Death Interrupted (Blair Bigham)
OVERVIEW
This book is about the grey zone between life and death caused by too much medicine. When a doctor says “there’s a chance,” it’s an invitation to ask “a chance for what?” Death Interrupted: How Modern Medicine is Complicating the Way We Die was written by emergency and ICU physician Blair Bigham (shout out, Canada!). Before becoming a doctor, Bigham was a journalist and a paramedic. While I expected this book to be similar to Atul Gawande’s “Being Mortal,” there were totally fresh perspectives, and plenty of interesting stories about medical innovations (like did you know CPR was discovered by someone doing defibrillation experiments on dogs?).
Between 1850 and 1950, life expectancy doubled, attributable to vaccines, antibiotics, public health measures, and technological advancements. Combined with the progress in resuscitation technology in the 50s and 60s, this was “the perfect recipe for creating a world where people, and their doctors, would forget how to die.” The care of our dying was outsourced to healthcare facilities. Hospitals began organizing resuscitation teams. Governments developed the infrastructure for ambulatory care (imagine a time before this, where if you got into a car accident, even if someone could find a nearby pay phone, did they know the number for emergency services? Were there any organized teams a hospital could find to send out?). So it was ventilators, and CPR, and drugs, but it was also political will and rapid changes to healthcare systems. A lack of breathing or a stopped heart at home or in a hospital no longer signified death. We could get a person breathing, we could get a heartbeat back. We could keep a person artificially “alive” long after their brain had stopped working. Unlike most of human history, death could now be deferred.
That deferral has created the grey zone, and a “death dilemma.” When exactly is a person dead? When is someone allowed to die? And who decides? Just because we can keep someone breathing, should we? In modern hospitals, technology and medicine are often aggressively applied to prevent death in the short-term, but at what cost? Is survival always better than death? Today, you can be “breathing” but brain dead – your heart beating but your consciousness and personhood irrevocably lost. And for the person who has already been dying for awhile, aggressive resuscitation intervention doesn’t return them to living, it only returns them to dying (if it returns them at all).
WHAT NOW? (actions for mortal atheists)
Bigham doesn’t profess to have all the answers, but he does think we should start by addressing our fear of death – that includes patients, their families, and their healthcare team. To do this, Bigham encourages us to think about and talk about death. Appoint a substitute decision maker, make your end-of-life wishes clear. Write about death, put your wishes down on paper. Before accepting medical interventions, consider whether these can reasonably promote a return to life, or if they are just staving off immediate death in favour of suffering, in favour of more dying. Will you accept painful complications for potential microimprovements? Explore your fears. Explore your values. Talk to your family, tell your doctors. If you want to consider quality over quantity, if you want to discuss palliation, if you want to discuss goals of care, you will need to be prepared, and you will need to speak up.
IN SUM:
Is this book entirely secular? Yes.
If I had to describe the book in one sentence? A Canadian ICU physician explores the journey to our modern day “grey zone” in medicine.
Who should read this book? Those new to the topic of medicalization at end-of-life.