̽��ֱ�� of Cambridge - Emma Wilson

Questions of life and death

amb206 — Fri, 04 Nov 2016 12:30:00 +0000

Toast is burning in one of the ward kitchens at St Christopher’s Hospice in south London. Members of the nursing staff rush to open the windows, laughing at this minor disaster. In a room down the corridor a young man called Kevin is confronting a future in which he will play no part. He’s married with two young children – and has terminal cancer. Imagining his boys growing up without him is more painful than the disease destroying him. Kevin and his wife have accepted that he will soon be gone: she wants him to die at home but he doesn’t want to frighten his sons.

These are just two of the moments captured in ̽��ֱ��Time to Die a documentary made in the 1990s by Nikki Stockley. Commissioned by the BBC, the film addresses a subject that remains taboo for many of us: death. Stockley focuses on three people whose lives are ending. They and those they love share their feelings. Doris hopes she won’t linger: she doesn’t want to die “inch by inch”. Hazel has lost interest in clothes and no longer looks in the mirror. She has told the hospice staff that she wants to die at home. Her boyfriend fears he would not cope; often he feels like running away.

Earlier this year, academics from three different disciplines (Emma Wilson, Professor of French Literature and the Visual Arts, Dr Stephen Barclay, Senior Lecturer in General Practice and Palliative Care, and Dr Robbie Duschinsky, Lecturer in Social Sciences) sat down to plan a seminar series that would encourage a broad dialogue about care and dying, using the medium of film as a framework. Wilson, who has a specialist interest in film, proposed that ̽��ֱ��Time to Die would make a powerful starting point.

Wilson said: “What I admire so much about Nikki’s documentary is the openness of the interviews, Nikki’s presence, her connection to her subjects, allowing complex emotions to be put into words. It feels like a work of accompaniment, very patient, very calm, opening up possibilities for a non-intrusive presence of the camera in this community, and a tender, caring work of editing, piecing together a visual narrative.”

̽��ֱ��first of five seminars planned for the current academic year took place last week. Revd Dr Derek J Fraser, lead chaplain at Addenbrooke’s Hospital, talked about the role of his team in supporting patients and those close to them. A screening of ̽��ֱ��Time to Die was followed by a Q and A. Stockley took questions from an audience who included health professionals, members of the public, counsellors and representatives from local hospices. ̽��ֱ��making of a documentary about so sensitive a topic prompted questions about the relationships involved and the editing process.

Stockley spent four weeks filming at St Christopher’s. ̽��ֱ��Time to Die is, perhaps most importantly, a tribute to those it features, the patients and staff of a hospice acknowledged to be a pioneer in end-of-life care. She spoke of the closeness that developed between her team and the people they filmed – and her own emotional response. “I needed to remind myself that my sadness was nothing compared to those I was filming.” She also talked about the difficulty of negotiating a commission to make a film looking at death.

Junior doctors can expect to deal with as many as 40 to 50 deaths a year in the course of their work. Yet most people, in a society that protects itself from the reality of human frailty and mortality, have never witnessed death close up. Stockley suggested that film could offer a “safe way” of exploring some of the things we ask ourselves (how do people die, what’s it like to die) but seldom give voice to. Even the staff at St Christopher’s seldom talk about their own deaths. Medical statisticians have their devised their own code for death – they call it 'negative patient outcome'.

If ̽��ֱ��Time to Die is brave, it is also deeply respectful – and quite rightly so. Film, certainly not one made for general viewing, cannot convey the emotional rawness of death. Death has a smell. It can be messy and protracted. It’s exhausting and deeply sad. Death affects the professionals involved as well as patients and their loved ones. At one point in the documentary, a nurse is overcome by emotion and fights back tears. How do we negotiate the line between personal and professional?

Several Cambridge ̽��ֱ�� medical students attended the seminar. Chris Kassam said: “Working with patients at the end of life can leave you feeling overwhelmed by the magnitude of the experience, and the easy option is to withdraw behind a mask of professionalism. I think the film and discussion helped me to realise that what patients and their families may need most at such times is not a doctor but another human being to simply be there with them."

Health care assistants are among the front line staff who get to know patients best. Aiden Ferguson, a healthcare assistant at Addenbrooke's, said the documentary demonstrated that "professionalism is not nearly enough". He commented: " ̽��ֱ��film crystallises the importance of connecting with others in a way that is deeply present and true - and these connections can be forged with patients who have a terminal diagnosis and those who do not, with friends and family, with someone unknown."

