Extreme Measures
Finding a Better Path to the End of Life
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Narrated by:
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Jessica Nutik Zitter M.D.
About this listen
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 AudioListeners also enjoyed...
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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)
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There’s a quiet revolution happening in the way we die. More than 1.5 million Americans a year die in hospice care - nearly 44 percent of all deaths - and a vast industry has sprung up to meet the growing demand. Once viewed as a New Age indulgence, hospice is now a $14 billion business and one of the most successful segments in health care. Changing the Way We Die, by award-winning journalists Fran Smith and Sheila Himmel, is the first book to take a broad, penetrating look at the hospice landscape.
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Sadly, not very engaging.
- By Debra S. Long on 06-16-18
By: Sheila Himmel, and others
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When Breath Becomes Air
- By: Paul Kalanithi, Abraham Verghese - foreword
- Narrated by: Sunil Malhotra, Cassandra Campbell
- Length: 5 hrs and 35 mins
- Unabridged
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At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated.
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Phenomenal book!
- By A. Potter on 01-16-16
By: Paul Kalanithi, and others
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Your Heart, My Hands
- An Immigrant's Remarkable Journey to Become One of America's Preeminent Cardiac Surgeons
- By: Arun K. Singh MD, John Hanc - contributor, Delos Cosgrove MD - foreword
- Narrated by: Shridhar Solanki
- Length: 8 hrs and 39 mins
- Unabridged
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Leaving a life marked by crippling setbacks and his father's doubt, in 1967 a 20-something doctor from India arrived in America with only five dollars and the desire to claim his American dream. Faced with an entirely new culture, racism, and the lasting effects of disabling childhood injuries, through hard work and perseverance he overcame all odds. Now having performed over 15,000 open-heart surgeries, more than nearly every surgeon in history, Dr. Singh reflects on his most memorable patients and his incredible personal life.
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Remarkable!
- By Stacey on 12-01-22
By: Arun K. Singh MD, and others
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The Good Death
- An Exploration of Dying in America
- By: Ann Neumann
- Narrated by: Suzanne Toren
- Length: 8 hrs and 44 mins
- Unabridged
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Following the death of her father, journalist and hospice volunteer Ann Neumann sets out to examine what it means to die well in the United States. When Ann Neumann's father was diagnosed with non-Hodgkin's lymphoma, she left her job and moved back to her hometown of Lancaster, Pennsylvania. She became his full-time caregiver - cooking, cleaning, and administering medications. When her father died, she was undone by the experience, by grief and the visceral quality of dying.
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Ugh, so boring
- By Maranto on 05-13-19
By: Ann Neumann
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The Desperate Hours
- One Hospital's Fight to Save a City on the Pandemic's Front Lines
- By: Marie Brenner
- Narrated by: Kirsten Potter
- Length: 15 hrs and 41 mins
- Unabridged
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In the spring of 2020, COVID-19 arrived in New York City. Before long, America’s largest metropolis was at war against a virus that mercilessly swept through its five boroughs. In The Desperate Hours, award-winning journalist Marie Brenner, having been granted unprecedented 18-month access to the entire New York-Presbyterian hospital system, tells the story of the doctors, nurses, residents, researchers, and suppliers who tried to save lives across Manhattan, Queens, and Brooklyn and the northern periphery of the city.
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Way too much politics
- By Josh on 07-18-22
By: Marie Brenner
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The Spectrum of Hope
- An Optimistic and New Approach to Alzheimer's Disease and Other Dementias
- By: Gayatri Devi MD
- Narrated by: Wendy Tremont King
- Length: 12 hrs and 41 mins
- Unabridged
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Imagine finding a glimmer of good news in a diagnosis of Alzheimer's. And imagine how that would change the outlook of the five million Americans who suffer from Alzheimer's disease and other dementias, not to mention their families, loved ones, and caretakers. A neurologist who's been specializing in dementia and memory loss for more than 20 years, Dr. Gayatri Devi rewrites the story of Alzheimer's by defining it as a spectrum disorder - like autism, Alzheimer's is a disease that affects different people differently.
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Aging with Grace
- By Lisa F on 05-19-21
By: Gayatri Devi MD
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Falling into the Fire
- A Psychiatrist's Encounters with the Mind in Crisis
- By: Christine Montross
- Narrated by: Christine Montross
- Length: 8 hrs and 56 mins
- Unabridged
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Falling into the Fire is psychiatrist Christine Montross's thoughtful investigation of the gripping patient encounters that have challenged and deepened her practice. Beautifully written, deeply felt, Falling into the Fire brings us inside the doctor’s mind, illuminating the grave human costs of mental illness as well as the challenges of diagnosis and treatment. At once rigorous and meditative, Falling into the Fire is an intimate portrait of psychiatry, allowing the reader to witness the humanity of the practice and the enduring mysteries of the mind.
