Dr. ATUL GAWANDE: [voice-over] It’s impressive for a patient — and a family — to be so clear about their priorities, like Jeff Shields was. Sorry. To me, the beginning of the epilogue sounds like it would have made a good introduction: Being mortal is about the struggle to … And? max_width:"", It may have shortened her life. And that’s despite three of us being doctors. 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. And she basically was saying no, and we needed to know that. BILL BROOKS: I’m really declining quickly. Dr. LAKSHMI NAYAK: You started to have some pressure? But my father was realizing that that time later was running out. PBS is a 501(c)(3) not-for-profit organization. (function($) { GENIE SHIELDS: Here, Malcolm. I opened them up, and it’s a huge mass and it’s concerning. How can the medical profession … Dr. ATUL GAWANDE: [voice-over] Aymen Elfiky was one of those doctors. 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. 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… BILL BROOKS: Well, Mary and I have talked many times. Being Mortal has an introduction, eight chapters, and an epilogue. Dr. And so, you know, of course, you have your pity party. The film investigates the practice of caring for the... Read more Frontline follows renowned New Yorker writer and Boston surgeon Atul Gawande as he explores the relationships doctors have with patients … padding_top:"", Why do we always go off the rails? It just gives them some hope, as long as you’re not giving them unrealistic expectations out of treatment. Of course, everybody is fighting for every chance that she’s got. 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. “Aging and dying — you can’t fix those,” says Dr. Gawande. His mother died from malaria when he was about 10. 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. [on camera] He emailed the images. MARY BERNARDO BROOKS: She takes it very personally when she wants— has to give us bad news. 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. You don’t want to be the downer. You could lose your license for this! JEFF SHIELDS: 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 felt he had brought us there and connected himself to all that was important to him. Dr. ATUL GAWANDE: When I came on the scene was when she got diagnosed with a second cancer. Dr. KATHY SELVAGGI: All right, Norma. His symptoms started getting more aggressive. And unfortunately, about a year after the transplant, he showed signs that his disease was coming back. NORMA BABINEAU: But I need to take the baby to—. You know, what’s working against him in a way is that he’s young and strong. JEFF SHIELDS: I wanted to clarify something I said. Dr. KATHY SELVAGGI: I wanted to talk with you about— I know the other day, Norma, we talked about where to go from here. The book addresses end-of-life care, hospice care, and also contains Gawande's reflections and personal stories. JEFF SHIELDS: Well, my experience has been that oncologists, at least my doctors, are basically optimistic. 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. 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. KATHY SELVAGGI: You know, I think, in— I think it’s hard to hear sometimes the timeline. Follows writer and surgeon Atul Gawande as he delves into the relationships doctors have with … I think she knew that she was getting sicker and weaker. She’s enthusiastic. Dr. ATUL GAWANDE: You’ve got to ask what those priorities are. It took me 15 years to collect this. Dr. ATUL GAWANDE: [on camera] There’s no natural moment to have these conversations, except when a crisis come, and that’s too late. The disease, we knew, has been acting up. It turned out it also taught me how to do better for my dad. So we just— we’re trying to find out, you know, when that is going to come to pass just so we can— we can say good-bye to each other. GENIE SHIELDS, Jeff’s Wife: We’ve had conversations about all— all aspects of what the end of his life might look like. 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. Go into your Benadryl stupor! 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 little bit of what it means to be good at doing our jobs. I hadn’t known he felt that way. At that point, he had a bone marrow transplant. “Aging and dying — you can’t fix those,” … You know, suddenly, you have a hospital bed in the middle of your living room. And if we don’t ask and if we don’t have these discussions, we don’t know. Since then, my mind has been in rapid decline. RICH MONOPOLI: Well, you had joined us in our, in our sunny disposition, hoping for the best. Thousand Islands Bridge Authority and Boldt Castle Facilities. You woke up, and she wasn’t doing so well— on a Friday. 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. ATUL GAWANDE, M.D., Author, Being Mortal: I’ve been a surgeon for more than a decade now. The chemo had made her so weak that she couldn’t hold Vivian. SANDRA RULAND: We do things together. 