Being Mortal shows the complex end-of-life equation

(Harrisburg) — Recently, WITF-TV broadcast a documentary about the end of life.

It looked at questions like what kind of care is available and how do different people handle an end they can see coming.

Frontline’s Being Mortal was an extraordinary piece, partly because it made such a difficult topic easier to understand and think about.

It sparked conversations among many families, but also in the medical community.

“I was getting emotional and I didn’t think I would because I had read the book, but the stories still tug at you,” says Doctor Maggie Kreher, who leads Penn State Hershey Medical Center’s palliative care team.

And as I watched Being Mortal, I couldn’t help but see my grandfather in Jeff Shields, who lends wisdom to one of his grandsons in a bedside conversation just before dying peacefully at his farm.

“I viewed the farmhouse scene with the grandson to me is one of those palliative miracles that happen when a person is able to make those connections. And he was guiding this grandson and to me that’s a miracle,” says Dr. Kreher, who sees it as an ideal to work towards.

“Being Mortal” follows a group of families all coping with cancer diagnoses.

But that’s where the similarities end.

Some have advanced past the first couple stages, others are younger than others.

Some want to fight and fight and fight, while others like Jeff Shields want to be able to talk and live pain-free through their last moments.

Watching it, you often can’t move or take your eyes off the screen as the stories of a handful of people nearing the end of life receive a thoughtful, measured treatment.

“At different times I could see different pieces. I could see my own family members, I could see things that maybe I could do better, I could see things that I can understand in my collegaues better,” says Doctor Kristina Newport with Hospice and Community Care, which serves Lancaster General Health’s patients. 

“So I think he really did present it in a way that makes you think about yourself, but also makes you think about how you can help other people through what you’re seeing. And how we can use this as a tool to start the conversation for people that aren’t necessarily comfortable.”

As the doctors watched the film, there was silence. No one’s hands picked up their cell every couple minutes to check email, and no eyes wandered around the room.

In one way, it was very much like what the best palliative care doctors do, 

“The biggest noise that you can make is the silence because some of this information takes quite a bit to process. And allowing that process and allowing that to filter down is very important,” says Doctor Arlene Bobonich with PinnacleHealth’s palliative care division.

“The less you say, in the circumstances when you’re having these tough conversations, the better it is for the patient,” says Doctor Kreher.

“And you ask a question and wait and listen, and then you clarify, reflect back what that patient has just said and then listen, and the less you say, the better it is because then you can actually help the patient figure out what’s important, how do they want to feel and what you’ve done is really offer them the opportunity to speak to what they need.”

While the documentary focuses on families on coping with cancer diagnoses, it’s not the only area where palliative care can help.

The patient, or their family, really drives the conversation.

“It’s not just about calling hospice or palliative at the end, and it’s not just about us as palliative physicians, it’s really about medicine and even society in general taking a bigger picture about how we live with chronic illness, and that we all as a society and as medicine have to ask who is the person and what are their priorities, right along with whether we’re asking what their renal function and what their lab numbers are.”

“And that’s a piece that has been lost in medicine,” says Doctor Newport.

Doctor Bobonich says from PinnacleHealth’s side, the conversation should start as soon as a patient receives a diagnosis that could lead to their death.

“How to make as bad a news as possible better, and when I do have the occasion of bad news, that’s the very, very difficult thing, very, very difficult things. Sometimes that takes giving news in little portions, takes working with people.”

That seemed to be one of Being Mortal’s goals. The three experts all saw this as a chance to create awareness, to open up a conversation that has no real starting point…

“The real impetus of facing this I think is generated through this program and is a really good starting point for how good can we be, how much better can be make the end of life for people,” says Dr. Bobonich.

If a couple of families were willing to allow Frontline to show such a personal process like dying on the screen for millions to see – having a conversation with your parents might not sound so difficult after all.