​Extremis by Dan Krauss – Review and reaction

Extremis by Dan Krauss– An analytic note

Carved by my own visceral reaction, my inner dialogue echoes against the walls of the hollow in my chest. Whittled; by feelings of fear, of empathy, love of my own parents and family members. Far-reaching and aching hope for those I watched making the hardest decisions of their lives. Multifaceted and aching, melancholic thoughts tinged with love and hope. A tiring wish for something to help, to negate the inevitable, to preserve the consciousness of those lost and loved. To envelop and protect those childlike, elderly bodies and the vulnerability that being witness to the in-between may bring; the pain it may inflict.

Extremis follows two similar yet juxtaposed narratives of the liminality between life and personhood, and biological death. Where technological advances give us more options than ever, and can perpetuate the biological aspects of life, breathing, hearts beating; These technologies do not give us the objective instructions of morality and ethical consideration for the individual. This complex and subjective decision is left in the hands and hearts of medical professionals and the kin of those between two worlds. These topics emerge through Extremis, sharp and stabbing, a plethora of difficult ethical dilemmas which, as technologies continue to advance, many people will have to face within their own lives (Siegel, 2016).

A shrill but regular beeping, whirring white noise. Dr. Zittie’s concern bounces against the sharp white walls and shiny plastic machines as I am introduced to the ICU. A loving and nurturing voice, the kind of tone that you’d use with a small child who had lost its mother. It doesn’t really matter what Zittie is saying, all I hear is that she is speaking, and she cares.

Poignant utterances hum, tunnelling themselves into the back of my head as they pass by within the film, and on to the next movement. These doctors deal with death every day. ‘Everybody dies’ a cross-cultural universal truth which although is biologically determined; in human life, is deeply imbedded in culture (Hertz, (2006) [1960]). A social transcendence, a crossing over, from one life to the next, in spirit form or even in memory. Our understanding of others’ consciousness makes it impossible to truly separate biological death from social life, for one will always live in a memory; however fleeting (Hertz, (2006) [1960]).

True universals of human social life are hard to find, we can find them in biological truths, death, birth, life. But when life and death become confused, we find that hope and love are transparent and reflexively understood or interpreted. Arguably, but still, nothing can resonate more universally as the human understanding of other people’s consciousness (Avis and Harris, 1991).

That being said, accurately inferring the detailed truths of other people’s inner dialogue is problematic. As intersubjectivity is not something we can accurately infer; and, intrinsically and simultaneously, without articulation, can potentially be read and understood intuitively, yet falsely (Jackson, 1998). Introspective interpretation can never be objective, each individual has their own truth which is multifaceted and may have an internal and external mindful differentiation (Irving, 2011) (Douglas, 1978).

The interpretation of intersubjectivity may also have an associated interpretation imposed upon it by the cinematography and editing of the visual ethnography. Interpretation and individual reflexivity being the only truth within the genera of ethnographic film. Although film is static, the interpretation of intersubjective narratives may be influenced by oneself, and therefore fluid, and undulating.

Within Extremis I see examples of what could be construed ‘good’ and ‘bad’ death (Bloch and Parry, 1982), although both main narratives of Donna and Selena’s stories are similarly ‘good’ death (where the person passing through to death has had a long life and children (Bloch and Parry, 1982) (Simpson, 2001)). There are juxtaposing examples within the film of what a ‘bad’ death may look like. Harrowing, grief stricken conversations, not fully explained or explored by the film. Emotional howls singing the background melody of the ICU. A woman explaining that she doesn’t want to die, that she is only 38 years old, a woman apologising to her daughter, the daughter, a new mother herself; pained, hysterical, veiled with a slick of tears.

Extremis resonates within me, a realisation of a modern differentiation of ‘good’ and ‘bad’ death. Where good death is quiet, free from the tape and intrusive plastic tubing of hospital intervention. Where bad death is a slowly waning, clinical decline, filled with the smell of disinfectant and cold walls.

