Originally published in Modern Healthcare.

By Adam Rubenfire & Jaclyn Schiff

September 16, 2016

For most hospital administrators, the idea of allowing filmmakers to roam the halls of the ICU is probably no more appealing than getting into the nitty-gritty of their compensation.
But uncomfortable situations can yield powerful results, which must have been what executives from 236-bed Highland Hospital in Oakland, Calif., were reaching for when they agreed to let filmmaker Dan Krauss document dying patients at their public facility.

The result is “Extremis,” a 24-minute glimpse into end-of-life discussions that was released this week on Netflix. In April, the film took first place at the Tribeca Film Festival in the short documentary category.

Dr. Jessica Nutik Zitter, the ICU doctor and palliative-care specialist featured in “Extremis,” acknowledged that administrators were “very, very wary and very protective, but also very brave in considering it.”

It helped that they had previous television exposure. Highland Hospital was the setting for “The Waiting Room,” a documentary about the uninsured that aired on PBS in 2012.

Administrators “had an experience of a filmmaker in the ER, and it made them a tiny bit more comfortable, but even so it was a lot of due diligence and a lot of work and a lot of going back and forth and clear boundaries of what was acceptable” in terms of filming, Zitter said.

It was the experience of seeing “The Waiting Room” that Zitter says first inspired her to pursue a film project about end-of-life decisionmaking. This is no surprise given that Zitter is one of those rare clinicians who is as adept at public conversation about the medical issues with which she is so professionally engaged. She has published articles about palliative care, including in the New York Times and Huffington Post, and is the author of the upcoming book—Extreme Measures: Finding a Better Path to the End of Life— due out in February.

Shortly after Zitter was introduced to Krauss, she invited him to observe life in the ICU. For his part, Krauss said he came to the film without a strong interest in end-of-life issues.

“The topic decided to tackle me in a way,” Krauss said.

He was drawn in as Zitter described the daily decisions facing her and other doctors in the ICU, which are rife with ethical and moral conundrums—a central theme Krauss has explored in his past films. Though he was a little reluctant to spend time in the ICU at first, Krauss said it was clear to him from the day he started shadowing Zitter that there was a story to tell.

“You really sense that there was almost a sacredness to the place,” he said. “It’s a truly fascinating world where science and faith intersect.”

Viewers have noted the film’s short length. At just under a half-hour, it can almost feel like the first part of a series rather than a stand-alone film. Despite months of filming and accumulating “gobs and gobs” of footage, Krauss said, “in the editing of it, I felt like we could really say a lot with a little.” Krauss also notes that Netflix doesn’t require films to be exactly 90 minutes and gives filmmakers more flexibility because content is made to stream. “The film can now tell us what it wants to be,” he said.

Both Zitter and Krauss said they’ve been delighted with the reception to the film. Krauss said a handful of medical institutions have already gotten in touch expressing interest in using the film for teaching.

Unsurprisingly, the palliative-care community is delighted with the exposure of these issues. “We think it’s an excellent documentary to put out there on a platform like Netflix,” said John Radulovic, vice president of communications at the National Hospice and Palliative Care Organization.

Radulovic applauded Zitter for explaining in the film that sometimes medical interventions can do more harm than good. “It’s so important for people to begin to understand. … While death is always hard, it’s sometimes unavoidable.”


Edited on June 14, 2018.