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DEBBIE MOLONEY: All right, John, you're back home for a while. Who are you-. Readers' comments that include profanity, obscenity, personal attacks, harassment, or are defamatory, sexist, racist, violate a third party's right to privacy, or are otherwise inappropriate, will be removed. He knows. Dr. BARBARA MANN: You never really want to impose your own personal morals or beliefs on a family. OK? Dr. JUDITH NELSON: Now let's address the family situation because we did meet with them yesterday and they're coming back in today, and we have some difficult issues that we've got to address with them. FRONTLINE's Facing Death is available on DVD. JULIA ROMERO, Robert's Wife: He was here two months ago, also with pneumonia. I really don't know. Stopping treatment almost means that we acknowledge that death is near. I think this week has changed me because I think I really believed that he was going to get stronger, and I really didn't think this was going to happen. The question is, if we remove the tube and she does not breathe on her own, what should we do? DEBBIE MOLONEY, John's Wife: He won't say that he's going to die from this. I didn't want that for him. She lift up those two fingers and showed. You know, I think everything went downhill from that. Patients that we didn't think could breathe do breathe. But ultimately, we can't overcome the patient's illness in most cases. Tim, who has cancer, with his mother Marietha Woods in "A Lion in the House." And let's face it, you've been here for so long, it's time to leave for a little while. Nowadays, he doesn't want to be bothered. The lines are blurred. Home for only a week, he was brought back in on an emergency admission. DEBBIE MOLONEY, John's Wife: This has been crazy. JEROME GROOPMAN, M.D., Professor of Medicine, Harvard University: Patients with severe illness will go with you to the edge. Unfortunately, what has happened is that Americans are now coming to ICUs to die. Entries that are unsigned or are "signed" by someone other than the actual author will be removed. His cost of care is covered by Medicaid. It's a lot of stuff that has been said that John's not prepared to hear. You know, so we have different feelings on that. She's getting maximum support from the respirator. DEBORAH ALBERTI, Albert's Wife: Why give up? Dr. SCOTT LORIN: Right. Learn more about conversations with doctors, the misconceptions surrounding end of life choices and much more. We asked him. NARRATOR: John never did sign a DNR, but he did agree to go to hospice. Jim Ferguson Listen, I want to say something that you should think about today, but you don't have to say anything about it now. So that will happen again. SHERLEY SCHWARTZ: The quality of life, the arguments will be the same because we know that, you know, that Alzheimer's is progressing. Dr. KEREN OSMAN: Sometimes it's not completely clear what's reversible, what isn't, will they rally from this moment from this infection. So she is very, very wasted, you know, very poor nutritional status. How far would you go to sustain the life of someone you love, or your own? It's 11 months, and they have no answers. And nobody wants to die badly. With doctors in this film -- Jerome Groopman, David Muller, Judith Nelson, Keren Osman, Telling a patient the end of life is near ... the great uncertainty in medicine ... weighing the costs ... most families are unprepared ... more, ...share your own story, or that of a loved one. To order, visit Shoppbs.org or call 1-800-PLAY-PBS. ADRIANA MALONE, M.D., Bone Marrow Transplant Unit: Hi. Sometimes those things can still — and it only takes a little bit sometimes to put them over the edge into — back into the living. In Fight Against ISIS, a Lose-Lose Scenario Poses Challenge for West. We can endure some level of suffering among our patients because we believe that while we do make them suffer, that there is a greater good at the end of it, that they will come out the other side. NARRATOR: When Albert Alberti, 53, was first diagnosed two years ago with MDS, a type of leukemia, he was given only months to live. SENIOR EDITORIAL CONSULTANT Sometimes there are forces outside of the patient and myself that are the patient's family, other physicians. Never. I think he —. MANAGER by Bruce Scott, MD The producers at FRONTLINE were kind enough to reach out to Pallimed to preview the "Being Mortal" episode being aired on local PBS stations starting this Tuesday Feb 10, 2015 (also available online on Tuesday). Because the chemo treatment would —, Dr. CELIA GROSSKREUTZ: The stronger you are, the better it will be for you, so —. But then you talk and you say, "OK, let's try something mild" because doing nothing — it's scary to do nothing because what if — I don't want him to die, you know? We're going to just listen to your chest and do a few other things on the exam, and we'll try very hard not to hurt you in any way. Dr. KEREN OSMAN: That's what you always did express to me, but I want to make sure that hasn't changed. But I think you can have a lot of conversations about these things, but I think when the moments come, I don't think that anybody can be completely prepared for what it's really all about. He got better, they sent him back to the nursing home, and came back in Tuesday. If you can stop breathing, do you want us to put you on a vent? And they get sick enough so that they can die from infection or bleeding or other organ toxicities. I'd have to —. When the moment comes, and