Directed by Rob Epstein and Jeffrey Friedman
A Telling Pictures Production, 2018
USA, 40 minutes.
End Game by award-winning directors Rob Epstein and Jeffrey Friedman, casts its lens on end-of-life care. Released on Netflix, the documentary invites us to participate in the penetrating intimacy of dying as seen from the perspectives of patients, their loved ones, and health care practitioners.
We meet Kym, Bruce, Pat, Mitra, and Thekla at the ends of their lives. We spend time with their families and with volunteers, social workers, nurses, aides, chaplains, and physicians at the University of California San Francisco Medical Center (UCSF) and Zen Hospice Project Guest House, also in San Francisco. We vicariously form relationships. We don’t want these people to die, but they will.
In this compact documentary the filmmakers, who broke ground in the 1980s with documentaries such as The Times of Harvey Milk and Common Threads: Stories from the Quilt, have chosen to focus entirely on the present. We join Iranian-born Mitra, her mother, Vaji, and husband, Hamid, at UCSF. We meet Mitra’s 8-year-old son and a sister from Switzerland, but we don’t know how they came to be here. Instead, we are privy to their hopes and fears, solicitude and love, in the moment. We watch as the conversation shifts from Hamid stating early on, “Still, we have the chance to fight and I think we should fight” to “Mitra is leaving us. I don’t want to let her go,” later in the film. There are times when Mitra herself is hopeful. “My goal is being able to walk,” she says, “and being in a positive mood.”
The same goes for the other patients. We see how tenderly they are cared for—by family, clinicians, and gentle volunteers—but we never learn who they were. We must be contented with glimpses of who they are.
We also encounter the palliative care team at UCSF and professionals at Zen Hospice. Utterly skillful and compassionate, they give a good sense of the humanity that infuses these disciplines and the power of an integrative approach to medicine. This, the viewer may soon think, is how medicine should be practiced. The teamwork and nitty-gritty all ring true—I’ve worked as a palliative care and hospice chaplain myself—as does the delicate task of trying to respect everyone’s ready-to-face-the-truth timeline when the clinicians’ tacit consensus is that the sooner that truth is faced, the better.
Viewers who are not used to thinking about mortality may find that 40 minutes is quite long enough. Despite its brevity, End Game offers plenty of scenes that stick: Bruce’s grateful smile; final visits between Mitra and her family; threshold singers by the hospice bed; Pat, who has been told that her uterus is a “great cancerous mass,” stating that every moment is a gift; Thekla telling her physician that she has failed the assignment he gave her: to make friends with death. “I love to live,” she says. “I am not accepting this.”
There’s also a parting scene at the Zen Hospice Project Guest House, where a patient who has died is being honored with a flower petal ceremony in the back garden. We watch as children adorn the deceased with handfuls of freshly plucked petals. This vignette, a poignant close-up of change and renewal, was filmed before caregiving services at the Guest House were suspended in summer 2018 because of insufficient funds.
Watching End Game with loved ones could open the door to conversations that are best had before they become necessary. To this end, the film’s website (below) offers additional information and valuable resources for patients, caregivers, and communities. The film itself, however, neither delves into advice nor spends time criticizing the way people die in America. There are no shots of patients wasting away on life support or dealing with the wretchedness of last-chance chemo. End Game doesn’t show us what home hospice looks like, nor does it instruct us on the importance of living wills and timely conversations. What it does do is remind us of the inevitability of death, get us thinking about our own what-ifs, and give us insight into the help that palliative care and hospice can offer.
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