Thinking about illness and death is not pleasant. Even though in modern society there is no taboo in the strict sense, these are topics that people tend to avoid. They remain unexplored. When you yourself become seriously ill, it can feel like entering a foreign land. The controversial publicist Christopher Hitchens spoke of the “land of malady” and “Tumortown,” to which he suddenly felt transported after his own cancer diagnosis. It is a world with its own language, its own procedures, its own smell, and special people.
In the extension of this metaphor one could regard Philipp Döring’s four-hour documentary “Palliativstation” as a travelogue. It would be nice if this metaphor eased access and removed the fear surrounding the topic. For “Palliativstation” does what only the best travelogues can do: the film lets the viewer partake in the experience of having been there.
For several months Döring shot in the palliative care department of the Franziskus Hospital in Berlin. Almost everyone here has probably driven past it at some point; it sits in the middle of the old West district, not far from KaDeWe and the Zoological Garden. Döring begins his film with footage from “outside,” from Tauentzien and Kurfürstenstraße, before he enters the foreign territory, “the land of malady.”
The transition is made as gently as possible, the camera initially more of a bystander. One looks from the hallway into a hospital room where a doctor speaks with a patient who is not seen and hardly heard. The doctor sits with his back to the camera at the bed, but his explanations directed at the patient are clearly audible.
The content of his explanations simultaneously serves as an introduction to the tasks and fundamental conflicts of palliative medicine. It represents a transitional station: here is where those who have received the status “incurable” are helped, for whom there is no return to healthy life, but at most a postponement before death. The aim is to care for the patients as well as possible so that they can, if strengthened, go back home, or from here move on to a hospice.
The latter stands for the fact that death is imminent. Even though the understanding doctor tries to ease his patient’s fear of this step: that he could also leave the hospice and go home again if he wished. It is important to make clear that the patient has a say in the matter.
From this overheard conversation one understands quite a bit: that every decision in this situation can only be provisional, that any improvement is temporary and must be expected to deteriorate at any time. It becomes clear, too, how elemental it feels that the non-curable patients can still participate in the final steps, have a say and speak up, rather than being simply disposed of without a voice.
Filmed with the Consent of the Affected
In the four hours that Döring’s film lasts, one gets to know a few patients a little better. It takes courage to allow oneself to be filmed in this situation, vulnerable and weak. With gratitude one notes Döring’s effort to maintain discretion despite the intimate proximity. Not all conversations are recorded with a microphone, some utterances are left out, and more importantly: there are no “covert” or secret glances. What Döring films, he clearly filmed with the knowledge and consent of the affected.
That creates a sphere of trust even for the viewer. Döring does not set out to shock the audience. What one can hear from the discussions about and with the patients is often frightening enough; one does not need images of open wounds or growing tumors. At one point – Döring repeatedly also films the discussions among doctors or in other administrative areas – the particular demands on the nursing staff of a palliative unit are described. One should not be squeamish, one can hear.
What is not to be confused with grossness. For, on the contrary, the willingness to empathize is absolutely essential. It takes time. Again and again Döring shows how the nursing staff works with a hands-on approach. The hands convey care, patience, and conversation. In one gathering, however, complaints about cost pressures, to which this hospital is exposed and which make it harder for the staff to take the necessary time for each patient, are voiced.
No False Hopes
Things are not sugarcoated here. On the contrary, Döring allows space for the feelings of grief and pain. They inevitably arise when there is no turning back to the land of the healthy. Not only the patients are affected, but also their surroundings. In the very first hour one meets a woman whose great, burdensome worry does not concern herself but her husband. A little later you see him in a counseling session, visibly stunned, overwhelmed, and in mourning, so that you understand the woman’s pain.
“Palliativstation” is not a film that promises false hopes. “It is what it is” – at one point a nurse in a staff meeting recites Erich Fried’s well-known poem as a prayer: “It is ridiculous, says Pride; It is reckless, says Prudence; It is impossible, says Experience; It is what it is, says Love.”
The discreteness and restraint, combined with openness and empathy, that characterize Döring’s film, more than compensate for the fact that none of the stories you encounter here find a happy ending in the traditional sense. There are no miracles, and there is no “despite everything” that makes people at the brink of death happy in a moment. “Palliativstation” moves you because it shows essential things in such an honest, unguarded way.
Medical Details Remain Out of View
There are relatives who take care, even when they themselves can hardly manage – “My 80-year-old brother!” emphasizes a patient –, but there are also real catastrophe situations: For one patient, her husband dies during her palliative treatment, and in the first shock she thinks of banalities like the need to deregister the car. Yet with almost unbelievable strength she pulls herself together again, completely without self-pity. “I’ve had a good life,” she says. The doctor understands that it must have been an incredibly hard life that made her so pragmatic.
The medical details and individual diagnoses are left out by the film. Döring focuses on the feelings of the individual patients. A man grieves that his ordinary sense of time has been lost. He increasingly does not even know what time it is. Does he feel better when someone comes in again to tell him the day and the time? The wise doctor hears the fear of self-loss and tries to reassure him that he will remain himself, even as he grows weaker and death approaches.
Undoubtedly, “Palliativstation” does not only elicit pleasant feelings, but its intensity stands for a deep experience. And not least, Döring’s documentation is an immensely important film, especially in these times when, in some places, the “efficiency” of medical care for the elderly and dying is questioned.
