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By Shayna Rich and J. Maggio

The HBO show The Leftovers has a deceptively straightforward science fiction premise: What happens to people left behind after a Rapture-like event? The Rapture is an apocalyptic event prophesied in the New Testament where people chosen by God disappear into Heaven. In the show, roughly two percent of the world’s population--about 140 million people--mysteriously disappear in an instant. Unlike the popular Christian book and film series Left Behind, The Leftovers is agnostic to the cause of the sudden departure. Some characters believe it was the Christian Rapture, but other characters disagree.

The show never offers an explanation. By using the second-person narrative style, the show revels in the ambiguity of the departure. This ambiguity reflects the way the characters process the event itself.  Was it a scientific or a spiritual event? Why did their loved ones leave? Why did the remaining stay? What does it mean? Where did they go? Whereas pulpy fiction would dwell on that last question--where did they go--The Leftovers is brave enough to tackle the bigger issue: What does it mean? The series is about people trying to find meaning in their confusion, grief, and loss. It occasionally leaps into sci-fi tropes, but it never forgets its mission to examine a world filled with seemingly random and meaningless loss. Since the show is rooted in its desire to find meaning in the context of loss, the viewer is forced to grapple with the power of loss.  Given this theme, The Leftovers often struggles with the same question that we do in palliative care-- how do we help people cope with grief?

Every episode of The Leftovers focuses on one character and it shows how that person copes with loss, either past or anticipated, and struggles to find meaning. Characters ask “Why did this happen to me?” And much as it is for a dying patient, the answers vary. One character, the long-suffering Reverend Matt Jameson, compares himself to Job, a Biblical character who is continuously tested in his belief in God with numerous trials. Matt and other characters insist that God must have purpose in their suffering. Some lose faith or blame themselves. Some even join a cult. But all prefer the certainty of an explanation over the abyss of the unknown. For example, Matt Jameson talks to a man claiming--with some credibility--to be God. Matt wants answers! Yet he struggles to find meaning, even in his conversation with “God.” Likewise, in our work as palliative clinicians, we see the search for meaning every day. Patients seeking a reason for why they were diagnosed with a serious or terminal illness may struggle with their spirituality and their belief in God. Patients often blame themselves if they cannot find a definitive cause of their illness. They may ask us if this happened because of their diet, their smoking habits, or their genes. Patients want a reason, a story to determine a meaning for their suffering.  Regardless of the story, any reason is always more satisfying than not knowing why you or a loved one is dying.

Like the narratives patients often impose upon their illness, The Leftovers is about the stories people tell to make sense of loss. For most people, it is unsatisfying to view the world as a set of unconnected, random events, and evidence shows that people process the world with narrative. The show focuses on how people choose which story to tell, how they treat others’ stories, and our willingness to impose a story on our lives even if it conflicts with logic, experience, or life events. Nora, a character whose husband and two children all disappeared, struggles with the feeling that she does not want to invent a story for what happened unless it is scientifically accurate. The finale of The Leftovers ends with Nora stating “I knew that if I told you what happened that you would never believe me,” followed by another character responding “I believe you.” Her willingness to accept that others can believe her story without proof, represents her growth over the course of the show. Similarly, in palliative care, much of what we do is provide a sounding board for stories. We listen to patients and family members tell stories of how they were told about their diagnosis, what treatment has been like, and what they have been going through in hospitalization. We encourage our patients and families to do life review and make meaning from their lives by telling stories. And much of the support we provide takes the form of listening and believing their stories. The Leftovers emphasizes the value of that support, especially when the truth is unclear or ambiguous.

Cultural critics examining The Leftovers grapple with this ambiguity of truth in their reviews. The show also gives critics permission to explore their own experiences of loss.  Even normally stoic critics like Alan Sepinwall open up about their personal lives and how the show shaped their personal grief. Critic Matt Zoller Seitz’s review of a season 2 episode discussed how The Leftovers connected to his feelings of loss as a widower. Seitz's article even inspired the show’s co-creator Damon Lindelof to write a subsequent episode dealing with grief, loss, and belief in God.  Most beautifully, critic Mo Ryan's article "'The Leftovers,’ Life, Death, Einstein and Time Travel" connects The Leftovers with her complex feelings toward her dying parents, especially her mother’s death from Huntington’s Disease. It has been shared through social media, causing many tears.