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, as far as worst case scenarios go, if you would want hospice at home or hospice at a facility or—. That changed. if_empty:"", [on camera] It made me very mad, because it was— I mean—. I just want you to be comfortable. You know, as your— as your world comes closer and smaller and smaller, it becomes bigger and bigger. In addition to that, he has a complication of transplant, where the donor cells are actually attacking his body. Being Mortal has won awards, appeared on lists of best books, and been featured in a documentary. PBS Frontline Documentary Film: Being Mortal. And what we’ll do is, we’ll— we’ll keep you here and we’ll take care of you here. FRONTLINE teams up with writer and surgeon Atul Gawande to examine how doctors care for terminally ill patients. Dr. KATHY SELVAGGI: OK. And I’ll get— why don’t I clear this out for you. And we know the lymphoma is growing and— and sort of rampant. And they had new hope. I think we started talking about the experimental therapy that you all would like, or were hoping to get on for a trial with the lung cancer. And so I want you as my doctor, my good friend, to know that. Dr. LAKSHMI NAYAK: I think that I’d scared them the first time. I just saw it on the news yesterday. And then, you know, all of a sudden, it’s like our world was turned upside down. NORMA BABINEAU: Yeah, I think it’s coming close. And it’s a group discussion for all of us. Support for the endowment fund for FRONTLINE is provided by Jon and Jo Ann Hagler. [on camera] I remember I took notes in my journal around that time. I think it’s important to pause at the right time, some time. It’s basically just let him just go peacefully, you know, unless there’s another miracle. You know, he said, “Let me die” if that should happen. There’s going to be a time when we’re not going to be able to deal with the pressure with the steroids. 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. We have— you know, each of us has an odd patient who’s survived for 10 years or 15 years, but that’s less than 5 percent of all of the patients that suffer from the most common malignant brain tumor. He wanted to be cremated in the traditional Indian way, and he wanted his ashes spread on the Ganges River. Dr. ATUL GAWANDE: [voice-over] So after the phone call, Dr. Nayak ordered a series of spinal taps to relieve the pressure in Bill’s brain, and it worked. It’s not super-large, but it’s there. Dr. ATUL GAWANDE: [voice-over] Kathy Selvaggi had helped Norma understand that she was dying. Bill’s sister had also died of a brain tumor, and that was what he was worried of the most. That connection to people going back that many years makes you feel like you’re connected to that many years going forward, as well. Among the most uncomfortable difficulties was grappling with those cases where we couldn’t solve the problem. [voice-over] It was hard for us, as a family, to talk about this. [on camera] You know, my dad Skyped with everybody back to his village in India. “Being Mortal,” by Atul Gawande: Discussion Questions “We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. I don’t want to linger. Dr. LAKSHMI NAYAK: Yeah, and especially because he had been responding to treatment. We’ve got to find the right medicine to get me better so I can take my trips. Dr. ATUL GAWANDE: You saw that with Bill Brooks. I think that is first and foremost because, oftentimes, what we say as physicians is not what the patient hears. 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. We’re not even knowing whether we can leave the hospital. My father answered these questions. Dr. LAKSHMI NAYAK: The headaches, the not being able to lie down. Subscribe on YouTube: http://bit.ly/1BycsJW"The two big unfixables are aging and dying. Dr. LAKSHMI NAYAK: So Bill’s story from the very beginning has been challenging because when I first saw him, I thought he had 5 to 10 years. Doctors, uncomfortable discussing patients anxieties about death, fall back on false hopes and treatments that are actually shortening lives in… SUSHILA GAWANDE: Completely not right. BILL BROOKS: Well, those are going to be the good ones. I remember my parents visiting. Join in a guided conversation with Wichita health professionals about end-of-life goals after the screening of the documentary “Being Mortal… Dr. ATUL GAWANDE: I know! So how many of your patients will you cure or help them have a better life? Dr. Dr. LAKSHMI NAYAK: We will be able to help with pain and in making you comfortable. I’ve thought often about what did that cost us. Dr. ATUL GAWANDE: [on camera] 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? Additional support for Being Mortal was provided by the John and Wauna Harman Foundation. Dr. ATUL GAWANDE: Then you’ve got to tune the treatment to those priorities. Accepting that life can be shorter than we want is very difficult. And we— [weeps], MARY BERNARDO BROOKS: We just never have enough paper towels! It’s like two carpenters looking at a house. But the medications and the things that we’re requiring— it’s just not going to happen. And so therefore, we should do all these things to her. It all depends on him, so— yeah, I’m just going to go check on him. Charlie Rose, October 27, 2014 Atul Gawande on his book: Being Mortal… He got some bad news back home in Ohio. That, basically, in his case, has led to raised pressure in his head. What are the goals that you have?” And