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by David Rosenthal
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Film Review on Sparrowpost.net
Reviewed by Carla Blackmar

David Rosenthal’s new short film “Witnessing Death” is a powerful, inquisitive film essay about the death of the filmmaker’s Grandfather, Kurt Rosenthal from Alzheimer's. In contrast to our habitual, perhaps even socially mandated tendency to sweep the details of death under the rug until we must personally confront them in silence, “Witnessing Death” addresses them with a lucid honesty that does justice not only to the difficulty of dying, but also to the way the process defines us as family, community and culture.

The film begins with footage of Rosenthal’s Grandfather about four years after he has been diagnosed with the disease, at a time when his more youthful personality is still visible in his quips and interactions with Rosenthal and his camera. Over the course of the film, we see his grandfather diminish, thinning physically and withdrawing cognitively as he grows closer to death. The film centers on the way the progression of Alzheimer’s confounds the social conventions associated with “the good death.” How does one say goodbye during such a prolonged period of departure?
In order to answer this question, Rosenthal seeks out different perspectives on the role the living play in the life of the dying. Rosenthal has a gift for conducting and filming interviews, and his discussions with doctors, nurses and chaplains are woven into his personal narrative, re-shaping his understanding as his grandfather moves towards death.

Some of the most remarkable interviews are those Rosenthal conducts with CNAs (Certified Nurses Assistants) who attend to the most basic needs of the dying in nursing home facilities. Following close on the heels of a comment from a psychotherapist about the way our culture doesn’t value “caring for the body of the dying,” the CNAs frankly describe what it is like to do just that on a daily basis. While the CNAs are open about the difficulty of their work, they nonetheless assert that there is an element of closeness and sanctity in serving those who can no longer serve themselves. It is surprising to hear CNAs suggest that there is something tanscendent about work so many of us imagine to be repugnant and dismal. It is remarkable to hear that there can be something redemptive about dying: a process so many of us would like to ignore, or even to euthanize our way out of.
The startling interviews with the CNAs mark a turning point in the film. In contrast to our familiar way of talking about disease and dying in martial terms “battle with cancer” or “struggle against Alzheimers,” the interviewees suggest a different approach, not fighting or curing, but instead “witnessing” death; to mark someone’s departure from the world with the same attentions merited by someone’s entry as an infant.

In the case of Kurt Rosenthal’s passing, this “witnessing” is accomplished quite beautifully in his Grandson’s film. As sad as it is to watch Alzheimer’s steady progression, the care Rosenthal has taken in telling the story of his Grandfather’s end is a testament to the life he led prior to the stage chronicled in the film.

Though we are told almost nothing of Kurt Rosenthal’s life from the film; (there are no old black and white pictures, grainy 8mm footage, or nostalgic reminiscing), we can’t help but feel as though we know him through the process of watching his son and grandson witness his death. The love evident in these last attentions tells us volumes about the man Kurt Rosenthal was in life.




Interview with Sparrowpost.net

Sparrowpost: One of the things I find most interesting about your movie is the way we learn some important things about your Grandfather, but you don’t tell us these things directly. For example, you tell us he was an avid photographer, but we don’t see any pictures of him as a young man. Did you intentionally exclude these pictures?

Dave Rosenthal: Good question. The decision to include and exclude information about my grandfather was made intentionally and perhaps slightly unintentionally. As much as I wanted to include personal information about my grandfather, I decided to limit some of the footage because the piece was focused on the end of his life and his care at the nursing home. In a way, the piece uses the personal story of my grandfather as a means to explore care at the end of life and the meaning of death. I think that many of the important points can be inferred from the way the story of the end of his life was told.

SP: Just out of curiosity, though, what did he think of your video habit? Did you catch the photography disease from him?

DR: I think that by the time I had begun seriously filming, he was already somewhat demented so it was difficult for me to understand what he comprehended. In a way, you could say that I started filming precisely because I recognized that he was losing something, that every time I would film him, he would understand less and less, and to me that necessitated capturing each encounter in some way. A video camera was my medium, but it could just have easily been a diary, a film camera, or a tape recorder.
As for the photography disease... I would like to think that I caught it from him. It seems reassuring that there is a cycle of photography in my family.

SP: At what point did you formalize the idea of editing the footage into a film?

DR: Well, I guess that as I was filming initially, there was a compulsion to capture each moment because it inherently seemed important. I didn't know what, if anything, I would do with the footage. As a student in Alfred Guzzetti's Experimental Video class at Harvard, I started screening some of the interview footage cut together and realized the power of the story and the images. I think after that point, a few late night discussions with Andy Rice in Bar Harbor pointed me in this line of thinking. A few years, two cities, a wife, and med school later, I finally completed it.

