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change "can't be done." Parental guidance on what to eat or the val- ues to hold are overwhelmed by direct advertising and the media messages of what counts. The gap between what this corporate-dominated society actually produces and what people need to live healthy lives creates the opening for change. Nader points out that "when you steadily put forces in motion that embody what people believe is good for them- selves and their children, the leverage of a few for the benefit of the many is often enormous." But we must overcome the lowered expec- tations for government and collective action drummed into us by the advertiser-driven media. So we must first raise expectations that change can be done. Whether it's the "hereditary factor" of being exposed to protest as a child or experiencing a preventable tragedy that motivates people to organize for change, we must all develop what Nader calls a "civic personality," the mindset that can overcome the superficiality of the culture industry that leads to demoralization and inaction. Let historic social change heroes inspire us. Nader cites the activism of individuals that have reasserted the civic boundaries around corporate action, including establishing the Fairness Doc- trine that until its revocation under Ronald Reagan, required equal access for opposing point of views on TV and radio, the public air- waves. And people like Concepcion Piccotto who mounted a 35-year vigil against nuclear weapons in front of the White House. And a dozen citizens who maximized their power, like Lois Gibbs, who organized to clean up the Love Canal and Wenonah Hauter, the founder and director for Food and Water Watch, focused on the safety of what we eat and drink. These activists turned their personal experience and commit- ment into movements. They are part of the small segment of Ameri- cans who have historically been the agitators for transformative change. Per Nader, this minority exerts enormous influence over social policy, and the rest of us need to join them to counter the power of corporations in the regulatory, judicial, political, and eco- nomic spheres. As Nader says, corporate power has insinuated itself into non-market political institutions. Democracy is the vehicle that can overrun corporate prerogatives, but it has been "hollowed out" and undermined by the privatization of civic life and the relentless primacy of profit. But what is to be done today? Nader has specific suggestions: devote 300 volunteer hours per year to advocacy in your legislative district with four or five other advocates; raise $200 as a participant in a local advocacy group; utilize the "Citizen Summons" to demand elected representatives appear before the people in a town hall; engage in creative social networking to promote an issues agenda. Throughout the book, Nader insists that taking that power is easi- er than we think. Though funneled and corralled into a narrow two- party political system, most people, in Nader's view, are neither Left nor Right, but in fact, "there is a bedrock commonality of what peo- ple…want out of life." Run for one of the 2.5 million local elected offices and advocate on issues that appeal to the Left and Right: demand a return of the airwaves to the public, defend and extend civil liberties, abolish unconstitutional acts of war, tax pollution, increase the minimum wage, rein in Wall Street, crack down on corporate crime, empower people to challenge corporations and the govern- ment in court. These all enjoy support across the false political divide. To do social change organizing requires the same kind of training and preparation we utilize to develop skills and knowledge that mat- ters to us in other areas. Such training is necessary to overcome the inertia of excuses: "I don't have time," "My job depends on me being quiet," "It's all too negative anyway," or "It won't make a difference." Personal bonding with people in your community and using social networks to drive movement building can liberate us. As Nader points out, the happiest people are those who organize for social change. "Freedom," he says, quoting Cicero the Roman philosopher, is "participation in power." —Michael Lighty Extreme Measures: Finding a Better Path to the End of Life By Jessica Nutik Zitter, MD; Avery Every once in a while, an honest, pro- found, and deeply personal narrative leaps from the pages of a book to remind us of our own sense of vulner- ability. One that compels us to reflect on our aspirations and reconsider our perceived failures, both as nursing and medical professionals and as car- ing human beings with the passion and desire to help and mentor others. Extreme Measures is at once provocative ("In medical school, no one teaches you how to let a patient die.") and compassionate. Dr. Zitter practices the unusual combination of critical and palliative care medicine at Highland Hospital, a public county hospital in Oakland, Calif. Her book traces her journey in critical care medicine from "wanting to be one kind of hero to another: a doctor who prioritizes the patient's values and preferences in an environment where the default choice is the extreme use of technology." Conversations between staff and patients about end-of-life arrangements often take place too late, according to Dr. Zitter. Peer- ing through her lens in chapter three, "Abandoned in a Sea of Options," we see the seeds of empathy and advocacy blossom into a life's calling through a series of poignant and satisfying stream-of-con- sciousness encounters that immediately draw the reader into her cir- cle. These crucial conversations and critical thought processes become the stepping stones toward "finding a better path to the end of life." On the topic of ventilator and long-term acute-care (LTAC) facil- ities, Dr. Zitter makes some compelling statements regarding the "conveyor belt of technology" in a place where "plugged-in patients" may begin to feel abandoned together with family who may have been set up for unrealistic expectations of our medical system. A worst-case scenario we all fear is being patients placed "squarely in the path of a mechanized death" without even knowing that we are dying while clinging to an unrealistic hope for an eleventh hour cure. "The belief that more is better runs deep in this culture, and the concept of autonomy morphing into allowing access to all the marketplace had to offer," writes Zitter. This is disturbing reading which continues in the section, "Health Care Providers Die Differently." Personal and anecdotal observation led Dr. Zitter to the realization that doctors and nurses that she worked with tended to opt out of the types of treatments that she offered as a matter of course, or those which were demand- ed by some of her patients. She cites a reference to a 2014 research study that validates the perception she shares with many colleagues. 14 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T | S E P T E M B E R 2 0 1 7