Director: Frederick Wiseman
By Marilyn Ferdinand
Among the documentarians whose films are hallowed by critics and audiences alike, perhaps none stand taller than Frederick Wiseman. A fly-on-the-wall chronicler of subjects as varied as the University of California at Berkeley, the New York City Ballet, the Panamanian Canal Zone, and Long Island’s Belmont Park racetrack, Wiseman demonstrates again and again that those entities we call institutions are, in fact, human expressions, organizing principles for social intercourse. At the perhaps not-incidental age of 60, Wiseman chose to spend several months filming the denizens of the medical intensive care unit (MICU) at Beth Israel Hospital in his home town of Boston. His interest was more specific than the workings of an MICU, however—he fixed his gaze only upon dying patients. Thus, Near Death looks at the modern approach to the end of life and the clinicians who work near death on a regular basis.
Health care has come a long way in less than 100 years. The discovery of penicillin in 1929 heralded an age of miracle drugs that eradicated the death sentences previously dealt by many infectious diseases. Further advances in medicine, medical technology, and surgery have increased the life expectancy and vigor of the aged; today, the United States has more centenarians than any other nation—53,364 reported in the 2010 census, or 17.3 per 100,000 people. Health care has become a consumer-driven industry from which we have come to expect a fix for every ailment from infertility to paralysis. The formerly unimaginable ability to prolong life after a person’s vital functions have failed is a particularly acute one for Beth Israel’s MICU clinicians.
Just what constitutes life and death had become a real muddle by the time Wiseman began this film. He shows MICU nurses participating in an ethics training group discuss the difficulty family members have understanding that “brain dead” means “dead” because they see their loved ones breathing with the aid of a respirator. The growth of the hospice care movement since the 1990s has eased this confusion and offered a real alternative to patients and families searching for a more consistent and peaceful end-of-life care plan. None of the clinicians in this film seem to think that prolonging life at any cost is humane, but Wiseman gives us room to consider whether they might sometimes be in too big a rush to throw in the towel.
Bernice Factor, a stroke victim who cannot speak, was admitted to the MICU after her breathing proved inadequate to sustain her. A tube was inserted down her windpipe through her nose and attached to a ventilator to support her breathing. This is the seventh time Mrs. Factor has undergone the painful procedure of temporary intubation, and the clinical staff discuss creating a permanent airway for their tubes via a tracheostomy in her neck. After telling a nurse and the attending physician, a pulmonary specialist named Dr. Weiss, that she doesn’t want a tracheostomy or further intubation should she stop breathing after the tube is removed—in effect, that she wants to be allowed to die naturally—her long-time physician, Dr. Curlin, goes to see her and finds her to have grown more ambivalent about her decision.
Mrs. Factor is not truly terminal in the sense that prolonging her life is pointless—she can still communicate and share time with her devoted husband—thus Dr. Weiss seems to have jumped too far forward in thinking that he understood the clear wishes of the patient. To further illustrate this point, Mrs. Factor’s story follows one in which a dying patient named Mr. Gavin and his family are told at least five times in exhaustive detail about treatment options and the consequences of a “do not resuscitate” (DNR) order, even though the patient has a living will stating his wish to be allowed to die with dignity. Although these discussions get a bit tedious for the viewer, they are vitally important to include to illustrate how difficult it is to help people in crisis to reach a rational decision, particularly when the decision will lead to death.
At the time this film was made, Beth Israel’s policy of including patients and families in all treatment decisions was not routine in the medical community, and it’s clear that some of the clinicians find it frustrating. We hear Dr. Weiss say what many had long suspected—that lethal doses of morphine were administered to patients who were “imminent.” Behind this seemingly cold-blooded “angel of death” approach are philosophical questions that clinicians face every day and that society at large has yet to come to grips with: Are we managing patients’ lives or manipulating their deaths for our own emotional ends?
In the film, Dr. Taylor is the individual who provides a bridge for the audience between the clinicians and the patients and their families. A man who can speak frankly about death to his colleagues, he shows seemingly infinite patience as he listens carefully to Mrs. Sperazzo as she goes over the choices for her beloved husband Charlie. She is a sweet, old woman who breaks down in tears frequently as she contemplates life without Charlie, but she affirms to Dr. Taylor that she understands what he is saying about working not toward Charlie’s recovery, which is unlikely, but toward his comfort. Dr. Taylor, choosing his words carefully, never rules out the possibility of a miracle, never claims 100 percent certainty about Charlie’s prognosis, but helps ease Mrs. Sperazzo toward acceptance of the inevitable. Wiseman’s carefully tuned ear offers as much dignity to her in his edit of Near Death as he tries to offer to the gravely ill patients on the MICU—both are sometimes robbed of their humanity by the machines that engulf them and the medical professionals who dismiss their intelligence and emotional struggles.
Although the core of Near Death is death’s approach, the film inevitably spills into the after-death activities at Beth Israel, including showing nurses move a body discreetly through the hospital corridors and into a drawer in the morgue. We see only one of Wiseman’s subjects beyond death, Mr. Cabra, a 33-year-old Latino father of three who successfully fought testicular cancer. He returns to the hospital in rapidly failing health and is eventually found to have fibroids in his lungs, a rare side effect of gliomycin, the drug used to treat his cancer. He will never be able to breathe with his own lungs again, and his wife bravely agrees to a DNR order and donates his body to science. The end point of this tragedy, as an MICU nurse accurately describes it, is knowledge for a medical school class that has a chance to examine his lungs.
With a running time of 6 hours, Near Death is Wiseman’s longest film. Through his compassionate, unblinking gaze we become attuned to the rhythms of the MICU, the regular comings and goings of the orderlies appearing to pick up the trash and wipe down the rooms and floors, the nurses giving report on their patients’ status to the next shift, the meetings and grand rounds of clinicians, the beeps and displays of monitors and infusion devices. Wiseman gets exceedingly lucky in recording a snippet of diagetic music, the Nino Rota/Eugene Walter love song “What Is a Youth” from Franco Zefferelli’s Romeo and Juliet (1968). The lyrics provide a wistful commentary on the human drama unfolding on the screen:
What is a youth? Impetuous fire.
What is a maid? Ice and desire.
The world wags on,
a rose will bloom….
It then will fade:
so does a youth,
so does the fairest maid.
Death will come soon to hush us along.
Wiseman’s deep engagement with this most primal of subjects avoids the romance of Romeo and Juliet, but reveals the peculiar kind of love of humanity these sometimes brusque clinicians must have to face down death every day of their working lives. By escorting us through their world, Wiseman largely succeeds in getting us past the kind of morbidity that causes most of us to crane our necks toward a car accident and breathe an uneasy sigh of relief that it was someone else, not us, who was unlucky—this time.