1
00:00:00,160 --> 00:00:03,080
Speaker 1: Getting a great night's sleep is fantastic, and you can

2
00:00:03,160 --> 00:00:05,960
Speaker 1: get that with a Sleep Number bed. The Sleep Number

3
00:00:05,960 --> 00:00:08,560
Speaker 1: bed lets you choose your ideal comfort on each side,

4
00:00:08,560 --> 00:00:11,799
Speaker 1: so it's the perfect bed. Four couples with optional sleep

5
00:00:11,840 --> 00:00:14,920
Speaker 1: i Q technology inside attracts your sleep and gives you

6
00:00:15,000 --> 00:00:18,200
Speaker 1: personal insights. You see how life affects your sleep and

7
00:00:18,440 --> 00:00:21,560
Speaker 1: how'll sleep affects your life. Sleep Number has been ranked

8
00:00:21,600 --> 00:00:25,400
Speaker 1: highest in customer satisfaction with mattresses by j D Power

9
00:00:25,480 --> 00:00:28,000
Speaker 1: for two years in a row and for JD Power

10
00:00:28,040 --> 00:00:32,280
Speaker 1: Award Information. Visit JD power dot com. My Sleep Number

11
00:00:32,320 --> 00:00:35,360
Speaker 1: setting is ninety. My sleep i Q score last night

12
00:00:35,479 --> 00:00:38,199
Speaker 1: was two. And there's never been a better time to

13
00:00:38,560 --> 00:00:41,600
Speaker 1: visit a Sleep Number store. Say fifty percent on a

14
00:00:41,680 --> 00:00:45,040
Speaker 1: limited edition bed during the Ultimate Sleep Number event plus

15
00:00:45,120 --> 00:00:49,880
Speaker 1: Queen c two mattresses are now only five. You'll only

16
00:00:49,880 --> 00:00:52,080
Speaker 1: find Sleep Number at any of the five hundred Sleep

17
00:00:52,200 --> 00:00:58,040
Speaker 1: Number stores nationwide. Find one nearest you called one zero hundred,

18
00:00:58,280 --> 00:01:01,760
Speaker 1: Tell them George Nored sent you. Now Here's a highlight

19
00:01:01,920 --> 00:01:05,800
Speaker 1: from Coast to Coast AM on iHeart Radio. Welcome back

20
00:01:05,800 --> 00:01:08,800
Speaker 1: to Coast to Coast. Dr Jessica Zetter with us m

21
00:01:08,920 --> 00:01:11,880
Speaker 1: D is an expert on the medical experience of death

22
00:01:11,920 --> 00:01:15,560
Speaker 1: and dying. She specializes in critical care and medicine at

23
00:01:15,640 --> 00:01:19,959
Speaker 1: Highland Hospital in Oakland, California. Graduate of Stanford University in

24
00:01:20,000 --> 00:01:24,600
Speaker 1: Case Western Reserve Medical School, completed her residency and internal

25
00:01:24,640 --> 00:01:27,840
Speaker 1: medicine at the Brigham and Women's Hospital, part of the

26
00:01:27,920 --> 00:01:31,679
Speaker 1: Harvard Medical School, as well her book Extreme Measures, Finding

27
00:01:31,720 --> 00:01:35,720
Speaker 1: a Better Path to the End of Life. What a subject, Jessica,

28
00:01:36,240 --> 00:01:39,920
Speaker 1: something that a lot of people are scared about, aren't they? Yes,

29
00:01:40,040 --> 00:01:41,840
Speaker 1: I would. I would say that we sort of have

30
00:01:41,880 --> 00:01:45,960
Speaker 1: a collective fear and denial of death in this culture

31
00:01:46,200 --> 00:01:49,320
Speaker 1: and in many cultures. Why do people Why do people

32
00:01:49,360 --> 00:01:53,200
Speaker 1: fear death so much? You know, I almost wonder if

33
00:01:53,240 --> 00:01:57,280
Speaker 1: it's if it's evolutionary and genetic that that we really

34
00:01:57,360 --> 00:02:01,640
Speaker 1: just want to live forever? Are their Greek myths going back,

35
00:02:01,800 --> 00:02:05,720
Speaker 1: you know, tends many many many years. However many years

