“I’m going to call 911: a doctor is torturing a patient.”
So said Nurse Pat Murphy to Dr Jessica Zitter – just as Zitter was about to plunge a syringe into the neck of a patient with a host of health issues.
Tho the 911 call wasn’t made, it was a turning point for Zitter – who trained as a critical care doctor, and for whom going gently into that good night felt like she was abandoning a patient, a failure. That encounter with Nurse Murphy led her to completely change her own medical ‘mandate’ – becoming a Palliative doctor – the specialty that embodies the philosophy of ‘patient-centered’ medicine.
I first ‘met’ Dr Zitter in a New York Times essay in which she admits on her first night on call as a Palliative doctor she hadn’t yet completely relinquished her ‘critical care save the life at all costs’ ‘tude.
A healthcare team in conflict
The patient – a Holocaust survivor – was sleeping peacefully. She’d been admitted with pneumonia, but it hadn’t responded to treatment. As she got sicker and her breathing harder, she was made comfortable. The doctor attending the patient told the team gathered that she had clearly said she didn’t want a breathing tube, but the respiratory therapist wasn’t comfortable not intubating: “I’m not really sure she ‘got it’ she was pretty out of it.” Zitter was also unsure. The compromise was to strap on an oxygen mask overnight and re-assess in the morning. The morning found the patient ‘delirious and terrified, her mask off center and totally ineffective.”
Confirmation of commitment to Palliative Care
Zitter was no longer in doubt:
“I would be a palliative care doctor. I would not increase her suffering again. I had the expertise to keep her comfortable and know I would use it without hesitation.”
Luckily for non New York Times readers this essay is in Extreme Measures, the highly readable book Dr Jessica Zitterr managed to fit in between advocating for patients peaceful death, participating in the Oscar-nominated short, Extremis, and caring for three children.
The book is a treasure trove of ‘case studies’ to help put into perspective the complexities of emotions of end of life and life-prolonging decisions, along with the simplicity and peace that can come with ‘letting go’. In story after story, we meet patients, their families and the complex patchworks of healthcare professionals who step in and step out.
Zitter also explains – in layman’s terms – life-prolonging procedures and interventions and repercussions of same. The context of patient stories is a gift. But Dr. Zitter doesn’t stop there. She takes pains to ensure an understanding of ‘what then?’ – after the breathing machine, after the feeding tube: those decision points are equally emotional and stressful.
It’s neither pretty nor dignified and often painful and futile. And that’s exactly the message she knows we – and our ‘decision makers’ – need to understand.
Giving further context, Extreme Measures also offers fascinating history of the evolution of the ICU – the Intensive Care Unit – giving background to today’s push to stay alive. It’s not just physicians who interpret ‘do no harm’ as ‘don’t let the patient die’. It’s patients and their families, too: when explaining a doctor’s conundrum in face of patient and family expectations. Readers would be wise to take heed:
“Most physicians feel they are powerless to withhold these treatments if the patient or family insists on their use. They are not only viewed as rights but have also become the de facto rites expected before death.”
Hopefully, as ‘palliative’ becomes more understood for its holistic and humanizing approach to medicine, doctors, patients and families will reframe their perception of what’ keeping alive at all costs’ to ‘living the best right up to the end.’
Jessica Nutik Zitter was born to be a doctor – that much is clear right from the start of Extreme Measures. That she’s become an advocate for an end–of-life that is not unduly and painfully prolonged by modern medicine is a tribute to her heart and soul.