The title of Frederick Wiseman’s six-hour long, grueling, engrossing, and revelatory documentary masterpiece “Near Death” (1989) refers not just to the terminally ill patients it observes but to the caregivers and loved ones close to those struggling with the inevitable. This complex relationship is observed as Wiseman tracks the progress of four terminally ill patients in the medical intensive care unit at Boston’s Beth Israel Hospital, shooting in muted black and white, mostly in claustrophobic hospital interiors, achieving a detached, acute, respectful, and sometimes unbearably intimate and empathetic record of life in extremis.
The processes of death and attending those dying are shown to have their own lulling rhythms. The specific illnesses are indirectly referred to, but the situations are all similar. Physicians and nurses — often very young, with their stethoscopes and haggard efficiency — attend to intubated faces pale with pain and terror. Most of the patients are old, their bodies ravaged, their long-term prospects nearly non-existent. One patient is a man in his 30s with a wife and three young children. “It’s tragic,” a nurse comments, hopelessly. Later a group of doctors and students examine and discuss the man’s organs, which are laid out on an autopsy table.
Each episode is punctuated by recurrent images in rhythmic patterns: a custodian cleaning up (“the grim sweeper,” as it were), an exterior of the hospital, pedestrians, and traffic on Brookline Avenue, day and night. Inevitably there’s another round of doctors and nurses counseling patients, their loved ones, and consulting each other. These interactions differ from each other in subtle and not so subtle ways, offering distinct points of view on the grim business, from the repeated explanations of diminishing options to patients and family, to the blunter talk among the staff – each conversation with its own lexicon of jargon and euphemisms. Let’s just say if you’re a patient and a doctor gently asks, “What is your understanding of the situation?” you might be in trouble.
A revealing discussion between two doctors occurs near the end of the film. One argues that everything must be done to keep the patient alive unless the vague state of “brain death” sets in. The other wonders about the efficacy, expense, and needless suffering incurred by patients because of the questionable boon of technological progress. Is it better to live for six months with continuous suffering or three months with managed pain?
Though he seems to be presenting life unmediated and uncut, Wiseman in fact subtly orchestrates and structures his film. It opens and closes with boats on the Charles, brilliant and brimming with life in the sunshine. And towardsthe end there are two shots that epitomize the pathos and hope of mortality: a gurney wheeled out carrying just the sad little bag of a deceased patient’s belongs, and later, another gurney, but with the bag accompanied by a patient who was near death, but is going home, for now.
“Near Death” can be seen on Wednesday at 4 p.m. as part of the “Frederick Wiseman: For the Record” series that continues through June 4 at the Museum of Fine Arts. The screening will be preceded by an introduction by Mitchell T. Rabkin, professor of medicine at Harvard Medical School, who was CEO of Beth Israel Hospital from 1966-1996.Peter Keough can be reached at firstname.lastname@example.org.