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Buy this book! and READ it
- By joyce on 08-15-13
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Advice for Future Corpses (and Those Who Love Them)
- A Practical Perspective on Death and Dying
- By: Sallie Tisdale
- Narrated by: Gabra Zackman
- Length: 7 hrs and 11 mins
- Unabridged
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You get ready to die the way you get ready for a trip. Start by realizing you don't know the way. Listen to a few travel guides. Study the language, look at maps, gather equipment. Let yourself imagine what it will be like. Pack your bags. This book is one of those travel guides - a guide to preparing for your own death and the deaths of people close to you. The fact of death is hard to believe. Sallie Tisdale explores our fears and all the ways death and talking about death make us uncomfortable - but she also explores its intimacies and joys.
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I thought I had more time...
- By Alyssa on 09-09-19
By: Sallie Tisdale
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Peace, Love & Healing
- Bodymind Communication & the Path to Self-Healing: An Exploration
- By: Bernie S. Siegel
- Narrated by: Bernie S. Siegel
- Length: 2 hrs and 56 mins
- Unabridged
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A classic of patient empowerment, Peace, Love & Healing offered the revolutionary message that we have an innate ability to heal ourselves. Now proven by numerous scientific studies, the connection between our minds and our bodies has been increasingly accepted as fact throughout the mainstream medical community. In a new introduction, Dr. Bernie Siegel highlights current research on the relationships among consciousness, psychosocial factors, attitude, and immune function.
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horrible horrible
- By Honestly on 02-09-15
By: Bernie S. Siegel
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Heart
- A History
- By: Sandeep Jauhar
- Narrated by: Patrick Lawlor
- Length: 8 hrs and 43 mins
- Unabridged
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For centuries, the human heart seemed beyond our understanding: an inscrutable shuddering mass that was somehow the driver of emotion and the seat of the soul. As cardiologist and best-selling author Sandeep Jauhar tells in The Heart, it was only recently that we demolished age-old taboos and devised the transformative procedures that changed the way we live. Deftly alternating between historical episodes and his own work, Jauhar tells the colorful and little known story of the doctors who risked their careers and the patients who risked their lives to know and heal our most vital organ.
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Fascinating Insight
- By Ironcharles on 10-27-18
By: Sandeep Jauhar
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A Bittersweet Season
- Caring for Our Aging Parents - And Ourselves
- By: Jane Gross
- Narrated by: Kate Reading
- Length: 15 hrs and 35 mins
- Unabridged
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In telling the intimate story of caring for her aged and ailing mother, Jane Gross offers indispensable, and often surprising, advice for the rapidly increasing number of adult children responsible for aging parents. Gross deftly weaves the specifics of her personal experience with a comprehensive resource for effectively managing the lives of one's own parents while keeping sanity and strength intact.
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Exceptional, thought-provoking, liberating!
- By Anne on 08-10-11
By: Jane Gross
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Rise and Shine
- The Path to Life
- By: Simon Lewis
- Narrated by: Kelsey Grammer
- Length: 8 hrs and 59 mins
- Unabridged
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Crushed between a truck and a tree, Simon and his wife were both pronounced dead at the scene of a horrific car accident. Enduring a broken skull, jaw, arms, clavicle and pelvis, followed by a coma, Simon lives to tell his remarkable journey from tragedy to triumph.
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Amazing opportunities for healing!
- By Leah on 04-29-17
By: Simon Lewis
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The Lost Art of Dying is filled with much-needed insight and thoughtful guidance that will change our perceptions. Dr. Dugdale offers a hopeful perspective on death and dying as she shows us how to adapt the wisdom from the past to our lives today. Part of living well means preparing for the end, Dr. Dugdale reminds us. By recovering our sense of finitude, confronting our fears, accepting how our bodies age, developing meaningful rituals, and involving our communities in end-of-life care, we can discover what it means to both live and die well.
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You get ready to die the way you get ready for a trip. Start by realizing you don't know the way. Listen to a few travel guides. Study the language, look at maps, gather equipment. Let yourself imagine what it will be like. Pack your bags. This book is one of those travel guides - a guide to preparing for your own death and the deaths of people close to you. The fact of death is hard to believe. Sallie Tisdale explores our fears and all the ways death and talking about death make us uncomfortable - but she also explores its intimacies and joys.
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What listeners say about Extreme Measures
Average customer ratingsReviews - Please select the tabs below to change the source of reviews.
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- Allison Pavish
- 04-17-20
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!
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- Bob Kelley
- 03-16-17
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
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3 people found this helpful
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- Casey
- 10-01-17
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.
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- D. Lopez
- 01-26-22
Formative and Compassionate
A must read for everyone. Dr. Zitter provides a lot of useful information in the field of death and palative care.
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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.
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- Liz
- 06-20-20
A must read for every mortal human!
I am a retired ANP who has listened twice to this amazing book. Wonderfully articulated.
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- Isabella
- 07-16-18
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 !
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- karen jean stevens
- 12-12-18
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.
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1 person found this helpful
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- Martha Moore
- 06-30-18
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.
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- MuddyPaws
- 03-12-24
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.
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