The documentary … Right now, in this state, more treatment would hurt you more than help you. This was an incredibly important moment. Doctors, uncomfortable discussing patients anxieties about death, fall back on false hopes and treatments that are actually shortening lives in… What I’m worried about is, could we be coming to a place where it’s— it’s actually killing you and we don’t have the opportunity to really talk with the children and the—, JEFF SHIELDS: You mean where I am in what I consider in hospice — in other words, end stage —, JEFF SHIELDS: —and we don’t have a— I’m going to live for four weeks, and we’re thinking, “Oh, maybe there are three months.”. JEFF SHIELDS: I wanted to clarify something I said. OK. Let me just tell you this. So the oncologist lays out 8 or 9 different options, and we’re swimming in all of it. [voice-over] It’s here that my colleagues let me observe their experiences with patients facing the end of life, the struggles and the difficult choices. Follows writer and surgeon Atul Gawande as he delves into the relationships doctors have with … And they’re always looking for a way to push the disease into remission than they are in talking about the longer-term picture of mortality. So the MRI— there’s a little change, unfortunately. Dr. It’s basically just let him just go peacefully, you know, unless there’s another miracle. It’s like two carpenters looking at a house. Who knows, you could be playing tennis by the end of the summer.” I mean, that was crazy! Find us on the PBS Video App where there are more than 250 FRONTLINE documentaries available for you to watch any time:https://to.pbs.org/FLVideoApp, Subscribe on YouTube: http://bit.ly/1BycsJW, Instagram: https://www.instagram.com/frontlinepbs PAUL BABINEAU: Is there a time, you think, a timeline, or—. We should have started earlier with the effort to have quality time together. That, basically, in his case, has led to raised pressure in his head. Dr. ATUL GAWANDE: [voice-over] Jeff Shields’s words about his last weeks being his happiest seemed especially profound to me because they were among his last words. MARY BERNARDO BROOKS: [laughs] They always look delicious. We have an appointment that I hope will result in them saying that the disease is lessened. If we do it, we’d have to do it as a compassionate use. $.post("https://www.wpbstv.org/wp-admin/admin-ajax.php", { Dr. ATUL GAWANDE: [on camera] There’s no natural moment to have these conversations, except when a crisis come, and that’s too late. Dr. ATUL GAWANDE: I knew— I knew it was not going to— I mean, I— in other words, the reason I regret it is because I knew it was a complete lie. We’re trying to stabilize the situation and try to become a little— spend a little bit of time as a family. SANDRA RULAND: 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. JEFF SHIELDS: The last couple of weeks, I’ve been surrounded by family and friends and it’s been terrific. AYMEN ELFIKY, M.D., Oncologist: So how are you feeling? Charlie Rose, October 27, 2014 Atul Gawande on his book: Being Mortal… I’m not afraid of dying. Three years in the making with Gawande as the correspondent, the PBS documentary explores the themes introduced in his 2014 book Being Mortal… SUSHILA GAWANDE: Completely not right. Dr. LAKSHMI NAYAK: But I’ll definitely look into that. My writing has become the way that I can focus in and begin to understand the problems that most confuse me. By Joanna Goddard. 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 we know the lymphoma is growing and— and sort of rampant. It’s just a fight mentality that perhaps goes back to training in med school and just the way we are wired, and we’re not trained for that other mode. We waited to see if there would just be one more breath. He felt better. Dr. ATUL GAWANDE: [voice-over] Dr. Selvaggi works with doctors throughout the hospital to help with their hardest patient conversations. But he feels really well. What happened then? What are your fears and worries for the future? padding_top:"", Accepting that life can be shorter than we want is very difficult. Dr. ATUL GAWANDE: Accepting death comes with incredibly complex emotions. Dr. ATUL GAWANDE: Are you at all worried that he would just have toxicity from the drug without benefit? I spoke to Gawande the day his documentary film about end of life was to premiere on PBS's Frontline. BILL BROOKS: Pleased to see you. This was one of the most difficult circumstances. ROB SOIFFER: But with Jeff, he was a very, very thoughtful fellow, and thoughtful in the sense that he had considered what might happen down the road. ROB SOIFFER, M.D., Oncologist: Hey. 