Intensivist Jessica Nutik Zitter, MD, MPH, had spent two decades focused on keeping patients alive in the intensive care unit (ICU). But it wasn’t until a nurse shamed her for placing a dialysis catheter in a dying patient that she began to think about how to improve the quality of life for patients with serious illnesses.
In her recent book, Extreme Measures: Finding a Better Path to the End of Life, Dr Zitter chronicles how she shifted from seeing her work as treating organs and diseases to caring for the whole patient. Her work is also featured in the Oscar-nominated short documentary Extremis (Netflix, 2016).
Dr Zitter completed a board certification in palliative care in 2010 and is currently a critical care and palliative care physician at Highland Hospital in Oakland, California. She is also cofounder of Vital Decisions, a telephone-based counseling service for patients with life-limiting illness.
Medscape recently spoke with Dr Zitter about how intensivists can incorporate palliative care into their work.
Dr Zitter: I’ve been writing about my medical experiences for many years. During residency, I wrote mostly for myself, in an attempt to process what I was going through. It’s hard to care for sick and dying patients, especially in the beginning, when most of us are still shocked by the suffering inherent to our work.
I would write a piece, and sometimes share it with friends and family, but it was not meant for publication. I was writing about private and painful emotions, about my moral distress. Most of my pieces brought up sadness; ethical issues that I was wrestling with; or conflict that I may have had with the patient, the family, even a colleague.
It was only after I began to learn about palliative care, and to see a new way of doing things, one that actually worked better a lot of the time, that I began to try and share it. I encountered a lot of rejection—from publishers, newspapers, sometimes colleagues who didn’t like what I was saying. But one article eventually led to another. I wanted to share my new knowledge with colleagues and patients. I felt that it time to write a book and put it all out there.