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

Abstract

This book is a memoir by a physician who went into medicine to be a lifesaving hero and emerged advocating for a cultural shift in the way we care for dying patients. I expected Extreme Measures to be a didactic discussion of end-of-life care for seriously ill patients in critical care units; however, it is a personal account of one physician’s journey from new intern to attending physician, dual certified in critical and palliative care. In an honest narrative tone, Dr Zitter describes a diverse assortment of clinical experiences, each illustrating a specific lesson learned. Although some cases demonstrate the depth of her compassion, others show how she struggled to communicate effectively with patients and families and realized that her education and training had not prepared her for an essential component of patient care.Nurses reading this text can both relate to Dr Zitter’s experiences and learn from them. When she describes the disparity between the book learning of medical school and the real world of health care, I thought of my own transition from nursing school to working as a new graduate. New physicians, like new nurses, seek to reconcile the gap between our ideal vision of patient care and the actual events that take place in a complex, harried environment. In medical training, this is sometimes managed through a focus on tasks—procedures, consults, and interventions—rather than on the patient as a person. Early on, Dr Zitter adopted this approach but not without misgivings. She wondered why cardiopulmonary resuscitation was continued when the patient was clearly dead, and if it was right to start dialysis in a patient in the end stage of cancer. Over the course of her career, Dr Zitter bravely allowed interactions with patients to mold her into a patient-centric provider. Her greatest satisfaction came from knowing that her care matched the goals of her patients.Because Dr Zitter is candid about her journey, we as nurses, get an inside look at how medical socialization contributes to the manner in which end-of-life care is delivered. I appreciated Dr Zitter’s perspective, not only because it validated my own, but also because it gave me an opportunity to consider the challenges that physicians face in communicating with seriously ill patients and their families. Because collaboration between nurses and physicians is fundamental to high-quality care, books like this one, which help us understand a physician’s perspective, are priceless.There are a few moments in the text in which Dr Zitter alludes to professional role conflict with nurses. This book is her perspective and those views are real, if unsettling for nurses to read. Early in her critical care career, Dr Zitter worked with an advanced practice nurse who second-guessed invasive medical interventions in patients with poor prognoses. In retrospect, she acknowledges that this nurse’s concerns were troubling because they nourished her own burgeoning doubts about the care she was providing. She later attributes her transition to patient-centered care in part to the experiences she had with that same nurse.I strongly recommend this book to nurses interested in examining how we provide end-of-life care. The author is not only a talented health care provider and an excellent writer but also a role model for self-reflection and honest communication with patients. Dr Zitter states she went into medicine to be a hero who saves lives and then became disillusioned. I think this text shows she is exactly the kind of hero that our health care system needs.