Louis Theroux's L.A. Stories (2014) s01e02 Episode Script
Edge Of Life
This programme contains scenes which some viewers may find upsetting Nathan? Will you open your eyes for me, baby? Your dad's here, your mom's on her way.
You can talk to him, if you like.
Hi, Langston.
We've come from London, England.
We're making a TV programme.
You're in the hospital, and, so, we've been filming your family a little bit and filming with you a little bit, too.
So, we're hoping you're going to wake up and we can tell you a little bit more about what we're doing.
SHE SIGHS How are you feeling? Um, good, I feel really good.
I know some people don't think there's a lot of progress but something's better than nothing.
You know, there's been miracles in many hospitals and they can't say why.
So, this is going to be a miracle right here.
I was in Cedars-Sinai Medical Center in Los Angeles, meeting patients looking for a last chance at life.
If I do this, I'm buying maybe months right? It could be more than that.
All right, then, let's do it.
In America, doctors will go further to treat extreme cases than almost anywhere else in the world.
He's young, he's a fighter.
We decided to keep going.
I'd fight for life, I certainly would.
I mean, what? Sit there, and just die? But the financial costs are enormous, the side effects sometimes severe, and the odds of success often very small.
Patients and their families face the harrowing choice of accepting death or carrying on, in the hope that one last procedure will pay off.
On the seventh floor of Saperstein Critical Care Tower, Langston Jackson, a 22-year-old college athlete, was non-responsive in the intensive-care unit.
His family had been by his bedside since his arrival five days earlier, among them, his mother Lyle.
Can you, can you tell me a little bit about what's going on? Well, Langston was in rehab for the past 19 days, and on Saturday morning, he had He and his roommate had gotten in contact connected with drugs and he had an overdose, from what I understand, from the facility, at about 3am.
What do you understand about his condition at the moment? I understand he's in very critical condition.
He has compromised liver and kidney function, and a traumatic brain injury.
And they are waiting for him to be able to breathe on his own to diagnose his brain injury further.
How optimistic are you for Langston? Well, I understand that this is going to take quite a while but that he's hopefully able to walk, talk, do everything that he wants to do, and continue to live his life, even with limited marked limitations - that's fine.
In charge of Langston's care was the ICU medical director Dr Heather Jones.
She'd called a family meeting to discuss his prognosis.
All right.
OK if I sit next to you? OK.
So, erm, what Langston has is nota blood clot that blocked a certain part A certain artery going to a certain part of the brain.
He has Basically, certain areas of his brain were very, very, er, sensitive to the fact that his oxygen level was very low.
And, so, that's the part where it gets really heartbreaking, is that, you know, when I asked Dr Moheet, who was the neuro-intensivist who took care of him when he was first sick, and Dr Palestrant, as well, felt that his chances of waking up and being normal again are very small.
And they just said that? Did they just say that? Well, you know, I think that, that, erm I've been concerned about that from the beginning, and I think that we've all been concerned about that but, you know, time will tell.
And, so, in the first 24, 48, 72 hours, you kind of hope for the best, and you hope that what you're seeing on the scan is not real.
I think that we're all sad because I was really hoping he would wake up and I know that the first night What do you mean, hoping he would wake up? He's still planning on waking up, though, right? Probably not.
He's probably had such severe brain damage that he's not going to wake up.
That he's going to be in, kind of, a comatose state and that, even if he does wake up, he would probably have pretty severe brain damage.
How was that for you? Well, it's so hard.
It's a really hard one cos I You know, and also I'm talking at them and I know they're not They're not hearing me.
If you allowed them to continue maybe in a state of slightly unrealistic Mm-hm.
.
.
hope, what would have been the downside of that? Well, I think they're still in that slightly unrealistic hope.
I don't think I could really penetrate that, you know.
But you did your best to do that.
Yeah, yeah, yeah.
And why was that? Well, cos it's time to start talking about that, you know.
It's not 24 hours later, it's What is it? It's four days later now, five days later, you know? So we need to start talking about those things, so Cos they don't hear a lot, so we have to keep coming back to it.
I was in Cedars-Sinai South Tower, home to another group of patients fighting for their lives against cancer.
I had an appointment with Dr Yuliya Linhares.
She was visiting a leukaemia patient, 29-year-old Javier Galvan.
She had news about his cell count.
How are you? Hello.
How are you feeling today? I'm OK.
He looks good, right? Yeah, yeah.
Much better.
Yeah.
I just wanted to tell you the counts - it looks like the absolute neutrophil count is showing up, so it's not certain whether they're bad or whether they're good, you know.
Sometimes they're good ones that just means that they're young cells that your bone marrow is spitting out and if they are the bad cells SHE SIGHS I will really have to kind of pick my brain of what to do next.
I mean, we can't go back to anything he's already had.
I think that's still If he's in a good enough shape, I think that's still a choice.
OK.
So whatwhat are you up against right now, as you understand it? As far as I understand, it's my blood - I'm fighting myself.
My blood is killing me.
It can't hold any nutrients, it can't do anything, can't produce itself and it's dying.
How would you characterise it, Dr Linhares? What's the scenario we're in right now with Javier? So, yeah, basically, erm, right now, erm, we're battling acute myeloid leukaemia, and we've been trying to kill it with a series of different treatments.
The treatments themselves are life-threatening.
If Javier had died from that, what would have been the actual medical cause? Kills all the, like, dividing cells, so it kills the lining of the gut, the lining of the mouth, so you can get terrible mouth sores.
Pretty much the whole inside of the mouth can pretty much fall off, just, like, fall off.
It's very painful.
Are you OK with hearing This is getting kinda gruesome.
Yeah, it's fine.
Yeah.
Cos you've already been through this.
Already, he went through that, he survived that.
I know.
But even so, it's making ME feel a little bit ill.
You can hear them screaming.
I've heard people screaming in the night.
In the night, from what? Pain.
Just It's your whole body turning against you.
It becomes like fire to move.
Without, like, anything to calm it, it consumes you.
It's really terrible, it's pretty much And you can't do anything about it.
How was the decision taken to continue with all these chemotherapies in the case of Javier? He's young, he's a fighter.
His body organs, overall, are functioning well.
We decided to keep going.
What would be the reasons not to offer further treatments, further chemo? He's had a lot of treatment already and his body is weak.
It's weakened by so many chemotherapy treatments - they're very toxic.
So, at one point, the risk of treatment is so high - the risk of treatment taking the patient's life is so high - that physicians just don't offer it any more.
And last time, I actually told him that he may live longer just choosing comfort type of care rather than chemotherapy because, in the short run, chemotherapy could take his life fast, but they still chose to go on with the treatment.
That was New Year's 2010, so the year before he got sick.
Before his health set-backs, Javier had been financing his dream of becoming an X-ray technician by working in a photocopy shop.
It was there that he'd met Adriana in 2006.
What was your plan before any of this happened? We were going to get part-time jobs cos we quit our full-time jobs.
Then we were going to start school and then we were going to get married.
Yeah, that was the plan.
Pretty simple.
As far as the care goes and the different stages on the journey, have you always been in sync, the two of you? Erm, he's made it very clear what he wants and .
.
you know, you kind of have to It's his It's his journey and he's the one that's sick and he's the one that, kind of, is in charge of his own care.
And I asked him, I said, "Well, if you don't think you can do it, if you can keep going "like, will you tell me?" I'll never deny that for him if that's what he chooses but, you know, he's always been, like, the, "We can kind of do this," like, "I can fight this," like, "It's OK.
" Javier and Langston were facing life-threatening conditions in a country that leads the world in spending on end-of-life care.
So proud of you.
The US has turned its famous sense of can-do on to the problem of extreme illness.
Most Americans either have health insurance or their care is paid for by the state.
For them, there is a smorgasbord of expensive treatment options.
But also the question of when to stop.
Back with Dr Jones, and she had an appointment to discuss Langston's brain scan results with her colleague Dr Yu, a neurologist.
The best-case scenario is that he might wake up but he'll never be able to walk, he'll never be able to feed himself.
Will he know who he is? Will he be able to follow commands? Best-case scenario.
So, best-case scenario, patient will end up in a persistent vegetative state.
That's the best-case scenario.
He will open eyes, yawn.
Vegetative state with a minimal conscious level.
OK.
All right.
And that's the best-case scenario? Yeah.
This is a pretty severe injury.
OK.
What are the choices going forward, then? It's I've been thinking a lot about this, you know.
If it was me - and I've told my family in no uncertain terms - that I would not want to be kept alive.
They're not going to be ready to do that with him.
I don't think anybody really wants that but I think sometimes families really have a hard time letting go.
And my experience is that, you know, it's going to take some time.
So I wanted to talk to you guys about what's going on.
I don't want to dash your hopes but I need to tell you that from a scientific medical standpoint Yes.
.
.
he's not going to wake up.
And that he's had very severe brain damage and that the best-case scenario is that he will be in a persistent vegetative state, meaning he will be in a nursing home, on tube feeds, he will have a diaper, he won't be able to interact, he won't ever be able to talk again, he won't know who he is.
I want you guys .