36
00:02:05,720 --> 00:02:09,320
Speaker 1: it is talking about this perpetual life and what it

37
00:02:09,520 --> 00:02:11,639
Speaker 1: and and this desire for it. So I think it's

38
00:02:11,680 --> 00:02:14,040
Speaker 1: something that's been with us for a long time now,

39
00:02:14,080 --> 00:02:16,960
Speaker 1: our fear of death, of course, and there is that

40
00:02:17,080 --> 00:02:21,000
Speaker 1: tendency as you believe to ignore it. Is that very

41
00:02:21,040 --> 00:02:25,440
Speaker 1: smart to do well, I would definitely say not. I

42
00:02:25,480 --> 00:02:28,000
Speaker 1: think that, you know, my front row seat in the

43
00:02:28,000 --> 00:02:31,680
Speaker 1: intensive carrying it, I see the results of people ignoring

44
00:02:31,680 --> 00:02:34,920
Speaker 1: it all the time, and it's it's pretty devastating. Um.

45
00:02:35,240 --> 00:02:38,440
Speaker 1: You know, people really end up not knowing what what

46
00:02:39,200 --> 00:02:41,600
Speaker 1: is the power of what we can do with these

47
00:02:41,680 --> 00:02:45,800
Speaker 1: machines that can keep bodies alive, And many people really

48
00:02:45,800 --> 00:02:47,959
Speaker 1: wouldn't want it if they knew. And I think we

49
00:02:48,120 --> 00:02:50,320
Speaker 1: just assume that more technology is going to help us

50
00:02:50,360 --> 00:02:52,400
Speaker 1: and it's going to be better, but in fact that's

51
00:02:52,440 --> 00:02:55,560
Speaker 1: not the case in many especially for dying patients or

52
00:02:55,560 --> 00:02:59,040
Speaker 1: patients with serious illness. What was the catalyst that pushed

53
00:02:59,040 --> 00:03:02,200
Speaker 1: you into writing extra measures? You know, I've been writing

54
00:03:02,240 --> 00:03:05,600
Speaker 1: for years, um, i'd say, I mean since I was

55
00:03:05,600 --> 00:03:07,520
Speaker 1: a kid. But I did a lot of writing in

56
00:03:07,520 --> 00:03:09,760
Speaker 1: my early years of my career when I was going

57
00:03:09,880 --> 00:03:11,920
Speaker 1: you know, when I had gone into intensive care medicine,

58
00:03:11,960 --> 00:03:14,440
Speaker 1: and I was very excited at first got the idea

59
00:03:14,480 --> 00:03:17,400
Speaker 1: of of really just prolonging life and saving life. And

60
00:03:17,440 --> 00:03:20,839
Speaker 1: I started to see that in many cases, um, I

61
00:03:20,880 --> 00:03:24,320
Speaker 1: was actually causing more suffering and it was very distressing

62
00:03:24,360 --> 00:03:27,200
Speaker 1: to me. So I started to write really to deal

63
00:03:27,240 --> 00:03:30,800
Speaker 1: with my own moral distress. But as I went forward,

64
00:03:30,840 --> 00:03:32,600
Speaker 1: and if you you know, see in the book, I

65
00:03:33,280 --> 00:03:38,040
Speaker 1: found a new type of medical training that I incorporated

66
00:03:38,040 --> 00:03:41,680
Speaker 1: into my I c YOU practice, which is palliative care UM.

67
00:03:41,760 --> 00:03:45,640
Speaker 1: And this is really a reasonably new subspecialty which focuses

68
00:03:45,760 --> 00:03:49,640
Speaker 1: very much on communication and and UM also managing symptoms

69
00:03:49,680 --> 00:03:53,000
Speaker 1: and and and it's a terrific adjunct to what I

70
00:03:53,040 --> 00:03:54,560
Speaker 1: do in the I c U. And I started to

71
00:03:54,600 --> 00:03:57,040
Speaker 1: feel much more hopeful and UM see a new way

72
00:03:57,080 --> 00:03:59,480
Speaker 1: of doing this that I felt was working much better

73
00:03:59,480 --> 00:04:02,000
Speaker 1: for my patient sense. And so then this book really

74
00:04:02,040 --> 00:04:04,640
Speaker 1: just came out of that experience of going from in

