You've Only Got One Death to Live

Serene Meshel-Dillman tackles life’s hardest topic: Death (Outfeetfirst.com).

“I’m trying to die correctly,” said the writer Lawrence Durrell, “but it’s very difficult, you know.” In a culture that would rather the subject never came up, having a good death is often impossible. Documentarian Serene Meshel-Dillman is trying to change that with her documentary series, Take Me Out Feet First.

The show is a hit on Prime, but don’t expect the usual binge. It’s a frank and moving depiction of dying. Made in partnership with the organization Compassion & Choices, the series follows patients with terminal illnesses who decide to end their lives through Medical Aid in Dying, or MAID.

MAID is not euthanasia, but a practice in which a competent, terminally sick adult requests a lethal prescription from a physician, which they may use to end their life (many such patients never take the drugs). It’s legal in the District of Columbia and 10 states (California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington), but remains the subject of intense ethical debate.

For Meshel-Dillman, whose previous work includes Getting to The Nutcracker and The 5th Dementia, the subject is personal: Her parents Miriam and Robert Meshel both chose MAID. That experience led the documentarian and her husband, filmmaker Ray Dillman, to travel the country, interviewing 25 individuals who took similar steps. “There is a lot of misinformation about the subject,” says Meshel-Dillman. “Hopefully, the series and the people in the episodes are helping to educate in that regard. This series is part of their legacies—their last wish for everyone to see.”

Meshel-Dillman hopes the series will nudge more states into legalizing MAID. But if the political process is fraught, the show sheds light on a critical aspect of life that’s mostly kept hidden. In the Wag Interview, she discusses how important it is to bring dying into the light. “Having the opportunity to be present when your loved one is dying is a gift,” she says. “There is warmth, understanding, love, and quite a bit of joking around. I hope I can leave this earth that way. Yes, there is sadness. The person you love will no longer be here. But knowing they’ve had the choice to avoid pain and suffering and being witness to that is pretty f—ing special.”

CultureWag: Your mother and father come across as incredibly brave and thoughtful. How did their experiences influence your decision to make this film? 

Serene Meshel-Dillman: My mother and father opted to use medical aid in dying five years apart. The idea to do the series was both my father’s and mine. My mother and I were not close for most of my life. My dad was always running interference and desperately tried on numerous occasions to broker the peace. I believe my mother put a lot of her sadness about our relationship on him and he had to live with her so he was always trying to make it better.

After she passed, he asked me to follow through on the idea I’d had while filming her the night before she took the medicine to pass away using MAID. My mother and I had spent about five hours together talking late into the night. We ended up in a really nice place of understanding, acceptance, and love. I filmed most of what we discussed— when my camera did not turn itself off from overheating. I put the footage away and didn’t think about what I’d do with it for a couple of years.

My dad ultimately asked me to make the film as a tribute to her. He thought I’d see more in my mother to love by going back through our lives. Through an odd series of coincidences, I ended up working with Compassion & Choices which is an organization that supports MAID legislation nationwide.

My husband, Ray, was the cinematographer and editor. We ended up traveling to various states for about two years interviewing terminally ill people who were advocates for MAID through C &C. They wanted to share their stories about why they were opting to use MAID or why they were angry that they didn’t have the choice.

About five years after my mom passed, my father also opted to use MAID when he was diagnosed with terminal cancer. I filmed his journey as well. To his immense credit, he was generous enough to allow me to cover every minute of the end of his life. This was much, much harder for me. Throughout my life, my dad was my person. He was completely on board with everything I did to tell his story. My mother and father’s story became the pilot episode in Season One of Take Me Out Feet First.

CW: The public has a poor understanding of end-of-life issues. Are you seeing a shift in attitudes as people see the series? 

SMD: Compassion & Choices have a lot of data they compile about medical aid in dying every year, from states where it’s legal as well as from states where they help try to get legislation for MAID passed. Some of the statistics are startling. For example, in states where it is legal, only one percent of people who die use MAID. When a patient requests the medicine for MAID, one-third do not use the medication. The relief they get from knowing they have an out is enough. A lot of times, the patient lives longer because of the peace they feel from having the medication just in case they decide to use it.

