“I have to be right for her”
If there’s substance to Dan Krauss‘ documentary short Extremis beyond its observational look at the emotionally heavy compromises made when a patient is faced with life or death scenarios, it’s to provide concrete evidence as to why you should put your own decisions down in writing before anything bad can occur. It’s a difficult conversation to start, but that difficulty is ultimately for you and you alone. Your not having the courage to start it is what subsequently transfers the difficulty onto the shoulders of family and doctors, the weight of it growing exponentially since they’ll never know whether the choice they’ve settled on was the one that was best for you or them. Differentiating this is literally impossible and they’ll question themselves the rest of their lives.
The film is unfortunately too brief to truly dig into each ramification of what could happen, but it does do a wonderful job introducing multiple examples (a still communicative wife, virtually comatose mother, homeless man with no kin, and father wrestling his desires against those of the son he’ll leave behind) that force you to contemplate innumerable “what ifs.” We hear a little from Dr. Jessica Zitter about her wake-up call to recognize how some long shot procedures deliver more pain than assistance; a little from Dr. Monica Bhargava about the ethical responsibility of explaining facts and pushing someone towards a choice they wouldn’t have chosen themselves; and a bit from families willing to let God decide so their consciences remain clear. There’s no right answer.
A fly on the wall throughout, moments that feel like someone is talking to the camera are revealed as doctors in conversation or family members in debate (sometimes alone). We witness the tragic sadness of recognizing death as inevitable and blind faith in miracles as coping mechanism more than actual hope. Extremis is a compact expression of futility in the fact that no one but the patient can truly know what’s wanted so their situation can play out on their terms—even if wrong—rather than an outsider letting emotions shield away hard truths. But don’t assume this means the doctors are immune as third parties. The most powerful moment onscreen proves to be Zitter breaking down in the knowledge that there’s nothing more she can do.
Death comes for everyone and it’s hard enough to have to deal with your own let alone someone else’s without discussing the myriad possibilities we all try to avoid. Setting those decisions in stone or being conscious enough to have them in the moment, however, hardly renders the circumstances bearable. There are still feelings of abandonment, regret, guilt, and love no matter the ordeal set in front of these families. There’s the burden of knowing what your spouse wants and still being unsure if their situation has become direr enough to do so. And that’s why doctors are paid the big bucks and respected for their objectivity. They discover whether their options have been exhausted to the point where comfort is all that’s left. That responsibility is unimaginable.