you're confronted with the prospect of "pulling the plug," do you know how you'll respond? Henry King DEBBIE MOLONEY: John, you're not understanding, honey. Although Diana told doctors that she did not want to be permanently dependent on machines, her family is not ready to take her off the ventilator. I ask, Who is the health care proxy? “The Most Risky … Job Ever.” Reporting on “ISIS in Afghanistan”. But you cannot escape the reality that too often, that success is not the case and you risk amplifying suffering. Web Site Copyright ©1995-2014 WGBH Educational Foundation, In Fight Against ISIS, a Lose-Lose Scenario Poses Challenge for West. I closed my pool. Dr. JUDITH NELSON: You've got a patient who's in shock. Interviews With doctors in this film -- Jerome Groopman, David Muller, Judith Nelson, Keren Osman The Big Issues Telling a patient the end of life is near ... the great uncertainty in medicine ... weighing the costs ... most families are unprepared ... more Discussion...share your own story, or that of a loved one Educational Guides When the time comes, how will you decide? Certainly, as Facing Death shows, in scenes that are both intimate and respectful, it’s hard to see any of the process as “waste” when you’re going through it. NARRATOR: In the Intensive Care Unit at Mount Sinai Hospital in New York City, a family gathers. FRONTLINE is a production of WGBH/Boston, NARRATOR: Although doctors believe they can no longer control his myeloma, John doesn't want to stop treatment, so they've agreed to send him home on a mild chemotherapy. Because I don't see Norman walking out of this hospital. But now there is a chance to go home. He is not going to be in pain. ADRIANA MALONE, M.D., Bone Marrow Transplant Unit: I think doing nothing is a very important consideration. There's a group of people who defy expectations. ALBERT ALBERTI: We'll make it through this. NARRATOR: John Moloney is also back in the hospital. There's no question that the technology has saved, in a meaningful way, hundreds of thousands, if not millions of lives. But with those advances and all of that progress comes an ultimate tradeoff. Learn the importance of advance care planning when facing a serious illness and how to find the help you need to get the kind of care you want. Mary Leonard was "pretty direct about things in her life," and so it was when it came to facing death and dying. And these are the broken survivors of intensive care. I think I can't humanly say that to a patient. And although it is something that will be missed greatly, but to me, if it gets to that, it's something I would accept because of compassion for her. And at the same time, nobody wants to die badly. The uncertainty is the most disturbing part of the decision-making. That was —. PHYSICIAN: We've come to a crossroads as to — with regards to a decision. The episode is based on the recent book of the same name by Dr. Atul Gawande that many of us are probably already familiar with. That's what I wanted to talk to you about. Dr. KEREN OSMAN: But I think we've accomplished the goal that we tried to accomplish, to get you on some oral chemotherapy, to get you strong enough to go home, to keep things stable. And the availability of the therapies has created this fiction that we can orchestrate this one way or the other, when the truth of it is that, for all of this magnificent technology, the underlying illness and the medical condition of the patient are far and away the most important factors in determining the outcome. Dr. KEREN OSMAN: That's OK. That's OK. Take your time. Yes. NURSE: If something should happen and you were to have trouble breathing, do you want to be put on a respirator to help you breathe? Firstly, the PBS Facing Death is explicit in the issues involved with the end-of-care life practice. His liver began to fail. SHERLEY SCHWARTZ, M.D., Marthe's Daughter: I don't want to be the one to say DNR and to be responsible for her death before her time. PHYSICIAN: It looks like that is the GVHD. “The Most Risky … Job Ever.” Reporting on “ISIS in Afghanistan”. In order to foster a civil and literate discussion that respects all participants, FRONTLINE has the following guidelines for commentary. Thomas Kalb, M.D. John MacGibbon He has now been on a ventilator in the intensive care unit for over a week. You know, it's very hard to see him like this. Dr. KEREN OSMAN: Norm, we don't have to do it. Now, if you look at the history of critical care, the idea of an intensive care unit was for you to come there with a life-threatening illness and respond to the treatment and get better. But I mean, the truth is, I thought that probably the most humane thing to do would be to take the tube out and to see if she could breathe, and if she couldn't, then to just make sure she was comfortable. There's always the nagging concern in the back of your mind, "Have I really left no stone unturned?". But I offer. Janice Flood I'm watching the seasons go. The Galarza Family All right. Entropy Media, LLC, DIRECTOR OF NEW MEDIA & TECHNOLOGY Sarah Moughty But now a bone marrow transplant gives them a chance of survival. (Photo credit: PBS) Death is not a topic easily broached. Frontline investigates the complex and often agonizing end-of-life choices that are made by physicians and families. Posts: 4912 Joined: May 2005 Nov 24, 2010 - 9:57 am. PHYLLIS HUNTE: Unfortunately for me, when I come, he never says any of those things to me. And I'm not sure that we added to his quality of life at all. Dr. KEREN OSMAN: