Wednesday, January 26, 2011

PBS Frontline - Facing Death

Facing Death is an impressive documentary report on end-of-life at the hospital. It is the visual version of Dr. Gawande’s New Yorker article, Letting Go. Only this time the message is directed at us, not the doctors. We are told that almost half of all deaths take place in hospitals and then we are shown just how awful that looks.

The film should be called “fighting death” rather than “facing death” because that is what the people do who are featured in this film. Patients do not want to die and their families do not want to decide for them. They fight death like heroic soldiers in a desperate war. It is wrenching to watch as fragile and failing bodies submit to yet another painful intervention on the wisp of a hope that this time they’ll beat the odds. For most, the end is death, for some it is unconsciousness on a ventilator for unknown years to come.

The medical system is absolved. Although there is always uncertainty, the doctors know the odds and do their best to convey that to their patients. But what can they do in the face of people who don't want to die and families that won't let go? And of course there is always one more thing to be done. And you never know, sometimes patients surprise you.

Throughout the film we are continually reminded of the financial costs of various procedures. Is this why medical insurance is so high? We are informed that the United States is the only country that allows this vast expenditure of resources at the end-of-life. Do you remember the palliative care conferences that were to be paid by medicare until Fox News started calling them "death panels?" They were removed from our new health bill.

The film's vision is true one. Our current approach to death is painful, scary and expensive. See Sharon R. Kaufman's book . . . And a Time to Die -- How American Hospitals Shape the End of Life. Yet I feel manipulated -- by all the images of suffering, the monetary statistics, the compassionate doctors talking to distraught families who resist their advice. The film is intended, I believe, to prepare us for things to come. Big changes in health care are inevitable. The first of the baby-boomer will turn 65 this year. They are the first flakes in the coming storm of aging medical consumers. Our hospital approach to end-of-life will buckle under those numbers. And what will our brave new world look like? I cannot tell you. But I believe that people in this country will need more than fear-provoking film images to change their response to death. They need a palatable alternative, and that the film does not provided.

Monday, January 24, 2011

Films About Life and Death

Below are some films I've recently found in the library and enjoyed.

A Rumor of Angels
There are a number of things to recommend this American film directed by Peter O'Fallon back in 2000. It’s unflinching stance on death very refreshing in this age of doubt and equivocation. The film follows the blossoming relationships between an 11 year old boy haunted by the car accident that killed his mom and an eccentric elder, Maddy, who lost her only son in the Vietnam war. Maddy, played by Vanessa Redgrave, helps the boy face his grief by sharing her own experience. A significant part of this is her journal of communications with her deceased son. “Death,” she is told in heavenly Morse code flashes on the night of his passing "is like stepping off a bus.” The take-no-guff interactions between Maddy and the grieving boy celebrate intergenerational communication, elder-wisdom, and a be-true-to-yourself spirit. It is an uplifting and reassuring film.

The Son of the Bride
This 2001 Argentine comedy/drama about a frazzled restaurateur and his aging parents, is not so much about death as about embracing life. After a sudden heart-attack, this 42 year old divorced man starts to re-think the direction his life has been taking. Fully caught up in keeping alive the restaurant his parent started, he has no time for his girlfriend, his daughter or anything else in his life. Gradually and at times painfully he finds his way back to living. What make this film special are the quirky characters that guide him. The acting and humor are charming in that South American way and the loving relationship between the man’s father and his mother who is suffering from Alzheimer’s is precious. A lot of lessons are learned, both humorous and serious, on the meaning of love, friendship, and marriage.