Being Mortal (full film) | FRONTLINE

tonight on Frontline all the stuff you learned about in medical school is just a tiny little bit of what it means to be good at our jobs based on his best-selling book being mortal so many people I see their death comes as a complete surprise dr. Atul Gawande takes us inside conversations with doctors and patients about dying oftentimes what we say as physicians is not what the patient here's a personal journey my dad cried my mom cried I cried he did not want to end up on a ventilator he said let me die the struggle between hope what did we forego by pursuing treatment after treatment after table which made her sicker than sick and sicker and making peace with the end the last four weeks have been surrounded by family and friends some of the best he's my life I must say tonight on Frontline being water [Music] [Music] I've been a surgeon for more than a decade now in medicine your first fear as a doctor is that you're supposed to be able to fix a problem and our anxieties include wanting to seem competent and to us competent means I can fix this in fact there's often a kind of implicit promise I'm gonna be able to fix this I'm gonna certainly give you the best shot you can have nobody could have given you a better shot and then when things aren't working part of your anxiety is was there something I missed was there anything else I could have done when I started out in my training and surgery you discover that all the stuff you learned about in the books in medical school is really just a tiny little bit of what it means to be good at doing our jobs it's not just about how smart you are anymore as a doctor it's about how you have to be able to work with teams and how mistakes get made and how you handle them and how you learn among the most uncomfortable difficulties was grappling with those cases where we couldn't solve the problem the two big unfixable czar aging and dying you know they're not you can't fix this [Music] I'm a surgeon and I'm a writer my writing has become the way that I can focus in and begin to understand the problems that most confuse me one case in point of was a piece I wrote called letting go about a woman named Sarah Monopoly who might help take care of who was diagnosed with stage 4 lung cancer during the ninth month of her pregnancy at the age of 34 this was one of the most difficult circumstances you have a young woman with a brand-new baby of course everybody is fighting for every chance that she's got she was young she was enthusiastic she wants to tackle this you don't want to be the downer so you're looking you're grasping for a straw that says well there's something here that it's gonna be beneficial stage 4 lung cancer we know it's not curable but suppose she's the one that somehow gets cured maybe she's the one and so therefore we should do all these things to her having any kind of discussion that would begin to say look you probably only have a few months to live what do we do to make the best of that time without giving up on the options that you have that was a conversation I wasn't ready to have I don't think any of us were hey there take me back to when she's pregnant she's doing great 39 weeks your due date is coming and the collapsed lung would not allow for a c-section it was too dangerous to be opening her up with all that fluid buildup so Sarah had Vivian basically pushing with one lung it was so difficult but she had baby you want to be part of that 15% that survives more than five years you want to be that part of that for that group so badly and you say yourself why not us you know it wasn't about okay how can we have good days to the end we didn't focus on that enough we're trying to stabilize the situation and try to become a little it's been a little bit of time as a family but it was just it was an impossible situation possible summer well it's just excruciating when I came on the scene was when she got diagnosed with a second cancer you know in my mind what I was thinking was I wouldn't offer this surgery because the lung cancer was gonna take her life and yet I didn't feel I can say that to you all I think we started talking about the experimental therapy that you all would like we're hoping to get on for a trial with the lung cancer and I remember saying something I sort of regret which was you know maybe that experimental therapy will work for the thyroid cancer too I said I know it was but you had joined us Indian are we in our sunny disposition I'm hoping for the best I knew that I knew it was not good I mean I I in other words the reason I regret it is because I knew it was a complete lie I just was wanting something positive to say I did not know it was an outright lie you could lose your license for okay but I you know I think I don't think I was terribly equipped for having that conversation and maybe you all weren't I don't think we were I've thought often about what did that cost us what did what did we miss out on what did we forgo by consistently pursuing treatment after treatment after table which made her sicker and sicker and sicker the very last week of our life she had brain radiation she was planned for experimental therapy the following Monday you woke up and she wasn't doing so well on a Friday what happened then so she woke up and was gasping for air and I tried to crank the oxygen up I said let's max this thing out maybe we get a bigger oxygen machine we're so close to getting for the next potential fix and she said I can't do this I can't do it at home I'm too scared I'm gasping for air and I can't I can't do this we should have started earlier with the effort to have quality