Are you immune to death?

Extreme measures: Book by Jessica Zitter: contains exploration of how she thought of herself as immune to death

Jessica Nutik Zitter is an ICU doctor who’s “around death every day” but thinks she’s immune to death. I wanted to share and discuss part of her renowned book: Extreme Measures. This describes how, at a mindfulness seminar, she realised that she had never thought in any real way about her own death. Dr Levy, running the seminar, asked:

“How can we expect to help our patients plan for their deaths if we haven’t planned for ours?”

This is a really important point that Dr Zitter makes, I think. I’m no longer working as a doctor, so I don’t ‘have’ to do this for myself right now. But I’ve got two life-limiting diagnoses, even though I’m not acutely unwell today. I’m hugely in favour of Advance Care Planning. So when ‘should’ I or other ‘ordinary people’ do something like the exercise Dr Zitter describes, as summarised below?

The seminar Dr Zitter attended included an exercise for the participants to picture their own deaths:

•Who would be there?

•What would they be saying?

•Who would be crying?

•What would you have not gotten done?

•For what would you be grateful?

•Who would be holding your hand?

•Who would be standing at the foot of the bed? In the hall?

Dr Zitter realised that she had never allowed herself to consider her own death: “It was as if I had willed myself immune to death.” 

Dr Zitter is apparently Jewish, which gives her a specific opportunity to consider her own death every year, in the Rosh Hashanah (Jewish New Year) service. This includes the prayer Unetaneh Tokef (Let Us Cede Power), which “attests to our lack of control over our mortality, willing us to repent and mend our ways. Its words are sobering, even grisly”. But as Dr Zitter wrote: “Somehow it never felt real …”

When she let the sadness and the possible uncompleted tasks seep in: “the tears started to fall down my cheeks. One big fat one at first, brimming over and paving a salty track down my dry cheek to come to an embarrassing stop at the corner of my mouth. I wasn’t sure if I should lick it or ignore it.” Dr Zitter “realised I’d been running away from [my own death].”

She “began to think more deeply about how I would help all of those walking that path before me. How could I possibly help my patients accept their deaths if I hadn’t stopped to accept mine?”

As she said: “I am, of course, no different from my patients, no better or worse. Often no wiser. And no more entitled to live another day. I reminded myself that death comes for us all, and sooner or later, I will be the one in that bed, on the other end of the stethoscope. I considered what type of doctor I would want to have with me as I made these final decisions, as I breathed my final breaths.”

Of course, those of us who are not doctors, are no different from other ‘patients’ either.

Just like Dr Zitter, I seem to think I’m immune to death!

Dr Zitter struggled especially with her tears: “my mindfulness exercise ended because I needed all of my focus to suppress my impending sobbing. I had been saved from the mortification of being an ICU physician sobbing uncontrollably as I pondered my own death. And right in front of the nurses, physical therapists, and respiratory therapists that I feel I must stand before confidently, never wavering in my resolve that I can make it right for my patient.”

‘Ordinary’ people like me don’t have this particular status problem. But I felt very concerned about why this was a problem for Dr Zitter. Being confident is great. But “never wavering in [her] resolve that [she] can make it right for my [sic!] patient” … ?!

Dr Zitter is an ICU physician. Surely she can’t make it right for all of the ICU patients she and her colleagues deal with?

Or is that another ‘immunity’ that Dr Zitter might want to think about?

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