.
to think about Langston, about whether, if he could be part of this conversation, and let's say not now - let's say a month from now if he hasn't woken up, would he want to be kept alive in that state? I mean, you know, I understand what you're saying.
I hear what you're saying and I respect because I know doctors have to be ultra conservative, cos if you say that he's going to be all right, and this, and he's not, then we'll be leaving here disappointed.
So I understand how that goes.
You know you didn't know him before coming in here, but he is a fighter, and he is very stubborn and he comes around at his own time.
And, last night, I said, "Hey, it's Uncle Stallion.
"I'm getting ready to leave," and then I said, "If you hear me, open your eyes.
" And he opened his eyes? And he opened his eyes and I was not touching, I was away, and he opened his eyes and he looked at me.
That was my experience, it wasn't yours.
You weren't there.
Most doctors don't have time to come and sit and watch like the family sit and watch.
When the nurse comes around we're like, "Look," and he won't do it, and I'm like, "Langston, I'm going to hurt you.
" Do you want to go try now? Yes.
Let's go take a look, let's see what we can do right now.
Hey, sweetie pie.
Langston, if you hear Ashley, look over to Ashley.
Langston, squeeze my hand.
Langston, squeeze my hand, come on.
He's way more alert when he's not drugged.
Right, right.
Let's see.
So he has this doll's eye reflex so I think he's probably, you know, not conscious right now.
So see how they go back to the middle? That's a doll's eye reflex so I think he's probably What he's looking like now Yeah.
That's not how he was yesterday.
Yeah, OK.
OK, guys, any other questions right now? Well, thank you for coming in.
I really appreciate it.
It seemed as though the doctor had one message and you, kind of, respectfully disagreed.
For sure.
And you made that quite clear.
So what point were you putting across? That I don't think we're going to necessarily have to worry about my brother being a vegetable.
And even if he's You know, has a slight disability of some sort, that he will be able to cope and will be a little bit better that the prognosis that they are assuming.
And you don't resent them For what happened? .
.
for trying to let you know what their clinical impression is of the situation? Definitely not.
We get that that's reality.
We're not delusional, we're not in the fantasy world, you know.
I know it might seem that way but we have to be super-positive when such great odds are against him towards everybody else.
When the doctor had said something about, "What would Langston want if he were in the room now?" did you give any thought to that? I did.
I mean, my brother, although he suffered from depression at times, or whatnot, he was always full of life and full of hope.
And full of optimism in regards to things could get better which is why he checked himself and stayed in the rehab.
Clearly, he didn't foresee what happened happening but he was still, like, trying, so I know that he wouldn't want us to give up on him cos he never gave up on himself.
For patients who have stabilised in ICU but are still not responsive, there are other facilities that offer what is called long-term sub-acute care.
One is Fountain View.
Here, many of the residents are in states of minimal consciousness that can last years.
Hi.
Hi.
Are you Rosa Lee? Yes, hi.
Hi.
Louis.
Hi.
Nice to meet you.
This is Francisco? Yeah.
Hi, Francisco.
Francisco Fahado was a physician originally from the Philippines.
He's been a full-time resident of Fountain View since a stroke in 2010.
His sister Rosa Lee is a daily visitor.
The interesting thing is Francisco's face is showing all kinds of expressions.
Do you think he's registering that there's an unusual voice here? Maybe he hears He's looking quite stimulated - is that OK? Yeah.
Are you OK, Francisco? SHE SPEAKS OWN LANGUAGE We're from the BBC.
We're making a documentary about people with serious conditions.
And we'd We just wanted to get to know you a little bit.
And how long has he been in this state? Three years in December.
We've always hoped that, you know, one day he would wake up.
But he's made progress, at least for us.
I mean, maybe the doctors might not say that that's progress but for us, family, you know, just little things that we see different every day from the time he got sick - that's improvement for us, no matter what it is.
Have the doctors said what they feel is a realistic prognosis? From the start, they said that he was not going to recover.
And, you know, like I said, we believe differently, you know.
We understand, you know.
I work in health care and I understand but, you know, as a family .
.
you know, that's We believe differently.
In the nearly three years that Francisco has been in this state, have you had any words from him? No.
No.
Not words.
Mostly facial expression.
Dr Michael Soffer is the director for Francisco's unit.
Once a week, he makes rounds on the patients under his care.
What is the prognosis like for Francisco at this point? No recovery.
A few years until some event happens that results in his passing, whether it's an overwhelming pneumonia, or another stroke, or heart attack, or any number of possibilities.
Could you give an idea of what you think his quality of life is like? Well, when I ask patients who are able to understand and respond appropriately, if they were in a vegetative state such as this, would they want to be kept alive like this, pretty much universally they tell me no.
So I don't believe that there is much quality in his unfortunate existence.
Has something gone wrong with the system here in some way, that these types of cases are being cared for for years and years? Years ago - 20, 30 years ago - we didn't do this.
We didn't have these facilities available.
And if people got to this point where they could not function .
.
you know, at this level, then they died, you know.
There are always trade-offs, and when society When we as a society choose to spend our money on keeping the end-stage-of-life patients alive longer, we chose not to spend money on services for other people that perhaps could benefit more.
Have you ever thought about if something like this were ever to befall you, what you would do? What you would want done to you? I've already made that decision cos, you know, when this happened, you know .
.
I would do the same thing.
Do you feel you still have .
.
a good relationship with him? Yes.
Even though he's just lying there and, to some extent, he's unresponsive, you feel that there's still? Yes.
I don't I can't explain it, but I just know that he knows .
.
we're here, you know.
We're looking after him.
MUSIC PLAYS SHE TALKS SOOTHINGLY At Cedars-Sinai South Tower, on the cancer ward, I was with Dr Richard Gould with an appointment to meet his patient, Dontay Rogers.
Hi, Dontay.
How are you? Good, how are you doing? Good.
Good.
Nice to meet you.
Nice to meet you, too.
You know we're from the BBC, right? Yes.
From London, England.
Yes.
Viva London.
THEY LAUGH DONTAY SIGHS Dontay had come to LA with dreams of making it as an entertainer but, aged 31, he'd been diagnosed with cancer.
With no health insurance, he qualified for public assistance for his medical care.
So, how long have you two beenhad this relationship, doctor/patient? Probably a little over nine months now.
Yeah, almost five months, so, five months I've been here.
Yeah.
Dontay was initially diagnosed with a locally advanced anal cancer that we treated with chemotherapy and radiation with the hopes of curing, but, unfortunately, the treatment was difficult for Dontay to get through and once we got through it, there was still active cancer there.
So, there was chemo and radiation but, basically, it did not eradicate the cancer? Exactly.
So, then? Really, the best chance that we had at that point to try to get rid of the cancer was to do a large surgery to remove the anal rectal cancer and to remove the spots from the liver.
Yeah, it saved my life.
Saved my life.
They got rid of the cancer so far.
You've basically been residing in the hospital for about 150 days, is that right? Close to, but it's more like 120-something days so about 125 days now.
So that is a lot ofmedical attention and a lot of expense.
I could buy two houses and maybe have something Move to London and have a chateau.
So, if it's not So, if it's not an indelicate question, do you have a figure of how much it would have cost? Well, my last bill I looked at, we're probably at about $2 million - somewhere close to that.
Is it helpful to talk about you know, a time frame, or how likely it is How long he'll live, you know, things like that? I give people a general sense of how much longer I think they're going to live, based upon days, weeks, months, or years, but I have no idea how long anybody has, you know, cancer or no cancer.
And so it's one of the hardest questions to answer.
Have you had a conversation like that with Dontay? I have.
I have.
You know, Dontay is a silver-lining guy.
You know, he focuses on the hope, he focuses on the good things and trying to keep a positive attitude.
So for him thinking about, "Well, the cancer has such a high likelihood of coming back," that is hard for him.
And so he focuses on that small percentage that maybe the cancer won't come back, maybe we'll be able to give him further treatments, and to get him through this.
Back with Javier - and Dr Linhares had the results from his biopsy and his cell count.
Hi, Javier.
How are you feeling? Cancery.
THEY LAUGH Just, er, hanging in there.
Just trying to get through the day.
All right, so are you ready to talk? Sure.
All right, so we did the bone-marrow biopsy yesterday and, unfortunately, it's full of leukaemia.
So it's not in remission.
Actually, it looks like it just grew.
All the good cells, again, are down.
So it went from 24% to? 95.
OK.
95% less, and there are no good cells.
The options remain the same .
.
which isone is, of course, if you feel like enough chemotherapy is enough, is to just not do anything.
The other one is a real, erm, you know, brain twister because I knew that that wouldn't be what you would want.
I kind of guessed that.
So, erm, we were trying to think of the treatments that could still benefit you and the only one I could think of with there being the most sure bet is the very first we gave you because that one was the one that killed the leukaemia.
You did have the complications but they were due to influenza.
So, erm, I think that if we could stay on track, then you could have maintained the remission.
I mean, we've come this far.
I mean Yeah.
Really.
You ready? I'm ready.
It's up to you.
Yeah.
