Jessica Zitter knew she was going to be a doctor from the time she was a little girl. It was a tradition in her family; her father, grandfather, uncle and later in life after a career change her mother, were all doctors.
Saving lives was in her blood. She even helped save her maternal grandmother’s life when she was suffering from post-surgery septic shock. Though she changed course a couple of times – from wanting to be a surgeon to working internal medicine – ultimately Zitter decided on pulmonary and critical care, what she called the “most heroic and invasive of the medical subspecialities.”
Over the years, Zitter has worked in at least twenty hospitals. Along the way, she came to realize that in this culture we tend to put people on what she calls the “end-of-life-conveyor-belt.”
Having worked in at least twenty hospitals over the years, Zitter shares some of her most memorable stories. While working at University Hospital in Newark, she was showing a student how to insert a catheter into a neck vein of a woman in the intensive care unit (ICU) who was clearly dying. Then, she noticed the head of the Family Support Team in the ICU standing in the doorway.
“Pat lifted an imaginary phone to her ear. ‘Nine-one-one, get me the police,’ she said glaring at me. ‘They’re torturing a patient in the ICU at University Hospital,'” Zitter wrote. She was horrified as she realized that Pat was right. The procedure would not help the patient and would cause more pain, but it was still the correct procedure. Zitter went through with inserting the catheter.
Throughout the book, Zitter presents some of the conflicts that arise between different medical professionals in order to explore important ethical questions about what the “right” thing to do is in any given circumstance. For instance, some disciplines take the philosophy of doing “whatever it takes” to keep a person alive, while others emphasize the minimization of pain that may reduce the quality of what life is left.
Of course, conflicts are not limited to practitioners. Some family members may hold on to hope for a miracle, and will want every option executed no matter how dim the hope or how painful the procedures. Conflicts that arise in both the disagreements between medical staff and among family members highlight some potential answers to the question of when enough really is enough.
Zitter advocates that physicians be as honest and open as possible with patients and families so that they can make informed choices and avoid unnecessary suffering. Her checklist – which is spelled out in the the acronym PADDLES – was designed to help medical staff remember steps of care in the intensive care unit.
Zitter is a strong advocate that all individuals should take control of their lives by letting loved ones know preferences for care ahead of time. She provides a wealth of resources for lay readers, caregivers and medical staff to help with the process and the difficult conversations. The process is difficult and is an ongoing process over the course of life as situations change with age. Zitter suggests that individuals revisit choices as often as needed, and continue to revise appropriately.
Toward the end of the book, Zitter shares a story of having attended a conference at which she was asked to picture her own death. Despite dealing with death every day, she had never pictured her own. As it turns out, picturing out own death is painful. Perhaps this is why we don’t take the steps we need to let those close to us know what steps we would want taken if we are unable to decide for ourselves when the time comes.
Extreme Measures: Finding a Better Path to the End of Life
Jessica Nutnik Zitter, MD
Hardcover, 352 Pages