The Leftovers not only echoes the concerns of our patients and their caregivers, it also actively helps viewers process their own losses. It is a profound discussion of loss and pure grief. As with much of our work in palliative care, though, it is leavened with humor. The Leftovers is the type of show where Matt Jameson, dying of cancer, argues about suffering with a character calling himself “God,” but it is also a show where he watches "God" be eaten by a lion. Like most art works asking "big" questions, The Leftovers revels in both the wonders and terrors of the mysteries of life.

Shayna Rich, MD, PhD is a doctor who just completed her palliative medicine fellowship and is starting work at Haven Hospice in Lake City, FL. J. Maggio, JD, PhD is her husband, political science professor, and a passionate aficionado of the philosophy of pop culture.

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by Beth Budinger Fahlberg PhD, RN, CHPN

A physician, when asked how he wants to live at the end-of-life, states “I want to die in my own bed in my bedroom, holding my wife.” Yet how do most Americans die? In a hospital room after prolonged multi-system health issues, with a seemingly endless series of hospitalizations, procedures, tests, treatments and medications, and self-care regimens.

This discrepancy between the “ideal” view of death and the reality of death in America today is the challenge explored in the new award-winning documentary, Consider the Conversation 2: Stories about Cure, Relief, and Comfort. This is the second film by Michael Bernhagen and Terry Kaldhusdal, who produced Consider the Conversation: A Documentary on a Taboo Subject in 2011.

Over the course of Consider the Conversation 2 (CTC2), we learn from physicians and patients about the importance of communication in navigating the uncertainties and the many decisions associated with chronic serious illness. Palliative care and communication are forefront in this movie, which includes interviews with Palliative Medicine experts including Diane Meier, James Tulsky, Anthony Galanos and Jim Cleary.

While the perspectives and information provided by these medical experts is a critical element of this film, the most powerful messages about communication come from the patients themselves:

• Laura, whose journey through cancer treatment is prompting her to take care of things for her loved ones. She talks about cleaning out her basement and writing a note for her family: “Hopefully you will find this when I’m 94. But if not….” For Laura, statistics about her disease provide her with hope, and the motivation to achieve her goal of “being an old damn lady.”
• George, a federal highway administrator with lung cancer who is famous for his giant pumpkins. He faces his journey one day at a time. He didn’t want to look at the mortality tables for his disease, as he views himself as an individual, not a statistic. He just wants to know if something changes, but he doesn’t want the details.
• Greg, a younger man with advanced cancer who doesn’t want to know anything about his disease. This is illustrated as his wife talks about how he had to look away when they were completing the disability claim form question “what do you have”. We see this couple at an advanced stage in Greg’s journey, just a week or two before his death. One of the most touching scenes in the movie is when he is talking with his two young daughters over the phone, sharing “magic kisses” with each other.

Each of these people has a unique way of thinking about their diagnosis and their future, and of coping. We see how their physician, Dr. Toby Campbell, at the University of Wisconsin, tailors how and what he communicates, based on what he knows about them, and what they want to know. The film concludes with a story by Robert Fulghum, from his classic book All I Really Need to Know I Learned in Kindergarten. Seeing this iconic storyteller is both a rare treat and a powerful reminder of the importance of relationships in advanced illness.



With the release of this film, a big-screen premiere was recently held at the Oconomowoc Arts Center, near Milwaukee. The highlight of this event was a panel discussion that included several people who were featured in the film. George was there. He is still growing big pumpkins, and going through more treatments, living one day at a time. Greg’s wife was also there, eloquently sharing about her husband and their experience, using these types of speaking opportunities to help her heal and move forward. Toby Campbell shared his perspectives on the film and on communication, while Jim Cleary challenged us to consider the language we use when communicating with patients. Do we use words of war, such as “fight” and “battle”? Or, do we use words that can instill more peace in our patients, such as “journey” during the ups and downs of serious illness? It was a memorable evening to celebrate a remarkable film.

So how can YOU see Consider the Conversation 2 and share it with others, to get the conversation going in your area?

CTC2 is being aired on PBS stations across the US. You can also purchase the DVD through Amazon via the CTC website. The DVD pricing is $30 for personal use, $200 for educational use.

Beth Fahlberg is a nursing educator, researcher, and author interested in palliative care in heart failure and evidence-based, innovative teaching and learning approaches. She enjoys spending time with her daughter and husband, and her three guinea pigs, at their home in Madison and their family's lakefront cottage in northern Wisconsin.

