Page - 82 - in JRFM - Journal Religion Film Media, Volume 02/02

82 | Alyda Faber www.jrfm.eu 2016, 2/2, 69–98 iprocity within inequalities of medical expertise and family members who lack this knowledge and are further disadvantaged by their distress. The “literal” (visual and aural) layering is compounded by “abstract” layering that implies reciprocity between patients, their families, and medical staff in the enormity of the situation they face. Their sense of powerlessness is evident in references to God and in repetitive speech. In a conversation between two phy- sicians about a patient, the attending physician says, “God decides. God decides. We don’t decide. These things have a life of their own; they really do, you know, I mean they really do, they have a life of their own” (ND 73). Mrs. Sperazza also appeals God as an expression of her helplessness: “I’ll put it in the hands of God. There’s nothing I can say or do except pray” (ND 82). The doctors have limited tools at their disposal while facing unrealistic expectations that they can and must do something for patients near death, an existential situation that relativ- ises the social hierarchy of physician-patient relations. Dr. Weiss observes that physicians are “minor actors” dealing with “things … that are bigger than us” (ND 110). Despite their expertise, physicians often tell patients’ family members that they don’t know how to interpret a patient’s symptoms, or how to predict his or her future (ND 82). Dr. Weiss expresses, in metaphorically vivid language, his sense of helplessness and despondency about medical technology’s limits: he refers to a treatment as using a “pea shooter against an atomic bomb” (ND 2); says he feels like Sisyphus pushing a rock up a hill only to have it roll down again (ND 58); is frustrated at not being able to express limitation (“we can’t do anything for that, we have no way to help that yet” [ND110]) or to be frank about the “torture” of cancer treatments (ND 57), not to mention rising costs of medical care that conflict with the wishes of family members to have “eve- rything” done for patients. His colleague conveys the physician’s dilemma in a futile desire to help when a patient receives a devastating diagnosis: “If you wanted to give people quality of life, you could like be a furniture salesman … it’s easy to fix things that are fixable” (ND 58). In conferences, grand rounds and one-on-one conversations, medical staff repeatedly debate questions: what is informed choice? (ND 57); what is “dead”? (ND 58); what is hopeless? (ND 72–73); “When does a terminal illness really become terminal?” (ND 73). Such questions are difficult to answer, while communication with patients and family members demands some kind of answer. And this doesn’t even begin to address the family problems that manifest themselves at hospital bedsides. The Intensive Care Unit brings together paradoxes and terrible ironies: an autopsy conference for Mr. Cabra, a thirty-three year old man, reveals that treatment for his testicular cancer successfully eliminated the cancerous growths but caused fatal pulmonary fibrosis. One of the physicians comments, “This is an example of curing the tumour but that the cure is deadly, the therapeutic index is very low” (ND 76).