time together the chemo had made her so weak that she couldn't hold it in hmm it was exhausting and that was not that was not a good outcome for the final final months it's not what we wanted to be in the last three months of her life almost nothing we'd done the radiation the chemotherapy had likely done anything except make her worse it may have shortened her life it was interesting to me was how uncomfortable I was and how unable I was to deal well with her circumstances it felt like a revelation in that here was a case which I could unpack enough to understand why do we always go off the rails it made me want to explore what other doctors were doing in these extremely difficult circumstances what I hoped was that maybe I might learn something that I should be doing differently I work at the Brigham and Women's Hospital and dana-farber Cancer Institute in Boston they're connected together across one street it's here that my colleagues let me observe their experiences with patients facing the end of life the struggles and the difficult choices one was Lakshmi Nayak she's a specialist in cancer of the brain and she has to have these end of life discussions with almost all of her patients you picked a pretty tough field right so if you how many of your patients will you cure or help them have a better life it's almost always fatal we have you know each of us has an odd patient who survived for 10 years or 15 years but that's less than 5% of all of the patients that suffer from is the most common malignant brain tumor so yes I I don't get to tell people I'm gonna cure you one of dr. Nayak's most challenging cases at the time was a man named Bill Brooks he was 46 years old bill has brain cancer that basically in his case has led to raised pressure in his head but he feels really well Bill's sister had also died of a brain tumor and that was what he was worried of the most he always liked delicious everything is good for you use anything you know we're so lucky we we have each other we have great families we have great friends we are great jobs we live in a beautiful home and we're lucky and then you know all of a sudden it's like our world was turned upside down it's a battle you know some people say don't listen to the numbers that I always say well that gives me something to shoot for if they tell you five years let's go for six ten 10 so build storing from the very beginning has been challenging because when I first saw him I thought he had five to ten years with that change his symptoms started getting more aggressive the headaches the headaches the not being able to lie down I actually called Mary I said we don't have much time we probably have a few days to a month and I told her she should take time off work she started having pressure decided and we dr. Knight gets very um she takes a vertical she takes it very personally when she wants to give us bad news if she basically just told us to get ready and so you know of course you have your pity party and then you kind of like don't give up hope so after the phone call dr. Nayak ordered a series of spinal taps to relieve the pressure in bills brain and it worked the pressure came down he felt better and they had new hope but the disease was still progressing you started having some pressure can I check a few things haidle what I was looking into your eyes was not the way your pupils reacted was but to see what the pressure might be and I'm worried that the disease will be growing I think that it's important for us even though it would be easy to sort of skip over this today yeah that we should talk about if things are not going as we hope to just talk about worst-case scenarios a little bit and then best-case scenario - what made you jump in to say best case as well as worst case I think that I'd scared them the first time hmm you're thinking back to when you talked about in you're worried that you'd lose their confidence if you only talked about the bad side yeah and especially because he had been responding to treatment it just gives them some hope as long as you're not giving them unrealistic expectations out of treatment what's the third option has to be a third option we do things together we often are finishing each other's sentences if dr. Nayak had said let's talk about worst-case scenarios then I would have said and we'll talk about best-case scenarios have you thought at all first worst-case scenarios go if you would want Hospice at home or husband facility do it at home when we talked about Hospice I was reading Mary's body language that was sort of saying to me don't go there but given all the things that were going wrong I felt like we had to do that have you thought about anything after the MRI I thought and marries her we say it a lot is I want to see the next one to kind of see if it's showing anything or not before I start to get worried or get too hopeful okay thanks good to see ya it was amazing to see how my colleagues had these conversations and it was teaching me what I might do better for my own patients [Music] turned out it also taught me how to do better for my dad you got some bad news back home in Ohio I remember I took notes in my journal around that time do you remember when dad first started to get pain in his neck he had been in his shoulder and he thought that either clean too much tennis or just muscle so when the result came even a shark you've gotten an MRI and as a surgeon he knew the results were not good he emailed the images I opened him up and it's a huge mess and it's concerning he called me up and as we're piecing it together over the phone we're kind of realizing this is right in the middle of the