Life Matters Media
Quality of life at the end of life

‘End Game’ Is The Documentary Film America Needs

New Netflix Offering Highlights Hospice Care

BY DANIEL GAITAN | daniel@lifemattersmedia.org

You’ve been dealt a hand of cards. We could wish we had different cards, or we could play a different game, but this is where we are now.

That’s what palliative care specialist Dr. Steve Pentilat tells the defiant family of a dying middle-aged wife and mother in the prodigious new documentary on Netflix, End Game.

The 40-minute short directed by Oscar-winning filmmakers Rob Epstein and Jeffrey Friedman focuses on a handful of San Francisco Bay Area families grappling with disease, death and denial.

Dr. B.J. Millers comforts Bruce in ‘End Game.’

Among the patients we meet: Thekla, a terminally ill senior anxious about life after death; Bruce, a severely underweight man who enrolled in Dr. B.J. Miller’s revolutionary Zen Hospice after stopping dialysis; and Pat, whose womb is a “cancerous mess.”

Most of the film, however, focuses on an Iranian-American family making a home of sorts in the University of California-San Francisco Medical Center as they struggle to accept that 45-year-old Mitra is dying.

Mitra, devoted wife to Hamid and mother to 8-year-old Aaron, doesn’t have much time left. Her cancer is incurable and she’s in a lot of pain. She cannot walk and is seldom lucid.

Her care team is compassionate but firm with the family: Mitra will die, they patiently explain, and aggressive, even experimental treatments won’t save her.

Pentilat recommends that Mitra’s family enroll her in an inpatient hospice program to keep her comfortable and allow time for visitors. Viewers get the impression he has had this conversation countless times with varying degrees of success.

“Hospice means death,” Mitra’s mother, Vaji, tells a hospital chaplain.

“She’s a big fighter,” Hamid tells doctors.

The family is not ignorant. They’re just not prepared to lose Mitra.

Still, despite their misgivings about hospice, they come around to the idea of comfort care slowly.

Dr. Shoshana Ungerleider

Executive producer Dr. Shoshana Ungerleider, a hospice and palliative care physician, advocate and philanthropist, said she’s inspired by Mitra and Hamid.

“She’s quite sick, it’s pretty close to the end, and Mitra’s husband is hugging her and kissing her in such a normal, real way,” Ungerleider told Life Matters Media. “It’s a beautiful depiction of their love for each other, and his incredible support of her.”

End Game, with its lean running time, doesn’t exploit Mitra and isn’t syrupy.

At times, End Game feels like an uplifting sequel to 2016’s Extremis, a chaotic look inside a bustling hospital’s intensive care unit.

“It’s a coincidence that one came after the other,” said Ungerleider, a producer of Oscar-nominated Extremis. “It’s interesting that they’re both based in the Bay Area. I think we’re really lucky to have forward-thinking doctors, health care professionals and filmmakers who want to tell these stories.”

While Extremis prioritized the physical, End Game ponders the spiritual.

“From doing this work and being near people who are at the very, very end, everything I’ve ever seen would suggest that wherever we’re going, whatever abyss we’re meeting, ain’t so bad,” Miller tells Thekla in a particularly moving scene.

End Game isn’t an easy watch, but it’s a film America needs.

Netflix, which boasts more than 100 million subscribers, is bringing frank, honest filmmaking on mortality to American televisions, smartphones and tablets.

“We’re so lucky to have Netflix,” Ungerleider said. “It’s a wonderful platform to get short documentaries out to the world. Up until streaming services started buying them, it was challenging to make sure that people had a chance to see them.”

Above all, Ungerleider said she hopes audiences are empowered with information about hospice and palliative medicine so they can make better, more informed decisions when facing death.

Critically ill patients enrolled in hospice programs are far less likely to opt for costly, often unnecessary invasive procedures and die in hospitals, according to recent study published in the Journal of the American Medical Association.

Unfortunately, only about 20 to 25 percent of Americans eligible for comfort care take advantage of such services.

Ungerleider is working to change that. She founded End Well, the first of its kind interdisciplinary symposium on design and innovation for the end of life experience.

“The earlier people engage in conversations about what matters most to them with the people they love, the more likely it is that they’re going to get care down the road that’s in line with their goals and their values,” Ungerleider added. “It’s critically important.”