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(Note: we have a short poll about your thoughts on this show. It doesn't matter if you have seen it or not. Let us know what you think - Ed.)


by Chris Okon

"Getting On" is an HBO series about the daily and often absurd experiences of nurses, doctors, attendants, and patients in the "Billy Barnes" extended care wing of the fictional Mt. Palms hospital in southern California. ​Some viewers may be offended by the gallows humor that threads through each scenario, and so viewer discretion is advised. For others who don't mind, and in fact appreciate, the dark humor that's possible with any human interaction, be prepared for sudden bouts of the laughter of recognition.

While trying to sustain some level of compassion for the elderly, frail and sometimes dying patients, the overworked clinicians and staff must work under the knuckles of a red-taped hospital administration which in turn is squeezed by the larger powers-that-be of a broken and somewhat Kafkaesque healthcare system, CMS/Medicare, digital technology, hospice service salespeople, and other monkey wrenches.

Add the personal goals, quirks and challenges of each character and you get unexpected and hilarious situations that may ring very true for those involved in palliative care, long-term care, and hospice.

For example, floor nurse Dawn Forchette (Alex Borstein) knows her profession well but is insecure and so hungry for love that she foists a zero-to-sixty commitment on the unwitting supervising nurse Patsy de La Serda (Mel Rodriguez) who is still in the dark about his own sexual preferences.

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Nurse DiDi (Niecy Nash) is probably the most likable and steady character, keeping a level head and caring compassion while navigating the chaos of quirky protocols, emotional meltdowns of coworkers, and the overarching bureacracy. In once scene, DiDi lets the family enter the room of the mother who just died. "Take as long as you want," DiDi says, quickly followed by Dawn's whisper of "we actually need that bed by 11."


The frazzled department lead Dr. Jenna James (Laurie Metcalf​), in denial that she has reached a career dead-end, still clings to the dream of producing groundbreaking research about fecal anomalies, so much so that she chastises a nurse for removing a critical study sample of "feces, not a turd" left on a chair by one of the more impish dementia patients.


Several ancillary characters add depth, such as the sweet and eager hospice volunteer; the mixed batch of ornery, sweet, or just plain vacant patients; the ingratiating saleswoman for a profit-driven hospice care enterprise; the steady stream of various family members who argue, compete, cajole, or cry over the mother, father, sister, in the hospital bed.

Based on the BBC series of the same name, the American version of Getting On just completed its second season but can be viewed on HBO or HBO Go. ​Start from the beginning with Season 1 to see how character dynamics are established, although any episode presents hilarious and familiar situations.

(Note: we have a short poll about your thoughts on this show. It doesn't matter if you have seen it or not. Let us know what you think - Ed.)

Season 1 Trailer


Season 2 Trailer


As a volunteer with Hospice by the Bay, ​Christine Okon​ offered ​gentle bodywork to many people at the end of life, feeling privileged to hear their stories. She learned much from Les Morgan who founded Growth House, ahead of its time for using technology to build a social network for those involved with EOL. Christine lives in San Francisco and works for Kaiser Permanente on the patient safety aspects of their EHR.

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PBS Frontline is known for in depth documentaries on important issues of the day, often focusing on specific narratives about individuals to help illustrate the larger dilemmas at hand.  They have covered palliative related topics like geriatrics, Parkinson's, suicide tourism and the gaps in US health care, but next week is one that seems to be right in the palliative care wheelhouse; "Facing Death" focuses on the life and death decisions in the ICU.  And to be more specific the Mount Sinai ICU.

Interestingly PBS Frontline has decided to air the episode during Thanksgiving week, maybe in hopes like the Sesame Street episode on the Death of Mr. Hooper, it will spur family discussions about what one values and what choices your family would make in similar situations.  But lucky for you, the internet has made time and space bend so you can actually watch the full episode right now online.   Or you can wait until next Sunday  the 21st at 9p ET when you can watch it simultaneously with hospice and palliative care advocates online at Twebevent. You do not need to be on Twitter (unless you want to participate) to watch the stream of comments.

The PBS Frontline site also has extra materials, interviews and footage so make sure to explore the main site, leave comments and share with your teams.  If anyone would like to post a review of the show here to Pallimed, please email them to me ctsinclair@gmail.com and I will post them next week.  The deadline is Nov 22nd at noon CT. I will accept reviews that are anonymous if well written. If you don't want to leave a full review please feel free to post comments here.    I would love to hear your comments on the choice of title, how palliative care is portrayed, if this is helpful for education to health care professionals or patients and families.