Extreme Measures

Finding a Better Path to the End of Life

By: Jessica Nutik Zitter M.D.

Narrated by: Jessica Nutik Zitter M.D.

Length: 11 hrs and 11 mins

Publisher's summary

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.

©2017 Jessica Nutik Zitter (P)2017 Penguin Audio

Critic reviews

"Like Atul Gawande's Being Mortal, Zitter's book shows how knowing when do to nothing is as vital to being a good doctor as knowing when do to everything." (New York Times Book Review)

"You wouldn't take a trip to a foreign country without learning as much as you could about its rituals, its culture, and its landscape. The ICU, a place many of us will pass through at least once in our lives, is as foreign as it gets. Thus Dr. Zitter provides an essential illumination for her fellow humans." (Diane E. Meier, MD, director, Center to Advance Palliative Care)

“Jessica here reveals a fuller truth of how the end-of-life plays out within our healthcare system. There’s nothing easy in these pages, but plenty to learn from, cautions to absorb, and material for creating a better way.” (BJ Miller, MD, assistant clinical professor of medicine at UCSF)

Must read!

Wonderful book! The author keeps you engaged with stories we can all relate to patients we’ve had in the past. It gave me so much insight into why the medical system seems so inept at dealing with dying patients and end of life issues. As a nurse, I have a renewed passion to advocate for my patients at end of life. We all deserve to have our choices heard and honored. I would highly recommend!

Brilliant & eye-opening

For anyone who wants to know what "the end" really looks like, this book is must reading. In fact, it should be mandatory reading for anyone who is - or is related to anyone who is - mortal. And I think that covers ALL of us. Spoken by the author with visceral compassion, Dr. Zitter compresses her 20+ years in the ICU with so many you-are-there stories of patients and family members in end of life crises, it truly becomes a rallying cry for us to Do Something Now, even beyond Advance Directives. Thank you for telling it like it really is, Dr. Zitter! m

A compelling new voice

Physician writers don't often accomplish what Nutik Zitter has with Extreme Measures. This was as informative as it was moving. I'm left with a deep sense of gratitude for the work she has done and will continue to do.

Formative and Compassionate

A must read for everyone. Dr. Zitter provides a lot of useful information in the field of death and palative care.

I am a medical professional with a terminal disease

This book helped me to have those “tough” talks with my husband. I am going to spell out in detail what l would or more likely would not like done. I have had that difficult talk with families including showing the endo tube and explaining how far I would have to compress the chest. I will never forget the first time I did chest compressions on a frail old lady and hearing her ribs break.
Thank you for this compassionate look at the true end of life in a hospital.

A must read for every mortal human!

I am a retired ANP who has listened twice to this amazing book. Wonderfully articulated.

Should be required reading

Love her caring and courage --will recommend to all, and also discuss life planning with family,before an imminent situation develops !

Must Read

This work provides clinical, practical, spiritual, and emotional perspective to human beings dealing with serious health and end of life issues.
I am forever changed by the education this book details.

Insightful, informative and a valuable resource.

I'm new to Hospice nursing. This book has helped me understand and appreciate it so much more. I'm sure I will listen to it again. I may buy it to have as a reference. I loved it and didn't want it to end.

for one and all, a most important read

one of the most superbly articulate accounts of preparing urself and ur beloveds to “die well” — as told from the belly of the beast, ie an ICU physician who later also became a palliative care consultant and merges these two very different philosophies on a daily basis. i so appreciate this labor of love delivered with passion snd compassion ! i also watched the documentary “short” on netflix and wished it had become a full length feature film. my many hearfelt thank yous, dr zitter, for all the questions i have learned to ask and the countless resources u included.