A new film, Amour, which deservedly won the Palme d’Or at the 2012 Cannes Film Festival, throws a new light into the harsh realities of the lives of stroke patients and their carers once they leave hospital. Georges (Jean-Louis Trintignant) and Anne (Emmanuelle Riva) are retired music teachers in their late eighties leading an independent life in a nice flat in Paris. They enjoy frequent trips to the opera house to attend musical concerts. Tragedy strikes when Anne suffers a stroke, and Georges becomes her sole carer. Their only social support network exists in their kindly neighbour and his wife who help them with shopping, and infrequent visits from their daughter who lives in London. Caring single handily for Anne takes its toll on Georges physically and emotionally as she deteriorates after a second stroke. Anne, who used to be a feisty music teacher, is now a helpless bed bound frail woman showing signs of depression and dementia. Although Georges remains the loving husband, he can’t help feelings of frustration due to her lack of communication, enforced loss of dignity, and uncontrollable pain. Through his daily routine of caring for her, he starts asking the question of whether it is in her best interests to stay at home, or to move to a nursing home, and what life he would have without caring for her.
Stroke services and care in hospital and the community in the UK have benefitted from great investments from the government in the last five years. Organisations such as the Royal College of Physicians (RCP) and the National Institute of Clinical Excellence (NICE) have issued guidelines detailing the best models of clinical care in the acute setting. Increased awareness campaigns into the importance of early presentation to hospital with symptoms suggestive of a stroke such as “the FAST campaign” have transformed the way lay people, pre-hospital, and hospital teams deal with stroke in view of the availability of stroke thrombolysis. However what happens to patients and carers after they leave the acute hospital and the rehabilitation unit still remains an area where a lot of work needs to be done; published literature highlighted that stroke patients and their carers need information, education, and support to enable them to cope at home following discharge from hospital. Carers of stroke patients are at an increased risk of isolation, depression and loss of social role. Amour serves as a timely reminder that the situation is still far from perfect regarding the way we currently support stroke patients and carers in the long term. Sadly in the film, the medical and social support teams are conspicuous by their absence, as we never see them or hear the couple taking about them. Caring for a stroke patient is challenging both physically and emotionally, with the potential of interdependency leading to undesirable outcomes such as physical, financial, and emotional abuse, a fact that the film tackles without any sentimentality. In spite of its candid subject matters tackling old age and frailty, the film does not delve into sentimentality, and shows the positive image of old age too in Georges’ determination and resilience in caring for his disabled wife. At a time when cinemas are dominated by blockbusters and action packed films, it is heart warming to see films such as Amour winning major awards at international film festivals.
As a stroke specialist, seeing this film made me wonder what special care and provision have I given to the carers and families of my patients; have I asked about their physical and psychological well-being, have I ensured their information needs are met, have I referred them to the appropriate support organisations, have I explored enough pertinent feeding and end-of-life decisions with the patients’ relatives when the patients themselves do not have the capacity to inform me of their wishes. Caring for stroke patients involves several occasions where ethical, moral, and medico-legal feeding and/or end of life decisions need to be made. Films such as Amour can serve as a catalyst for stimulating a debate and discussion for teaching undergraduate medical students, and also for helping doctors at all professional levels to reflect on their practice. By engaging with arts and humanities in popular media such as film, healthcare professionals may be supported in how to provide optimal human holistic care.
Amour will be released in the UK on 16 November 2012.
Khalid Ali is a senior lecturer in geriatrics and stroke consultant, Brighton and Sussex Medical School.