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Living in the shadow of death

The human side of a cancer is often not understood by health professionals.

In the last months of her life, Rhodes Scholar and medical pioneer Dr Anna Donald made the decision to share her experience of living with advanced breast cancer.

The result is a unique cross-platform documentary, Anna’s Adventure, which will be launched earlier this year.

The 22-minute film and complementary website www.annasadventure.com.au offer extraordinary insights from both sides of the patient -doctor divide.

Directed by Donald and Jessica Douglas-Henry of Iris Pictures, the film and website was launched by renowned health economist Helen Owens, one of a growing number of Australians who are living longer with advanced cancer.

“Anna Donald’s courage and determination were extraordinary,” says Owens.

“She has left an invaluable legacy to patients with advanced cancer such as myself. Thanks to some brilliant new medical technologies, more people like me are living longer with advanced cancer, but the technical expertise has tended to outstrip health professional’s understanding of the human side of a cancer diagnosis.”

At the peak of her medical career and at the young age of 37, Donald was diagnosed with aggressive breast cancer. With time on her hands, she wrote a series of blogs for the British Medical Journal (BMJ) about her experience called From the other side.

Much like the documentary, the blog entries were at times funny, other times sad and many times confronting.

Her first blog read: “I hope to write about things that may interest doctors, other health workers and policy makers about what it’s like to have life threatening disease; to be on the other side of the doctor-patient divide, and to experience 21st century health care for a chronic disease (Sydney’s hospitals are pretty similar to Britain’s), from a quality-of-care perspective”.

While insisting she was far from Pollyanna, Donald was determined to give a meaning to her illness.
As the cancer progressed she made the decision to return from the UK, home to Australia in 2008. Here she began a collaboration with filmmaker Douglas-Henry and started keeping the video diary that was to become the focus of the project.

When Donald had an unexpectedly violent reaction to a course of chemotherapy she continued to record her video diary from hospital. She died in February 2009.

“It was a risk committing to a project whose main participant is living with life threatening illness, but Anna and I knew we could make something powerful and relevant from the material we had already gathered,” says Douglas-Henry.

“Beginning the post-production without Anna was hard. Editor Melanie Sandford and I worked closely together, reviewing the material and figuring out the best way to make it work. Plans to shoot additional material exploring Anna’s life and career before cancer were superfluous when it became clear that the heart of the film lay in the material Anna had recorded on her trip to Central Australia and in the blogs she had written for the BMJ.”

Douglas-Henry says Donald’s experience of being in the bush and contemplating the immensity of the landscape caused her to reflect on her condition in a way she never had before. This footage, interwoven with the blogs and sequences of Donald’s time in hospital, was augmented by evocative animation of her dreams.

The resulting 22-minute film is a “poetic exploration” of Donald’s last months. It captures her unwavering commitment to asking some of the really big questions right up to the final days of her life.

The website has a practical focus that will be useful viewing for health professionals and patients with advanced cancer and their families and carers.

Douglas-Henry says the next stage is to use the film and website as the foundation for a range of educational resources for health professionals, cancer patients and their carers, that focus on the needs of the increasing numbers of Australians living longer with life limiting illness.
Donald’s last blog for The other side was found on her computer after she died, written a month before.

“Cancer pain takes many guises, of course. My particular version is still gripping, spasmodic-colicky abdominal pain that just quietly drones on and on in the background, or, alternatively, thrashes about like a fury, grabbing every bit of me down into a dark, burning, crushing place and won’t be appeased.

“Not that I haven’t tried. I’ve taken every pain killer known to us…My much-appreciated palliative care team continue to chide me for failing to take enough drugs, soon enough. They are probably right. Latest research would suggest that I have an ‘attitude problem’ to pain: I don’t like taking tablets and think I should just grin and bear it until I break. I agree this is a stupid policy and, after several consecutive nights of excruciating pain have adapted it somewhat.

“So I am now taking, to my mind at least, hefty doses of opiates of one kind or another as well as laxatives and non-steroidals. I’ve found that paracetamol can be an amazingly effective drug. But it’s hard not to get constipated and end up dry retching at the least convenient times.”

Go to www.annasadventure.com.au

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