Despite the sadness of its subject matter, there is a gentle optimism about ̽��ֱ��Time to Die – and many of the scenes it captures are revelatory. Patients in palliative care, says a nurse, find it “quite comforting” to see other patients immediately after death. St Christopher’s doesn’t cover the faces of those who die. Instead a single flower is placed on the pillow as the body is wheeled away. Interviews with relatives are reminders that life goes on. “I’ve thrown away his toothbrush,” says Kevin’s wife, shortly after his death. “And now I’m looking at the shoes he wore last time he came home.”

Doctors like to fix things: they train in medicine because they like solving problems and want to make people better. In his introduction, Barclay suggested that this impulse is at the root of the profession’s difficulties with handling death and bereavement.

̽��ֱ��Time to Die is a portrait of a hospice dedicated to end-of-life care. A general hospital faces different pressures, many of them driven by time. Fraser said that time was not always the critical factor – it was often a question of finding the right moment and language for a fairly brief conversation. A personal loss had, he said, “changed profoundly” how he approached his role at Addenbrooke’s. “I’ve learnt that there is sometimes nothing to say – no solution. But to validate sadness is so important.”

Among the professionals in the audience was Michelle Reynolds, Acting Head of Staff Counselling at Cambridge ̽��ֱ��’s Counselling Service. She said: “ ̽��ֱ��combination of the film and Fraser’s own testimony made the seminar an evocative experience. Twenty years have passed since the making of the documentary – and the need for good palliative care is as great as ever. Death doesn’t change its impact on the family, friends and the professionals involved. No-one is immune.”

We don’t know when or how we will die: death is one of the life processes that defies organisation. But with careful planning, an acknowledgment of our wishes and the support of skilled professionals and loving family and friends, there is much we can do. ̽��ֱ��Time to Die shows no happy endings but demonstrates how much caring means. Kevin dies at St Christopher’s, as he had wanted, with his wife with him. Hazel dies at home, quietly and gently in her boyfriend’s arms. Standing in a rainswept churchyard after Hazel’s funeral, he is quietly proud.

̽��ֱ��seminar series continues on Wednesday, 9 November 2016 with guest speakers Professor Bee Wee, NHS England's National Clinical Director for End of Life Care and Dr Anna Elsner, ̽��ֱ�� of Zurich. Professor Wee will discuss developments in national policy and practice in palliative and end of life care since the withdrawal of the Liverpool Care Pathway for the Dying. Dr Elsner will discuss a documentary exploring end-of-life care in Switzerland, 'Die weisse Arche'/' ̽��ֱ��white ark' (2015) and the Ars Moriendi (arts of dying) tradition. All welcome, no charge, booking required.

Inset image: Physician; credit: Yuya Tamai.

An ambitious seminar series began last week with a discussion of a remarkable documentary. Filmed in a pioneering hospice, ̽��ֱ��Time to Die addresses a subject that remains taboo for many. Joining the conversation are health professionals, medical students and members of the public, as well as those interested in film and ethics. ̽��ֱ��series continues on 9 November 2016.

̽��ֱ��film and discussion helped me to realise that what patients and their families may need most is not a doctor but another human being to simply be there with them.

Chris Kassam, medical student

nrllhdgrmnc (Flickr Creative Commons)

Life and death

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

Licence type:

Attribution-ShareAlike

Death and the image: an introduction to palliative filmmaking

bjb42 — Tue, 29 May 2012 14:17:41 +0000

You don’t see her slip away, even though you are watching. A woman lies motionless in bed for 13 minutes, attended at intervals by nurses and her daughter – the artist Sophie Calle. Without these intrusions you might think you were looking at a still photograph. By the end of the film clip the woman has moved from life to death, but the point at which she dies remains invisible.

̽��ֱ��clip is part of an art installation by Calle called You Couldn’t Capture Death, which is one of the contemporary artworks explored by Professor Emma Wilson from the Department of French in her new book Love, Mortality and the Moving Image. In the book, Wilson’s research involves moving image artists who are working with the space between life and death in a variety of ways – from home movies to photographic collages.

Wilson, who is also Course Director of the ̽��ֱ��’s MPhil in Screen Media and Cultures, examines the way different artists use both moving and still images to generate works as a coping mechanism for the emotional wrench that comes with the death of loved ones – and how we use visual media to see the dead as living, helping to manage the pain of loss.

“I’m interested in artists who are using their own intimate experiences to test how far a moving image artwork can offer recall of the deceased as still responsive,” said Wilson. “Art and its creation can be used to organise experience, the editing process allowing a sense of control in the face of brute, annihilating emotions.”

“I wanted to investigate moves from family acts of mourning to more public acts – the instigation of dialogue around death through moving image displays. In the case of Calle, the installation was a space that could be entered, opening the private experience up to other views and opinions.”