spinal cord so the puzzle is how do you get this out we're two surgeons looking at amassed slike two carpenters looking at a house you know you're not saying oh yeah we can't fix this but you know at the end of that conversation I'm thinking this could this this could be a life-threatening problem it was hard for us as a family to talk about this and that's despite three of us being doctors in fact talking with anyone near the end of life about their decisions is so difficult they're actually physicians who specialize in the process they're called palliative care physicians people like Kathy selvaggi who works at the dana-farber her technique is as much about listening as it is about talking what would be on your checklist for what I should make sure I do when I'm doing it next time first of all I think it's important that you ask what their understanding is of their disease I think that is first and foremost because oftentimes what we say as physicians it's not what the patient hears and if there are things that you want to do let's think about what they are and can we get them accomplished you know people have priorities besides just living longer yes you gotta ask what those priorities are yeah tune the treatment to those priorities exactly and if we don't ask and if we don't have these discussions we don't know dr. Sivaji works with doctors throughout the hospital to help with their hardest patient conversations so how are you feeling ayman al Faqih was one of those doctors he's an oncologist who like me grapples with reaching good decisions with his patients about dying he'd been caring for a patient named Norma Babineaux for two years he said that during that time he had tried to broach how dire her prognosis was but he had not been successful let me start by giving you both an overview where or at now because the cancer has have developed a more aggressive course to it right it's a more resistant type Tim but just keeps marching along this is where the tough discussions come up the disease we knew has been acting up right now in this state what treatment would hurt you more than help you that's just a fact and you would not get the benefit of it or we could be talking about three to four months we can be longer it can't really be shorter if it if the pace picks up it wasn't gonna happen in between it's a question you had to ask and I don't want you to dwell on that if I were gonna bet on somebody doing better it would be I'd be betting on you to do better than that timeline our goal is for whatever time is left is to make it the best quality that we can are we gonna find the right medicine to give me a good house but I can't take any tricks so the really hard part I find in these situations is you know it'll come to this point when do you help them understand that looks fun through your mind now what does it feel like to you but I wish I could do better I still feels like a little bit of a failure it's very much a family that's hard even though you knew from the beginning you weren't gonna be able to you aren't curing this problem it's just a fight mentality that perhaps goes back to training in med school in just the way we are wired and we're not trained for that other mode yeah that's where we have to take our cues because I tell you don't care doctors like Kathy selvaggi are different they're teaching us there might be a better way in these circumstances I think I think it's hard to hear sometimes the time line but I think it's also important to have a sense because if there are things that you want to say or do or people that you want to see it helps you define that time a little better I think she knew that she was getting sicker and weaker one of the goals was to try to get her home with hospice services but the medications and the things that were requiring it's just not going to happen we're not even knowing whether we can leave the hospital exactly so we didn't do that before last Monday feels really late in the game you know it does feel a little bit late in the game we you know we're all sort of taught that in order to make a difference in our patients lives we have to be doing something we have to be operating we have to be giving them a medication we have to be radiating we have to be giving chemotherapy in some ways I think the medicine is the easy part it's all of this other stuff that's much harder to deal with how are you I wanted to talk with you about I know the other day normal we talked about where to go from here you may need more and more IV or intravenous medications to control your symptoms and I'm worried that we're not going to be able to do that at home what do you think about that are you when you say coming close that we're coming near the end I worry about the same thing and what we'll do is real will keep you here and we'll take care of you here okay all right all right we'll see you a little later okay okay okay why don't I clean this out Kathy selvaggi had helped Norma understand that she was dying still Norma had little time to say her goodbyes she died 10 days later these are really important conversations that should not be waiting the last week of someone's life between patients families doctors other health care providers involved in the care of that patient there's no natural moment to have these conversations except when a crisis comes and that's too late so I began trying to start earlier talking with my patients and even my dad I remember my parents visiting my dad and my mom and I had sat in my living room and I had the conversation which was what are the fears that you have what are the goals that you happen you know he cried my mom cried and