Extreme Measures by Jessica Nutik Zitter M.D.

Extreme Measures by Jessica Nutik Zitter M.D.

Published by Penguin/Avery Publishing (February 21, 2017)
352 pages
Kindle Edition
Advance reading copy provided by the publisher
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This book is about how our collective tendency to ignore death, doctor and patient alike, fuels a tremendous amount of suffering. And about how we can move forward from this place. I hope that by being as honest as possible about my own shortcomings as well as my changes in thinking along the way, readers will see that we are in the midst of a paradigm shift. None of us has yet ‘arrived.’ One of my palliative care colleagues said to me recently, ‘The only reform that comes is from confession.’

Recently, I published a post that included some reflections on my work; I am a board-certified clinical chaplain in a hospital. During my training, and continuing through my first paid assignment, I primarily worked with oncology patients and the hospital's palliative care consult service/team; it was during this time that I discovered a passion for uncovering and acknowledging the choices patients make regarding their care, and the response to those choices by medical staff and family members.

No matter your age or health condition, talking about death is hard; there never seems to be a "good time" to bring up the topic, as it merely serves to remind each of us of our own mortality. Yet it is, quite possibly, one of the most important, significant conversations you will ever have and I encourage (okay, I've been known to nag) everyone to seek out resources and guidance in an effort to GET IT DONE. 

This directive, ‘I want you to do everything, Doc,’ often ends the conversation between doctors and desperate ICU patients. We’ve got a lot of ‘everything’ to offer, and the patient’s words are considered gold. [...] When patients push for ‘doing everything’ in the face of no significant medical benefit, we must give them more time, more opportunities to process their shock and emotional distress about death.

Thanks to my experience in this setting I can tell you, with confidence, that there are many things human beings endure during an illness, a hospitalization, that are far worse than death. As an advocate of appropriate palliative care and end-of-life decision-making discussions, my goal is never to diminish the feelings, the emotional toll, of families; instead, I attempt to help them work through their feelings and begin to recognize what is truly best for their loved one. 

Bone grinds against bone under my palms. One more strong push and I worry I will crush him. I envision my hands breaking into his chest cavity, swamped in blood and tissue. I hold my body rigidly upright to minimize the actual pressure on the patient’s chest, while trying to ensure that my compressions still look aggressive. I concentrate on breathing only through my mouth as nausea creeps from my stomach into the back of my throat. I begin to feel dizzy.

Dr. Zitter has provided an amazing resource for readers both within and outside the healthcare field; by sharing her own experiences, the stories that she has gathered, she illuminates some of the most difficult situations and the impact on all of the parties involved. This book is not filled with medical jargon, biased commentary, or sad reflections; it is an insightful look into the unknown world of emergency and intensive medicine and the way in which the capabilities, as they have expanded, have increased the need for better communication. 

In order to rebuild this broken system, we must begin by facing our fear of personal extinction, and the resultant drive to find something, anything, to save us from our own deaths.

Those of you who have personal experience with these situations, via family members and loved ones, will relate, but I believe that there are connections to be found by all of us; I highly recommend this book and hope it will encourage you to work toward a conversation about what you would want if/when you are no longer able to express your wishes. 

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