I get emails, DM’s, and texts almost every day from people who have watched the series thanking me for shedding light on the subject. Most people have no idea what MAID is, what the guardrails are that prevent any kind of abuse of the process, and where it is available. I have friends in California who still have no idea it is legal here. Even in states where MAID is legal, some doctors of terminally ill patients do not advise about the choice for MAID. There is a lot of misinformation about the subject.

I had a friend watch an early screening of the “Mimi” episode [the third episode of the series] and her comment stuck with me. She said: “Mimi spent her last two days of life with us. We better sit up and listen.” I thought that was such an insightful takeaway. I believe the process of changing minds will be slow but steady.

Ray wanted me to share the story of his Aunt Jayne. She lives in Georgia. She had a long career as a nurse, is a staunch Republican, and was against the concept of medical aid in dying. Jayne knew both of my parents. She called me after watching the first episode and said, “You’ve changed my mind.”

So yeah, I think it’s possible.

CW: The stars of your series are engaging and wise. They're also dying. You and your husband witnessed their last days. As a filmmaker, how did it feel to share that kind of intimacy with your subjects? How did it feel to say goodbye, over and over again?

Miriam Meshel was a social worker for terminally ill cancer patients before her diagnosis of spindle cell sarcoma, a rare form of incurable cancer (Outfeetfirst.com).

SMD: It’s heartbreaking but also joyful. I’m giving [my subjects] something only I can give them. A voice that will be heard after they’re gone. Take Me Out Feet First became the #1 TV Documentary Series on Amazon Prime for the first five months of streaming with over a million views. Obviously, people are interested in this subject. I became close not only with each person but with their friends and families. That’s where the joy comes in. I keep in touch with so many just from having spent short pieces of time together. It never felt like saying goodbye over and over. It felt like I’d made new friends and by editing their words after they’d passed, always made it feel like they were still here.

CW: Take Me Out First really is a kind of love letter to your feisty, funny parents. Does watching them onscreen help you process your grief?

SMD: Everyone grieves differently. I didn’t have any expectations about what my grief would look like having never experienced much death in my lifetime. I have to say that my relationship with my parents did not change after they passed. I still do not feel close to my mother, although I do have a better understanding of her and why she was the way she was with me. I still cry when I think or talk about my dad. I hope that I was able to convey what a wonderful man he was. So yes, I guess in a way the episode is my way of thanking him and saying I love him….still.

CW: Within your own family, your mom was the catalyst for having an end-of-life plan. Your father found letting go of her very hard. I'm wondering how seeing that sparked discussions within your own family.

SMD: Ray and I are on the same page when it comes to medical aid in dying for ourselves. It’s a no-brainer. We have not had “the conversation” with our kids but I’m guessing they know since they’ve participated in and seen the episode with their grandparents. Death is a hard conversation to have for sure. Some kids don’t want to even broach the subject. Some sit quietly and listen. Some are upset and some take it in and file it away for later. Nobody wants to think of a world without their loved ones in it. I guess forcing the issue is probably not the way to go but gently bringing it up until they are ready to hear it is likely the best avenue to having your wishes heard. I’d also add that talking about money is also a good idea. So many families are broken up by fighting over money, mine included. I’m not sure how to avoid this but maybe being very clear while you’re alive is one way.

CW: If there's a theme throughout the series, it's that the end of life can be dignified and filled with warmth and kindness. But it is still an enormous loss. There must have been times when you felt like you were intruding on deeply private moments, and with your own family, moments when you were overcome by sadness. As a documentarian, how do balance the urge to capture an indelible moment, and the urge simply to be present for say, your dad? 

SMD: It’s an interesting question, about being present as a filmmaker versus being the daughter. One of the traits I inherited from my dad was his honesty and straightforward approach to people. He was a successful New York lawyer in large part because of this aspect of his personality. He also inserted humor wherever he could. I did not separate my two roles while working on this series. I was able to ask the questions that interested me. If they were hard questions, I didn’t shy away because my time was so limited with whomever I was interviewing. By forcing some tough conversations, it brought people closer at a time when that was needed.

