In the following UNFILTERED blog post, filmmaker Patrick O’Connor reflects on his experience wrestling with creative choices and finding peace with the decisions he made on The Invisible Patients.

Perhaps more than anything, what kept me up at night while we were editing The Invisible Patients was imagining how our subjects – the four homebound patients (and a patient’s mother) who allowed us to capture some of the most intimate and difficult moments of their lives, as well as the nurse practitioner who cared for them – would respond to the film.

I visited each patient twice before we ever brought a camera into their homes – once to meet them and gauge their interest in participating in the film. And a second time to fill out paperwork and to set some expectations around the process:  how often we’d be there, what, if anything, was off-limits, and the role they’d play in the final edit of the film.

On that last point, I took my cues from Steve James, who has said that he usually tells his subjects that they’ll have an opportunity to watch the film before it’s released, and if they have issues with how they’re portrayed, he’d listen to their concerns, and, if he’s unable to change their minds, he’ll edit to allay their worries.  Aside from being the obvious right and ethical thing to do, I felt this approach would help lower their guard knowing they had a say in how their lives would be portrayed.

We shot the film over 10 months, and during that time, my sense of responsibility grew – I had grown to love and admire these people, and I wanted that love and admiration to be evident not just to audiences, but to them.

The edit took almost 10 months, a process that involves thousands of decisions about what story threads to follow, what small moments to keep or cut, how to get to the heart of a scene – all decisions that shape how an audience will receive the subjects.  When we had a cut that felt close to the finished film, I arranged to meet with each patient.  I sat with them at their kitchen tables, and, side by side, we watched the film on my laptop.

It was most difficult to watch the film with Shirley Roxbury, whose son, Roger, a young man rendered immobile by Duchenne Muscular Dystrophy, struggles with rapidly failing health and coming to terms with his own death.  The scenes where he finally says that he doesn’t want to be resuscitated, that he doesn’t need any more suffering, and tells his mother not to worry, that he’ll be ok, that he’s “going to a magical place” are raw and beautiful, and to this day I still can’t believe that I was permitted to be there in these moments.  When the film was over, we cried and hugged hard and, even though watching the film made her relive an incredibly painful experience of watching her son die, she said she really liked it  – The Invisible Patients would help her remember Roger’s courage and bravery as he faced death with incredible grace.

Nurse Practitioner Jessica Macleod leans in close to hear her patient Roger Brown. Photo credit: Patrick O’Connor.

For Ron, a 63-year old wheelchair-bound man with functional limitations caused by a motorcycle accident, his difficult relationship with his menacing older brother, Louis, drives the narrative and, in some ways, provides a kind of comic relief as Louis lies on a pallet on the floor and makes a case for not feeding his brother.  But Louis had a heart attack and died while we were editing, and I was unsure how Ron would respond to seeing his brother in this less-than-flattering role.  When I asked Ron how he felt about seeing Louis in the film, he smiled and shrugged as if to say, “that’s Louis.”

Director Patrick O’Connor helps homebound patient Ron Riordan with his lunch in his home in Evansville, Indiana. Photo credit: Ben Woehler.

For Wink and Patricia, an elderly married couple who were dropped by their physician for failing a drug screen, I was most concerned with how they would respond to being characterized as possible abusers of prescription narcotics.  Over the course of the film, it becomes pretty clear that they’re not abusing their pain meds, but still, the question is raised the first time we meet them, and the audience watches with that question in mind – are they bad people?  But when the film was over, and I asked them what they thought, they only responded to the other stories. Wink shook his head and said, “Oh, that poor young man, Roger – what his mother must have gone through.”  Patty asked if Ron and his brother were doing ok.

Nurse Practitioner Jessica Macleod reviews her patients Wink and Patty Sherrill’s prescriptions. Photo credit: Jordan Barclay.

Jessica MacLeod, the heroic nurse practitioner who led me to this story and who cares for these folks in the film, told me she found it very difficult to watch herself on-screen – mostly because she found herself second-guessing some of the medical decisions she made during the film. She was uncomfortable with some of her interactions with Roger – did she come on too strong in their conversations about hospice or in trying to convince him that resuscitation was the wrong decision? And she worries that perhaps she should have given more consideration to decreasing Patricia’s pain medication.  But she told me that she’s immensely proud of the film and humbled that it recognizes and will, perhaps, be an encouragement to, the thousands of nurse practitioners, nurses, therapists, social workers, aides, chaplains and unpaid caregivers who look after the invisible homebound every day.

I’ve watched The Invisible Patients dozens of times with audiences at film festivals, universities and health care conferences around the country, and I notice something different every time, and like Jessica, I second-guess decisions made in the editing room. Still, I too am proud of the film, mostly because it honors the daily struggles of ordinary people like Roger, Shirley, Wink and Patricia, Ron and Louis – people who are our neighbors, though we don’t often know they’re there.

Patrick O’Connor is a writer, producer and director who primarily works in marketing for healthcare systems, as well as numerous non-profit organizations, through his company o’connor/creative. His feature film writing credits include Ricochet River, produced by Gigi Pritzker and starring Kate Hudson, and the independent feature Sacred Hearts, which he also directed.  Sacred Hearts premiered at the Boston Film Festival and subsequently played at the Fort Lauderdale Film Festival (awarded Best First Feature) and the Lincoln Center in New York. His screenplay, ZOO, was purchased by Steven Spielberg’s Amblin Entertainment. Pat is married to the author Margaret McMullan and they have son, James.

The Invisible Patients, Pat’s debut documentary, premieres on America ReFramed, Tuesday, March 20, 2018 @ 8/7c on WORLD Channel. Streaming will begin the day after the broadcast on and all station-branded PBS platforms including, and on PBS apps for iOS, Android, Roku, Apple TV, Amazon Fire TV and Chromecast.

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AMERICA REFRAMED is a co-production of the WORLD Channel and American Documentary, Inc. AMERICA REFRAMED curates a diverse selection of films highlighting innovative and artistic approaches to storytelling from emerging and veteran filmmakers alike. Viewers will be immersed in personal stories from the streets of towns big and small to the exurbs and country roads that span the spectrum of American life. The documentaries invite audiences to reflect on topics as varied as culture, health care, politics, gun violence, religion and more. An award-winning documentary series, AMERICA REFRAMED is the recipient of an Alfred I. duPont-Columbia University Award for broadcast journalism and a George Foster Peabody Award. The series has earned several Christopher, GRACIE, Telly and Cine Golden Eagle Awards, as well as nominations for an EMMY, Independent Documentary Association, and Imagen Award.