How do we talk about the end of life? How does one live a quality life with an illness? Palliative care doctors and patients examine these and many other such questions in the moving feature documentary, Intensive Life Unit.
Doctors Kateřina Rusinová and Ondřej Kopecký are pioneers in Czech Republic hospital palliative care, a field that is often misunderstood and under-utilized. Many people simply associate palliative care with death, and this stigma and our fear of dying unfortunately overcome the importance of discussing end-of-life living. Over three years, director Adéla Komrzý documents Rusinová and Kopecký’s work with patients at the General University Hospital in Prague as they help families, and viewers, realize the importance of palliative care and improving quality of life for every patient.
Right from the beginning, the film dives into the difficult questions surrounding end-of-life care and ethical dilemmas doctors face; in med school they are taught to save lives, not to let the patient go. Dr. Kopecký offers a group of interns a scenario in which a patient dying of a fatal tumour experiences cardiac arrest. Would the med students resuscitate the patient or not? Most in the group say yes; one posits that not doing so is euthanasia. Kopecký doesn’t offer a right or wrong answer, but prompts the interns (and viewers) to consider what makes a life meaningful. It’s a particularly apt question in an era where medical advances have created possibilities to extend life artificially. The film encourages us to think and choose the answers that we are comfortable with for ourselves, opening up the conversation around the end of life.
Komrzý started on the film project after a friend’s sister died in hospital. Komrzý describes the family’s grief and frustration at the lack of information or clarity from doctors about the reality of the situation, meaning the family “never had the opportunity to come to terms with the inevitable.” While death will always be very sad, the film and the work Rusinová and Kopecký do shows us that palliative care is, in part, designed to give patients and families time to accept the finality of their situation so they can prepare and have those important conversations about how to live a quality and meaningful life.
Intensive Life Unit is shot from the perspective of the doctors as they work together with patients and their families. Determining personal values, managing emotions and providing decision-making tools lie at the heart of the palliative field. Rusinová and Kopecký ask tough questions to find out the patient’s values in order to better provide them with options and guidance, giving them back some autonomy over their life. In taking patients and their families through this process, we watch as many patients come to terms with their situation and choose to live at home with their family rather than stay in the hospital. Through every step of a patient’s hospital stay, the palliative team prioritizes communication in order to provide clear information and work together to find ways to improve the patient’s comfort and happiness. Meanwhile, the two palliative doctors also train incoming doctors and confide in one another about work.
Both Rusinová and Kopecký brush off questions about how they cope with the emotional toll of their jobs, seeming almost flabbergasted at the very notion. Perhaps this is because the very nature of their job requires them to empathize and connect with their patients while maintaining a professional distance from their emotions; it surely make sense if they compartmentalize. In quiet moments alone, however, we see Kopecký play his cello, while Rusinová takes a moment to rest her head in her hands.
While the film incorporates humour and heartwarming moments to shine a light on the positive role palliative care plays in our lives, it is nevertheless a tough watch as we witness many families prepare to say goodbye to their loved ones. However, we come away from the film with a greater understanding of and appreciation for the palliative field, as well as the willingness to have those tough but important conversations with our loved ones and ourselves.
Intensive Life Unit received a special jury mention at this year’s Karlovy International Film Festival (KVIFF). The film has also been selected as part of the Luminous section at this year’s International Documentary Film Festival Amsterdam (IDFA), the world’s largest documentary film festival with a mission to promote inclusivity and give a voice to underrepresented filmmakers. This year’s festival runs from November 17 to 28.