75
00:04:04,680 --> 00:04:06,480
Speaker 1: a way, from this sort of dark place to a

76
00:04:06,560 --> 00:04:09,080
Speaker 1: much more hopeful place. What do you think is a

77
00:04:09,120 --> 00:04:11,840
Speaker 1: better way to die, Jessica, Just to drop over, keel

78
00:04:11,920 --> 00:04:14,840
Speaker 1: over and die, or to you know, be in a

79
00:04:14,920 --> 00:04:18,800
Speaker 1: hospital room and just kind of wither away? You know,

80
00:04:19,080 --> 00:04:22,560
Speaker 1: I think it's so depends on the person. And what

81
00:04:22,600 --> 00:04:25,039
Speaker 1: I've learned in my many years of doing this now is,

82
00:04:25,560 --> 00:04:30,320
Speaker 1: you know, people are pretty different, and what's most important.

83
00:04:30,320 --> 00:04:32,400
Speaker 1: What I would say is a good death really is

84
00:04:32,520 --> 00:04:35,240
Speaker 1: one that is most in line with what a particular

85
00:04:35,279 --> 00:04:38,560
Speaker 1: person's preferences and values are UM. So I think that's

86
00:04:38,560 --> 00:04:40,760
Speaker 1: why we need to be communicating a lot more about

87
00:04:40,760 --> 00:04:45,919
Speaker 1: that particular um aspect of life. As you were studying this,

88
00:04:46,680 --> 00:04:50,280
Speaker 1: did you come across things where you would make recommendations

89
00:04:50,320 --> 00:04:56,080
Speaker 1: to people who are about to die? Well, I mean

90
00:04:56,200 --> 00:04:59,920
Speaker 1: I what I really try to do is not make recommendation.

91
00:05:00,120 --> 00:05:04,760
Speaker 1: What I really my ideal situation is to educate people

92
00:05:04,800 --> 00:05:09,320
Speaker 1: about their particular medical condition and about the particular treatments

93
00:05:09,360 --> 00:05:11,240
Speaker 1: that were you know, that are that are in front

94
00:05:11,279 --> 00:05:14,200
Speaker 1: of them, that that might be things that we could do,

95
00:05:14,440 --> 00:05:16,440
Speaker 1: the benefits and the burdens of those treatments, and then

96
00:05:16,520 --> 00:05:20,000
Speaker 1: have them decide based on what is really important to

97
00:05:20,040 --> 00:05:22,520
Speaker 1: them about how they live the rest of their lives.

98
00:05:22,560 --> 00:05:25,839
Speaker 1: So I don't necessarily like to make recommendations. Sometimes I do,

99
00:05:25,920 --> 00:05:27,760
Speaker 1: but but most of the time people come to it

100
00:05:27,920 --> 00:05:30,200
Speaker 1: on their own, once they've really thought about their own

101
00:05:30,200 --> 00:05:33,799
Speaker 1: personal values and preferences and and and understood the realities

102
00:05:33,839 --> 00:05:35,960
Speaker 1: of what live before them. What do you think about

103
00:05:36,720 --> 00:05:43,159
Speaker 1: prolonged living through like life support? You know, well, let's

104
00:05:43,240 --> 00:05:46,520
Speaker 1: let's put it this way. There, I would say, we

105
00:05:46,600 --> 00:05:49,080
Speaker 1: know from data that we do it all the time.

106
00:05:49,520 --> 00:05:53,200
Speaker 1: There are many, many people, and a rising number, especially

107
00:05:53,200 --> 00:05:55,599
Speaker 1: now as the baby boomers are starting to you know,

108
00:05:55,720 --> 00:05:58,440
Speaker 1: age that more and more people are dying this way.

109
00:05:58,480 --> 00:06:00,920
Speaker 1: We've got this this term called chronic critical illness, which

110
00:06:00,960 --> 00:06:04,600
Speaker 1: is quite a large population of people, um the chronically

111
00:06:04,640 --> 00:06:06,880
Speaker 1: critically ill. And these are people who really do have

112
00:06:07,360 --> 00:06:12,320
Speaker 1: profound debilitation and you know, require at the very least

113
00:06:12,320 --> 00:06:17,680
Speaker 1: institutional support until they die or many remain tethered to machines.

