Extreme Measures: Finding a Better Path to the End of Life

This is the most important and profound book I have read in a long, long time!

I was a parish minister for 13+ years and in that time I sat with countless families at the bedside of their dying loved ones. Most often that vigil took place in a hospital setting, whether the ICU or the hospice suite. Sometimes I was called to the nursing home and, on a few rare occasions, to a home. Dr. Zitter's insight and wisdom on a topic that most Americans spend their lives and energy avoiding at all cost provides us with clear insights and a care-filled journey through the inevitable. For a time I served on the local hospice board and tried to make sure that local and area clergy were kept "in the loop" on end-of-life care options that might provide better spiritual continuity for their members. Dr. Zitter's book should be required reading not only for all entering the medical field and palliative care teams, but for all seminarians, social workers and all who care about making sure that the way we leave this life matches the values with which we lived life. Any and all book clubs willing to breach the subject of death and dying will find a wealth of topics to discuss. I will be spreading the word about this wonderful, helpful book to anyone and everyone who will listen!

My deepest thanks to Dr. Zitter for taking on this important subject and for this sage book!! My thanks to the publisher for providing me the free review copy in exchange for this fair and honest review.

From the Publisher . . .

An ICU and Palliative Care specialist featured in the Oscar-nominated 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 becoming 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.

About the Author . . .

After two decades of caring for critically ill patients, Jessica Nutik Zitter, MD, MPH is a strong advocate for a new approach to caring for the dying. She practices the unusual combination of ICU and palliative care medicine at Highland Hospital, the county hospital in Oakland, California. Having herself participated in the default and indiscriminate use of technology with the dying and witnessed the resultant suffering, Dr. Zitter has come to view this situation as a public health crisis. She is committed to reorienting our care of the dying to a more collaborative process whereby the patient, rather than her organ or disease, is the primary focus of care.

Dr. Zitter’s first book, Extreme Measures, Finding A Better Path to the End of Life, (Avery, an imprint of Penguin-Random House, Spring 2017), offers an insider’s view of intensive care in America and its impact on how we die. Her essays and articles have appeared in the New York Times, The Atlantic, the Huffington Post, the Journal of the American Medical Association, and other publications. In 2005 she co-founded Vital Decisions, a telephone counseling service for patients with life-limiting illnesses.

Her work is featured in the Tribeca award-winning documentary, “Extremis,” which has been shortlisted for an Oscar, and is available on Netflix. This vérité film follows Jessica, her team and several patients and their families in the intensive care unit at Highland Hospital.

Dr. Zitter attended Stanford University and Case Western Reserve University Medical School and earned her Master of Public Health at the University of California, Berkeley. Her medical training includes an Internal Medicine residency at Harvard’s Brigham and Women’s Hospital in Boston and a fellowship in Pulmonary/Critical Care at the University of California, San Francisco.