"This city'll kill ya," says Mary (Patricia Arquette), a depressed New Yorker who has been clean for years but is now drifting back into drugs to bury her pain. Her comment could be taken metaphorically, but for the people in Martin Scorsese's new and gritty movie, a film that like all others by that gifted director relies only minimally on tired formulas, the suggestion is in fact literally true. The screenplay, written by long-term Scorsese collaborator Paul Schrader from a novel by Joe Connelly, is not the sort that the Big Apple Tourist Board would promote. "Bringing Out the Dead," which takes place in the early 1990s and is situated in the grimy Hell's Kitchen area of the West 40s (the scene as well of Leonard Bernstein and Arthur Laurents' musical "West Side Story"), depicts a city badly in need of a strong mayor and a heavy dose of moral fiber. It could, in fact, have served as a campaign video for Rudy Giuliani, who became its current resident in Gracie Mansion on a promise to tighten law enforcement and employ a zero-tolerance policy toward malefactors. While "Bringing Out the Dead" bears a strong Scorsese imprint (in some ways a virtual sequel to his 1976 masterwork "Taxi Driver"), life in the city's lower depths serves as mere background, however intensive, for an exploration of its central characters who are each grieving for a lost opportunity and seek closure in each other's companionship. This is also Nicolas Cage's finest performance since his equally somber role as an alcoholic determined to drink himself to death in Mike Figgis's wonderful 1995 film "Leaving Las Vegas."

This time around, Cage performs in the role of Frank Pierce, a paramedic who drives an ambulance on the night shift with three distinctly different partners, and who regrets that he has not saved a life in many moons. The movie is chock full of leathery scenes, many portraying Gorky-like depths of depravity. "Bringing Out the Dead"--based perhaps on the daily rounds made by its novelist, Joe Connelly, who was himself a paramedic--is likely as not to make you wonder why people choose high-stress occupations which for all the strain do not pay princely sums to their agents. Scorcese's movie, not for anyone who insists on a "good story" with a tight plot, takes us a three-day physical and psychological ride with Frank, with his three fellow drivers, and with the crew manning the emergency room of an overburdened New York City hospital appropriately named Our Lady of Perpetual Mercy. The burnt-out Frank, who openly and self-destructively challenges his boss (played in a small role by Martin Scorcese himself), to fire him, patrols the streets of the West Forties with his quirky partners, radio frequently jumping to life with emergency assignments. As Frank occasionally narrates his story in a voiceover, we follow him as he responds to a call regarding an old man in cardiac arrest whose entire family jumps each time Frank administers a shock from a defibrillator. Other calls, treated more routinely, include the picking up of a suicidal man; the parking of a chronic drunk into a wheelchair prior to his transport to the hospital; and the pursuit of an addicted, violent, and paranoid man named Noel (Marc Anthony) who regularly cries out for a cup of water. The film's one faintly humorous scene takes place in the crash-pad of a small-time drug seller, a regular Mr. Cool, who appears to take his customers' problems to heart and allows them to take much needed rests in his apartment while the sedative effects of his merchandise kick in.

Scorsese also makes points in displaying the idiosyncrasies of Frank's partners: Larry (John Goodman), a foodaholic who covers up his problems by overindulging; Marcus (Ving Rhames), a Christian fundamentalist who treats his job of bringing back the dead as the work of Jesus; and the sadistic Walls (Tom Sizemore), a veritable human vampire who figuratively thirsts for blood and welcomes the cracking of the ambulance radio that allow him to chase after mauled and maimed victims of violence.

Much of "Bringing Out the Dead" is unfortunately routine and predictable, the stuff of TV hospital dramas and "48 Hours" style documentaries. By now, most people are at least vaguely aware of the unending suffering of the poor, who seek aid in emergency rooms rather than embrace the services of private physicians. The druggies, the drunks, and the crazies are not particularly interesting and we learn nothing about them that could enlighten us to the sources of their misery.

On the other hand, the growing relationship of Frank and Mary (Cage and Arquette are married in real life and work together for the first time), is compelling, particularly because Scorsese does not push the usual buttons to establish a romantic bond between them. Mary has been estranged from her father for a few years and begs the hospital staff to use extreme measures to keep him alive. When that becomes increasingly unlikely, she turns to Frank, with whom she has established a tie, and who needs her as well to get over his repeated contacts with the ghost of an 18-year-old girl whose life he was unable to save. To the extent that they succeed in redeeming each other, the movie is not a downer--contrary to the opinion of Wall Street Journal critic Joe Morgenstern who, in a recent commentary on CNN, turned thumbs down simply because he felt that the film was not sufficiently feel- good. "Bringing Out the Dead," then, is a mixed bag--one whose background noise is unremarkable but whose success in establishing a compelling connection between Nicolas Cage and Patricia Arquette is most satisfying.