I cried he wanted to be able to be social he did not want a situation where if you're a quadriplegic you could end up on a ventilator you know he said let me die if that should happen I hadn't known he felt that way this was an incredibly important moment these priorities became our guideposts for the next few years and they came from who he was as a person who had always been my dad came from a little farming village in the middle of India you know thatched mud huts no running water a village of about 5,000 people his father had 13 children his mother died from malaria when he was about 10 that was when he decided he wanted to be a doctor he went to medical school in India afterwards he was offered a job in a hospital in New York City training to be a surgeon he met my mom and married her and they moved to Athens Ohio to set up their medical practices and raise a family there he was part of the community and that became especially important to him after the cancer as the tumor slowly progressed we followed his priorities and they led us and him to choose an aggressive operation and then radiation but eventually paralysis set in and then our options became chemotherapy so the oncologist lays out not hate or nine different options and we're swimming in all of it team is Olamide Vinnie Christine then started talking about how you know you really should think about taking the chemotherapy who knows you could be playing tennis by the end of the summer I mean that was crazy it made me very mad you know this guy's potentially within weeks to B of being paralyzed the oncologist was being totally human and was talking to my dad the way that I have been talking to my patients for 10 years it was holding out a hope that was not a realistic hope in order to get him to take the chemotherapy I then pushed we were still in the back of our mind thinking you know was there any way to get 10 years out of this anymore she basically was saying no and we needed to know that medicine often offers a deal we will sacrifice your time now for the sake of possible time later but my father was realizing that that time later was running out he began really thinking hard about what he would be able to do and what he wanted to do in order to have as good a life as he could with what time he had I guess the lesson is you can't always count on the doctor to lead the way sometimes the patient has to do [Music] when I first learned of Jeff Shields he had already gone through three years of treatment for a rare form of lymphoma chemotherapy hadn't worked he hadn't given up hope but he was also recognizing that his odds were diminishing even as his doctors were offering him more treatment options well my experience has been that oncologists at least my doctors are basically optimistic and they're always looking for a way to push the disease in entering mission than they are in talking about the longer-term picture of mortality I spent time talking to Jeanne my wife thinking about at least for me I want to make a decision I don't want to linger we've had conversations about all all aspects of what the end of his life might look like and most of all he says I want to be at the farm and you know hopefully I'm in a position to make sure that happens we have an appointment that I hope will result in them saying that the disease is lessened but they might say no it's not under control and then we're going to start having a conversation about mortality and because I don't think there are so many more choices for a Jeff in terms of treatment hey hey Jeff my pleasure any results of the biopsy yes the preliminary results do look like Rare versus host disease and that's not necessarily so surprising we we expected that I first met mr. shields about two years ago at that point he had a bone marrow transplant and unfortunately about a year after the transplant he showed signs that his disease was coming back in addition to that he has a complication of transplant where the donor cells are actually attacking his body and unfortunately it's wearing him down it almost goes without saying but we may have to make it you know a new game plan a weekly you have to feel really crummy or spend the last three or four weeks of my life in the hospital is not very appealing to me I bet not and so when we get to that point I'll rely on you to make sure we have that conversation and it's a it's a group discussion for us all right it's always a hard thing right how do you know if they're coming towards the end versus changing the therapy again well I don't think we ever know with Jeff he was very very thoughtful fellow and thoughtful in the sense that he had considered what would happened down the road and he made it very clear to me that if we thought some therapy might be helpful might prolong his life with reasonable quality of life he was happy to go for it he also made it very clear that if we thought that things were gonna go badly or things look like they weren't going to work didn't want to pursue therapy just for the sake of pursuing therapy [Music] it seems to me there's such a difference in these last few weeks and we know the lymphoma is growing and sort of rampant what I'm worried about is could we be coming to a place where it's actually killing you and we don't have the opportunity to really talk with the children that I am when I consider in hospice other words end stage and we don't have I am gonna live for four weeks and we are thinking oh maybe there are three months yeah yeah I think we should ask that at our next visit all right go into your benadryl stupor unfortunately your Billy Rubin is up but the other liver function tests are a