By Sara Faith Alterman
In the spring of 2003, Dr. Jessica Zitter, MD, was called into the ICU of UMDNJ in Newark to place a Swan-Ganz catheter in a patient with metastatic lung cancer, in order to assess her hypotension. Zitter swiftly explained the procedure to the patient’s husband, gowned and gloved, prepared the catheter kit, and was getting ready to insert the needle when she noticed another woman standing in the doorway. It was Patricia Murphy, an Advanced Practice Nurse who ran the family support team at the hospital. She put her hand to her ear, miming a telephone, and said “9-1-1? Get me the police. They’re torturing a patient in the University Hospital ICU.”
It was a life-changing moment for Zitter, who realized that she was about to perform an unnecessary procedure on a dying woman. Would the patient’s husband have consented, she wondered, if he knew that a Swan-Ganz catheter wouldn’t change his wife’s outcome or end her suffering?
Still, Zitter finished inserting the catheter. Her patient died the following day. And since then, Zitter has been dedicated to bringing palliative care practices into the ICU.
For this lecture, Zitter spoke of the history of the intensive care unit, the heroic mystique of its technology and the “glitter” of its life-saving procedures. She posits that doctors hide behind these technologies and procedures instead of communicating honestly and directly with patients, because frank communications can be harder and more painful than the procedures themselves. She also suggests that doctors prefer the “clean” process of procedures to that of “messy” communication with worried patients and families, in part because performing procedures satisfy a physician’s own need to “help.” She touches on the idea of the “end of life conveyer belt” in which many patients receive invasive ICU care at the end of life by default and are not given the opportunity to opt out.
She notes a 2013 study, which showed that 88.3% of doctors surveyed opted for a Do Not Resuscitate order if they were to become terminally ill. For many reasons, most patients grossly overestimate the survival rates after CPR and lack a clear understanding of what this aggressive therapy entails. Physicians know better.
Zitter suggests that adopting a patient-centric approach to care with “big picture” perspective and the option of “opting out” of ICU treatment could not only improve a patient’s quality of life, but also empower them to make informed decisions about their own life.
(lecture begins at 3:25)