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Although we know there are persistent inequalities with poorly coordinated and limited access to healthcare services, including pal- liative care, she remains a knowledgeable advocate and expert for the provision of advanced life support in the appropriate context. In a chapter titled "All That Glitters," Dr. Zitter shares an epiphany moment from 2003, before the words "palliative care" were part of the general medical lexicon. She credits a confident "Family Support Team" RN, "someone brave enough to hold a mir- ror to my face," with dislodging her "inculcated beliefs" in the prac- tice of "life prolongation at all costs paradigm of care." The nurse inserted herself as an advocate and engaged with or on behalf of patients whenever she felt it was needed. She imparted an impor- tant lesson, and taught her "how to use the word dying with patients, and showed her patients would usually be appreciative, even relieved, to hear what they somehow knew to be true." What does a "good death" mean to you? What are the "what ifs" you should consider? What about your "Code Blue/CPR" status? What if you lose your ability to communicate your wishes, to give consent or withdraw consent for treatment? If the questions and the subject matter leave you at a loss for words, this book will help inform those often difficult and necessary discussions with your patients, and even with your own loved ones, beyond the awkward silences and secret fears. Dr. Zitter's approach to her subject is not prescriptive or didactic. It is infused with a sense of moral agency born of experience and intellectual curiosity, which inspires our calling to serve in the inter- ests of those entrusted to our care. She offers helpful insights, deftly illustrated with compelling case studies that permit the reader to build on their own experience (or lack thereof ), about how to bridge the personal gaps between patients who have a life-limiting illness and their significant others who are hoping for a cure. This book is a standout in the emerging field of end-of-life care. I highly recom- mend it! —DeAnn McEwen, RN Modern Death By Haider Warraich, MD; St. Martin's Press Haider Warraich is a cardiologist who said he felt compelled to write a book about death when, in one case with a dying patient, the entire family stood around expecting him—even though he was the youngest person in the room— to have all the answers. People know so little about death. And even though medical workers encounter death much more frequently than your average per- son on the street, it is still not a topic that providers discuss routinely with their patients. Outside hospital or clinic walls, it is not even considered polite to discuss in society at large. Warraich hopes to change all that and, by doing so, give people more information and power to ultimately attain the kind of death that they wish for themselves. In his book, Warraich provides a fascinating history of death, as it were. He starts off at the cellular level, explaining the three different types of cell death: apoptosis (cells that neatly self destruct), necrosis (cells that break down after being deprived of energy and nutrients), and autophagy (cells that in times of scarcity consume and recycle themselves). He drills down to this level because later, when he explores how we will eventually struggle to define life and death in humans, what happens at this level will have important "metaphysi- cal implications." "At any breathing moment in our lives, we have cells being bequeathed life and cells that are signaled to die. So even as we live, parts of us are constantly dying," writes Warraich. "We comprise cells that are both coming alive and dying at all times simultaneous- ly. What pushes us as humans closer to death is when the net pull of apoptotic forces exceeds that of mitotic ones." After briefly covering how little was known about death in earli- er, pre-modern medicine periods of history (causes of death were sometimes recorded as "fainted in bath" or "white swelling"), War- raich quickly brings us to the modern day. With an understanding of the germ theory of disease, the rise of hospitals, the creation of emergency 911 dispatch, modern pharmaceuticals, medical advances and techniques like CPR, modern devices like ventilators and portable defibrillator machines, and modern procedures such as transplants, bypass surgery, and cardiac catheterization, we have dramatically lengthened life spans and even "saved" from death those who, in an earlier era, would simply have perished. All of these advances, however, made the line between "alive" and "dead" very murky. People used to determine that death occurred when the heart stopped beating. A major problem arose, however, when we got so good that we could keep peoples' bodies alive—their hearts beating and lungs breathing—even when their brains were dead. Warraich explains how the definition of death in the late 1960s among the medical and legal community shifted to focusing on brain activity, what kind and frequency of activity could be detected, what constituted "brain death," and how that became the new standard for death. But even "brain death" was not easy to define or determine. "There are many patients who do not fully meet brain-death criteria yet are almost certain to have no recovery of their vital functions," writes Warraich. This led to major questions about the rights of patients and their families to refuse to exist in this type of limbo. In 1975, a young woman named Karen Ann Quinlan apparently overdosed on tranquilizers and alcohol and became comatose, breathing only with the help of a ventilator and "eating" through a nasogastric tube. Her parents decided to remove her from life sup- port, but her doctors refused. Warraich does not necessarily fault them; "This space was a complete ethical and legal vacuum at that time," he writes. The Quinlans filed a lawsuit that would go all the way to the New Jersey Supreme Court, which eventually decided in the Quinlan's favor. According to Warraich, the Quinlan case was seminal because it brought modern end-of-life care out into the public eye for all to see and debate, and was the first major case that delineated what a patient's rights were, subsequently leading to today's "right-to-die" movement. About halfway through the book, Warraich delves into the role religion, spirituality, or the lack of belief in either influences patients' views and approaches to death. He argues that medical professionals rarely discuss these matters with their patients, but that they should learn how to because a belief system that so heavily influenced patients while alive will certainly influence their death as well. Being sensitive to patients' religious and spiritual beliefs, or lack thereof, will improve their experience toward the end of life, he says. Warraich also dedicates chapters to discussing how, since death J U LY | A U G U S T | S E P T E M B E R 2 0 1 7 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 N A T I O N A L N U R S E 15