“Being Mortal” Explores End of Life Conversations Between Cancer Patients and Health Care Providers
by Tiffany Thompson, MSW
I lost an aunt and a grandmother to cancer in 2015, just before I graduated from the MSW program at Spalding University on June 3, 2015. As a young child, I watched my great aunt and great grandmother slowly decline in nursing homes. If you have never watched someone die or worked with the terminally ill, it is difficult to imagine their personal struggles and the weight of end-of-life questions on their family members and friends. I realized from these experiences that, “Yet, you do not know what your life will be like tomorrow. You are just a vapor that appears for a little while and then vanishes away” (a passage from James 4:14 New American Standard Bible).
I was introduced to the film “Being Mortal” by a Spalding University professor who was using it in his undergraduate Religious Studies course. Being Mortal is also a book by Dr. Atul Gwande, renowned surgeon at Boston’s Brigham and Women’s Hospital (BWH) and staff writer for the New Yorker. In the film version, which aired February 10, 2015, on Frontline (PBS), producer Tom Jennings and Gwande showcase the exploration of the relationships between the terminally ill and their healthcare providers. Gwande examines his role and that of his colleagues in providing innovative medical options along with actively listening to the desires of their patients. He comes to the realization that many physicians, himself included, are unable to face the prospects of death and allow their patients the opportunity to guide the inevitable process. The film, which took three years to create, was birthed out of Gwande’s own longing to revolutionize end-of-life care during his father’s heroic battle with cancer. The film also aired most recently on WMHT-TV in June 2016 and is available on YouTube at https://www.youtube.com/watch?v=VRkr09ZMI3w (trailer embedded below):
Gawande states in the film, "The two big unfixables are aging and dying. You can't fix those." Although he cannot solve the problem of dying, Gwande takes an in-depth look into the art, science, and practice of medicine from the viewpoint of both practitioners and patients. Gwande also says in the film, “When I started out in my training in surgery, you discover that all the stuff you learned about in the books in medical school is really just a tiny bit of what it means to be good at doing our jobs.” Gawande’s humble humanity as a surgeon adds to the appeal of this powerful film.
The film opens with Gawande scrubbing for surgery while he discusses the promises made to patients by well-meaning healthcare professionals. The next scenes depict Gawande’s colleagues having tricky conversations with their patients as you see the expressions of concern and confusion on some of the patients’ faces. Many cases are highlighted in this film, including: Sara Monopoli, age 34, who was diagnosed with Stage 4 lung cancer during her pregnancy; Gwande's colleague Dr. Lakshmi Nayak, a brain cancer specialist, and her 46-year-old patient Bill Brooks who had brain cancer; Gawande’s father, Dr. Atmaram Gawande, who was a surgeon himself, who had a cancerous mass in his spinal cord; and Gwande’s colleague Dr. Kathy Selvaggi, who is a palliative care specialist and teaches other physicians how to have difficult conversations with their patients. Taken together, the cases in this film show the vulnerability of the doctors and the fragility of their patients as they try to agree on the best strategy for each diagnosis.
Jennifer Day, author of “Review: ‘Being Mortal’ by Atul Gawande,” shares her thoughts in the Chicago Tribune. Day states, “It requires a level of acceptance: Death is approaching, but there are still options that will allow people to live better in their final days — with less pain and fewer symptoms. These interventions won't fix the problems, but they can allow families to concentrate on what's most important at the end, to wring as much meaning as they can out of whatever time is left.”
The stages of grief and self-determination are very familiar to social workers. Social workers also have a unique perspective on working with terminally ill clients in settings such as hospitals, nursing homes, or hospice care. According to the Social Work Policy Institute, social workers in these environments provide services such as local resource connection, case supervision, pain assessment and management techniques, advocacy, and consultation about ethical issues regarding end-of-life care. One of my graduate school cohort members, I will call her "E," is a cancer survivor, and her personal story compelled her to become a social worker. She currently works as an oncology social worker in Louisville, KY.
This film is truly a teachable moment for physicians, other healthcare professionals, and also social workers who care for terminally ill patients. It reminds us how important the concepts of person-in-environment and self-determination are when discussing next steps with patients and their families. Gawande does an impeccable job of allowing the viewer to eavesdrop on these intimate end-of-life conversations to see how doctors are taking a pro-active approach to palliative care. Although Gawande does not have all the answers, his concerted effort to create a patient-centered focus is quite admirable.
I urge social work students, medical students, and other helping professionals to integrate this film into their professional development. This film persuades us to reexamine our world view and approach when working with terminally ill clients.
Tiffany Thompson has an MSW from Spalding University, Louisville, KY. She has strong interests in education, social justice, and children and youth, specifically in foster care. Fond of volunteering, she is an educational support tutor for the Every One Reads program.