Why do you have to be so efficient? What would be a reason not to do it? Well, just because, honestly, the chances of chemotherapy working after somebody already had four different chemotherapy treatments which didn't work are less than 50%.
For many people, this would just be enough.
Is that a factor for you, Javier? I mean, really, they're offering me nothing or something, so I might as well just take something.
I don't see a point in not pursuing a chance.
SoI've gotta go for it.
I mean, really.
If Javier decided not to do it, he wouldn't be able to go home? He would.
He would just go home with basically Yeah, just A death sentence.
It would be, like, a week or two weeks - if that.
And what are you thinking, Javier? I'm thinking I've let everybody down.
How could you feel you've let anyone down? After I beat the first remission, it was kind of like, "Yay," you know, "I beat the first remission.
" So, it was just kind of uplifting.
And then I got a different kind of AML and now it's like all these promises that I've made are, like, completely haberdash, it's just garbage.
It's a garbage outcome for kind of an epic struggle.
It's just It's a big let down.
It really is.
I mean, Adriana, like .
.
I'm so sorry.
What can you do? It's OK.
I'm so sorry, baby.
Why would you feel you're Adriana, you don't feel Javier's letting you down, do you? No.
It's just, you know, I guess another bump in the road.
You feel let down by the disease, but not by Javier.
It's just so aggressive, you know? How much time could I buy? It may not be that much of a difference.
That's why I'm even offering this because I think that where things are already is Already pretty dire.
It's already not good, yeah, therefore it's hard to make it too It's hard to make it worse, basically.
All right.
If I do this, I'm buying maybe months, right? Well, it depends.
If you're in remission then you could do a transplant, so more than months.
If it works, it could be more than that.
Right, then let's do it.
Adriana, do you have a view on what you would like the decision to be? We kind of have to go for it, you know? It's going to be Either it's going to be chemo, or It's going to be weeks or it's going to be months.
I mean, we kind of have to I think we'll always kind of wonder, I guess - or at least I will - you know, if you tried it, would it have worked? And, you know, I kind of like him a little bit.
I want him around as much as possible! So we've got to try.
OK, all right.
Oh, I know.
Don't worry, he'll be fine.
See you later.
Now Javier's chances of surviving this are very close to zero.
Realistically, it'szero.
I mean, I was in the room when we were talking about this, and I didn't get the impression that his odds were quite so slim.
Do you think they understand that? Yes, I'm sure they understand because I, er, told him that his, er first choice, as I verbalised it, was to go home and just pursue comfort measures.
And, er, usually when we say that, that means that the odds are very, very slim.
So the textbook analysis of this situation would be, you should let him go home and be with his family and not go through any more interventions? Yeah.
But you know that and, you know, I respect your instincts for what you feel he needs.
There can be so many ethics discussions about this, and there can be so many people who would say, "What are you guys doing? "You're crazy.
Send him home - this is not going to work.
"Why is he going to die in the hospital?" But on the other hand, like I said, I hate pushing people in some direction because with him I would be pushing him.
This is not what he wants - he wants to keep fighting - and I just I can't, I can't be breaking him.
It's very tough and it seems like it doesn't make sense, but I don't know - if I were in his shoes, I might prefer the same.
You're going to feel a lot better after this.
You got great teeth.
Did you have to go through orthodonture or were you born lucky? Langston had now been in the hospital more than a month.
His family were convinced that he was getting better, and now even some of the nurses were starting to see progress.
Have you noticed any eye contact with you yet? No, I see him look at me but I don't see him track me, but I've seen him look at me and when he hears a sound he reacts.
Oh, OK.
That I do notice.
That's a start in the right direction.
Yeah.
Langston? Can you hear me? Langston, can you hear me? I'd arranged a visit with his sister Ashley to try to get to know him and learn a little about his football career and his brush with drugs.
Hi.
Hi.
How are you doing? Nice to see you.
'We started with some old photos of Langston 'with his twin brother Lorne.
' That's a nice one.
That's you in the middle.
Yeah.
'If you have someone that makes you feel like a buttercup, 'that's good.
'If you don't have that anyone makes you feel like a buttercup, 'or doesn't love you, I'm just going to say it - I love you 'and you are my buttercup.
'Don't ever forget that.
' Do you have any sense of what would have induced him to start taking serious drugs? No, I think, you know, in Simi Valley it's been an epidemic.
He's lost 11 friends in the past Since 2011.
I think it's just To drugs, to heroin? To heroin, in Simi Valley, so I think it's just a drug that came, that followed.
Some places it might be coke, some places it might be meth, in Simi Valley it's just heroin.
SometimesI mean, there's so many different reasons that people do drugs - was there anything in his life that was Did he seem troubled in any way? Yeah.
About what? He was, likealways had high expectations for himself.
There was always competition between him and our other brother.
His twin, Lorne? Yeah.
And Lorne always seemed to get it right and, you know And Lorne was, er, doing better academically - is that right? Correct.
And in any other way? No.
Or was he just Was Lorne Is Lorne a bit more of a I mean, would get into trouble less? He would never get in trouble.
Why not? He was scared.
He was scared of authority, scared of consequences, scared of things like that.
We weren't.
Langston has never been like that? No.
Do you think he's been depressed? Yeah.
We went to a USC Cow Game in San Diego and he couldn't take the game.
Like, he was crying hysterically and I left with him to go outside because he just was feeling bad at the decisions that he'd made and he had regrets, and he was, like, he should be on the field, he could do better than any of those guys there and it was just harder for him.
Let's just say he stays exactly where he is now - would that be I mean, you'd still be OK with that? I would, but I know he's not going to stay where he's at now.
I know he's going to get better.
I mean, if you were in his position, you would want exactly the same? I'm only going to die when my heart stops beating and when I can't breathe on my own, says God, not says a human being.
As long as there's life in my body, allow me to fight.
At the hospital, the 24-hour vigil at Langston's bedside had been joined by a new family member.
How do you do? I'm Louis.
Nice to meet you.
What's your name? Miss Jackson.
Miss Jackson.
Langston? Langston.
It's your grandmother.
Come on, turn your head over and give me a smile.
Don't give me no crying now.
I came too far for tears.
I've been crying for so long I want to laugh.
Come on over here.
Hey! Come on over here.
What do you close your eyes when I do that for? You think I'm going to slap you? SHE CHUCKLES Granny ain't going to hurt the baby! How would you describe Langston before he got ill? How would I describe him? He has always been polite.
He hasn't ever talked back dirty.
He's always been a malleable child.
Like I say, God forgive you.
God forgive you.
And he told the devil you can hurt him but you sure ain't going to kill him.
And I believe it.
I'm a child of God and all of my seeds All of you are my seed.
You're hurting now.
God's going to make you laugh at the devil, cos he won't never succeed.
He's not going to carry you.
You're in the fog, but it's going to be clear.
One day you're going to see.
The image of Langston's family praying for him was undeniably moving.
It was hard not to get swept up in the emotion and the temptation to believe that an appeal to the supernatural might help.
More than ever, I was reminded of the resolve of families to keep going at any cost.
It was three weeks since my first conversation with Dontay.
Recovery from surgery was proving slower than expected.
Dr Gould had arranged a meeting with his surgical team.
Yeah, I've got the whole team here, so So that we could talk with you and answer any questions that you have, so we would have everybody.
How are you doing? How are you feeling? I'm OK, just trying to position myself.
So we all met to talk about, er, where things are at with you and with your cancer and with the surgery and with your healing and needing more pain medicine and, er, we've been doing everything that we can to help the wound to heal, but we just hit a roadblock where it's not healing any further and that the area around the wound is starting to break down.
And so we've been talking about what our options are to try to help with that.
We wanted to get both of your surgeons in the same place to talk with you about that, so I want CJ, since he does the most, to talk about it.
Yeah, I mean, when we look at the progression at the time of the APR, the abdominoperineal resection, you had, you know, we took viable tissue and we bought it into the perineum area and then when we look at the way it healed, unfortunately the surrounding tissue is not integrating the flap, and so that's what we were brainstorming about is like, what are the likelihoods if we bring in other tissue that the same type of situation will again arise and place you in a worse situation then you are at this time? So what does that mean? I have to Am I just stuck with, er, trying to make this heal or what? Yeah, we're unfortunately at a place where it's not healing and it doesn't look like it's going to heal.
And so it's about what we can do to keep you comfortable and to take away the pain but we're not going to be able to make it better, unfortunately.
OK.
OK? So it's about looking at comfort measures and, basically, hospice.
The best that we can do for you is to focus on not doing anything which is going to make you feel worse and only give you treatments which will help you to feel better.
It seems so simple yet so complicated.
I don't understand it.
The tissues just aren't healing, Dontay.
You know, it's the toughest decision for a surgeon not to offer surgery, and for an oncologist not to offer any treatment options, so coming to this decision, you know I can't imagine how hard it is on you but it's pretty hard on us too.
Thank you for the news, and maybe a miracle will happen, I don't know.
We'll still be here checking on you and taking care of you - that hasn't changed.
It's just the direction of our treatment has changed so that we can make sure that we're keeping you as comfortable and as pain-free as possible.
OK.
Thank you.
You're welcome.
God is with you.
