The Final Passage: 'End Game' Offers a Lesson on Death and Dying
What does it mean to die well in the 21st century, and how does it feel? End Game, from longtime collaborators Rob Epstein and Jeffrey Friedman (The Celluloid Closet; Common Threads: Stories from the Quilt), takes us inside the world of hospice and palliative care, following the journey of terminally ill patients, their families and caretakers in two cutting-edge San Francisco facilities. Documentary spoke with the Oscar-winning filmmakers about their vérité approach to a universal subject that most of us spend our whole lives avoiding.
DOCUMENTARY: What would an Oscar win do for End Game?
ROB EPSTEIN and JEFFREY FRIEDMAN: More people would see it. [laughs]
RE: Did we just say exactly the same thing at exactly the same time?
JF: We’re going to answer the questions in harmony.
D: What surprised you about death and dying while making this film?
RE: Just how much we don’t want to think about it. How much we want to push away the unimaginable. It’s a very hard thing to wrap your mind around. It’s too scary. That was one of the reasons why we wanted to make this film—to make it less so. And that’s what we were experiencing as we were doing the research and conceptualizing the project—witnessing these people whose job it is to alleviate suffering and to make death less scary.
JF: Yeah, I think one of the things that surprised both of us was that there were so many moments of beauty and intense expressions of love. As difficult as it was to watch people go through this really devastating piece of their lives, there was just so much caring and loving that it actually became a very beautiful experience for us.
D: Did you learn what a good death is?
JF: We got a better idea. It’s when your values and goals are aligned with how you live your last moments. Because we don’t think about death and because we push it away, we leave ourselves at a disadvantage. Birth and death, to state the obvious, are the most universal life passages we face. And of those two, death is the one we have the option of facing consciously. Most of us do just the opposite, which is avoid thinking about it until it’s too late. By avoiding the issue, we set ourselves up to lose control of our life story when we’re at our most vulnerable. We’ve both experienced friends and family who’ve died and it’s always painful, but, you know, there are choices that you can make that can change the outcome. And there are also opportunities for really profound, human connection.
D: Did you have a story arc before you started filming?
RE: It’s a very different kind of film and filmmaking for us in that we didn’t have a story arc. Usually, in our nonfiction feature-length work, we have a predetermined story arc that we’ve arrived at through the research process and the casting process, but in this, all we knew was we had the two doctors that we would be following and their teams: Steven Pantilant at the UCSF Med Center and B. J. Miller at Zen Hospice. Beyond that, we didn’t know who the patients would be until we walked in a room with them and met the patients. In that sense, we had the subject and the thematics, but we really didn’t know what the story would be. But we always imagined it as a short—in part because we didn’t have the sense of a narrative arc that a feature-length film demands, we could approach the subject in short form and get to where we wanted to get to thematically.
JF: And it was a different process, a different kind of filmmaking for us—really, the closest to cinema vérité we’ve ever done. It was not knowing what was going to happen and just spending time in these two institutions where we’d met people and followed stories as they came along. It was also the first film that we shot ourselves. Rob did a lot of the camera work, I recorded sound, and our producer, Rebekah Fergusson, was our support person and also shot in town when one of us couldn’t be there. She also taught us almost everything we know about the technical aspects of filming.
RE: Rebekah was really our mentor in that regard. We were very much a three-person team.
D: Did you know going in that the film would be vérité?
RE: We did. Although, there’s one interview in the film, with B. J. Miller, the doctor from the Zen Hospice Project. The first day we were shooting at the hospice we did that interview with him because we wanted to get his backstory. We felt that had to be told in an authentic, organic way and the only way to do that was ask and tell it. Everything else was purely observational. When we got into the edit, we felt that B. J. was really kind of the conscience of the film and that he could serve that purpose. So he’s the only sit-down interview.
JF: B.J. presents the philosophical context. In addition to telling us his own story and giving us an understanding of what leads a person to go into this field, he was able to articulate some of the philosophical underpinnings of what we were observing.
D: When you start watching the film, you feel like you might cry through the entire 40 minutes. But there are moments of lightness and levity, surprise and wonder. How did you manage that kind of emotional viewing experience?
RE: Those are intuitive editing decisions. Certainly, in looking at the material and shooting it, we know all the things that you just described were in those everyday experiences. The time we spent with Mitra over that two-week period while we were filming her last weeks… she lived all those moments of joy and laughter and pain and heartache. So, we had to represent that in the film.
JF: And you have to have humor, in film and in life. A lot of our films deal with very heavy subjects. Without some humor to leaven the experience, it would become very burdensome on the viewer.
RE: That’s why we consciously opened with that scene of Mitra when they ask her who’s president and she rolls her eyes.
D: Death and dying is at the heart of modern queer culture because of AIDS. Much of your work deals with that. Is End Game a queer film?
RE: Well, for our generation, death and dying was front and center. But I don’t think that’s true for a younger generation. We lived through the worst of those years and lost many of our dearest friends. In that sense, it’s an offering, because we have had that experience. I think it made us a little less timid about approaching it in this context. It’s cliché to say, but it’s true: It reminds you that every moment that you’re living matters; make the most of those moments. You see that with people at the end of their life. Being at the end of their life, people innately have a sense that every moment matters, even if the moment comes down to appreciating a glass of water.
D: This is arguably one of the most intimate spaces for a camera. How did you get consent from participants? Was the process different from your other docs?
JF: It was different because we were dealing with life and death in the context of institutions that are designed to deal with them. It was the medical team that made the introductions and the chaplain and their social workers and media people at the hospital who were determining who might be appropriate subjects for us to follow. They made sure that the patients understood what was going on and made the initial approach and asked if they were interested in participating. So, there was no instance where we were trying to convince people to be in the film. I mean, we wanted to be invited in.
RE: I think the best doc subjects have something at stake for some reason. Whether it’s a conscious thing or unconscious thing, they have some reason that they want others to bear witness. In this case, they were so appreciative of the palliative care that they were getting and understanding its value, that they wanted to be part of demystifying and educating others through their experience to help alleviate the suffering of others. There’s a point in which Vaji, Mitra’s mother, says in the film, “I’ve suffered so much, I don’t want other mothers to suffer in this way.” That was their motivation. That’s what they had at stake for being in the film. The only time we were asked not to be in the room was when Mitra was dying. That’s when we’re outside of the hospital room over that course of the night with time-lapse.
D: What was it like working with Netflix?
RE: Netflix was a great partner. They came in at, maybe halfway or two-thirds of the way through production, and we showed them some scenes, and they responded. And then they came in full throttle for the last part.
JF: And they supported the idea of making a short film, which was great. I’m very grateful that they’re offering a platform for films of all different lengths, which is, I think, one of the great strengths of streaming as a platform.
RE: People really dig short documentaries.
D: Next up for you is State of Pride. What should audiences expect?
RE: We have actually two feature docs coming out within a couple of months of each other. State of Pride is a film in commemoration of the 50th anniversary of Stonewall, which is this June. We go to Pride in three different locations and look at it through the lens of millennials.
JF: Millennials and younger. What generation are we up to now? Generation Z.
RE: And then we also have a feature documentary about Linda Ronstadt we’re just finishing.
End Game will screen as part of IDA’s DocuDay, a daylong showcase of the Academy Award-nominated documentaries, taking place at the Writers Guild of America theater in Beverly Hills.
Peter Kurie is a cultural anthropologist and creative producer based in Los Angeles. He can be reached at www.peterkurie.com.