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 to find that time a little better. MARY BERNARDO BROOKS: There’s no third option. It’s a more resistant type, and that just keeps marching along. We can be longer. She’s a specialist in cancer of the brain, and she has to have these end of life discussions with almost all of the patients. He suggests that medical care should focus on well-being rather than survival. [on camera] What would be on your checklist for what I should make sure I do when I’m doing it next time? As the tumor slowly progressed, we followed his priorities, and they led us and him to choose an aggressive operation, and then radiation. The disease, we knew, has been acting up. And you would not get the benefit of it. That’s my desire. You woke up, and she wasn’t doing so well— on a Friday. We’ll see you a little later, OK? The hospice people will know it. Dr. KATHY SELVAGGI: Our goal is, for whatever time is left, is to make it the best quality that we can. The ultimate goal, after all, is not a good death but a good life — to the very end. RICH MONOPOLI: Well, you had joined us in our, in our sunny disposition, hoping for the best. Chemotherapy hadn’t worked. Dr. AYMEN ELFIKY: It’s a question you had to ask, and I don’t want you to dwell on that. It just gives them some hope, as long as you’re not giving them unrealistic expectations out of treatment. SANDRA RULAND: We do things together. Support for the endowment fund for FRONTLINE is provided by Jon and Jo Ann Hagler. 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. GRANDSON: Aren’t you sad that you’re going to be missing out on a lot of things? ATUL GAWANDE, M.D., Author, Being Mortal: I’ve been a surgeon for more than a decade now. You know, I can’t put a particularly good spin on that. He explores his own humble journey with the realization … Dr. KATHY SELVAGGI: 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. Dr. ATUL GAWANDE: [on camera] It’s impressive just being able to be silent for a while. Dr. ATUL GAWANDE: [voice-over] 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. 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. Dr. LAKSHMI NAYAK: You started to have some pressure? Yes, I’m going to take her for Christmas. I realize that Atul Gawande is becoming a leitmotif of this site, but I love him so much and can’t stop writing about his work. That was when he began to prepare. Dr. LAKSHMI NAYAK: Like your eyes. They’re called palliative care physicians— people like Kathy Selvaggi, who works at the Dana Farber. There he was part of the community, and that became especially important to him after the cancer. [voice-over] One of Dr. Nayak’s most challenging cases at the time was a man named Bill Brooks. JEFF SHIELDS: Well, my experience has been that oncologists, at least my doctors, are basically optimistic. Of course, everybody is fighting for every chance that she’s got. I’ve thought often about what did that cost us. 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, with a swami and a boatman taking us out in a dingy. Major funding for FRONTLINE is provided by the John D. and Catherine T. MacArthur Foundation and the Ford Foundation. MARY BERNARDO BROOKS: She takes it very personally when she wants— has to give us bad news. $(".bsa_pro_ajax_load-7").html(result); JEFF SHIELDS: I don’t want to go back in the hospital. And that’s especially the case with younger patients, and that is where a doctor needs to be skilled, I think. It turned out it also taught me how to do better for my dad. Dr. KATHY SELVAGGI: I worry about the same thing. He entered hospice four months, as it would turn out, before he died. I think it’s important to pause at the right time, some time. Additional funding is provided by the Abrams Foundation, the Park Foundation, and the FRONTLINE Journalism Fund with major support from Jon and Jo Ann Hagler on behalf of the Jon L. Hagler Foundation. So how many of your patients will you cure or help them have a better life? And what we’ll do is, we’ll— we’ll keep you here and we’ll take care of you here. And one of the nice things about being at the farm is that you realize everything dies. Among the most uncomfortable difficulties was grappling with those cases where we couldn’t solve the problem. It almost goes without saying, but we may have to make a— you know, a new game plan a week from now. The two big unfixables are aging and dying. 