There’s a moment Dr. Jessica Zitter likes to recount. An “epiphany” precipitated by an experienced nurse when Zitter was a young doctor.
She told the story in an Oscar-nominated short documentary “Extremis,” and again to doctors at Bartlett Regional Hospital on Tuesday. After that, she recounted it one more time to a group of about 200 at Centennial Hall.
It goes like this: Zitter always wanted to be a doctor. A hero doctor, like the ones on TV. She wanted to swoop in at the 11th hour to save people from dying.
So Zitter went to medical school for pulmonary and critical care medicine. There she thought she could be a hero. Though it wasn’t at all like TV, she loved the work, the intensity, the importance.
One day, while working in an Intensive Care Unit, Zitter was asked to install what’s called a Quinton catheter in the neck of a patient with terminal breast cancer.
“She was really sick, she was going into renal failure,” Zitter said.
The patient was in bed five of the ICU. The patient’s husband had been waiting, and after being briefed on the procedure, rushed to the waiting room.
“I got ready to insert the needle, but I felt somebody watching me in the doorway. It was Pat Murphy,” Zitter said.
Murphy was an advanced practice nurse. Her team had won a grant to work in Zitter’s ICU to try and enhance communication. At the time, Murphy was Zitter’s “nemesis.”
“I thought, ‘Who are these people?’ They’re always coming into my unit, telling me how to talk to my patients, that I haven’t explained enough,” Zitter recounted to doctors at BRH on Tuesday. “I didn’t really think there was a problem with my communication with my patients.”
“Now Pat’s standing in the doorway, and she’s looking very angry. She takes her hand like she’s going to make a phone call with a pretend phone, and she says, ‘Call the police. They’re torturing a patient in the ICU.’”
It was then that she realized she may not be the hero she thought she was. Sometimes she was able to prolong the lives of her patients, but at what cost? Were the painful treatments worth prolonging life for a few months?
She felt a wave of shame under Murphy’s gaze.
“I am realizing that what I am going to do for this woman isn’t going to stop her from dying. It is just going to hurt her in her final moments,” Zitter said.
That moment was a turning point in Zitter’s career. Since then, she has worked to change the way people look at dying in America. Her new book “Extreme Measures” takes a hard look at end-of-life care in America.
Many dying people end up on what Zitter calls the “end-of-life conveyor belt.” They depend on one machine to keep breathing and another to keep their kidneys functioning. It can be an uncomfortable way to go and hard on families and loved ones.
When applicable, Zitter advocates for what’s called palliative care, which has only been an official medical specialty in America since 2006.
Palliative care focuses on a holistic view of dying. It’s about redefining success and allowing patients to be in control of how they die.
There’s a stigma that those at the end of their lives shouldn’t “give up” by foregoing certain treatments. But Zitter said sometimes it’s unrealistic to count on a miracle, and when you can’t save a life, you can sometimes still save a death.
“I used to believe that success could only mean fighting the disease and winning, and our patients are going to follow us into battle if that’s the only option you give them,” Zitter said.
But there are other options. Patients can reasses their values. Is another two months living worth drinking wine with your family before you die? Is it worth checking off the bucket list?
You have to weigh your values, she said, with what a treatment may take away.
“Where do you want to be when you’re dying? Who do you want at your side? And how important is it to you that you’re able to communicate?”
Dr. Bob Urata hosted Zitter during her Juneau lectures. He’s the volunteer director at Hospice and Homecare of Juneau. Urata has run the nonprofit through a patchwork of funding and medicaid dollars since 1980s.
About four dying people move through Hospice and Homecare of Juneau every month, about 50 a year he said. Urata hosted Zitter during he talks in Juneau. He said being open and honest with prognosis is important.
Cancer patients are often told a fourth or fifth round of chemotherapy has a certain percentage of success, even if just to keep a patient alive for a few months. Many take that chance, Urata said, which is their choice alone.
But it’s important also not to overlook what cost continued care could have on a patient’s remaining quality of life. Most people would take their chances on a third round of chemotherapy at a 30 percent success rate, but it might not be worth it.
It can be hard to fight the stigma that choosing to be comfortable at life’s end constitutes giving up.
“You have to sort of talk about it and decide for yourself what is a good death. And that goes back to your values,” Urata said. You may value ice cream, Urata said, but maybe a treatment would require you to stop eating ice cream.
“It’s those kind of values. When that time comes, when you can’t have your ice cream, then maybe it’s time to think about (stopping treatment).”
• Contact reporter Kevin Gullufsen at 523-2228 or kevin.gullufsen@juneauempire.com.
