump into people who struggle because they don’t have healthcare. There’s nowhere for them to turn.

For many people who’ve seen the film, the response has been, “I can’t believe this is happening in our country.” People overseas are baffled that we don’t have healthcare in the wealthiest country on Earth. 

While the health wagon is a great resource, how good of a substitute is it for an actual hospital? This is not to question the abilities of those doctors, but how far can it go toward fulfilling the needs of a community without a hospital?

They need much more care. It’s a huge resource and those two women are amazing. And there are others like them, who run wagons in other parts of the country. But people need greater medical attention. It doesn’t take much for a person’s life to be upended by a medical problem.

[Spoiler and Trigger Warning]

The most shocking sequence is the text after the interview with Danny and Melanie that he killed her seven months after the interview, and the bitter irony is that he’ll finally obtain healthcare in prison. Had you heard of caregiver stress syndrome prior to this? 

I hadn’t. As soon as I heard the term, it was just so obvious. It highlights that the caregiver in any situation has their own plight. If one person in a marriage or family becomes ill, one becomes the caregiver for the other. It’s hard to imagine that everyone doesn’t know someone who is doing this. The producers told me [about Melanie’s death] and we were stunned. It was heartbreaking to hear. It’s a scene that always results in people gasping out loud. It’s disturbing.

How did you pick your locations and interview subjects?

I wanted to be in Appalachia because of my own background. We read about Dr. Paula and Teresa in the news and they were so good on camera—so compelling—and they started to introduce us to their patients. That trust became a good resource for us in getting the film made and access to people. I wanted to have vignettes of different people and the health wagon helped with that.

Is there a possibility of following up with any of these people for another film?

I’d love to see if there’s a way for this to inspire a fiction film based on this reality. I’d love to try to do that at some point.

​​Nathan Duke is a journalist and film writer of more than 20 years. An avid movie watcher, he reviews films of all types on his blog, and his work has appeared in numerous New York City and Pittsburgh publications.

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