As the film fades to black it is quiet enough for me to reflect, text appears and I learn the outcome of Donna and Selena’s death narratives. Donna dies days after her machines are turned off. Selena continues to survive for six months occasionally regaining consciousness. A tearing, wretched feeling overcomes me as I read the latter. I feel so much regret and sadness for Selena and her daughter; But upon a space of reflection and reflexivity, I realise that Selena’s daughter may have interpreted the six months of illness as a miraculous and happy event, and not the painful stretch of inevitable decline that I imagine it to have been.

And with this realisation, deep feelings of empathy and a longing to validate, to understand. I conclude with letters written to both Selena’s daughter and Donna’s son in the hopes of explaining my feelings, interpretations and reactions to the two family’s narratives;

A letter to Selena’s daughter.

You felt like they were all judging you didn’t you? Your tone was blunt, you’ve had to be blunt all your life, you feel like people don’t listen. They just didn’t understand what she meant to you, right? You’d die too, you said. You’d die if she did, and if you took those machines away it would be murder. That loss would sever you, you’d bleed. Blood that no one else could see; sticky, thick, hot and wet, and you’d scream too, I know. You’re far from weak though, it’s just…this symbiotic connection, this interconnectedness. You shared so much, far beyond what they could understand. That pain you must have felt when she finally left you, she was ripped from you. You saw God’s miracle, you prayed, you wished she would come back to you. She was never conscious enough to tell you what she really wanted so you just had to trust in the only other thing that meant any sense. Then when she left, it was a quiet violence, it was gentle in the physical world, but in your head, in your body, you were searing with pain. You died too, you changed too, they could see it coming and they wanted to help you. You didn’t want their help, you wanted God’s plan, and God was cruel and vicious in his apathy for your need.

A letter to Donna’s son.

I know she loved you, I know you wanted to squash her back together. You wanted to be strong, in strength you showed tears. I see the grateful ache in your gaze. You liked being needed, you wanted to give back to her, to show her the tenderness and nurturing she had birthed you with. Something you could return. You knew she was in the in-between, you wanted it to be her decision and you wanted to support her, just as she’d supported you, is that right? I bet she was amazing, I bet she was colourful and snappy, I bet she drove you crazy with her stubbornness and honesty. That tattoo on her hand, papery now. You promised, you promise “I’ll look after her”, your daughter? I imagine she’s always had something to say, some advice framed as an order. You know she loved you, I can see it in you, I can feel it through the screen, the swelling of your heart as hot tears bubble over your eyelids, fat and salty. She made you a good man.

References

Avis, J. and Harris, P.L. (1991) ‘Belief-desire reasoning among Baka children: Evidence for a universal conception of mind’, Child Development, 62(3), p. 460. doi: 10.2307/1131123.
Bloch, M. and Parry, J. (eds.) (1982) Death and the regeneration of life. Cambridge: Cambridge University Press.
Douglas, M. (1978) Purity and danger: An analysis of the concepts of pollution and taboo. London: Routledge and Kegan Paul.
Hertz, R. (2006) [1960] Death and the right hand. London: Routledge.
Irving, A. (2011) ‘I gave my child life but I also gave her death’, The Australian Journal of Anthropology, 22(3), pp. 332–350. doi: 10.1111/j.1757-6547.2011.00149.x.
Jackson, M. (1998) Minima ethnographica: Intersubjectivity and the anthropological project. Chicago: University of Chicago Press. pp. 1-36
Siegel, M. (2016) Netflix’s extremis pinpoints the tension between doctors and patients on end-of-life care. Available at: http://www.slate.com/articles/health_and_science/medical_examiner/2016/09/netflix_s_new_documentary_extremis_shows_the_tension_of_end_of_life_care.html (Accessed: 31 October 2016).
Simpson, B. (2001) ‘Making “bad” deaths “good”: The kinship consequences of posthumous conception’, Journal of the Royal Anthropological Institute, 7(1), pp. 1–18. doi: 10.1111/1467-9655.00047.

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