little down I can't put a particularly good spin on that I don't know how negative is spent to put on that but I can't put a good spin on that I wanted to clarify yeah I don't want to go back to the hospital I want to die at home yeah and that's really my goal yeah and so I want you as my doctor my good friend and know that the hospice people won't know it yes Jeanne knows it that's my desire it's impressive for a patient and a family be so clear about their priorities like Geoff feel to us accepting that life can be shorter than we want is very difficult it's easy for all of us patients and doctors to fall back on looking for what more we can do regardless of what we might be sacrificing along the way and that's especially the case with younger patients and that is where a doctor needs to be skilled I think it's always a challenge how to say it that this is not working and I have nothing more I try to deliver the bad news in pieces over a period of time I feel a lot of times they don't absorb all of the information and that's why you have to keep repeating it and you saw that with Bill Brooks yeah so the MRI there's a little change unfortunately there's a small area a new spot it's not super large but it's there this is the beginning of the end I think it's progressing to an extent that we may not be able to do anything to control it he's one of those few people and whom you know if there's something that you could try it's worth trying rather than just waiting what do you think about the happy I just saw it on the news yesterday they just got FDA approval for one of their brain tumor medications that drug we actually have trial with that drug I'll look into it I'll look to see what the status of that is and see if it makes sense for you to get it it's not gonna be on a clinical trial for you if we do it would have to do it as a compassionate use and I wouldn't want to give you something if it would potentially make things worse so I'll definitely look into that bill brought up this particular drug but it is experimental are you at all worried that he would just have toxicity from the drug without benefit yes and no at this point I knew that he wasn't gonna live for too long without anything so whether he at least he felt that he could try [Music] bill was only able to get one dose of the experimental drug because he was getting sicker the spinal taps were beginning to stop working push push the pressure has had continued to build and the effects were becoming undeniable that was when he began to prepare I'm really declining quickly I need a lot more help even doing basic basic walking and things like that I just don't have the strength in my left side so if I get leaning one way just I can't catch myself can I flip oh yeah took me 15 years to collect this more valuable more collectable things or you know from back years ago I died tomorrow she's not gonna know how to dispose of this properly to get the most bang for her buck let me just move all these canvas ones well those are gonna be the good ones these are the good ones the canvas ones yeah okay yeah that one's a good one I'm just overwhelmed with everything the mental roller coaster has been the hardest thing to deal with it's like okay am i dying am I not can i function can I not you know and then they're trying to tell you stay positive keep hoping keep fighting and I'm like I've been doing that for two and a half years I'm out there and then my tropes as far as that goes I can't take any more bad news I try they're going to the meeting I ever just pull a gun out and shoot me I didn't have to listen to her try and be nice while she's giving me bad news like I said I'm I'm a positive person but at the end of my ropes with it it's best I get accepting death comes with incredibly complex emotions bills hopes for more years had turned to weeks and the question became when to let go of treatments if they're not helping to accept what dr. Nayak and Sandra had been conveying about considering hospice I think we need to talk about what's been going on for the last few days the fact that you didn't respond to the spinal taps I wouldn't want to put you through any more spinal taps there is going to be a time when or not going to be able to deal with the pressure with the steroids we will be able to help with pain and then making you comfortable I'm worried that your disease is progressing quickly we've talked about you know hospice before and I think this is the time where we need to discuss a bit more about it oh we're and I have talked many times I thought again is I'm not afraid to die but I'm afraid of all the suffering that goes beforehand so we just are trying to find out you know one that it's gonna come to pass this week say goodbye to each other so much information did your that over and over again but you just tell people what I think it's a reality compressor just being able to be silent for a while were you deliberately trying to be silent look let it happen yeah I think it's important to pause at the right time sometime it's a lot of information but hopefully the last bad news for the day [Music] at this point is just making sure it's as comfortable as he can be you know and that's the most important thing you know what's working against him in a way is that he's young and strong it'll just mean that he'll linger longer this is that yeah it's basically just let him just go peacefully you know unless there's another miracle okay anyway like you said it just depends God the bad daddy home so yeah I'm gonna go check out if I just want to make sure he's okay are you okay I'm right here sweetie just want you to be comfortable bill died two