Extreme Measures Quotes

“I heard a compelling lecture by an African American pastor from the north side of Chicago. He opened his talk with numbers, counting up all of the hours that a God-fearing person in his parish has spent in church over the course of her life. It was a lot. Then he described what is talked about during those hours in church. It’s all about hope, he told us. For change, for a better future, for justice, for relief of suffering. And then he asked the predominantly white audience why we expected our African American patients to give up hope—for a cure, for another chance at life—at this most vulnerable point in their lives. This is a time, he said, when they need hope the most. If the doctor’s only concept of hope and miracles is the cure of disease, then there truly is nothing more to talk about with a family wanting everything done in the name of God. But guided by Betty Clark, the pastor on our palliative care team, I have found other ways of transmitting hope to families looking for a miracle. The miracle of time at home, of pain management, of improved quality of life. These are all concepts I have seen families embrace in place of survival—the only concept of hope previously imagined. I have also found it helpful to open up the question of God’s will. Once, a religious family explained to me that they didn’t want to play God by withdrawing the breathing tube from their dying loved one. I asked them whether another interpretation might be that they were playing God by keeping her alive when her body was actively dying. Mightn’t this be God demonstrating that it was her time to die? And were we, in our hubris, thwarting God’s will? Many families agreed with my suggestion that almighty God doesn’t need help from mere mortals. If He wants to heal a body, He can do it on his own.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life

“Data show that the more patients actually know, the less they want of our treatments at the end of life. A study of 230 surrogate decision makers for patients on breathing machines demonstrated that the better the quality of clinician–family communication, the less life support was elected. Another study showed that people were less likely to want CPR after they learned what it actually entailed. Most people dramatically overestimate the likelihood of survival after CPR. When they learn the real numbers, they are less likely to want it by about 50 percent. In short, when people have a more robust understanding of the benefits and burdens of the treatment they are actually getting, they want less of it.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life

“Maybe, I thought, we should have protocols for a Code Pain like we do for Code Blue.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life

“Palliative care isn’t only for the dying: any patient with serious symptoms or communication needs can benefit. But for patients approaching the end of life, its offerings are often critical.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life

“When it comes to dying and the risks of a bad death, does our responsibility as doctors override cultural values? Is it ever acceptable to bypass cultural norms and expectations in an attempt to get to the human truth? While in many cultures the tradition is to work through the family rather than talk directly to the patient during the dying process, the potential for harm is great, and patients may unintentionally be held hostage by their families.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life

“it makes no sense to scoop people out of the river when we could go upstream and prevent them from falling in in the first place. The ICU is not the place for these conversations to begin, and yet that is where they are often happening, if they do at all.”
― Jessica Nutik Zitter, Extreme Measures: Finding a Better Path to the End of Life