In medical school, no one teaches you how to let a patient die.
Zitter started her career as an ICU doctor, one of the more intense specialties in medicine. It’s your job to do stuff to turn around patient problems – put them on breathing machines and kidney machines when organs stop functioning, place a tube so they can be fed, use medications to stabilize blood pressure or prevent a clot. It’s your job save a patient’s life, so why would you stop when there’s another procedure or a different medication you’ve yet to try?
This, she says, is why doctors are so awful at helping their patients have a good death. A patient dying is akin to failure and no one, especially highly trained professionals with a wealth of options and technology at their disposal, wants to fail. Add in a family that wants you to “do everything”, and it’s a recipe for more and more machines and care that will make it impossible for the patient to die peacefully at home. Zitter calls it the “end-of-life conveyor belt” and she got certified in palliative care to help people navigate and possibly avoid it.
This book is an extension of that work. She details how and why we got to this point and what we – both patients and health care professionals – can do to guide people towards the death they want. Patient stories are woven through to illustrate what things look like when they go right, go wrong, or just… go. End of life care is a minefield of pitfalls and potential missteps and she doesn’t shy away from any of it.
It’s a bit of a side note, but I want to give Zitter a great big hug for discussing my profession of medical interpreting in a chapter about cultural values. She includes the interpreter as part of the care team, asking about cultural differences and how to approach a thorny topic. In my experience interpreters can be treated like walking dictionaries, more a thing than a person, and it means a lot to me that Zitter accurately depicts and advocates for the important work we do.
The author reads the audiobook and I really liked it, though I did have to crank up the speed a little bit more than usual. I liked it so much that I went back and relistened to sections so I could add them to my notebook word for word. Here’s some of the wisdom she drops:
The human being is unknowable. Unless, maybe, you ask.
While I may be the expert on the patient’s disease I am not the expert on the patient.
Sometimes it isn’t that the doctor needs to work harder to elicit the patient’s values, but that those values are simply different from the doctor’s. Yet another lesson in listening.
An amazing must read for anyone with anything do to in medicine, and highly recommended to everyone else.
…and because I have an inkling it will come up in the comments – no, I haven’t read Atul Gawande’s Being Mortal yet. 🙂 I hope to get to it sooner rather than later. I’m curious to see how a surgeon approaches these same issues and where the two doctors’ views converge and divide.