November 14, 1999 -- Martin Scorsese grew up in these hard, violent streets of New York and he's shot a lot of film there, from "Mean Streets" in 1973 (which kick-started his career and that of a couple of unknown actors in that film, Robert De Niro and Harvey Keitel) to "Taxi Driver" in 1976, to "Gangs of New York" coming out next year.

Scorsese has an ear for the street sounds, for the siren call of the prostitutes and drug dealers and an eye for the flashing lights of gunfire, police cruiser and ambulance lights, the silhouette of a passionate kiss, the bulge of a baby in the belly of a prostitute, all against a background of grinding poverty, drug addiction and violence. The creative energy contrasts with the destructiveness of life. These are the things Scorsese sees when he closes his eyes, and he has the craft to pull you into that world of his.

These are also the things that Frank Pierce also sees when he closes his eyes. Pierce (played by Nicolas Cage of "8 Millimeter) is also haunted by the patients he has tried to save and could not. In the ultra-high stress job of a paramedic in this hellish place, Pierce is losing his battle with sanity. Once the ghosts of his lost patients only haunted his dreams, now he sees them in his waking hours. He can't sleep. He lives on coffee and whisky.

If Pierce is losing his sanity, he is not alone. The paramedics he works with have their own problems. Larry (played by John Goodman of "The Big Lebowski") is a maniac behind the wheel of the ambulance as he seeks food on his nightly rounds. Tom Walls (Tom Sizemore of "Saving Private Ryan") would just as soon kill patients as save them. Marcus (Ving Rhames "Entrapment," "Out of Sight") is off the wall too, but manages to hold himself together with evangelical faith tempered by a healthy libido. At the "Our Lady of Misery" hospital a police officer tries to maintain order in a chaotic situation. "Don't make my take off my sunglasses!" he warns. A nurse relentlessly tells her patients that if they are going to take drugs and make other unhealthy lifestyle choices, she would appreciate it if they went to another hospital next time.

One thing all these people have in common is the need to save lives. Pierce's problem is that he's on a bad streak. He knows that in 80 percent of the cases his paramedic training is of no use at all and his chances of saving a life are small, but when he does save a life, the effect is stronger than any drug, it lifts his spirits and makes him whole again. He walks on air. It's been weeks since he saved anyone and he is going mad.

When Pierce is late for work he and his boss go through this routine. Pierce asks his boss to fire him and his boss says he can't. He needs him on the street, maybe later. He slams his fist down on the bosses desk. The boss promised yesterday he would be fired if he showed up late today! Scorsese manages to achieve a perfect balance between the comedy and horror of ths story, and between hoplessness and hope.

Pierce and his co-workers drive endlessly through the city nights. Suicide attempts, shootings, women giving birth, drunks, lunatics. It all blurs together. Scorsese gives us different angles, reflections, swirling lights of colored madness. Everywhere he sees the face of a young girl he failed to save. "You killed me," she says, looking at him with lovely, mournful eyes.

Pierce finally makes a connection with a woman, Mary Burke (Patricia Arquette of "Stigmata"), who seems as desperate as he is. Pierce grabs on to this lifeline, trying to pull himself up into sanity. In a dream, he sees himself pulling people up out of the streets, where they seem to have sunk, as if in quicksand. Will he find redemption and come to terms with his ghosts?

Cage here has a character very similar to the Oscar-Winning role he had in "Leaving Las Vegas." He has this act down very well. Arquette is also very good as a woman who is trying to cope with her love-hate relationship with her dying father. Rhames is excellent as the born-again ambulance driver who likes to deliver sermons and miracles while cruising for chicks. Sizemore once again shows he's great at playing scary guys on the very edge of psychosis. This is one of Scorsese's best films in his illustrious career, the best since "Goodfellas." It rates an A.

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