114
00:06:18,240 --> 00:06:21,160
Speaker 1: And you know, this is a this is in my opinion,

115
00:06:21,440 --> 00:06:23,400
Speaker 1: a public health crisis. And this is a big part

116
00:06:23,440 --> 00:06:25,760
Speaker 1: of why I do my advocacy. I really feel like

117
00:06:25,760 --> 00:06:29,359
Speaker 1: people need to know about this. But the other piece

118
00:06:29,360 --> 00:06:31,080
Speaker 1: of data that we have is that, you know, most

119
00:06:31,160 --> 00:06:33,880
Speaker 1: people don't want that. If you if you look at surveys,

120
00:06:33,920 --> 00:06:35,880
Speaker 1: and there's lots and lots of surveys and more and

121
00:06:35,920 --> 00:06:38,440
Speaker 1: more coming out all the time. People want to die

122
00:06:38,480 --> 00:06:40,640
Speaker 1: at home. People want to die at home. But what

123
00:06:40,720 --> 00:06:43,599
Speaker 1: percentage do you think die at home? Not that many

124
00:06:44,920 --> 00:06:48,160
Speaker 1: twenty It's a very very low percentage. The other thing

125
00:06:48,200 --> 00:06:49,960
Speaker 1: that's interesting is that, you know, we know that when

126
00:06:49,960 --> 00:06:52,680
Speaker 1: patients have access to more information about end of life

127
00:06:52,720 --> 00:06:56,000
Speaker 1: issues and about the options ahead of them, they always choose.

128
00:06:56,320 --> 00:06:59,799
Speaker 1: Most patients choose a much lower level of technological intervention,

129
00:07:00,520 --> 00:07:04,719
Speaker 1: and in fact, they don't die sooner um. And so

130
00:07:05,400 --> 00:07:07,599
Speaker 1: there's there's quite you know, this is I think that

131
00:07:07,680 --> 00:07:09,440
Speaker 1: we know that people don't want to die that way,

132
00:07:09,480 --> 00:07:11,400
Speaker 1: and more and more people are dying that way, and

133
00:07:11,440 --> 00:07:14,320
Speaker 1: I just think we need to raise awareness about that, well,

134
00:07:14,440 --> 00:07:17,640
Speaker 1: especially when they prolong it, because if that's the way

135
00:07:17,680 --> 00:07:20,680
Speaker 1: you're going to stay alive, you know, with an apparatus

136
00:07:20,720 --> 00:07:24,320
Speaker 1: on you and you cannot live without it. Who wants

137
00:07:24,360 --> 00:07:27,480
Speaker 1: to live that way? Jessica, Well, and that's I mean,

138
00:07:27,560 --> 00:07:29,200
Speaker 1: it's a very important point where you just what you

139
00:07:29,320 --> 00:07:32,080
Speaker 1: just said, with an apparatus on you that let me

140
00:07:32,120 --> 00:07:34,800
Speaker 1: describe it a little bit more, a little bit more

141
00:07:34,920 --> 00:07:37,720
Speaker 1: um in detail, because I think it's important for people

142
00:07:37,720 --> 00:07:39,960
Speaker 1: to understand what it means to have, for example, chronic

143
00:07:40,000 --> 00:07:44,080
Speaker 1: critical illness. UM. It means that many of these patients

144
00:07:44,120 --> 00:07:48,360
Speaker 1: are attached to breathing machines and by that point it's

145
00:07:48,400 --> 00:07:50,920
Speaker 1: more of a permanent connection through a you know, tracheostomy

146
00:07:50,960 --> 00:07:53,840
Speaker 1: through the neck. They usually have feeding tubes that go

147
00:07:53,920 --> 00:07:57,000
Speaker 1: into their stomachs. They're usually you know, in a bed,

148
00:07:57,240 --> 00:08:01,480
Speaker 1: lying flat, they're often have their arms tied down because

149
00:08:01,800 --> 00:08:04,760
Speaker 1: dislodging tubes, which is you know, is a very risky

150
00:08:04,760 --> 00:08:06,880
Speaker 1: and dangerous thing. So a lot of these people have

