Before she could begin to film the Afghan patient's yearlong battle with stomach cancer, Dr. Maren Grainger-Monsen had to earn Mohammed Kochi's trust. And that of his family.
"I spent a lot of time having tea at their house," she recalls. "He liked the idea that the film would be used for medical students. And in the end, it was about his belief that the project would help his community and improve health care."
As an emergency medicine physician, Grainger-Monsen is trained to help people in what she calls "concrete" ways. As a documentary filmmaker, she also wants to focus on solutions: "There are lots of documentary filmmakers doing films on social issues, but we're trying to make films that are created for medical education." They are intended for the public, too, through broadcast by pbs stations nationwide.
Director of the program in bioethics and film at Stanford's Center for Biomedical Ethics, Grainger-Monsen has been the center's filmmaker-in-residence for four years. This spring and summer she toured the United States, speaking on panels convened by medical schools and community groups to screen her latest film. Hold Your Breath tells the story of Kochi and his family, who fled Afghanistan in 1979 and settled in Fremont, Calif. Diagnosed with stomach cancer, he agrees to surgery but rejects chemotherapy, choosing instead to make a pilgrimage to Mecca, which he believes may relieve his pain. Instead, his condition worsens, and his daughters can't understand why he declined the treatment. Was there a cross-cultural miscommunication about how chemotherapy would be administered? Did Kochi worry, needlessly, that an infusion of chemicals would conflict with prayer rituals?
Grainger-Monsen says some post-screening conversations among doctors have centered on the consequences of using family members as interpreters. In Kochi's case, she wonders if a Muslim imam "would have been able to say, 'It's perfectly fine for you to receive treatment. There's nothing in the Qu'ran that would prevent that.'"
An art history major, Grainger-Monsen, '84, went to medical school at the University of Washington. The day she saw the film Dax's Case: Who Should Decide, she knew she'd found her calling. The documentary looks at the circumstances under which a severely injured patient has the right to refuse medical treatment. "It was tremendously powerful and had a lot more impact than lectures."
Grainger-Monsen took a year off from medical school to study film at the London International Film School, and then received a grant to make her first documentary. Although Where the Highway Ends: Rural Healthcare in Crisis won an Emmy, she returned to Stanford to complete her residency in emergency medicine.
"It's an incredible patient population, and you meet people in poignant, important moments," she says about her former day job. Between shifts at San Francisco General Hospital and the Mission Neighborhood Health Center, Grainger-Monsen filmed Grave Words, which received first place at the 1996 American Medical Association Film Festival for its black-humor examination of resuscitation and end-of-life care decisions. Then came 1998's The Vanishing Line, broadcast on pbs's Point of View series, which looked at the hospice movement. Nominated for an Emmy, the film took first-place honors at the Nashville Independent Film Festival and received Program of the Year Award from the National Hospice Organization.
In 2003, Grainger-Monsen made Worlds Apart, a series of four short films, with a study guide, to help teach the importance of cross-cultural communication. She took Kochi's story—one of the four—and expanded it into the evocative Hold Your Breath. In one memorable scene, images of American doctors in white lab coats are transformed into archival footage of white-robed pilgrims circling the Kaaba in Mecca. Later in the film, cameras focus on a helicopter flying above the Afghan countryside, then slip inside the body for a twisting slide down a long and winding colon. pbs aired the film last spring.
"Once we've built the story, we try to go back and create beautiful imagery that evokes an emotion"—like filming bees buzzing against a windowpane to represent passing time. "The buzzing is an excruciating sound, and you're just waiting for it to get over." Add the distinctive color of a Klezmer band in the background, with Grainger-Monsen's husband, Jeff Grainger, '84, playing slide guitar on a Dobro, and the sense of urgency only grows.
