The Conversation by Angelo E. Volandes

Author:Angelo E. Volandes [Volandes, Angelo E.]
Language: eng
Format: epub
Publisher: BLOOMSBURY PUBLISHING
Published: 2014-11-11T05:00:00+00:00

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Creating the video Tom was about to see was not easy. Fortunately, my early dabbling in filmmaking provided a good starting point. My godfather was an amateur filmmaker in New York City. From a very young age, I was exposed to the process of filming and editing in his makeshift studio in his living room, where I would be in charge of splicing film ends together and gathering the discarded pieces of negative film from the cutting-room floor. When I was a teenager, my parents bought me a secondhand sixteen-millimeter movie camera to nurture my interest.

My interest in film continued throughout high school and college, but it wasn’t until medical school in the 1990s that my pursuit of documentary filmmaking took off in earnest. Despite the workload of my medical studies I took a seminar that focused on what was at the time a revolutionary new way of filmmaking, one that did not rely on the cumbersome process of splicing negative films and sorting through discarded strips of film on the cutting-room floor: Digital Filmmaking and the Documentary Film Tradition. Little did I know then how truly life-altering that seminar would be for me and, quite a few years later, for Tom and all of my other patients.

That seminar reminded me of the single most important lesson I’d learned from my godfather: A good deal of thinking and interviewing needed to be accomplished before framing the first shot. I applied that same approach to the production of my new medical video.

For an entire year prior to filming, I interviewed scores of seriously ill patients and their families, as well as loved ones of deceased patients, to understand what the experience of making decisions about medical care was like. Their insights were astounding.

“No one explained to me what all that medical jargon really meant,” one elderly patient with advanced heart disease told me. “You doctors don’t speak English.” A middle-aged patient with aggressive cancer told me, “I wanted to discuss my options with my physician, but she was more interested in talking about what combination of surgery, chemo, and radiation worked best. She didn’t bother to ask if I were interested in any of the above.” And perhaps most telling was the refrain that I heard from numerous family members: “I don’t think anyone ever had a conversation with us or asked what we wanted.”

At the same time, I began talking with clinicians including oncologists, ICU doctors, cardiologists, ethicists, geriatricians, surgeons, palliative care doctors, medical residents, nurses, social workers, and chaplains. As I’d seen before, some doctors never had a conversation with their patients about end-of-life care. For those who did, each had his or her own way of broaching the issue and discussing care at the end of life, especially when it came to CPR: the actual mechanics of it, the prognosis, the complications, and even whether or not CPR was appropriate for some patients with a serious illness. But it was not simply a matter of differences in style.

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