151
00:08:07,000 --> 00:08:10,760
Speaker 1: their arms tied down, and you know, you can imagine

152
00:08:10,800 --> 00:08:13,360
Speaker 1: the patients of their families, as much as they love them,

153
00:08:13,760 --> 00:08:16,240
Speaker 1: can't really stand vigil for that, you know. I mean,

154
00:08:16,760 --> 00:08:19,480
Speaker 1: you're to stand at the bedside of somebody like this

155
00:08:19,560 --> 00:08:24,560
Speaker 1: is I think, not only extremely difficult from a physical

156
00:08:24,640 --> 00:08:27,320
Speaker 1: financial perspective, but in terms of an emotional and so

157
00:08:27,360 --> 00:08:29,280
Speaker 1: a lot of these people just end up really dying

158
00:08:29,280 --> 00:08:32,800
Speaker 1: in this very isolated environment um of an institution attached

159
00:08:32,840 --> 00:08:36,559
Speaker 1: to machines. The name of the book, of course, is

160
00:08:36,600 --> 00:08:39,679
Speaker 1: called Extreme Measures. Finding a Better Path to the End

161
00:08:39,679 --> 00:08:43,440
Speaker 1: of Life. Now, is there indeed a better path to

162
00:08:43,559 --> 00:08:47,480
Speaker 1: the end of life? I absolutely think so, and I

163
00:08:47,520 --> 00:08:49,880
Speaker 1: have seen it, and you know, my book is filled

164
00:08:49,880 --> 00:08:52,880
Speaker 1: with stories of people who have really taken their own

165
00:08:53,080 --> 00:08:55,600
Speaker 1: lives into into their own hands and instead of going

166
00:08:55,600 --> 00:08:58,640
Speaker 1: along what I call this end of life to conveyor belt.

167
00:08:59,280 --> 00:09:04,520
Speaker 1: And to me, it's extremely uplifting to see people who

168
00:09:04,600 --> 00:09:06,400
Speaker 1: have said, no, you know, I want to take control

169
00:09:06,400 --> 00:09:08,760
Speaker 1: of this and do this my way, instead of just

170
00:09:08,840 --> 00:09:12,840
Speaker 1: going down this default path of you know, high tech treatment,

171
00:09:12,840 --> 00:09:15,600
Speaker 1: which is what we do, and I've seen it shift

172
00:09:15,679 --> 00:09:17,760
Speaker 1: many times and really go from something that could have

173
00:09:17,800 --> 00:09:22,000
Speaker 1: been a really you know, highly medicalized death to something

174
00:09:22,040 --> 00:09:27,079
Speaker 1: that's much more home based and comfort based and family oriented.

175
00:09:27,440 --> 00:09:29,680
Speaker 1: So to me, that's a success. But for some people,

176
00:09:29,800 --> 00:09:33,160
Speaker 1: you know, some people really feel that, you know, even

177
00:09:33,160 --> 00:09:35,200
Speaker 1: if they understand all the details of what this chronic

178
00:09:35,200 --> 00:09:38,920
Speaker 1: critical illness could look like, they still feel that they

179
00:09:38,920 --> 00:09:40,920
Speaker 1: would want their bodies to be kept alive. And I

180
00:09:41,520 --> 00:09:44,120
Speaker 1: respect that. Um, we we do that a lot um

181
00:09:44,280 --> 00:09:46,240
Speaker 1: Most of the time. We do it without people really

182
00:09:46,559 --> 00:09:48,640
Speaker 1: telling us to do it. We do it by default.

183
00:09:49,120 --> 00:09:51,080
Speaker 1: But it certainly if someone said to me, you know,

184
00:09:51,160 --> 00:09:53,280
Speaker 1: this is really important to me that I be kept

185
00:09:53,320 --> 00:09:56,360
Speaker 1: alive as long as possibly, I'd say, okay, you know,

186
00:09:56,800 --> 00:09:59,880
Speaker 1: will we in this state, in this modern medical era,

187
00:10:00,040 --> 00:10:01,920
Speaker 1: we we will do that if you ask for it.