Do you have, like, flexibility to take a little bit of time? Raney Aronson-Rath, A FRONTLINE production with Mead Street Films, LLC, ©2010 And I told John, I said "No more cancer treatment, no more chemo. In fact, the development of health care system sometimes makes it harder to decide to keep trying to prolong a life or not. For more on this and other FRONTLINE programs, visit PBS.org. In a perfect world, the patient designates a health care proxy and has a discussion about what their preferences would be at the end of life. And on Monday, I was in good shape. A collection of information from FRONTLINE's Facing Death, a film that intimately examines today's complicated end-of-life decisions. NARRATOR: Here in the bone marrow transplant unit, a team of oncologists treats people with blood cancer who a generation ago would have died. FRONTLINE home page | Privacy Policy | Journalistic Guidelines | PBS Privacy Policy | PBS Terms of Use, FRONTLINE is a registered trademark of WGBH Educational Foundation. That's — that's my goal. He said, "I had to take the chance. It's a lot to take in today. And we've seen it enough times that we hold it as a belief. You know, knowing that you've had many, many therapies for your myeloma, including two transplants, and now when we make a decision, we need to think very carefully because many therapies that we give you may affect your quality of life or may even shorten your life. Of course we applaud, we were so happy about it. The risk is that somebody ends up in a position that they absolutely do not want to be in, and they are very vulnerable and voiceless and cannot extricate themselves from that position. He still wanted everything done, but —. Married with three young children, he knew a bone marrow transplant was his only hope for a cure. But then what might happen is that the bleeding might start again because we're not really doing anything to definitively fix that bleeding because we really just can't anymore. The bigger problem I think right now is his lungs. And now her daughters — Nadege, a nurse, and Sherley, a physician — have to decide whether to remove her from the ventilator. NURSE: I don't want to do it if you're scared. He said, "I want everything." That's it. She has now been living on a ventilator for over a year. Joanne Langer-Kellas PRODUCER And that's not a position that any of us wants to be in. Sometimes there are patients for whom I think about them and I wish we'd stopped earlier because I think they suffered unnecessarily, but in the moment, in the heat of that moment, maybe I didn't realize it at that time. And then we'll go on, make a choice, and we'll see what happens. New items just added! By submitting comments here, you are consenting to these rules: Eric Brass Up to 70% off Clearance. And that is my job. Norman Smellie has been in the hospital for two months suffering from life-threatening complications of his transplant. WEBSITE DESIGN AND TECHNOLOGY Essentially, you can support pretty much every body system for years because you can keep their lungs breathing and keep their heart beating, keep their blood pressure up and keep their blood flowing. Voila. David Nierman, M.D. Michael H. Amundson, ASSISTANT EDITORS PHYLLIS HUNTE: OK? BARBARA MANN, M.D., Medical Intensive Care Unit: People surprise us all the time. And have you thought about that more and do you want to tell me something about that? If he thought it would, he would do it. So the decisions at the end of life have become much more complicated for everyone involved. The words are the introduction to a documentary film which was written, produced and directed by Miri Navansky and Karen O'Connor for PBS Frontline and which is a visual, aural and dramatic companion to Lynch's award-winning collection of essays, The Undertaking: Life … JEROME GROOPMAN, M.D., Professor of Medicine, Harvard University: There's a tremendous pressure now to reduce care to numbers, as though there's an algorithm for every decision. ANNOUNCER: Tonight on FRONTLINE, an intimate journey to the edge of life. Dr. BARBARA MANN: People surprise us all the time. So doctors called in his sister, Phyllis, who is his health care proxy. And that is, I think, where the art and science of medicine mix. And I would like a straight answer. But I'm not sure it will really help. I'd rather be like that than dead. JOHN MOLONEY: Oh, I was [unintelligible]. JOHN MOLONEY: I can get out of here, right? ALBERT ALBERTI: And I just fell off the toilet bowl, slow motion. Maureen Masterson Tonight, the PBS show Frontline illuminates the Dartmouth data with a bedside view of the New York style of end-of-life care. Additional funding is provided by the Park Foundation, committed to raising public awareness. ALBERT ALBERTI: When the first transplant didn't work, we went to the second one, and I still stayed positive. There's nothing wrong with the catheter. still believes he wants to stop treatment, Dr. Osman and Norman's sister decided to send him to the intensive care unit to see if he could be stabilized. Go along with that, as crazy as that sounds, he knew a Bone transplants! Can count all the rapidly evolved technology, people can not escape the reality that too often, 's... Watched the PBS show FRONTLINE illuminates the Dartmouth data with a grant from scott Nathan and Laura DeBonis that... To give you is whether we should take the chance family gathers a to! The family voted two to one that always say, `` OK, a. 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