SP: Do you have footage from a time earlier than the first footage you show in the film?

DR: I know that I have footage of him at earlier times, in fact there is quite a bit of footage of him from home movies, but I chose not to use it a couple reasons. Firstly, I did not shoot the other footage and didn't know how I felt about using that footage. Secondly, again, I was making the film as part of the Summer Program in Geriatrics at the Buehler Center on Aging, and part of the focus was trying to expand this personal story to have more universal themes about end-of-life care. The personal story, albeit necessary for the film to function, was a delivery device for the voices of experts and caregivers.

SP: At what point in the process did you decide to interview the CNAs? How did the things they had to say influence your experience of the dying process?

DR: When I began discussing this project with my advisors at the Buehler Center, it became clear that one of the most powerful parts of visiting my grandfather was the care by the CNAs. When the CNA told me that it was a "blessing" to care my grandfather, it was profoundly moving. I felt that I needed to talk to other CNAs to try and extract what it was that was so compelling. Ultimately, the CNAs taught me a great deal about the dying process, and I was honored to be able to interview them. Perhaps the nicest part of making this video was that at a screening for the Nursing Home in Skokie, IL, after the film ended, an impromptu standing applause was given to the CNAs in the room.
They felt that I accurately depicted their stories and sentiments.

SP: Wow. That's so cool.

DR: Yeah no kidding. And supposedly the same thing happened when it was screened for the executive board of the nursing home.

SP: Is there an existent body of work about CNAs already out there? Would you consider making a second film more pointedly about them?

DR: As far as I know, there isn't much work on formal caregivers (i.e. CNAs from institutions); however, there is a great deal of work done on informal caregivers such as family members. I've watched a lot of films dealing with the family care giving experience. You can check out www.terranova.org and Fanlight Productions.

SP: At one point, I read “How We Die” by Dr. Sherman B. Nuland. In that book I believe he suggests that our society has overly sanitized the dying process... and that our culture suffers because of the cloak of mystery we have built around it. Is this something that you discuss in Medical school? Do you think that our tendency to hide the facts of death in the back closet has something to do with the problems our health care system faces in general?

DR: That is almost exactly one of the questions that I asked some of the ethicists!
It is true that nursing homes are a place separated from the rest of society where many people die at the end of their lives. Interestingly, the vast majority of people never move into a nursing home and stay at home with the care of a relative. That said, I do believe that our society does have a tendency to sanitize the dying process and in a way, quarantine those members of society who are old, infirm, or disabled and keep them out of sight. In medical school, we do address end of life issues, but not with regard to the social issues surrounding end of life care. For the most part, physicians work closely with social workers to address these issues.

SP: I guess along the lines of the last question, One of the most disturbing articles I have read in recent history was an opinion piece which I believe was penned by someone involved in the White House Bioethics committee. His article argued against Doctor assisted suicide and euthanasia, not on a religious basis per se, but on the basis that the process of caring for the dying is one of the most humanizing, and one of the things that defines us as a civilization. While I would generally count myself as someone who believed physician-assisted suicide should be an option, I found that this article deeply challenged my beliefs on the subject. Did the experience of making this film change your attitude towards these ethical dilemmas?

DR: Interesting question. Physician-assisted suicide is a complicated issue. I do believe that if people want to die, and can clearly be deemed of sound mind, that they should be given the right to humanely end their lives with the aid of physicians and our medications. The tricky part for me comes when someone with Alzheimer's or dementia is then put in that same situation. How can we determine what the wishes of that person should be? Should a loved one be able to decide at what point his or her father should die? In making the film, I did realize that life is a very complicated thing to define and qualify.

SP: I'm interested in books like Nuland's and movies like yours. I know that Fred Weisman made a movie somewhat on this topic called "near death." or something like that. Are there others you would recommend?

DR: Yes. “Complaints of a Dutiful Daughter by Deborah Hoffman.” “Grace” by William Whiteford, “Alzheimer's: My Mom, Our Journey” by Julie Meisner Eagle. And a few by Jim Vanden Bosch.

SP: So what’s next for you, Mr. Rosenthal?

DR: What's next for me? Step 1:Passing the USMLE (United States Medical Licensing Exam) in June and Step 2: trying to implement a plan to put video cameras in every hospital room around the country.

SP: Whoa! Videocameras?

DR: It's an idea I have for better analysis of doctor-patient interactions and reducing malpractice costs.

SP: Pretty crazy stuff.

DR: Yes, it would be crazy! Gotta think outside the box!

SP: Maybe we'll hear about that one in some future Sparrowpost episode!


 
 


David Rosenthal
1455 N. Sandburg Terrace #1006
Chicago, IL 60610

dirosent@md.northwestern.edu
dirosent@post.harvard.edu
(310) 460-8552