Give in to God, and I know Boy, they talked it out, though.
They looked at everything, they talked it out.
All those minds together, because everybody so so cares about you and loves you.
You have to give in to God, sweetheart.
So what am I supposed to do? Am I just supposed to sit in a bed for ever? You must be Aunt Bonnie? Yes.
I'm Louis.
Louis, nice to meet you.
Nice to meet you.
How are you doing? Fine.
Justfine.
Just trying to absorb everything that's going on with Dontay.
I'm just shocked that a wound is going to take his life.
I-I-I just can't believe that.
I-I won't believe that.
Dontay, and you? What are you thinking? It's even more devastating for me because my mind has been set that I was going to get out of here and um, you know, the To see the doctors that you've looked up to through all this time and them look at you empty in the face and See, I didn't want to get started again.
We're just hoping for a miracle.
He's just a special young man to us and, er, we just don't We just can't believe this.
We just can't believe this is the end.
What do you think Dontay's thinking? I think he's devastated and I think he's in shock.
He's talking about fighting and he's done so much fighting, and based on what the doctors are saying, it seems like maybe now isn't the time to fight, you know.
Maybe now is the time to try and be comfortable I'd fight for life - I certainly would.
I mean, what? Sit there and just die? No, I wouldn't do it and I wouldn't encourage him to do it.
But to lay there and just, you know, do nothing - I don't think that's the answer.
It sounds like that's what the doctors are saying.
They can only do what they feel they've been trained to do, you know, but doctors are humans and they make errors just like everybody else.
Honestly, would you do that? Would you sit up You look like a fairly young man yourself.
If someone told you, would you lay up there and just die? It's so hard to know, to even imagine what would be going through your head in that situation.
Well, you know, I'm older - I'm in my late 50s - and I wouldn't do it.
I'veI'm not ready to give up.
Are you in a position to, sort of, put your foot down and say, "We want to try more things"? Yeah, but according to what they told me, they've gone over and beyond what they would have done.
So Two days after the bad news about his cell count, Javier and Adriana held a small gathering of friends and family at the hospital.
So today Javier and Adriana proclaim their love to the world, and everyone here, we rejoice with and for them.
Javier Alonso Galvan, do you choose Adriana Guadalope Rodriguez to be your lawfully wedded wife and your beloved one? And if so, please say, "I do.
" I do.
"Adriana, I give you my hand and my heart.
" Adriana, I give you my hand and my heart.
"As I join my life to yours.
" As I join my life to yours.
"With this ring" With this ring ".
.
I thee wed.
" .
.
I thee wed.
"Javier, I give you my hand and my heart.
" Javier, I give you my hand and my heart.
"As I join my life to yours.
" As I join my life to yours.
"With this ring "With this ring" With this ring ".
.
I thee wed.
" .
.
I thee wed.
"And with all that I am" And with all that I am ".
.
I cherish you.
" .
.
I cherish you.
"And love you.
" And I love you.
It is really a great honour and privilege to pronounce you .
.
husband and wife.
Thank you.
Thank you.
OTHERS CHEER Mr and Mrs Javier and Adriana Galvan.
CHEERING AND APPLAUSE Two days after the ceremony, Javier started a new round of chemo.
He died the following day.
His end was probably hastened by his treatment, but he had also died fighting.
Though I'd been just a small part of Javier's last days on Earth, I couldn't help grieving his loss.
I realised that for young people who have hopes and dreams, to ask them not to take everything on offer to keep going is almost impossible.
Two months after I first arrived at the hospital, I had an extraordinary call.
In a turn of events the doctors were having trouble explaining, Langston's family had got their miracle.
Hi, Langston, I'm Heather.
Do you remember me? Langston? Who's this? Who's that? My sister! Oh, my God.
Oh, my God! Can you tell me who's that? Who's that, Langston? My sister.
Oh, your sister.
Oh, I'm so happy you're OK.
I really am so happy.
Yay! OK, I won't cry.
Oh, wow! Who's that? Who's that? His name is Louis.
We're from the BBC from Britain.
We've been filming you while you've been ill.
This is amazing.
Watch.
I love you, Langston.
I love you, Langston.
I love you, too.
See? "I love you too.
" You don't seem that surprised.
I already told you what was going to happen.
I'm grateful and I'm thankful to God.
I knew he was going to be OK and I know he's going to get better.
Do you believe this was a miracle? Yes.
He said yes, too.
So, that was, um, unexpected Yeah.
.
.
would you say? Yeah, that was really unexpected, so I just called one of the neurologists too, er, that I was working with in the ICU and he said, "You know, it's like a one in a million.
" To recap, what had originally been said - and this is some while ago, a couple of weeks ago now - was that the best-case scenario was a vegetative state.
Yes.
With minimal high brain function, so they said that he would basically not follow instructions, not really be a person.
Right.
Exactly.
And that was the best-case scenario.
That was the best-case scenario.
Based on the scans.
Based on the scans, and what I was told by the neurologist and my experience with this, so usually if people don't wake up right away, like in a week or so, then they don't wake up, so But looking back on it, does that mean you and your colleagues made a mistake in this instance, or were you right to manage expectations and base your assessment on the likeliest outcome? I guess, you know I think that most people, I think it's appropriate to say, "This is the best-case scenario based on all the evidence that we have, "and based on most patients in this situation," so, er, I think it would It would be inappropriate to give anybody hope when the experts - the neuro-intensivists and neurologists - are saying there's no chance for a meaningful recovery.
As we say, they didn't read the textbook.
He didn't read the textbook - he's supposed to be brain You know, a vegetable, but he's not, he's waking up, so that's a miracle, I guess.
Is it possible he'll make a full recovery? I don't know.
I really don't know, you know, I God, wouldn't that be great? It would make it really hard to have these conversations with other families, but, um But I think that would be amazing, yeah.
Yeah, that would be so exciting.
I was on my way to see Dontay.
After five months and ten days in the hospital, he'd taken the step of accepting that the Cedars-Sinai doctors could do nothing further for him.
How are you feeling? I feel good.
I put on my This is the jacket and hat I said I was going to wear when I leave out of here - it's what I came here in.
So whatever experience can You know, I can embody and, you know, be involved in it and on to the new legacy.
How is your outlook? As far as? General outlook - are you feeling positive? Um, I've always been optimistic UmI'm definitely I think this is a better move for me because now I can look for other measures of medications.
I have, you know, too much life to live.
I think I can really either beat this or extend the time, at least.
Hi, Dr Gould.
Hi, Dontay, how are you? Good.
Yeah? Mm-hm.
Are you comfortable? Yes.
Good.
Any pain? No, not so far.
No? OK.
No pain.
Once you get home, the hospice team is going to be there to help take care of you.
And like we talked about before, I won't be seeing you at home, but I'll be talking with the hospice team and helping to take care of you with them.
It's been a pleasure working with you for 100 and how many days? Lord have mercy! Well, putting it all together, it's probably been around nine months - maybe a little longer than that.
All right, Doctor, see you soon.
OK.
Thank you.
Bye, Dontay.
Bye.
Dontay's been on a journey of acceptance to do with him not really wanting to face what's going on, to some extent.
Do you know where he is on that journey now? He's still on that journey towards acceptance.
He's not quite there yet.
Today, he was able to talk with me about hospice a little bit.
It's been difficult for him to look at going home, that he's going home on a hospice.
He's been looking at it a lot as, "Well, he's going home, he's leaving the hospital," but not really what that means - that it's about taking care of him as he's going through the dying process and accepting that he is dying.
And, er, even now he's still, you know, praying and hoping for a miracle.
Has there ever been a time when you've felt if he had not been so, um, keen on beating the cancer that he would have not put himself through so much suffering? I His strong willpower of wanting to live and needing to live and being willing to go through painful procedures and interventions that he knew would make him feel worse in the short term, that he knew would bring on more pain in the short term, for the chance of doing better, for the chance of being better afterwards, um Because of that, yes, he did go through more pain and more suffering but, you know, there's not a right or wrong way to do that and it's a very individual decision on whether somebody .
.
is willing to go through that.
And for Dontay, it was worth it.
Right, Mr Rogers.
Before we go, if I can just get a quick signature.
It's just for consent for us to take you back to your aunt's, right? Yes.
All right.
Here you go.
Just get your signature here.
Six weeks after he was discharged, Dontay died at his Aunt Bonnie's house, surrounded by friends and family.
Oh, my God! Hi, Langston! APPLAUSE Hi! Seven weeks after he woke up, after intensive rehabilitation at another facility, Langston paid a visit to the ICU.
Oh, my gosh! How you doing? I'm Louis.
Nice to meet you properly.
Wow! How are you feeling? I'm good.
You're good? Yeah.
These people - everybody is just so excited that you're here.
We're just You're a miracle - you know that, right? Yeah.
Yeah.
What's the first thing you remember? Er, nothing, really.
You don't remember? Just waking up.
Where do you remember waking up? At the other hospital.
At the other hospital? So you don't remember Cos when woke up here it was right before you were about to go, and that was amazing just to see that, yeah, yeah.
Congratulations.
Thank you.