Wrapping, soothing, holding

Calle’s controversial installation contained details of the last book her mother read, her last trip to the coast and the inscription she wanted on her gravestone. A sense of the active planning for death that mother and daughter went through becomes part of the artwork. In this way, aspects of these artworks could be seen as ‘palliative’, providing a framework to assist with preparation for eternal separation.

In health care terms, palliative refers to ‘end of life’ care in which treatment protocols are established and the emphasis is on well-being and dignity as an individual prepares to conclude their life. Artworks like Calle’s can be seen to feed into this ethos, regarding death as a natural process that to an extent may be planned for.

Palliative derives from the Latin word ‘palliare’, meaning ‘to cloak’. Moving image art can contribute to this ‘cloaking’ in a number of ways. Cloaking can be allied with covering, enclosing, wrapping, soothing and holding. One of the works that Wilson gives a close reading of in the book strives for this embracing of a dying loved one through moving and still images – both commemorating and ‘cloaking’ them with the camera.

In her work Jacquot de Nantes, the filmmaker Agnès Varda interposes still images of herself and her husband Jacques Demy with moving film footage she took of him during the last months of his life. They knew Demy was dying, and Varda wanted to build a collage of her husband by overlaying different forms of visual tribute.

Varda created a photographic inventory of Demy as he existed – close-ups of his hair, skin, eyes and so on – and blended it with reconstructions of Demy’s childhood and extracts from his films to create a sensory impression of the person, the idea of the palliative seen in the attention of the camera to the body and the subjectivity of the person facing death – the same type of respect and tenderness.

̽��ֱ��use of photography for direct commemoration that addresses death without flinching dates back to the 19th century, when common memorial practices included mortuary photography, the creation of daguerreotypes depicting the bodies of loved ones as if they are sleeping. For many people, the only pictorial record of their existence came when they had ceased to exist.

Hidden memory

Some argue that photography innately carries the reminder of death by ‘stilling’ a person – capturing a moment that will never be again. “There is a range of theory around this subject. ̽��ֱ��theorist Roland Barthes tells us that mortality is inherent in all photography, it creates a ‘temporal slip’ that draws attention to the emotion frozen in time,” said Wilson. “ ̽��ֱ��moving image as a medium however can present the subject as living by depicting action – so that boundaries between living and dead are, if only in illusory form, disturbed.”

Bringing the dead ‘to life’ as it were through moving images is also addressed in the book’s analysis of Alina Marazzi’s film For One More Hour With You, in which the filmmaker reconstructs a vision of her mother through home movies and family photos. Marazzi’s mother committed suicide when the filmmaker was a young child, and Wilson explores how Marazzi creates a version of her mother, and develops a relationship with a woman she barely knew through the imagery.

“Home movies have been used in acts of mourning since the earliest available cameras,” explained Wilson. “In this work, Marazzi both creates and seeks the kick of hidden memory. As this was recovered footage it gives the illusion of a fresh glance of the dead still living, allowing her to address a part of her past previously uncharted.”

“I use Marazzi’s film to examine representations of childhood memory in moving images, and how it can be a conduit for emotion, as the filmmaker is introduced through film to her mother as a child, and how this relates to memories of her mother from her own childhood.”

̽��ֱ��camera can be seen to allow access to the dead as living, or to the trauma of a loved one dying – Calle has said that having the camera in her mother’s room as she died was her way of being there in every respect that she could. But the camera can also create distance, reflecting and acknowledging the fact that death is ungraspable.

Alternative narratives

In palliative health care, thought is given to pathways and the stages that one faces. For Wilson, artists exploring this area can offer opportunities to imagine a variety of journeys through the extreme emotions involved in losing people to death.

“It’s not about finding a programmatic way of coping through art, but looking at how this kind of work can offer alternative narratives of death – by inviting people to share an example of how one person managed the loss of a loved one.”

Visually invoking and describing the dead will continue to be reinterpreted as technologies progress. Today, the images of those we’ve lost linger in the photo indexes of our smartphones and Facebook pages – testament to the power of the image, moving or otherwise, to prolong the illusion of a living presence, at the same time as it embodies the fleeting nature of all life, by trapping forever a moment never to be recaptured.

Love, Mortality and the Moving Image by Emma Wilson is available from Palgrave Macmillan.

A new book by Professor Emma Wilson from the Faculty of Modern and Medieval Languages looks at how death is addressed through modern artworks based in visual media.

Art and its creation can be used to organise experience, the editing process allowing a sense of control in the face of brute, annihilating emotions.

Professor Emma Wilson

Agnès Varda

Still from the film ̽��ֱ��Beaches of Agnès (2008), directed by Agnès Varda

This work is licensed under a Creative Commons Licence. If you use this content on your site please link back to this page.

Yes