days later [Music] as this home time began to unfold I began to realize how how difficult it was partly because our our house was not organized or arranged to to comfortably do this no suddenly of a hospital bed in the middle of your living room pop up take his slippers off can you do that you want it to be as comfortable and happy a place for him as it can be at the same time it's you know it's sort of the elephant in the room if I talked to you at all about my thoughts are dying and yeah is it too hard okay let me just tell you this I'm not afraid of dying I've had a long and wonderful life and one of the nice things about being at the farm is that you realize everything does there's a cycle of life the cows die the trees die the grass dies the fish bag and people like Angie said that you're going to be missing out on a lot of things well I will be and you know I had hoped to have another 10 or 15 yes but you'd always think what you want hell of you see in a few minutes in those last weeks no it's his as his space narrowed narrowed to that bed it grew in terms of the people he was drawing in a hate crime sorry but that's another one of those paradoxes you know as yet as your as your world comes closer and smaller and smaller and bigger and and and he was seeing that the last couple of weeks I've been surrounded by family and friends and it's been terrific you know some of the best days of my life and let's say but then there's a downward trend that's more rapid than I had expected I felt great during that time and my body was in rapid decline since then my mind has been in rapid decline I get confused [Music] so but I'm still a happy guy Jeff shields words about his last weeks being his happiest seemed especially profound to me because they were among his last words he died just hours afterwards in medicine when were up against unfixable problems were often unready to accept that they are unfixable but I learned that it matters to people how their stories come to a close the questions that we asked one another just as human beings are important what are your fears and worries for the future what are your priorities of time becomes short what do you want to sacrifice and what are you not willing to sacrifice my father answered these questions he entered hospice for months as would turn out before he died and he was a person mostly during that time he was not a patient my dad Skyped with everybody back to his village in India he had me and my sister come there and be with them and he remained in control of the priorities that were most important to him I remember sitting in a chair reading the newspaper light coming in the window my mother and my sister were having a conversation and then we realized he wasn't breathing we waited to see if there would just be one more breath and there wasn't my dad made his wishes for what his life would be like to the very end very clear to us including for what should happen even after the very end [Music] he wanted to be cremated in the traditional Indian Way and he wanted his ashes spread on the Ganges River we took his ashes my sister and my mother and I to the ancient city of Varanasi one of the oldest cities in the world [Music] with a Swami and a boatman taking us out on a dinghy and it was an amazing thing millions literally millions of families have brought the ashes of somebody and their families died to the Ganges that connection to people going back that many years makes you feel like you're connected to that many years going forward as well you're just this speck in time I felt he had brought us there and connected himself to all that was important to him how is dying ever at all acceptable how is ever anything except this awful terrible thing and the only way it is is because we as human beings live for something bigger than ourselves frontline is made possible by contributions to your PBS station from viewers like you thank you and by the Corporation for Public Broadcasting major support for frontline is provided by the John D and Catherine T MacArthur Foundation committed to building a more just verdant and peaceful world more information is available at macfound.org additional support is provided by the park foundation dedicated to heightening public awareness of critical issues the Ford Foundation working with visionaries on the front lines of social change worldwide at Ford Foundation org the wind coat foundation and by the frontline journalism fund with major support from John and Joann Hagler and additional support from Chris and Lisa cannon support for being mortal is provided by the John and wanna Harmon foundation for more on this and other frontline programs visit our website at pbs.org/manyrivers [Music] frontlines being mortal is available on DVD to order visit shoppbs.org or call 1-800 play PBS Frontline is also available for download on itunes [Music]

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Views: 1,053,723

Rating: 4.8781033 out of 5

Keywords: Being Mortal movie, Being Mortal takeaways, Coping with death, Atul Gawande, Death and dying, What to say when someone is dying, Accepting aging and dying, How to deal with dying, How to deal with death, Mortality, Mortality rate, Grief, Stages of grief, How to help a dying person, how to cope with dying

Id: lQhI3Jb7vMg

Length: 54min 2sec (3242 seconds)

Published: Tue Mar 17 2020

Reddit Comments

[u/audacityx]

pbs frontline always fucks me up

[u/Lisagreyhound]

Oh man. That was so beautiful.

[u/AVeryMadFish]

This is NOT from 2020!!!

It clearly says "Originally Aired February 10, 2015"

Can we plz get some enforcement of posting rules like the dates of documentaries?