Life Matters Media
Start the most difficult conversation American isn’t having- 
the conversation about our end of life preferences

‘Extremis’: An Unforgiving Look At Death In America

BY DANIEL GAITAN | daniel@lifemattersmedia.org

“Everybody standing in this room is going to die one day, and it’s good to have a little bit of a say in how.”

Those are some of the first words from Dr. Jessica Nutik Zitter as she addresses her team in the new Netflix documentary Extremis. The film follows the palliative care physician as she attempts to provide care – and counseling  – to dying patients at the bustling Highland Hospital, in Oakland, Calif.

In the first few scenes we meet Donna, a middle-aged woman stuck “in limbo” as her family debates withdrawing her artificial ventilation. Her vital organs are failing and she cannot breathe, talk or move, much – she has to be restrained to her hospital bed to prevent accidental removal of her breathing tube.

Unfortunately, Donna never had “the conversation” with her family about her end of life care wishes. She has no advance health care directive nor a prepared decision-maker. Family members must try their best to get an answer – or even a head nod – from Donna as they explain her options in the intensive care unit.

“I want to make sure that she knows that we’ve explored all the options,” a family member says. “I told her I’d never let the doctors stop.”

Donna’s fate could be the same for millions of Americans. Although most people want to die at home with comfort care, very few have put their wishes in writing or expressed them to loved ones. This film is a wake-up call.

For her part, Nutik Zitter doesn’t want patients to suffer, but it’s not always up to her. Sometimes family members insist upon aggressive, often futile, treatments for their loved ones. Others hope for a miracle and will wait as long as they can for it.

In a brief cutaway, Nutik Zitter offers viewers the experience that changed the way she practices medicine. As a young attending physician, she was asked to put a large catheter in a dying woman’s neck.

“Right before we were getting ready, I look up and I see this nurse in the doorway and she looked at me, locking eyes with me, and she said, ‘Call the police, they’re torturing a patient in the ICU,’” she recalls. “My heart dropped into my stomach and I realized ‘oh my gosh’ she’s right. What I’m doing right now is not going to help her. It’s not going to get rid of this disease that’s killing her, and I don’t want to do that anymore.”

The film lasts only 25 minutes, about the time it takes to be admitted to the hospital for an unexpected health emergency. The short is an exercise in careful  – and compassionate – filmmaking. There are no unnecessary scenes or moments exploiting the dying. Death demands dignity.

Directed by Academy Award and Emmy Award-nominated filmmaker Dan Krauss, Extremis is set to debut globally on the popular internet-streaming service Sept. 13.


– Image: Dr. Jessica Nutik Zitter is featured in the upcoming Netflix documentary “Extremis.”