Behind The Scenes - Obesity The Post Mortem
Filming a post-mortem for TV took us on a long and emotional journey, but the result is an eyeopening documentary, says Melanie Archer
First published on 8th September 2016 on Broadcast.
Production companies 7 Wonder; Third Street Studios
Commissioner Gian Quaglieni
TX BBC3, 13 September 2016
Length 1 x 60 minutes
Director/series producer Melanie Archer
Producer/camera Satiyesh Manoharajah
Executive producers Steve Condie (7 Wonder); Stephen Nolan (Third Street)
Editor Chris Weyman-Jones
Summary A post-mortem of an obese woman to explore the impact of obesity on our organs.
Sometimes a commission takes a long time to become a reality.
We’d set ourselves a huge challenge to deliver a UK-first: it is certainly not a simple task to televise a post mortem. But our executive producer Steve Condie championed it from the outset and throughout, and the team at 7 Wonder patiently put the pieces in place that would finally enable it to happen.
There was always a lot of belief in the strength of the idea; obesity is a global health crisis bringing health services to their knees. Three quarters of the UK population is predicted to be overweight or obese in less than 20 years. It’s an issue that affects all of us, but the debate is still often framed by the fat we can see.
We were suggesting a different perspective on obesity; a way of scientifically examining the damage it does on the inside, using a post mortem to look at the effect excess fat has on our internal organs. It seemed to all of us to be a worthwhile and vital thing to try to achieve.
Producer Satiyesh Manoharajah began forging vital relationships with senior medics and governing authorities prepared to trust us with what they believed to be an important and necessary project. After months of prep however, it was becoming clear that the way whole body donation in the UK works would have serious implications for our film. You can’t have a post mortem without a body, and we didn’t have one.
Melanie Archer: My tricks of the trade
Always surround yourself with people better than you. If you can’t afford them, make a film that people believe in, and they might go the extra mile.
Be brave enough to let go of early rough cuts. It’s really painful, but worth it.
Be careful with what you call your film. Some titles might grab headlines, but scare away the people you need to convince that you can be trusted with their story or reputation.
Dr Mike Osborn, our consultant pathologist, then suggested exploring the possibility of using an anonymous donor from the US.
In the UK, body donation only happens through medical schools, and less than 1,000 people per year choose to do so.
You can’t donate if you’re over a certain weight, or height. In the US, there are tens of thousands more body donors annually, of all shapes and sizes, and surgeons all over the world train on human tissue imported from the US.
This led us to the Royal College of Surgeons (RCS), which doesn’t conduct post-mortems, but does train thousands of surgeons in its theatres, using every conceivable body part from US donors.
The RCS put us in touch with a US-regulated body donation organisation that agreed to help us fi nd a suitable donor. We booked the RCS’s state-of-the-art surgical facility for the shoot, and applied for a temporary post-mortem licence from the UK statutory regulator, the Human Tissue Authority.
We had a glimmer of a film – and finally, five months later, we had a donor, from California. After death, her left arm was removed and cremated, and the ashes returned to her family. She was then frozen, shipped to London, thawed and prepared for the post-mortem.
Obesity is a global health crisis, but it’s still so often about appearance; in Mike’s words, it is “very poorly understood – even by most medics”.
We wanted to look at obesity from the inside, to examine its impact on internal organs. But we didn’t know what we would find when we cut open the body.
I was, to put it politely, terrified on the morning of the shoot: 12 hours to create 40 minutes of content, four cameras and a highly skilled pathology team with little or no tele vision experience to direct.
I had one chance to capture every step of the process visually, and to get the team to explain each discovery in lay language in editable chunks, not to mention witnessing a post-mortem and shooting a surgical procedure for the first time.
I’d been encouraged to view the body of the deceased woman the day before and say a quiet ‘thank you’. I was calmer for having done so. Once
I’d put on my scrubs, I felt more capable and clever than I did on the way in. I had tears running down my face as I left – a mixture of a release of adrenaline, relief, exhaustion and the significance of one woman’s final gift.
What kept me awake most in the edit was getting the tone right. The revelations of the post-mortem are the factual spine of the film and the emotional, personal testimony of the contributors is separated from the clinical, surgical content by stings and simple title cards. The material is never intercut. The additional statistical content comes via text on screen.
There are no graphics, and the narration is sparse – it’s really one woman’s story of obesity, told from the inside of her body, after her death.
The most common reaction I’ve had so far is “amazing/really interesting, but I don’t know if I’ll be able to watch”. I hope people do. It was an intense experience making it, and it’s a tough watch in parts. But in the words of one contributor: “It’s important to think about where we could end up. Where you could end up.”
STEPS TO THE SCREEN
Satiyesh Manoharajah Producer/camera
There’s nothing quite like being locked in the dark, inside a freezer full of dead bodies, to make you think about your career choices. But then you hit ‘record’ and witness some of the most extraordinary scenes you’ll ever be privileged to see, and it all makes sense.
Filming our donor’s body being prepared for her journey from LA to London was a milestone in our hugely complex production. The compliance questions around finding a donor, transporting her body and filming a full post-mortem were never going to be straightforward.
To get started, we had to win the unreserved support of the Human Tissue Authority (HTA); some of the most senior medics and medical institutions in the country; the BBC; and the leading US body donation organisation.
We needed to convince them that our unorthodox approach had the potential to reach young audiences who needed to understand exactly what obesity does under the surface.
Knowing that without the HTA’s support, no serious medic or institution would even speak to us, we arranged meetings with the head of regulation within the first days of development – months before commission.
Our production ‘bible’ related every relevant HTA, General Medical Council (GMC) and BBC guideline directly to the production process and ensured we fully understood what the film was going to be, and what it was not. This was especially useful at the other end, convincing both our young UK interviewees and the (understand ably) wary
Americans that we weren’t making a ‘look at those fat Yanks’ shock-doc and would treat both the issue and the donor body with the utmost respect.
The strength of the central idea and the seriousness of intent proved vital for holding everything together.