Wow! Do you want to see the room where you were? Yeah.
Yeah, come on down.
There's nobody in there, right? These are all the people that took care of you.
You can talk to him, if you like.
Hi, Langston.
We've come from London, England.
We're making a TV programme.
You're in the hospital, and, so, we've been filming your family a little bit and filming with you a little bit, too.
So, we're hoping you're going to wake up and we can tell you a little bit more about what we're doing.
SHE SIGHS How are you feeling? Um, good, I feel really good.
I know some people don't think there's a lot of progress but something's better than nothing.
You know, there's been miracles in many hospitals and they can't say why.
So, this is going to be a miracle right here.
I was in Cedars-Sinai Medical Center in Los Angeles, meeting patients looking for a last chance at life.
If I do this, I'm buying maybe months right? It could be more than that.
All right, then, let's do it.
In America, doctors will go further to treat extreme cases than almost anywhere else in the world.
He's young, he's a fighter.
We decided to keep going.
I'd fight for life, I certainly would.
I mean, what? Sit there, and just die? But the financial costs are enormous, the side effects sometimes severe, and the odds of success often very small.
Patients and their families face the harrowing choice of accepting death or carrying on, in the hope that one last procedure will pay off.
On the seventh floor of Saperstein Critical Care Tower, Langston Jackson, a 22-year-old college athlete, was non-responsive in the intensive-care unit.
His family had been by his bedside since his arrival five days earlier, among them, his mother Lyle.
Can you, can you tell me a little bit about what's going on? Well, Langston was in rehab for the past 19 days, and on Saturday morning, he had He and his roommate had gotten in contact connected with drugs and he had an overdose, from what I understand, from the facility, at about 3am.
What do you understand about his condition at the moment? I understand he's in very critical condition.
He has compromised liver and kidney function, and a traumatic brain injury.
And they are waiting for him to be able to breathe on his own to diagnose his brain injury further.
How optimistic are you for Langston? Well, I understand that this is going to take quite a while but that he's hopefully able to walk, talk, do everything that he wants to do, and continue to live his life, even with limited marked limitations - that's fine.
In charge of Langston's care was the ICU medical director Dr Heather Jones.
She'd called a family meeting to discuss his prognosis.
All right.
OK if I sit next to you? OK.
So, erm, what Langston has is nota blood clot that blocked a certain part A certain artery going to a certain part of the brain.
He has Basically, certain areas of his brain were very, very, er, sensitive to the fact that his oxygen level was very low.
And, so, that's the part where it gets really heartbreaking, is that, you know, when I asked Dr Moheet, who was the neuro-intensivist who took care of him when he was first sick, and Dr Palestrant, as well, felt that his chances of waking up and being normal again are very small.
And they just said that? Did they just say that? Well, you know, I think that, that, erm I've been concerned about that from the beginning, and I think that we've all been concerned about that but, you know, time will tell.
And, so, in the first 24, 48, 72 hours, you kind of hope for the best, and you hope that what you're seeing on the scan is not real.
I think that we're all sad because I was really hoping he would wake up and I know that the first night What do you mean, hoping he would wake up? He's still planning on waking up, though, right? Probably not.
He's probably had such severe brain damage that he's not going to wake up.
That he's going to be in, kind of, a comatose state and that, even if he does wake up, he would probably have pretty severe brain damage.
How was that for you? Well, it's so hard.
It's a really hard one cos I You know, and also I'm talking at them and I know they're not They're not hearing me.
If you allowed them to continue maybe in a state of slightly unrealistic Mm-hm.
.
.
hope, what would have been the downside of that? Well, I think they're still in that slightly unrealistic hope.
I don't think I could really penetrate that, you know.
But you did your best to do that.
Yeah, yeah, yeah.
And why was that? Well, cos it's time to start talking about that, you know.
It's not 24 hours later, it's What is it? It's four days later now, five days later, you know? So we need to start talking about those things, so Cos they don't hear a lot, so we have to keep coming back to it.
I was in Cedars-Sinai South Tower, home to another group of patients fighting for their lives against cancer.
I had an appointment with Dr Yuliya Linhares.
She was visiting a leukaemia patient, 29-year-old Javier Galvan.
She had news about his cell count.
How are you? Hello.
How are you feeling today? I'm OK.
He looks good, right? Yeah, yeah.
Much better.
Yeah.
I just wanted to tell you the counts - it looks like the absolute neutrophil count is showing up, so it's not certain whether they're bad or whether they're good, you know.
Sometimes they're good ones that just means that they're young cells that your bone marrow is spitting out and if they are the bad cells SHE SIGHS I will really have to kind of pick my brain of what to do next.
I mean, we can't go back to anything he's already had.
I think that's still If he's in a good enough shape, I think that's still a choice.
OK.
So whatwhat are you up against right now, as you understand it? As far as I understand, it's my blood - I'm fighting myself.
My blood is killing me.
It can't hold any nutrients, it can't do anything, can't produce itself and it's dying.
How would you characterise it, Dr Linhares? What's the scenario we're in right now with Javier? So, yeah, basically, erm, right now, erm, we're battling acute myeloid leukaemia, and we've been trying to kill it with a series of different treatments.
The treatments themselves are life-threatening.
If Javier had died from that, what would have been the actual medical cause? Kills all the, like, dividing cells, so it kills the lining of the gut, the lining of the mouth, so you can get terrible mouth sores.
Pretty much the whole inside of the mouth can pretty much fall off, just, like, fall off.
It's very painful.
Are you OK with hearing This is getting kinda gruesome.
Yeah, it's fine.
Yeah.
Cos you've already been through this.
Already, he went through that, he survived that.
I know.
But even so, it's making ME feel a little bit ill.
You can hear them screaming.
I've heard people screaming in the night.
In the night, from what? Pain.
Just It's your whole body turning against you.
It becomes like fire to move.
Without, like, anything to calm it, it consumes you.
It's really terrible, it's pretty much And you can't do anything about it.
How was the decision taken to continue with all these chemotherapies in the case of Javier? He's young, he's a fighter.
His body organs, overall, are functioning well.
We decided to keep going.
What would be the reasons not to offer further treatments, further chemo? He's had a lot of treatment already and his body is weak.
It's weakened by so many chemotherapy treatments - they're very toxic.
So, at one point, the risk of treatment is so high - the risk of treatment taking the patient's life is so high - that physicians just don't offer it any more.
And last time, I actually told him that he may live longer just choosing comfort type of care rather than chemotherapy because, in the short run, chemotherapy could take his life fast, but they still chose to go on with the treatment.
That was New Year's 2010, so the year before he got sick.
Before his health set-backs, Javier had been financing his dream of becoming an X-ray technician by working in a photocopy shop.
It was there that he'd met Adriana in 2006.
What was your plan before any of this happened? We were going to get part-time jobs cos we quit our full-time jobs.
Then we were going to start school and then we were going to get married.
Yeah, that was the plan.
Pretty simple.
As far as the care goes and the different stages on the journey, have you always been in sync, the two of you? Erm, he's made it very clear what he wants and .
.
you know, you kind of have to It's his It's his journey and he's the one that's sick and he's the one that, kind of, is in charge of his own care.
And I asked him, I said, "Well, if you don't think you can do it, if you can keep going "like, will you tell me?" I'll never deny that for him if that's what he chooses but, you know, he's always been, like, the, "We can kind of do this," like, "I can fight this," like, "It's OK.
" Javier and Langston were facing life-threatening conditions in a country that leads the world in spending on end-of-life care.
So proud of you.
The US has turned its famous sense of can-do on to the problem of extreme illness.
Most Americans either have health insurance or their care is paid for by the state.
For them, there is a smorgasbord of expensive treatment options.
But also the question of when to stop.
Back with Dr Jones, and she had an appointment to discuss Langston's brain scan results with her colleague Dr Yu, a neurologist.
The best-case scenario is that he might wake up but he'll never be able to walk, he'll never be able to feed himself.
Will he know who he is? Will he be able to follow commands? Best-case scenario.
So, best-case scenario, patient will end up in a persistent vegetative state.
That's the best-case scenario.
He will open eyes, yawn.
Vegetative state with a minimal conscious level.
OK.
All right.
And that's the best-case scenario? Yeah.
This is a pretty severe injury.
OK.
What are the choices going forward, then? It's I've been thinking a lot about this, you know.
If it was me - and I've told my family in no uncertain terms - that I would not want to be kept alive.
They're not going to be ready to do that with him.
I don't think anybody really wants that but I think sometimes families really have a hard time letting go.
And my experience is that, you know, it's going to take some time.
So I wanted to talk to you guys about what's going on.
I don't want to dash your hopes but I need to tell you that from a scientific medical standpoint Yes.
.
.
he's not going to wake up.
And that he's had very severe brain damage and that the best-case scenario is that he will be in a persistent vegetative state, meaning he will be in a nursing home, on tube feeds, he will have a diaper, he won't be able to interact, he won't ever be able to talk again, he won't know who he is.
I want you guys .
.
to think about Langston, about whether, if he could be part of this conversation, and let's say not now - let's say a month from now if he hasn't woken up, would he want to be kept alive in that state? I mean, you know, I understand what you're saying.