188
00:10:02,000 --> 00:10:06,040
Speaker 1: And it's not my choice, but that would that is

189
00:10:06,080 --> 00:10:08,600
Speaker 1: some people's choice. Have you ever seen a case, Jessica,

190
00:10:08,720 --> 00:10:12,920
Speaker 1: where they kept somebody on life support and then miraculously

191
00:10:13,360 --> 00:10:17,679
Speaker 1: they recovered from whatever ailment they had and they didn't

192
00:10:17,679 --> 00:10:24,320
Speaker 1: need it anymore. It's extremely rare. I've seen it a

193
00:10:24,360 --> 00:10:28,160
Speaker 1: few times in my career. UM. It's usually in the

194
00:10:28,320 --> 00:10:32,480
Speaker 1: context of a reasonably young person who's in a coma,

195
00:10:32,520 --> 00:10:36,240
Speaker 1: either from an accident or a very serious infection. UM.

196
00:10:36,960 --> 00:10:42,280
Speaker 1: I've never seen it happen in somebody who, for example,

197
00:10:42,320 --> 00:10:45,800
Speaker 1: has terminal cancer and who has been dying and come in,

198
00:10:45,880 --> 00:10:48,120
Speaker 1: you know, with very serious illness and then gotten sicker

199
00:10:48,120 --> 00:10:50,680
Speaker 1: and sicker and gotten into the intensive carrying it. I've

200
00:10:50,679 --> 00:10:53,520
Speaker 1: never seen those kinds of patients, Uh turn around and

201
00:10:53,559 --> 00:10:56,240
Speaker 1: all of a sudden, you know, recovered to the point

202
00:10:56,320 --> 00:11:00,120
Speaker 1: that they're going back to their lives with the with

203
00:11:00,280 --> 00:11:04,720
Speaker 1: this kind of end of life treatment. What do most

204
00:11:05,000 --> 00:11:07,880
Speaker 1: doctors say about this? Would they be in support of

205
00:11:07,960 --> 00:11:11,000
Speaker 1: what you've just said. It's an interesting question. And I

206
00:11:11,840 --> 00:11:15,280
Speaker 1: looked at the data on this. Doctors, Uh don't want

207
00:11:15,280 --> 00:11:17,960
Speaker 1: to die this way. UM, We've got there's a study

208
00:11:17,960 --> 00:11:19,679
Speaker 1: that I that was done in I think two thousand

209
00:11:19,760 --> 00:11:23,320
Speaker 1: thirteen UM out of Stanford surveying a bunch of young

210
00:11:23,520 --> 00:11:28,480
Speaker 1: doctors about what their preferences would be if they became,

211
00:11:28,559 --> 00:11:31,400
Speaker 1: you know, had a terminal illness, and of them said

212
00:11:31,400 --> 00:11:33,400
Speaker 1: that they would want to be made d n R,

213
00:11:33,480 --> 00:11:36,280
Speaker 1: which is do not resuscitate, which means that if you

214
00:11:36,320 --> 00:11:38,520
Speaker 1: know they when it when it comes time to their

215
00:11:38,600 --> 00:11:41,079
Speaker 1: organs start to fail, you know, let me go peacefully,

216
00:11:41,200 --> 00:11:44,400
Speaker 1: don't put me back on aggressive machines and bring my

217
00:11:44,440 --> 00:11:47,800
Speaker 1: body back on machines. Um And yet if you look

218
00:11:47,840 --> 00:11:51,480
Speaker 1: at another study that looks at a bunch of geriatrics

219
00:11:51,520 --> 00:11:56,400
Speaker 1: practice in Canada where there were about five survey geriatric's

220
00:11:56,400 --> 00:11:59,120
Speaker 1: patients in this practice, only eight percent of them had

221
00:11:59,120 --> 00:12:01,440
Speaker 1: ever had conversation stations with their doctors about this do

222
00:12:01,520 --> 00:12:04,960
Speaker 1: not resuscitate. So doctors don't want to die that way,

223
00:12:05,000 --> 00:12:08,160
Speaker 1: but their patients don't even have the chance to opt out.

224
00:12:08,559 --> 00:12:11,439
Speaker 1: Listen to more Coast to Coast a m every weeknight

225
00:12:11,640 --> 00:12:14,120
Speaker 1: at one a m. Eastern and go to Coast to

226
00:12:14,120 --> 00:12:15,880
Speaker 1: Coast am dot com for more