Engaging and informative, Jessica Zitter's examination of the current state of end-of-life treatments and how they might best be navigated is really excellent. Zitter is trained and experienced in both pulmonary/critical care medicine and palliative care medicine, and she balances these two perspectives to offer a nuanced look at the possibilities and dangers offered by medicine's technical “wonders” to those whose bodies are failing. Born into a family of physicians and surgeons, Zitter begins her book by telling of her early training in critical care medicine and her eagerness to save patients on the brink of death. Her gradual realization that the heroic measures which doctors, families, and patients typically assume are desirable might result in dramatically increased suffering and no true benefits, leads her to embrace an approach which focuses on allowing patients with “life-limiting” health situations to choose care that aligns with their values.

I've been reading about death and illness lately, but there was some eye-opening stuff for me in this about critical care/ICU treatments, and also the LTAC (Long Term Acute Care) thing. Yikes. Tubes, lines, and pumps chugging along, sustaining bodies, sometimes, for far too long. Zitter is not dogmatic, and she does not discount the benefits of life-sustaining technologies for patients who may recover some or all abilities or who may feel that life of any quality is worth continuing. Her emphasis is on educating patients and their families about the realities of “extreme” medicine, and on making sure that patients are aware of the options offered by palliative medicine.

As I read this I was overwhelmed with gratitude for the doctors who saw my mom after her unexpected diagnosis with metastatic lung cancer a couple months ago, in early November. All except the first one, at the ER, who came in and said that her seizure had not been the result of another urinary tract infection. No problems there. Oh, but there was a malignant node in her lung, and it appeared to have spread through her vertebrae. So we'd need to look into treatment options. And left. That guy was a jerk (I assume he still is a jerk.) But the rest of the doctors – pulmonary specialists, oncologists, primary care – have been marvelous. They looked at the whole patient, a frail woman with frontotemporal dementia, and at the progress of the cancer, and advised us of the options. Biopsies, surgeries, radiation were possible but they would ensure pain and sickness with no chance of cure and little in the way of longer life. And they told us about palliative care and Hospice. So now my mom is dying in her own home, relatively comfortable for the most part, nibbling the occasional little bites of crème brulee (minus the crispy sugar topping, so really just “creme,” I suppose), quiche, or hot cereal (my dad's specialty), being read aloud to, listening to music, and watching birds through the window. It's a very far cry from the life filled with friends, gardening, books, and so on that she Should be living now, but Zitter's book has made clear to me how much worse it could be. Her death seems to be rapidly approaching, and with FTD and metastatic lung cancer working their horrors in tandem it is not pleasant, but at least she is home, in the care of people who love her and who have been given the tools – medications, hospital bed, etc. – to keep her comfortable. She has Hospice nurses, aides, social workers, etc. on call, and they really Do come when needed, and even her wonderful primary care doctor (a last minute acquisition, who, fortuitously, has extensive experience in palliative care practice) makes house calls. All in line with her advance directive (Zitter's excellent appendixes provide links and tools to help readers make their end-of-life care wishes known to family and health care providers, and I intend to work mine out ASAP!), which is a great comfort to us.

Highly recommended to readers inclined to read about this subject. Zitter offers a sensitive, nuanced, multifaceted look at issues to consider related to end-of-life care. ( )

A MUST READ for anyone and everyone---it IS about the future of each and every person in the United States. How will "I" die? What is involved? Absolutely beautifully written with examples that cover so many things the author has learned and continues to learn in her medical career. Truly centering on what is best for the patient has been so easily buried in the enormous increases in medical treatments and doctor specialists. Who watches out for the patient? Zitter explained it all. ( )

This author trained first as an Intensive Care Specialist physician, but became increasingly troubled by the way many patients in ICU's were cared for. Descriptions of ventilator facilities that maintin patients who are placed on ventilators and will never be freed from them, is haunting. Numerous other situations are described; the author gives many patient scenarios of people she has cared for, or come to know, in ICU's around the country, recounting numerous efforts made to prolong life, with little thought about the quality of that life. Dr. Zitter does not take a bitter or judging tone toward other physicians, lauding them for their mostly tremendous committment to save the lives of their patients. But with her later training as a Palliative Care specialist, Dr. Zitter hopes to bring a new approach to medicine, where Patient Centered Care becomes the norm, so that patient's and their families are presented with very realistic information about their prognosis. And that those facing these choices about ventilators, CPR, heart defibrillators, feeding tubes, extensive chemotherapy, and many other options that the increasing medical technology provides us, will know all the realistic possible outcomes.
Dr. Zitter was not afraid to admit how complex this issue is for her on a very personal level, and also showed her own human emotional responses to many of her patients.
At the end of this book the author lists numerous resources, not only the Advanced Directieves that are fairly well known, but other documents and resources that could prove quite helpful. ( )

Exceptional book. Unfortunately, I think this is probably one of those "preaching to the choir" titles. Enlightening and thought provoking look at "right to die," as well as end of life (palliative) care.

**This was an advanced reader copy won through the LibraryThing Early Reviewers program.** ( )

Have you ever considered what it means to have a good death? What is a bad death? What kind of death would you envision for yourself, a parent or spouse? Perhaps you would prefer not to envision this possibility at all, but by avoiding the topic of death, we could be letting ourselves or our loved ones end up on the medical conveyor belt as described by Jessica Nutik Zitter, and ICU and palliative care specialist.

She has seen many deaths and asks us to consider the quality of our end of life experience: strapped down to a bed with tubes delivering liquid nutrition; a machine keeping the body breathing? Or perhaps at home, dying naturally with those close to us at our side?

In this book we are also asked to consider what quality of life we would find acceptable. Would medical measures that save your life but mean that you are incapacitated and unable to care for yourself be a life that you would find worth living?

We have a tendency to look to medical science to provide immortality, but the desire to fend off death at all costs can lead to an unnecessarily painful end.

Zitter shows us many cases, ask many questions and asks us to consider our responses to the end of life. Extreme Measures is a book that lay people and medical professionals will find thought-provoking and useful.

We often think of the fight against death as heroic, and it can be. But Zitter considers another kind of heroism: "Heroism doesn’t always mean fighting. Sometimes it means acknowledging the reality on the ground, retreating from the fight, and receiving the support you need from those around you." ( )