I hear what you're saying and I respect because I know doctors have to be ultra conservative, cos if you say that he's going to be all right, and this, and he's not, then we'll be leaving here disappointed.
So I understand how that goes.
You know you didn't know him before coming in here, but he is a fighter, and he is very stubborn and he comes around at his own time.
And, last night, I said, "Hey, it's Uncle Stallion.
"I'm getting ready to leave," and then I said, "If you hear me, open your eyes.
" And he opened his eyes? And he opened his eyes and I was not touching, I was away, and he opened his eyes and he looked at me.
That was my experience, it wasn't yours.
You weren't there.
Most doctors don't have time to come and sit and watch like the family sit and watch.
When the nurse comes around we're like, "Look," and he won't do it, and I'm like, "Langston, I'm going to hurt you.
" Do you want to go try now? Yes.
Let's go take a look, let's see what we can do right now.
Hey, sweetie pie.
Langston, if you hear Ashley, look over to Ashley.
Langston, squeeze my hand.
Langston, squeeze my hand, come on.
He's way more alert when he's not drugged.
Right, right.
Let's see.
So he has this doll's eye reflex so I think he's probably, you know, not conscious right now.
So see how they go back to the middle? That's a doll's eye reflex so I think he's probably What he's looking like now Yeah.
That's not how he was yesterday.
Yeah, OK.
OK, guys, any other questions right now? Well, thank you for coming in.
I really appreciate it.
It seemed as though the doctor had one message and you, kind of, respectfully disagreed.
For sure.
And you made that quite clear.
So what point were you putting across? That I don't think we're going to necessarily have to worry about my brother being a vegetable.
And even if he's You know, has a slight disability of some sort, that he will be able to cope and will be a little bit better that the prognosis that they are assuming.
And you don't resent them For what happened? .
.
for trying to let you know what their clinical impression is of the situation? Definitely not.
We get that that's reality.
We're not delusional, we're not in the fantasy world, you know.
I know it might seem that way but we have to be super-positive when such great odds are against him towards everybody else.
When the doctor had said something about, "What would Langston want if he were in the room now?" did you give any thought to that? I did.
I mean, my brother, although he suffered from depression at times, or whatnot, he was always full of life and full of hope.
And full of optimism in regards to things could get better which is why he checked himself and stayed in the rehab.
Clearly, he didn't foresee what happened happening but he was still, like, trying, so I know that he wouldn't want us to give up on him cos he never gave up on himself.
For patients who have stabilised in ICU but are still not responsive, there are other facilities that offer what is called long-term sub-acute care.
One is Fountain View.
Here, many of the residents are in states of minimal consciousness that can last years.
Hi.
Hi.
Are you Rosa Lee? Yes, hi.
Hi.
Louis.
Hi.
Nice to meet you.
This is Francisco? Yeah.
Hi, Francisco.
Francisco Fahado was a physician originally from the Philippines.
He's been a full-time resident of Fountain View since a stroke in 2010.
His sister Rosa Lee is a daily visitor.
The interesting thing is Francisco's face is showing all kinds of expressions.
Do you think he's registering that there's an unusual voice here? Maybe he hears He's looking quite stimulated - is that OK? Yeah.
Are you OK, Francisco? SHE SPEAKS OWN LANGUAGE We're from the BBC.
We're making a documentary about people with serious conditions.
And we'd We just wanted to get to know you a little bit.
And how long has he been in this state? Three years in December.
We've always hoped that, you know, one day he would wake up.
But he's made progress, at least for us.
I mean, maybe the doctors might not say that that's progress but for us, family, you know, just little things that we see different every day from the time he got sick - that's improvement for us, no matter what it is.
Have the doctors said what they feel is a realistic prognosis? From the start, they said that he was not going to recover.
And, you know, like I said, we believe differently, you know.
We understand, you know.
I work in health care and I understand but, you know, as a family .
.
you know, that's We believe differently.
In the nearly three years that Francisco has been in this state, have you had any words from him? No.
No.
Not words.
Mostly facial expression.
Dr Michael Soffer is the director for Francisco's unit.
Once a week, he makes rounds on the patients under his care.
What is the prognosis like for Francisco at this point? No recovery.
A few years until some event happens that results in his passing, whether it's an overwhelming pneumonia, or another stroke, or heart attack, or any number of possibilities.
Could you give an idea of what you think his quality of life is like? Well, when I ask patients who are able to understand and respond appropriately, if they were in a vegetative state such as this, would they want to be kept alive like this, pretty much universally they tell me no.
So I don't believe that there is much quality in his unfortunate existence.
Has something gone wrong with the system here in some way, that these types of cases are being cared for for years and years? Years ago - 20, 30 years ago - we didn't do this.
We didn't have these facilities available.
And if people got to this point where they could not function .
.
you know, at this level, then they died, you know.
There are always trade-offs, and when society When we as a society choose to spend our money on keeping the end-stage-of-life patients alive longer, we chose not to spend money on services for other people that perhaps could benefit more.
Have you ever thought about if something like this were ever to befall you, what you would do? What you would want done to you? I've already made that decision cos, you know, when this happened, you know .
.
I would do the same thing.
Do you feel you still have .
.
a good relationship with him? Yes.
Even though he's just lying there and, to some extent, he's unresponsive, you feel that there's still? Yes.
I don't I can't explain it, but I just know that he knows .
.
we're here, you know.
We're looking after him.
MUSIC PLAYS SHE TALKS SOOTHINGLY At Cedars-Sinai South Tower, on the cancer ward, I was with Dr Richard Gould with an appointment to meet his patient, Dontay Rogers.
Hi, Dontay.
How are you? Good, how are you doing? Good.
Good.
Nice to meet you.
Nice to meet you, too.
You know we're from the BBC, right? Yes.
From London, England.
Yes.
Viva London.
THEY LAUGH DONTAY SIGHS Dontay had come to LA with dreams of making it as an entertainer but, aged 31, he'd been diagnosed with cancer.
With no health insurance, he qualified for public assistance for his medical care.
So, how long have you two beenhad this relationship, doctor/patient? Probably a little over nine months now.
Yeah, almost five months, so, five months I've been here.
Yeah.
Dontay was initially diagnosed with a locally advanced anal cancer that we treated with chemotherapy and radiation with the hopes of curing, but, unfortunately, the treatment was difficult for Dontay to get through and once we got through it, there was still active cancer there.
So, there was chemo and radiation but, basically, it did not eradicate the cancer? Exactly.
So, then? Really, the best chance that we had at that point to try to get rid of the cancer was to do a large surgery to remove the anal rectal cancer and to remove the spots from the liver.
Yeah, it saved my life.
Saved my life.
They got rid of the cancer so far.
You've basically been residing in the hospital for about 150 days, is that right? Close to, but it's more like 120-something days so about 125 days now.
So that is a lot ofmedical attention and a lot of expense.
I could buy two houses and maybe have something Move to London and have a chateau.
So, if it's not So, if it's not an indelicate question, do you have a figure of how much it would have cost? Well, my last bill I looked at, we're probably at about $2 million - somewhere close to that.
Is it helpful to talk about you know, a time frame, or how likely it is How long he'll live, you know, things like that? I give people a general sense of how much longer I think they're going to live, based upon days, weeks, months, or years, but I have no idea how long anybody has, you know, cancer or no cancer.
And so it's one of the hardest questions to answer.
Have you had a conversation like that with Dontay? I have.
I have.
You know, Dontay is a silver-lining guy.
You know, he focuses on the hope, he focuses on the good things and trying to keep a positive attitude.
So for him thinking about, "Well, the cancer has such a high likelihood of coming back," that is hard for him.
And so he focuses on that small percentage that maybe the cancer won't come back, maybe we'll be able to give him further treatments, and to get him through this.
Back with Javier - and Dr Linhares had the results from his biopsy and his cell count.
Hi, Javier.
How are you feeling? Cancery.
THEY LAUGH Just, er, hanging in there.
Just trying to get through the day.
All right, so are you ready to talk? Sure.
All right, so we did the bone-marrow biopsy yesterday and, unfortunately, it's full of leukaemia.
So it's not in remission.
Actually, it looks like it just grew.
All the good cells, again, are down.
So it went from 24% to? 95.
OK.
95% less, and there are no good cells.
The options remain the same .
.
which isone is, of course, if you feel like enough chemotherapy is enough, is to just not do anything.
The other one is a real, erm, you know, brain twister because I knew that that wouldn't be what you would want.
I kind of guessed that.
So, erm, we were trying to think of the treatments that could still benefit you and the only one I could think of with there being the most sure bet is the very first we gave you because that one was the one that killed the leukaemia.
You did have the complications but they were due to influenza.
So, erm, I think that if we could stay on track, then you could have maintained the remission.
I mean, we've come this far.
I mean Yeah.
Really.
You ready? I'm ready.
It's up to you.
Yeah.
Why do you have to be so efficient? What would be a reason not to do it? Well, just because, honestly, the chances of chemotherapy working after somebody already had four different chemotherapy treatments which didn't work are less than 50%.
For many people, this would just be enough.
