At the Intensive Care Unit at Highland Hospital in Oakland, California, palliative care specialist Dr. Jessica Zitter treats terminally ill patients. As she and her team provide the best possible care, they try to help the patients and their loved ones make critical, often heartbreaking decisions.
Director: Dan Krauss
It goes without saying that nothing can prepare you for the moment that you find yourself standing over a hospital bed, looking down at a spouse, parent, child or sibling that has an infinitesimally minute chance of ever recovering. Worse still is the moment that you are asked to make the choice between putting them through more pain and discomfort in the hope of beating the odds, or to abandon any chance of saving them and letting them slip away peacefully. For many of us this would seem to be an impossible decision and either way, the results will be emotionally devastating. Director Dan Krauss demonstrates his awareness of this simple yet crushing fact in the way in which he approaches this fly-on-the-wall documentary.
The very nature of dealing with family members of terminally ill patients does not require soaring string music or tearful confessions to camera. As such, Krauss largely does away with filmic bells and whistles and opts to simply cover, as best he can, the difficult and often frank conversations in which the fate of a human life is decided.
A notable aspect of this film is the level of access that the filmmakers are given to these extremely painful and private moments. The main subject of the film is Dr. Jessica Zitter, who we follow as she examines patients, speaks to family members and debates with colleagues about whether or not a patient can or should be saved. Zitter acts as our point of access to many of the instances of bitter decision that play out, but Krauss anchors each scene in the often silent moments of turmoil of each family member tasked with deciding whether or not their loved one will live or die. There is a subtle yet practiced skill demonstrated here that allows us into these private moments without the presence of Krauss and his crew becoming an outright intrusion.
Krauss also refuses to use direct-to-camera accounts or interview techniques for narrative or character background. Instead he cleverly uses parts of conversations as voice-overs to contextually frame the scenarios that subsequently play out.
The spectrum of reactions on display is enough to disarm the most cynical viewer, from stoic silence to outright hysteria as the reality and finality of the situation begins to set in. There are also truly touching moments to be found between patients and their loved ones as they cherish what could be one of the final times they hold hands, embrace or look into each others eyes.
Krauss does not shy away from capturing those fleeting seconds of exhaustion that show on the faces of Zitter and her colleagues. The emotional fatigue that medical professionals have to hide from the people who receive their care does not escape Krauss’ eye, and its albeit brief presence serves to remind us of the toll it takes on them day after day.
An interesting theme that emerges is one of faith vs. fact. Nobody wants to give up on a family member, no matter how long the odds and as a result we see the concept of hope and miracles framed at times almost as a hindrance as opposed to a source of emotional strength. The sources of conflict often come from unexpected places in this film, and it is interesting to see how different families go about resolving the issues that arise. The audience is often challenged to ask the question, are family members making the decisions they make for their loved ones or for themselves?
This is a film not just of emotional heft, but moral dilemmas. The issue of medical costs is briefly touched upon as one critically ill patient had declined to come in the day before because of the cost of the ambulance transport. Wisely, Krauss chooses to stay focused on the primary subject and does not allow himself to be sidetracked by the issues of the medical services industry.
‘Extremis’ somehow manages to pull off the task of being both clinical and emotive. Krauss does a fine job of building bonds between the audience and the distraught families, while making an antagonist only of the situation that they, and likely one day, we have to collectively face.