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. SANDRA RULAND, R.N., Oncology Nurse: I think that it’s important for us, even though it would be easier to sort of skip over this today, that we should talk about, if things are not going as we hoped, to just talk about worst case scenarios a little bit. Support your local PBS station here: http://www.pbs.org/donate, Love FRONTLINE? This is it, yeah. Dr. ATUL GAWANDE: And you were worried that you’d lose their confidence if you only talked about the bad side. The cows die, the trees die, the grass dies, the fish die, and people die. Was there anything else I could have done? show_ids:"", And then we realized he wasn’t breathing. Join in a guided conversation with Wichita health professionals about end-of-life goals after the screening of the documentary “Being Mortal… FRONTLINE: Being Mortal DVD,FRONTLINE: Being Mortal Death is something we will all one day face. And I’m, like, “I’ve been doing that for two-and-a-half years.” I’m— I’m at the end of my ropes as far as that goes. Dr. ATUL GAWANDE: When I came on the scene was when she got diagnosed with a second cancer. So I began trying to start earlier talking with my patients, and even my dad. Am I not? So why is it so hard for doctors to talk with their patients about dying? Dr. Atul Gawande explores death, dying and why even doctors struggle to discuss being mortal with patients, in this Emmy-nominated documentary. And I cried. We’re not even knowing whether we can leave the hospital. That was when he decided he wanted to be a doctor. Dr. OK? Dr. ATUL GAWANDE: The very last week of her life, she had brain radiation. JEFF SHIELDS: Is it too hard? They’re connected together across one street. It wasn’t about, “How can we have good days to the end?” We didn’t focus on that enough. SUSHILA GAWANDE, Atul’s Mother: He had pain in his shoulder, and he thought that either playing too much tennis or just muscle. Dr. LAKSHMI NAYAK: The headaches, the not being able to lie down. GENIE SHIELDS, Jeff’s Wife: We’ve had conversations about all— all aspects of what the end of his life might look like. Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering this dynamic has produced. She basically just told us to get ready. You know, we’re so lucky. While hiding in the … What are you willing to sacrifice and what are you not willing to sacrifice? Dr. And I remember saying something I sort of regret, which was, you know, maybe that experimental therapy will work for the thyroid cancer, too. “Being Mortal” Documentary. But the medications and the things that we’re requiring— it’s just not going to happen. MARY BERNARDO BROOKS: Is it just this pile here? PBS just created a 54-minute documentary … I hate to cry! I don’t think any of us were. You know, he said, “Let me die” if that should happen. And I’m worried that the disease will be growing. 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. }); These priorities became our guidepost for the next few years, and they came from who he was as a person, who he’d always been. Can you do that? “Aging and dying — you can’t fix those,” … It can certainly be shorter, if it— if the pace picks up. link:"", Dr. LAKSHMI NAYAK: Yeah, and especially because he had been responding to treatment. She wants to tackle this. He’d been caring for a patient named Norma Babineau for two years. Dr. ATUL GAWANDE: [voice-over] Aymen Elfiky was one of those doctors. Like I said, I’m a positive person, but I’m— I’m at the end of my ropes with it. NORMA BABINEAU: There’s miracles that can happen in between. It was so difficult, but she had the baby. Jon and Jo Ann Hagler on behalf of the Jon L. Hagler Foundation. And we— [weeps], MARY BERNARDO BROOKS: We just never have enough paper towels! 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. So the puzzle is how do you get this out. You know, suddenly, you have a hospital bed in the middle of your living room. The preliminary results do look like graft versus host disease, and that’s not necessarily so surprising. 1 VIDEO Explores relationships between doctors and their patients nearing end of life. Dr. LAKSHMI NAYAK: Have you thought about anything after the MRI? attachment:"", There’s a cycle of life. I wouldn’t want to put you through any more spinal taps. [voice-over] It made me want to explore what other doctors were doing in these extremely difficult circumstances. 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. And yet I didn’t feel I could say that to you all. Can I not?” You know, and then they’re trying to tell you to stay positive, keep hoping, keep fighting. 