Is that a factor for you, Javier? I mean, really, they're offering me nothing or something, so I might as well just take something.
I don't see a point in not pursuing a chance.
SoI've gotta go for it.
I mean, really.
If Javier decided not to do it, he wouldn't be able to go home? He would.
He would just go home with basically Yeah, just A death sentence.
It would be, like, a week or two weeks - if that.
And what are you thinking, Javier? I'm thinking I've let everybody down.
How could you feel you've let anyone down? After I beat the first remission, it was kind of like, "Yay," you know, "I beat the first remission.
" So, it was just kind of uplifting.
And then I got a different kind of AML and now it's like all these promises that I've made are, like, completely haberdash, it's just garbage.
It's a garbage outcome for kind of an epic struggle.
It's just It's a big let down.
It really is.
I mean, Adriana, like .
.
I'm so sorry.
What can you do? It's OK.
I'm so sorry, baby.
Why would you feel you're Adriana, you don't feel Javier's letting you down, do you? No.
It's just, you know, I guess another bump in the road.
You feel let down by the disease, but not by Javier.
It's just so aggressive, you know? How much time could I buy? It may not be that much of a difference.
That's why I'm even offering this because I think that where things are already is Already pretty dire.
It's already not good, yeah, therefore it's hard to make it too It's hard to make it worse, basically.
All right.
If I do this, I'm buying maybe months, right? Well, it depends.
If you're in remission then you could do a transplant, so more than months.
If it works, it could be more than that.
Right, then let's do it.
Adriana, do you have a view on what you would like the decision to be? We kind of have to go for it, you know? It's going to be Either it's going to be chemo, or It's going to be weeks or it's going to be months.
I mean, we kind of have to I think we'll always kind of wonder, I guess - or at least I will - you know, if you tried it, would it have worked? And, you know, I kind of like him a little bit.
I want him around as much as possible! So we've got to try.
OK, all right.
Oh, I know.
Don't worry, he'll be fine.
See you later.
Now Javier's chances of surviving this are very close to zero.
Realistically, it'szero.
I mean, I was in the room when we were talking about this, and I didn't get the impression that his odds were quite so slim.
Do you think they understand that? Yes, I'm sure they understand because I, er, told him that his, er first choice, as I verbalised it, was to go home and just pursue comfort measures.
And, er, usually when we say that, that means that the odds are very, very slim.
So the textbook analysis of this situation would be, you should let him go home and be with his family and not go through any more interventions? Yeah.
But you know that and, you know, I respect your instincts for what you feel he needs.
There can be so many ethics discussions about this, and there can be so many people who would say, "What are you guys doing? "You're crazy.
Send him home - this is not going to work.
"Why is he going to die in the hospital?" But on the other hand, like I said, I hate pushing people in some direction because with him I would be pushing him.
This is not what he wants - he wants to keep fighting - and I just I can't, I can't be breaking him.
It's very tough and it seems like it doesn't make sense, but I don't know - if I were in his shoes, I might prefer the same.
You're going to feel a lot better after this.
You got great teeth.
Did you have to go through orthodonture or were you born lucky? Langston had now been in the hospital more than a month.
His family were convinced that he was getting better, and now even some of the nurses were starting to see progress.
Have you noticed any eye contact with you yet? No, I see him look at me but I don't see him track me, but I've seen him look at me and when he hears a sound he reacts.
Oh, OK.
That I do notice.
That's a start in the right direction.
Yeah.
Langston? Can you hear me? Langston, can you hear me? I'd arranged a visit with his sister Ashley to try to get to know him and learn a little about his football career and his brush with drugs.
Hi.
Hi.
How are you doing? Nice to see you.
'We started with some old photos of Langston 'with his twin brother Lorne.
' That's a nice one.
That's you in the middle.
Yeah.
'If you have someone that makes you feel like a buttercup, 'that's good.
'If you don't have that anyone makes you feel like a buttercup, 'or doesn't love you, I'm just going to say it - I love you 'and you are my buttercup.
'Don't ever forget that.
' Do you have any sense of what would have induced him to start taking serious drugs? No, I think, you know, in Simi Valley it's been an epidemic.
He's lost 11 friends in the past Since 2011.
I think it's just To drugs, to heroin? To heroin, in Simi Valley, so I think it's just a drug that came, that followed.
Some places it might be coke, some places it might be meth, in Simi Valley it's just heroin.
SometimesI mean, there's so many different reasons that people do drugs - was there anything in his life that was Did he seem troubled in any way? Yeah.
About what? He was, likealways had high expectations for himself.
There was always competition between him and our other brother.
His twin, Lorne? Yeah.
And Lorne always seemed to get it right and, you know And Lorne was, er, doing better academically - is that right? Correct.
And in any other way? No.
Or was he just Was Lorne Is Lorne a bit more of a I mean, would get into trouble less? He would never get in trouble.
Why not? He was scared.
He was scared of authority, scared of consequences, scared of things like that.
We weren't.
Langston has never been like that? No.
Do you think he's been depressed? Yeah.
We went to a USC Cow Game in San Diego and he couldn't take the game.
Like, he was crying hysterically and I left with him to go outside because he just was feeling bad at the decisions that he'd made and he had regrets, and he was, like, he should be on the field, he could do better than any of those guys there and it was just harder for him.
Let's just say he stays exactly where he is now - would that be I mean, you'd still be OK with that? I would, but I know he's not going to stay where he's at now.
I know he's going to get better.
I mean, if you were in his position, you would want exactly the same? I'm only going to die when my heart stops beating and when I can't breathe on my own, says God, not says a human being.
As long as there's life in my body, allow me to fight.
At the hospital, the 24-hour vigil at Langston's bedside had been joined by a new family member.
How do you do? I'm Louis.
Nice to meet you.
What's your name? Miss Jackson.
Miss Jackson.
Langston? Langston.
It's your grandmother.
Come on, turn your head over and give me a smile.
Don't give me no crying now.
I came too far for tears.
I've been crying for so long I want to laugh.
Come on over here.
Hey! Come on over here.
What do you close your eyes when I do that for? You think I'm going to slap you? SHE CHUCKLES Granny ain't going to hurt the baby! How would you describe Langston before he got ill? How would I describe him? He has always been polite.
He hasn't ever talked back dirty.
He's always been a malleable child.
Like I say, God forgive you.
God forgive you.
And he told the devil you can hurt him but you sure ain't going to kill him.
And I believe it.
I'm a child of God and all of my seeds All of you are my seed.
You're hurting now.
God's going to make you laugh at the devil, cos he won't never succeed.
He's not going to carry you.
You're in the fog, but it's going to be clear.
One day you're going to see.
The image of Langston's family praying for him was undeniably moving.
It was hard not to get swept up in the emotion and the temptation to believe that an appeal to the supernatural might help.
More than ever, I was reminded of the resolve of families to keep going at any cost.
It was three weeks since my first conversation with Dontay.
Recovery from surgery was proving slower than expected.
Dr Gould had arranged a meeting with his surgical team.
Yeah, I've got the whole team here, so So that we could talk with you and answer any questions that you have, so we would have everybody.
How are you doing? How are you feeling? I'm OK, just trying to position myself.
So we all met to talk about, er, where things are at with you and with your cancer and with the surgery and with your healing and needing more pain medicine and, er, we've been doing everything that we can to help the wound to heal, but we just hit a roadblock where it's not healing any further and that the area around the wound is starting to break down.
And so we've been talking about what our options are to try to help with that.
We wanted to get both of your surgeons in the same place to talk with you about that, so I want CJ, since he does the most, to talk about it.
Yeah, I mean, when we look at the progression at the time of the APR, the abdominoperineal resection, you had, you know, we took viable tissue and we bought it into the perineum area and then when we look at the way it healed, unfortunately the surrounding tissue is not integrating the flap, and so that's what we were brainstorming about is like, what are the likelihoods if we bring in other tissue that the same type of situation will again arise and place you in a worse situation then you are at this time? So what does that mean? I have to Am I just stuck with, er, trying to make this heal or what? Yeah, we're unfortunately at a place where it's not healing and it doesn't look like it's going to heal.
And so it's about what we can do to keep you comfortable and to take away the pain but we're not going to be able to make it better, unfortunately.
OK.
OK? So it's about looking at comfort measures and, basically, hospice.
The best that we can do for you is to focus on not doing anything which is going to make you feel worse and only give you treatments which will help you to feel better.
It seems so simple yet so complicated.
I don't understand it.
The tissues just aren't healing, Dontay.
You know, it's the toughest decision for a surgeon not to offer surgery, and for an oncologist not to offer any treatment options, so coming to this decision, you know I can't imagine how hard it is on you but it's pretty hard on us too.
Thank you for the news, and maybe a miracle will happen, I don't know.
We'll still be here checking on you and taking care of you - that hasn't changed.
It's just the direction of our treatment has changed so that we can make sure that we're keeping you as comfortable and as pain-free as possible.
OK.
Thank you.
You're welcome.
God is with you.
Give in to God, and I know Boy, they talked it out, though.
They looked at everything, they talked it out.
