Extremis (film)
Extremis is a 2016 American short documentary that follows Dr. Jessica Zitter, an ICU and palliative care specialist who leads a team in the Highland Hospital ICU in Oakland, California. She helps families make end-of-life decisions for their loved ones, who are often terminally ill. It is directed and produced by Dan Krauss.[1][2] It was shot at an intensive care unit at Highland Hospital in Oakland, California. The film was funded, in part, by physician and end of life advocate, Dr. Shoshana R. Ungerleider. [3] There are five patients shown in the documentary, however, it only focuses on three patients.
| Extremis | |
|---|---|
 Film poster | |
| Directed by | Dan Krauss |
| Produced by | Dan Krauss |
| Music by | Justin Melland |
| Cinematography | Dan Krauss |
| Edited by | Jeff Gilbert |
| Distributed by | Netflix |
Release date |
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Running time | 24 minutes |
| Country | United States |
| Language | English |
Director
The director for this film is Dan Krauss, a UC Berkeley graduate with a masters in journalism. Dan Krauss is a proponent for observational filmmaking rather than advocacy. Meaning, his documentaries are unbiased to the best of his ability, as he prefers to allow the public to make their own belief system based off the information provided. Most of his documentaries revolve around critical moments that lead to life or death decisions. He has been nominated for two Oscars, Extremis being one of them.
Dr. Zitter
Dr. Jessica Zitter graduated from Harvard and is an attending physician at Highland Hospital on Oakland, California. Aside from working at the hospital, she has published many articles as well as her own book, "Extreme Measures: Finding a Better Path to the End of Life" [4]. Her work is focused on end of life care and how to improve it. She believes that all medical staff at the hospital has to work together to improve patient decision making and that if families and the medical community understood the ICU as doctors see it, then the conversations between doctors and families in the ICU could improve as well.
Plot
The documentary begins as Dr. Zitter attempts to communicate with a patient named Donna who has myotonic dystrophy. Because of her breathing tube and other necessary equipment attached to her it is very difficult for Donna to communicate. At that moment Dr. Zitter had to sympathize and try to make the patient as comfortable as possible while trying to figure out a way to help her communicate. Donna has a very supportive family, however, in this case the doctor had to acknowledge when Donna could no longer communicate so that her next of kin could make the medical decisions for her. Throughout this process, her family is interviewed and we learn that they believe the best decision for her is to take her off the breathing tube and let her body be able to take control. However, this does not happen immediately, the doctors worst fear for this case is to tell Donna's family that there is no other way to help her when there could be a specialist that they may not know of. As the doctors search for a specialist and other options Donna's body slowly starts to shut down and her family decides to take her off the breathing tube. One day later, Donna dies.
After Donna, the patient introduced is Selena, who stopped breathing on the way to the ER and suffered severe brain damage. Unlike Donna's family, Selena's daughter is not ready to let her go and clings on to hope. In this case the doctors attempt to reason with Selena's daughter to let her know that there is no other option but to keep her on life support with no chance of her coming back or to pull the plug. When interviewed, Selena's daughter said that pulling the plug on her mother would feel like murder. Selena was kept on life support and regained periods of consciousness, but died six months later.
The next patient shown is a homeless man who had been institutionalized for a long time and the doctors had not yet made a prognosis. This patient did not have any family or friends to make the medical decisions for him if anything happened, and when it comes to this the doctors have to question whether the patient seems stable enough to decide for himself. The film shows the doctors trying to communicate with the patient, however, you could visibly see that this patient was not capable of making clear headed decisions, so the doctors decided to take matters into their own hands.
The other two patients are not named, their prognosis is not given either, only snippets of their experience is shown. One is a female, and a new grandmother, it seems that her situation is too far ahead and her family decides to take her off all machines. The other patient is a male who can still communicate but does need to be attached to a life support machine. He does express his desire to not be kept on the machine and accepts his fate, even though his son does not agree with his father decision, he does support him.
Purpose
The purpose of this film is to be able to show the side of every person involved in a medical situation, such as in the ICU. In this film, the doctors were interviewed, along with the family members of the patient, and the pain and stress the patient was enduring was obvious. It brings to question certain standards the public has, every person involved has a role and responsibility to ensure the best care of the patient. For example, in Selena's case, her daughter still had hope that her mother would come back to her, but the doctors have enough experience and have been through similar cases to know the reality. The doctors need to be able to communicate the truth in a gentle manner because of how sensitive these cases are. To some degree, the doctors need to be able to convince their patients, or patient family when to withdraw care as the expert in the field. Dr. Zitter herself said that when she began working in her field, she tried to have the same hope Selena's daughter had and tried to save everyone, but eventually she had to learn the stark truth, not everyone will make it and it is best to be honest about it.
Awards
- 2017: Academy Awards – Best Documentary Short Subject – Nominated[5]
References
- Fox, Cassie (September 14, 2016). "Gratitude for 'Extremis,' Netflix's new documentary about end-of-life care". Screener. Retrieved January 24, 2016.
- "Extrimis". Tribeca Film Festival. Archived from the original on 2017-02-02. Retrieved January 24, 2016.
- Tedeschi, Bob (April 9, 2020). "'Death is hot right now': An advocate for palliative care scored big with 'Extremis'". STATNews (website). Retrieved April 8, 2020.
- Gubar, Susan (April 9, 2020). "At the End of Life, a Way to Go Gentle". NYTimes.com (website). Retrieved April 8, 2020.
- Variety, Staff (January 24, 2017). "Oscar Nominations: Complete List". Variety. Retrieved January 24, 2017.