Extreme measures : finding a better path to the end of life

Extreme measures Finding a better path to the end of life

Jessica Nutik Zitter

Book - 2017

"An ICU and Palliative Care specialist featured in the Netflix documentary Extremis offers a framework for a better way to exit life that will change our medical culture at the deepest level. In medical school, no one teaches you how to let a patient die. Jessica Zitter became a doctor because she wanted to be a hero. She elected to specialize in critical care--to become an ICU physician--and imagined herself swooping in to rescue patients from the brink of death. But then during her first code she found herself cracking the ribs of a patient so old and frail it was unimaginable he would ever come back to life. She began to question her choice. Extreme Measures charts Zitter's journey from wanting to be one kind of hero to becomin...g another--a doctor who prioritizes the patient's values and preferences in an environment where the default choice is the extreme use of technology. In our current medical culture, the old and the ill are put on what she terms the End-of-Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused, and often in pain. In her work Zitter has learned what patients fear more than death itself : the prospect of dying badly. She builds bridges between patients and caregivers, formulates plans to allay patients' pain and anxiety, and enlists the support of loved ones so that life can end well, even beautifully. Filled with rich patient stories that make a compelling medical narrative, Extreme Measures enlarges the national conversation as it thoughtfully and compassionately examines an experience that defines being human."--

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Subjects
Terminal care.
Terminally ill > Care.
Published
New York : Avery, an imprint of Penguin Random House [2017]
Language
English
Main Author
Jessica Nutik Zitter (-)
Physical Description
xiv, 338 pages : illustrations ; 24 cm
Bibliography
Includes bibliographical references (pages 312-324) and index.
ISBN
9781101982556
  • Prefatory Note
  • Chapter 1. Alone in the Trenches
  • Chapter 2. The End-of-Life Conveyor Belt
  • Chapter 3. Abandoned in a Sea of Options
  • Chapter 4. The Illusion Collusion
  • Chapter 5. Where We Come From
  • Chapter 6. Who We Are
  • Chapter 7. The Personal Toll
  • Chapter 8. Sharing the Journey
  • Epilogue
  • Appendix 1. A Way Forward
  • Appendix 2. Avoiding Unnecessary Suffering
  • Resources
  • Notes
  • Acknowledgments
  • Index
Review by Kirkus Book Review

End-stage patient suffering and distress inspire an early-career watershed moment for a sympathetic physician. Zitter's impassioned advocacy for increased palliative awareness in modern medical establishments is both immediate and heartfelt. She notes that both doctors and patients have a tendency to ignore death, and this often "fuels a tremendous amount of suffering." Her own enlightenment began during her medical internship, when she harbored serious second thoughts about her career choice (her father was a neurosurgeon) after being "dumbstruck by this Armageddon" of critically ill patients throughout her first years in trauma medicine. "I have rehearsed for the wrong performance," she thought during a crisis of conscience. After much soul-searching, Zitter moved in a new professional direction, focusing on compassionate palliative care rather than treating pain as an "on-off switch." The often wrenching, emotionally resonant patient cases she shares illuminate an urgent need for medical communities to more uniformly embrace standards of care that include palliative approaches to terminal patients. Empathy and patient dignity have a tendency to evaporate amid a hard-core push to medically prolong life without humane consideration for a patient's eroded quality of life. Zitter describes the origins of palliative care as well as her somewhat steep learning curve adjusting to a holistic care approach. She also addresses issues of physician burnout, the delicate politics of do-not-resuscitate orders, and the challenging time sensitivity of communicating terminal prognoses. Her affecting narrative is also educative, as the author aims to create a paradigm shift in terminal patient treatment and steer medical trends and attitudes about death and dying toward a more sympathetic perspective and one that will eventually consider it "unacceptable to practice without considering the patient's needs above all else." A list of useful resources and Zitter's six-step approach to one's own final health care choices serve as fitting codas. Clarity and compassion unite in this touching and convincing new conversation on comfortable, patient-centered end-of-life care. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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