All those minds together, because everybody so so cares about you and loves you.
You have to give in to God, sweetheart.
So what am I supposed to do? Am I just supposed to sit in a bed for ever? You must be Aunt Bonnie? Yes.
I'm Louis.
Louis, nice to meet you.
Nice to meet you.
How are you doing? Fine.
Justfine.
Just trying to absorb everything that's going on with Dontay.
I'm just shocked that a wound is going to take his life.
I-I-I just can't believe that.
I-I won't believe that.
Dontay, and you? What are you thinking? It's even more devastating for me because my mind has been set that I was going to get out of here and um, you know, the To see the doctors that you've looked up to through all this time and them look at you empty in the face and See, I didn't want to get started again.
We're just hoping for a miracle.
He's just a special young man to us and, er, we just don't We just can't believe this.
We just can't believe this is the end.
What do you think Dontay's thinking? I think he's devastated and I think he's in shock.
He's talking about fighting and he's done so much fighting, and based on what the doctors are saying, it seems like maybe now isn't the time to fight, you know.
Maybe now is the time to try and be comfortable I'd fight for life - I certainly would.
I mean, what? Sit there and just die? No, I wouldn't do it and I wouldn't encourage him to do it.
But to lay there and just, you know, do nothing - I don't think that's the answer.
It sounds like that's what the doctors are saying.
They can only do what they feel they've been trained to do, you know, but doctors are humans and they make errors just like everybody else.
Honestly, would you do that? Would you sit up You look like a fairly young man yourself.
If someone told you, would you lay up there and just die? It's so hard to know, to even imagine what would be going through your head in that situation.
Well, you know, I'm older - I'm in my late 50s - and I wouldn't do it.
I'veI'm not ready to give up.
Are you in a position to, sort of, put your foot down and say, "We want to try more things"? Yeah, but according to what they told me, they've gone over and beyond what they would have done.
So Two days after the bad news about his cell count, Javier and Adriana held a small gathering of friends and family at the hospital.
So today Javier and Adriana proclaim their love to the world, and everyone here, we rejoice with and for them.
Javier Alonso Galvan, do you choose Adriana Guadalope Rodriguez to be your lawfully wedded wife and your beloved one? And if so, please say, "I do.
" I do.
"Adriana, I give you my hand and my heart.
" Adriana, I give you my hand and my heart.
"As I join my life to yours.
" As I join my life to yours.
"With this ring" With this ring ".
.
I thee wed.
" .
.
I thee wed.
"Javier, I give you my hand and my heart.
" Javier, I give you my hand and my heart.
"As I join my life to yours.
" As I join my life to yours.
"With this ring "With this ring" With this ring ".
.
I thee wed.
" .
.
I thee wed.
"And with all that I am" And with all that I am ".
.
I cherish you.
" .
.
I cherish you.
"And love you.
" And I love you.
It is really a great honour and privilege to pronounce you .
.
husband and wife.
Thank you.
Thank you.
OTHERS CHEER Mr and Mrs Javier and Adriana Galvan.
CHEERING AND APPLAUSE Two days after the ceremony, Javier started a new round of chemo.
He died the following day.
His end was probably hastened by his treatment, but he had also died fighting.
Though I'd been just a small part of Javier's last days on Earth, I couldn't help grieving his loss.
I realised that for young people who have hopes and dreams, to ask them not to take everything on offer to keep going is almost impossible.
Two months after I first arrived at the hospital, I had an extraordinary call.
In a turn of events the doctors were having trouble explaining, Langston's family had got their miracle.
Hi, Langston, I'm Heather.
Do you remember me? Langston? Who's this? Who's that? My sister! Oh, my God.
Oh, my God! Can you tell me who's that? Who's that, Langston? My sister.
Oh, your sister.
Oh, I'm so happy you're OK.
I really am so happy.
Yay! OK, I won't cry.
Oh, wow! Who's that? Who's that? His name is Louis.
We're from the BBC from Britain.
We've been filming you while you've been ill.
This is amazing.
Watch.
I love you, Langston.
I love you, Langston.
I love you, too.
See? "I love you too.
" You don't seem that surprised.
I already told you what was going to happen.
I'm grateful and I'm thankful to God.
I knew he was going to be OK and I know he's going to get better.
Do you believe this was a miracle? Yes.
He said yes, too.
So, that was, um, unexpected Yeah.
.
.
would you say? Yeah, that was really unexpected, so I just called one of the neurologists too, er, that I was working with in the ICU and he said, "You know, it's like a one in a million.
" To recap, what had originally been said - and this is some while ago, a couple of weeks ago now - was that the best-case scenario was a vegetative state.
Yes.
With minimal high brain function, so they said that he would basically not follow instructions, not really be a person.
Right.
Exactly.
And that was the best-case scenario.
That was the best-case scenario.
Based on the scans.
Based on the scans, and what I was told by the neurologist and my experience with this, so usually if people don't wake up right away, like in a week or so, then they don't wake up, so But looking back on it, does that mean you and your colleagues made a mistake in this instance, or were you right to manage expectations and base your assessment on the likeliest outcome? I guess, you know I think that most people, I think it's appropriate to say, "This is the best-case scenario based on all the evidence that we have, "and based on most patients in this situation," so, er, I think it would It would be inappropriate to give anybody hope when the experts - the neuro-intensivists and neurologists - are saying there's no chance for a meaningful recovery.
As we say, they didn't read the textbook.
He didn't read the textbook - he's supposed to be brain You know, a vegetable, but he's not, he's waking up, so that's a miracle, I guess.
Is it possible he'll make a full recovery? I don't know.
I really don't know, you know, I God, wouldn't that be great? It would make it really hard to have these conversations with other families, but, um But I think that would be amazing, yeah.
Yeah, that would be so exciting.
I was on my way to see Dontay.
After five months and ten days in the hospital, he'd taken the step of accepting that the Cedars-Sinai doctors could do nothing further for him.
How are you feeling? I feel good.
I put on my This is the jacket and hat I said I was going to wear when I leave out of here - it's what I came here in.
So whatever experience can You know, I can embody and, you know, be involved in it and on to the new legacy.
How is your outlook? As far as? General outlook - are you feeling positive? Um, I've always been optimistic UmI'm definitely I think this is a better move for me because now I can look for other measures of medications.
I have, you know, too much life to live.
I think I can really either beat this or extend the time, at least.
Hi, Dr Gould.
Hi, Dontay, how are you? Good.
Yeah? Mm-hm.
Are you comfortable? Yes.
Good.
Any pain? No, not so far.
No? OK.
No pain.
Once you get home, the hospice team is going to be there to help take care of you.
And like we talked about before, I won't be seeing you at home, but I'll be talking with the hospice team and helping to take care of you with them.
It's been a pleasure working with you for 100 and how many days? Lord have mercy! Well, putting it all together, it's probably been around nine months - maybe a little longer than that.
All right, Doctor, see you soon.
OK.
Thank you.
Bye, Dontay.
Bye.
Dontay's been on a journey of acceptance to do with him not really wanting to face what's going on, to some extent.
Do you know where he is on that journey now? He's still on that journey towards acceptance.
He's not quite there yet.
Today, he was able to talk with me about hospice a little bit.
It's been difficult for him to look at going home, that he's going home on a hospice.
He's been looking at it a lot as, "Well, he's going home, he's leaving the hospital," but not really what that means - that it's about taking care of him as he's going through the dying process and accepting that he is dying.
And, er, even now he's still, you know, praying and hoping for a miracle.
Has there ever been a time when you've felt if he had not been so, um, keen on beating the cancer that he would have not put himself through so much suffering? I His strong willpower of wanting to live and needing to live and being willing to go through painful procedures and interventions that he knew would make him feel worse in the short term, that he knew would bring on more pain in the short term, for the chance of doing better, for the chance of being better afterwards, um Because of that, yes, he did go through more pain and more suffering but, you know, there's not a right or wrong way to do that and it's a very individual decision on whether somebody .
.
is willing to go through that.
And for Dontay, it was worth it.
Right, Mr Rogers.
Before we go, if I can just get a quick signature.
It's just for consent for us to take you back to your aunt's, right? Yes.
All right.
Here you go.
Just get your signature here.
Six weeks after he was discharged, Dontay died at his Aunt Bonnie's house, surrounded by friends and family.
Oh, my God! Hi, Langston! APPLAUSE Hi! Seven weeks after he woke up, after intensive rehabilitation at another facility, Langston paid a visit to the ICU.
Oh, my gosh! How you doing? I'm Louis.
Nice to meet you properly.
Wow! How are you feeling? I'm good.
You're good? Yeah.
These people - everybody is just so excited that you're here.
We're just You're a miracle - you know that, right? Yeah.
Yeah.
What's the first thing you remember? Er, nothing, really.
You don't remember? Just waking up.
Where do you remember waking up? At the other hospital.
At the other hospital? So you don't remember Cos when woke up here it was right before you were about to go, and that was amazing just to see that, yeah, yeah.
Congratulations.
Thank you.
Wow! Do you want to see the room where you were? Yeah.
Yeah, come on down.
There's nobody in there, right? These are all the people that took care of you.