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Sparrowpost:
One of the things I find most interesting about your movie is the
way we learn some important things about your Grandfather, but you
don’t tell us these things directly. For example, you tell
us he was an avid photographer, but we don’t see any pictures
of him as a young man. Did you intentionally exclude these pictures?
Dave Rosenthal: Good question. The decision to
include and exclude information about my grandfather was made intentionally
and perhaps slightly unintentionally. As much as I wanted to include
personal information about my grandfather, I decided to limit some
of the footage because the piece was focused on the end of his life
and his care at the nursing home. In a way, the piece uses the personal
story of my grandfather as a means to explore care at the end of
life and the meaning of death. I think that many of the important
points can be inferred from the way the story of the end of his
life was told.
SP: Just out of curiosity, though, what did he think of your video
habit? Did you catch the photography disease from him?
DR: I think that by the time I had begun seriously
filming, he was already somewhat demented so it was difficult for
me to understand what he comprehended. In a way, you could say that
I started filming precisely because I recognized that he was losing
something, that every time I would film him, he would understand
less and less, and to me that necessitated capturing each encounter
in some way. A video camera was my medium, but it could just have
easily been a diary, a film camera, or a tape recorder.
As for the photography disease... I would like to think that I caught
it from him. It seems reassuring that there is a cycle of photography
in my family.
SP: At what point did you formalize the idea of editing
the footage into a film?
DR: Well, I guess that as I was filming initially,
there was a compulsion to capture each moment because it inherently
seemed important. I didn't know what, if anything, I would do with
the footage. As a student in Alfred Guzzetti's Experimental Video
class at Harvard, I started screening some of the interview footage
cut together and realized the power of the story and the images.
I think after that point, a few late night discussions with Andy
Rice in Bar Harbor pointed me in this line of thinking. A few years,
two cities, a wife, and med school later, I finally completed it.
SP:
Do you have footage from a time earlier than the first footage you
show in the film?
DR: I know that I have footage of him at earlier times, in fact
there is quite a bit of footage of him from home movies, but I chose
not to use it a couple reasons. Firstly, I did not shoot the other
footage and didn't know how I felt about using that footage. Secondly,
again, I was making the film as part of the Summer Program in Geriatrics
at the Buehler Center on Aging, and part of the focus was trying
to expand this personal story to have more universal themes about
end-of-life care. The personal story, albeit necessary for the film
to function, was a delivery device for the voices of experts and
caregivers.
SP:
At what point in the process did you decide to interview the CNAs?
How did the things they had to say influence your experience of
the dying process?
DR: When I began discussing this project with my
advisors at the Buehler Center, it became clear that one of the
most powerful parts of visiting my grandfather was the care by the
CNAs. When the CNA told me that it was a "blessing" to
care my grandfather, it was profoundly moving. I felt that I needed
to talk to other CNAs to try and extract what it was that was so
compelling. Ultimately, the CNAs taught me a great deal about the
dying process, and I was honored to be able to interview them. Perhaps
the nicest part of making this video was that at a screening for
the Nursing Home in Skokie, IL, after the film ended, an impromptu
standing applause was given to the CNAs in the room.
They felt that I accurately depicted their stories and sentiments.
SP: Wow. That's so cool.
DR: Yeah no kidding. And supposedly the same thing
happened when it was screened for the executive board of the nursing
home.
SP: Is there an existent body of work about CNAs already out there?
Would you consider making a second film more pointedly about them?
DR: As far as I know, there isn't much work on
formal caregivers (i.e. CNAs from institutions); however, there
is a great deal of work done on informal caregivers such as family
members. I've watched a lot of films dealing with the family care
giving experience. You can check out www.terranova.org
and Fanlight Productions.
SP: At one point, I read “How We Die” by Dr.
Sherman B. Nuland. In that book I believe he suggests that our society
has overly sanitized the dying process... and that our culture suffers
because of the cloak of mystery we have built around it. Is this
something that you discuss in Medical school? Do you think that
our tendency to hide the facts of death in the back closet has something
to do with the problems our health care system faces in general?
DR: That is almost exactly one of the questions
that I asked some of the ethicists!
It is true that nursing homes are a place separated from the rest
of society where many people die at the end of their lives. Interestingly,
the vast majority of people never move into a nursing home and stay
at home with the care of a relative. That said, I do believe that
our society does have a tendency to sanitize the dying process and
in a way, quarantine those members of society who are old, infirm,
or disabled and keep them out of sight. In medical school, we do
address end of life issues, but not with regard to the social issues
surrounding end of life care. For the most part, physicians work
closely with social workers to address these issues.
SP: I guess along the lines of the last question, One of
the most disturbing articles I have read in recent history was an
opinion piece which I believe was penned by someone involved in
the White House Bioethics committee. His article argued against
Doctor assisted suicide and euthanasia, not on a religious basis
per se, but on the basis that the process of caring for the dying
is one of the most humanizing, and one of the things that defines
us as a civilization. While I would generally count myself as someone
who believed physician-assisted suicide should be an option, I found
that this article deeply challenged my beliefs on the subject. Did
the experience of making this film change your attitude towards
these ethical dilemmas?
DR: Interesting question. Physician-assisted suicide
is a complicated issue. I do believe that if people want to die,
and can clearly be deemed of sound mind, that they should be given
the right to humanely end their lives with the aid of physicians
and our medications. The tricky part for me comes when someone with
Alzheimer's or dementia is then put in that same situation. How
can we determine what the wishes of that person should be? Should
a loved one be able to decide at what point his or her father should
die? In making the film, I did realize that life is a very complicated
thing to define and qualify.
SP:
I'm interested in books like Nuland's and movies like yours. I know
that Fred Weisman made a movie somewhat on this topic called "near
death." or something like that. Are there others you would
recommend?
DR: Yes. “Complaints of a Dutiful Daughter
by Deborah Hoffman.” “Grace” by William Whiteford,
“Alzheimer's: My Mom, Our Journey” by Julie Meisner
Eagle. And a few by Jim Vanden Bosch.
SP: So what’s next for you, Mr. Rosenthal?
DR: What's next for me? Step 1:Passing the USMLE
(United States Medical Licensing Exam) in June and Step 2: trying
to implement a plan to put video cameras in every hospital room
around the country.
SP: Whoa! Videocameras?
DR: It's an idea I have for better analysis of doctor-patient
interactions and reducing malpractice costs.
SP: Pretty crazy stuff.
DR: Yes, it would be crazy! Gotta think outside the box!
SP: Maybe we'll hear about that one in some future Sparrowpost
episode!
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