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

In his New York Times bestseller Being Mortal, Atul Gawande looks at the medicalization of age and asks how we can find a better way to exit life. In Extreme Measures, an ICU and Palliative Care specialist provides the answer, offering a framework 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 after the terrible experience of her first code, in which she found herself cracking the ribs of a patient so ancient and so frail it was unimaginable how he would ever be able to breathe again, she began to question her choice.

Extreme Measures charts her journey from wanting to be one kind of hero to becoming another—a doctor who midwifes death. In our current medical culture, the old and the ill are put on what she calls the End of Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to live out their final days alone, confused, and sometimes in pain. In her work Zitter has learned to understand that what patients fear more than death itself is the prospect of dying alone. She builds bridges between patients and caregivers, formulates plans so that patients never have to experience pain or anxiety, and brings in the support of loved ones so that life can end well, even beautifully.

Filled with the kinds of rich patient stories that make the most compelling medical narratives, Extreme Measures enlarges the national conversation as well as thoughtfully and compassionately examines an experience that defines being human.

Jessica Nutik Zitter, M.D., MPH, is an expert on the medical experience of death and dying. She attended Stanford University and Case Western Reserve Medical School, and completed her residency in internal medicine at the Brigham and Women’s Hospital in Boston. She was a fellow in pulmonary and critical care medicine at the University of California San Francisco. Zitter is double-boarded in the two specialties of pulmonary/critical care medicine and palliative care medicine—a rare combination. She writes for The New York Times, The Huffington Post, Pacific Standard, The Atlantic, and Journal of Palliative Medicine, and is featured in Extremis, an award-winning documentary about end-of-life decision-making in an ICU.