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. Bill’s sister had also died of a brain tumor, and that was what he was worried of the most. [both laugh] I said that, and I know it was complete—. And unfortunately, it’s wearing him down. JEFF SHIELDS: Then I need you to help me bring my feet up. Bill brought up this particular drug, but it is experimental. Dr. KATHY SELVAGGI: Yeah, that’s where we have to take our cues. GENIE SHIELDS: It seems to me there’s such a difference in these last few weeks. MARY BERNARDO BROOKS: At this point, it’s just making sure he’s as comfortable as he can be, you know, and that’s the most important thing. Twitter: https://twitter.com/frontlinepbs I’ve fought as best I can. JEFF SHIELDS: Have I talked to you at all about my thoughts on dying and—. RICH MONOPOLI: I don’t think we were. BILL BROOKS: Yeah. The chemo had made her so weak that she couldn’t hold Vivian. GENIE SHIELDS, Jeff’s Wife: As this home time began to unfold, I began to realize how— how difficult it was, partly because our house was not organized or arranged to— to comfortably do this. What did we forego by consistently pursuing treatment after treatment after treatment, which made her sicker and sicker and sicker? And that was not— that was not a good outcome for— for the final— final months. KATHY SELVAGGI, M.D., Palliative Care Specialist: First of all, I think it’s important that you ask what their understanding is of their disease. And so therefore, we should do all these things to her. I’ll look into it. I’ve had a long and wonderful life. We have great families. Dr. KATHY SELVAGGI: It does feel a little bit late in the game. … That changed. FRONTLINE is a registered trademark of WGBH Educational Foundation. And I tried to crank the oxygen up. MARY BERNARDO BROOKS, Bill’s Wife: How do they look? I hadn’t known he felt that way. A 20-minute Summary of Atul Gawande's Being Mortal: Medicine and What Matters in the End by Instaread Summaries , Jason P. Hilton , et al. You'll receive access to exclusive information and early alerts about our documentaries and investigations. We’ve got great jobs. No, you have more than that. What are the goals that you have?” And you know, he cried and my mom cried. And you know, I had hoped to have another 10 or 15 years, but you don’t always get what you want. We have great friends. Eyes wide open— what I was looking into your eyes was not the way your pupils reacted was— but to see what the pressure might be. His symptoms started getting more aggressive. The PBS on-demand streaming service, WPBS Passport, is now available in Canada! Earlier this month, PBS Frontline’s Being Mortal premiered. They’re teaching us there might be a better way in these circumstances. custom_image:"", Being Mortal FRONTLINE follows renowned New Yorker writer and Boston surgeon Atul Gawande as he explores the relationships doctors have with patients who are nearing the end of life. ATUL GAWANDE: [voice-over] You know, this guy’s potentially within weeks of being paralyzed. It’ll just mean that he’ll linger longer. In fact, there’s often a kind of implicit promise, “I’m going to be able to fix this, I’m going to 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? This film examines the relationships between doctors and patients nearing the end of life, and how the medical profession can better help people navigate mortality. He had me and my sister come there and be with him, and he remained in control of the priorities that were most important to him. I’m just overwhelmed with everything. Dr. LAKSHMI NAYAK: I think that I’d scared them the first time. })(jQuery); WPBS/WNPI is trusted as the media source for life-long education, entertainment, and information to our two-nation region through quality content, partnerships, and service that inspires those we serve. [Mary weeps]. How is dying ever at all acceptable? ATUL GAWANDE: [voice-over] 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. JEFF SHIELDS: Well, I will be. Dr. AYMAN ELFIKY: That I wish I could do better. I remember my parents visiting. MARY BERNARDO BROOKS: He started having pressure in his head. [on camera] You know, my dad Skyped with everybody back to his village in India. I love you. JEFF SHIELDS: I think we should ask that at our next visit. I’ve always loved Atul Gawande’s writing—with his compassion and common sense, he’s the kind of doctor you pray to get at the hospital—and in Being Mortal… Can I check a few things? NORMA BABINEAU: Yeah. You know, you’re not saying, “Oh, yeah, we can’t fix this.” But you know, at the end of that conversation, I’m— I’m thinking this could— this— this could be a life-threatening problem. NORMA BABINEAU: But I need to take the baby to—. But— but that’s another one of those paradoxes. And unfortunately, about a year after the transplant, he showed signs that his disease was coming back. He said that during that time, he had tried to broach how dire her prognosis was, but he had not been successful. You know, what’s working against him in a way is that he’s young and strong. I first met Mr. Shields about two years ago. She was young. 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