[When] I interviewed Sue in Rochester, New York. (Season 2) She had a six-month terminal diagnosis and I filmed her with her husband and two adult sons at her home. One of her sons came up to me in tears after we were finished and thanked me for asking the questions that forced the emotional answers that he needed to hear from his mom. He hugged her for a long time as they both cried. It’s a lot to take but also so nice to be able to elucidate that kind of result. I found that I’m able to cry and still ask questions.

With my parents at the end of their lives, I just had cameras rolling. There was no interview happening. The lens was forgotten. Later, I wasn’t able to watch what we had filmed for a long time. Ray was the editor and would call me in to watch a cut. That was hard. I mostly would break down and have to leave. It wasn’t like that with the other episodes.

CW: Was there something universal about the end of life that your work revealed to you? Were there misconceptions you had about death and dying that were revealed? 

SMD: Yes, there is a universal truth at the end of life that was something I think I knew, but wasn’t sure about. Now I am sure. Money, houses, toys, things, boats, cars, jewelry, clothing—none of it matters at the end of your life. The only thing that matters is the love of those surrounding you, loving you, holding your hand, and helping you transition from life to death.

CW: There's a natural aversion some viewers have about watching something like this. How do you persuade people it's important to see these stories? 

SMD: I do not try to persuade anyone to watch this series. I think there is a natural curiosity to watch someone experience death. When you see the raw emotion and physical deterioration of a person who has chosen to end their life using medical aid in dying, the desire to die with dignity, to avoid further pain and suffering [and be] in the arms of the people they love [is] enough.

CW: What would you like to see happen in terms of the politics of MAID?

SMD: I would like to see everyone who wants the choice to have it. MAID is humane. We just put our 17-year-old dog, Daniella, down last week. She was begging me with her eyes to help her. Her back legs were giving out. She’d stopped eating. She was pooping and peeing on herself. I held her in my arms as the vet administered the medicine. She was at peace. I was incredibly sad but I know it’s what she wanted. We do this for our animals because it is dignified and humane.

MAID is a choice for adults with a six-month terminal diagnosis. You must have two doctors agree on your diagnosis and you must be of sound mind. You must be able to take the medicine on your own. There is zero way to abuse the law. It is not a slippery slope. It can’t be. Every person I’ve interviewed desperately wants to live. When they decide to opt for MAID it is because they have no interest in being hooked up to tubes in a hospital bed, or on drugs that knock them out, or on medicine that weakens them to the point that they have no dignity left. Medical aid in dying affords people the path to avoid pain and suffering and allows people to choose when and how they will pass. This should be everyone’s right no matter where they live.

CW: You spent two years exploring what it means to die. How has it informed how you go on living? 

SMD: Jeez, your questions, man! I keep having to stop and get a tissue. I spent over two years exploring what it means to live, not to die. Living means you spend your time awake doing whatever you do with your friends and family. For me, that means time with my kids, husband, friends, eating, sleeping (and other stuff in bed), dancing, walking, cooking, swimming, tennis, skiing, crosswords, my book club, traveling, documenting, shooting pictures, and laughing. I love to laugh.

CultureWag is the brainchild of JD Heyman, former top editor at People and Editor-in-Chief of Entertainment Weekly (among other gigs), and staffed by the Avengers of Talent. Our goal is to cover interesting topics with wit and integrity. We serve smart, funny recommendations to the most hooked-in audience in the galaxy. Questions? Drop us a line at intern@culturewag.com.

If somebody forwarded you this issue, consider it a coveted invitation and RSVP “Subscribe.” You’ll be part of the smartest set in Hollywood, Gstaad, Biarritz, and Brookyn’s very own Gage & Tollner, still the best spot for Oysters Rockefeller.

Gage and Tollner, a Brooklyn institution since 1879 (Photo: G&T)

Wagging, to me, has always been the essence of good taste.― Cary Grant