you know, he cried and my mom cried. We’re trying to stabilize the situation and try to become a little— spend a little bit of time as a family. She was planned for the experimental therapy the following Monday. It almost goes without saying, but we may have to make a— you know, a new game plan a week from now. And it was an amazing thing. BILL BROOKS: Yeah. Dr. ATUL GAWANDE: It’s always a hard thing, right? Dr. LAKSHMI NAYAK: Yes and no. You know, in my mind, what I was thinking was I wouldn’t offer this surgery because the lung cancer is going to take her life. You know, they’re not— you can’t fix those. Dr. LAKSHMI NAYAK: Have you thought about anything after the MRI? ROB SOIFFER, M.D., Oncologist: Hey. PRODUCED AND DIRECTED By. SUSHILA GAWANDE, Atul’s Mother: He had pain in his shoulder, and he thought that either playing too much tennis or just muscle. In some ways, I think the medicine is the easy part. He met my mom and married her, and they moved to Athens, Ohio, to set up their medical practices and raise a family. And unfortunately, it’s wearing him down. Funding for FRONTLINE is provided through the support of PBS viewers and by the Corporation for Public Broadcasting. You know, I can’t put a particularly good spin on that. Sometimes the patient has to do it. I’ll look into it. The pressure in his head continued to build, and the effects were becoming undeniable. You want it to be as comfortable and happy a place for him as it can be. 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. It was holding out a hope that was not a realistic hope in order to get him to take the chemotherapy. We’ll see you a little later, OK? JEFF SHIELDS: Genie knows it. 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. The Being Mortal documentary examines how Gawande and other physicians struggle to talk with patients and families about death and dying. Dr. LAKSHMI NAYAK: Bill has brain cancer. But then there’s a downward trend that’s more rapid than I had expected. Feels really late in the game, you know? He’d been caring for a patient named Norma Babineau for two years. }); ROB SOIFFER: Right. We have each other. I actually called Mary. He’s one of those few people in whom, you know, if there’s something that you could try, it’s worth trying rather than just waiting. It’s not where we wanted to be. 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. Dr. AYMAN ELFIKY: That I wish I could do better. MARY BERNARDO BROOKS: These are the good ones? … $(".bsa_pro_ajax_load-7").html(result); This Frontline documentary follows surgeon and award-winning author Atul Gawande, MD, author of the bestselling book by the same name. He entered hospice four months, as it would turn out, before he died. An audience discussion followed each screening and 96% of audience … I’ve fought as best I can. 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. Dr. ATUL GAWANDE: You’re thinking back to when you talked about it before. But eventually, paralysis set in, and then our options became chemotherapy. Dr. Being Mortal Documentary. I said, “Let’s max this thing out.” Maybe we’d get a bigger oxygen machine. Learn More. JEFF SHIELDS: I think we should ask that at our next visit. RICH MONOPOLI: I did not know it was an outright lie. But anyway, my guess is that it just depends. So Sara had Vivian, basically, pushing with one lung. Dr. LAKSHMI NAYAK: That drug— we actually have a trial with that drug. JEFF SHIELDS: Have I talked to you at all about my thoughts on dying and—. Watch the full-length episode at http://video.pbs.org/video/2365422384/?Utm_source=youtube&utm_medium=pbsofficial&utm_campaign=fron_covefullprogram … Dr. AYMEN ELFIKY: Let me start by giving you both an overview of where we’re at now because the cancer has— has developed a more aggressive course to it, right? Dr. LAKSHMI NAYAK: 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. The questions that we ask one another just as human beings are important. ATUL GAWANDE: [voice-over] You know, this guy’s potentially within weeks of being paralyzed. They’re called palliative care physicians— people like Kathy Selvaggi, who works at the Dana Farber. I felt great during that time, and my body was in rapid decline. Right now, in this state, more treatment would hurt you more than help you. We have to be operating, we have to be giving them medication, we have to be radiating, we have to be giving chemotherapy. You have a young woman with a brand-new baby. Her technique is as much about listening as it is about talking. Hey, Jeff. I said, “We don’t have much time. We’re going to help Pop-Pop take his slippers off. 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. 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. Dr. AYMAN ELFIKY: It’s very much a failure. And I’m worried that the disease will be growing. MARY BERNARDO BROOKS: You go through this in your head over and over again, but you just don’t even want to think it’s a reality! And it’s hard. It’s just like, “OK, am I dying? It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. 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. 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—. 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