Death Interrupted: How Modern Medicine is Complicating the Way We Die

by Blair Bigham

NATIONAL BESTSELLER
In Death Interrupted , ICU doctor Blair Bigham shares his first-hand experiences of how medicine has complicated the way we die and offers a road map for dying in the modern era.
Doctors today can call on previously unimaginable technologies to help keep our bodies alive almost indefinitely. But this unprecedented shift in intensive care has created a major crisis. In the widening grey zone between life and death, doctors fight with doctors, families feel pressured to make tough decisions about their loved ones, and lawyers are left to argue life-and-death cases in the courts. Meanwhile, intensive care patients are caught in purgatory, attached to machines and unable to speak for themselves.
Through conversations with critical care and end-of-life professionals—including ethicists, social workers, nurses, and doctors—and observations from his own time working in ambulances, emergency rooms, and the icu, Dr. Blair Bigham exposes the tensions inherent in this new era of dying by addressing the tough questions facing us all.

Genres: Nonfiction, Medicine, Medical, Death, Health, Audiobook, Science

256 pages, Paperback

Published September 20, 2022

Reviews

[Janet Hutchinson · Rating 4 out of 5]

This was , in some ways, a heavy book to read, if only because we don’t talk about death. Not our death, not our family member deaths, none of it. As a paramedic and now a ICU doctor, Bigham has seen good, and not so good, deaths occur. His analysis of technology and its' complications that mean that death is no longer as easily defined as it was, and this has caused me to think a lot about my death - and that of my family. His advice at the end is important:
Think about death, talk about death, write about death, and live your life. Critical points to ponder for sure.

[Emily Burch · Rating 4 out of 5]

Thank you to House of Anansi Press and The Walrus Books for the ARC.

Death Interrupted is a critical care doctor's quest to reconcile the role of advancements in medical technology in today's world; examining their invention and integration into the critical care scene, as well as their unintended consequences. And the book is indeed unflinching in examining those consquences, bringing light to the reality that "surviving" certainly does not mean "living."

Dr. Bigham sheds light on the gray area between life and death, where patients may be kept alive thanks to machines that can maintain relatives stasis for their organs, the very things that make them human are lost. Along the way, Dr. Bigham covers long term acute care hospitals, DNRs/healthcare proxies/POAs, "slow codes," euthanasia, and the effect that insurance companies have on the ethics of all of this. It can be a bit of a meandering journey at times, reflective of the mental journey Dr. Bigham describes undertaking over the course of his career.

It's a fascinating deep dive into medicine, technology, bioethics, and the nature of life and death. I appreciate Dr. Bigham's honesty in exploring the topics that are so often shied away from until it's too late. He covers things that are controversial in terms of ethics (slow codes, etc.), providing insight as to differences between his native Canada and the U.S. healthcare system. He also touches on the importance of advance directives and the right to have a dignified death.

Overall, the book is a serious call to reconsider what it truly means to "do no harm;" a question that certainly must be continuously considered in the ever changing landscape of medicine.

[Christopher · Rating 5 out of 5]

Death Interrupted is smart, funny, compassionate, and poignant. In clear, approachable, and enjoyable prose, Dr. Bigham takes readers on a globe-trotting journey as he tries to understand how our most advanced medical technologies are leaving patients stranded somewhere between life and death. This book should be essential reading for anyone who might die one day.

[Bryan · Rating 5 out of 5]

This reinforces my wish to be a C1 Goals of Care.

[Risa ✿ · Rating 4 out of 5]

"Mors Vincit Omnia. Death Conquers All."

This was such an incredible read. We as a society have in a contradictory way, have tried to actively avoid the topic and concept of death, while at the same time being almost morbidly obsessed with it.

We'll watch tv shows where a new character dies every episode (looking at you GOT), and listen to true crime podcasts that go over the nitty, gritty, horrid details of death and murder without blinking an eye. Yet when it comes to our own mortality, or the mortality of those we love, we turn squeamish and turn any adjacent conversations into a full 180.

Blair Bingham sums this up pretty concisely with the quote "Like it or not, everyone you know will die. You will die. I will die. And its time we stop pretending that isn't the case." Through careers as both a paramedic and ER doctor, Bingham has come across hundreds of thousands of cases of death, from considerably 'normal' and 'expected' deaths, to those more shadowed in grey.

Though medicine in some form has been around for centuries, 'modern' medicine has bridged a gap that some argue should never have been bridged. Machines, technology and medicine have become so advanced that we can now keep someone alive, even if they aren't really 'living'. But with that power, how do you determine exactly when someone is truly 'dead' and how can you be expected to make that call, when there might be a chance that they could live?

Even if you're not familiar with medicine or think of death as a more taboo subject, this book is definitely worth the read. Bingham relays medicinal history (both old and new) and speaks on each side in an objective and compassionate voice, prompting thoughts and emotions that might not have been realized otherwise.

"Alive and dead aren't black and white. It's not binary, at least not anymore."

Death Interrupted is set to be published on September 20, 2022. Thank you to House of Anansi Press, The Walrus Books, NetGalley, and the author for the ARC.

[Brandi · Rating 4 out of 5]

As one who has been in the field a long time (greater than 20 years), I applaud Blair Bigham’s courage to pen this contemplative look at what modern medicine has done to the death and dying process. No one wants their loved ones to die. Yet, as Blair so blatantly puts it “like it or not, everyone you know will die. You will die. I will die. And it’s time we stop pretending this isn’t the case.” Life in the hospital is not like it is portrayed on TV; at all. These are hard conversations to have with patients and their loved ones. Just because we can keep someone alive, the question begs the asking, should we? Ultimately, at what cost? I love that Blair took the time to have in-depth conversations with people from all perspectives. Things are not always so black and white, and this is expressed beautifully in this book. Blair speaks from experience as a paramedic and then an ICU physician, where life-saving measures and priorities shift between paradigms. Whatever your views or beliefs, this is great book to get you thinking and to invite the conversation with others. It is necessary for health care providers to act ethically with the knowledge, resources, and skills we have been gifted with.
I received a complimentary copy from the publisher via NetGalley and all opinions expressed are solely my own, freely given.

[Tracy · Rating 5 out of 5]

I used to work in an ICU. I saw horrific things there, people kept alive and suffering because their families were unable to let them go. Doctors unwilling or unable to be honest with families, giving them hope that the loved one would one day return to their normal functioning. Families torn apart because they couldn’t agree on a plan of care or agree on withdrawal of care. A doctor who refused to palliate his patient because he didn’t want to be guilty of murder (that one was pre-MAID, but even then you could palliate patients, especially when all of their loved ones agreed it was for the best). I loved working there but I often felt traumatized and helpless. This book made me realize that physicians often feel the same way. My biggest take-away from this book is that you need to talk to your loved ones about how you want to die, write it down so that everyone knows what your wishes are. Realize that all of us die eventually, some sooner rather than later. My mother made me power of attorney for personal care because she knows I would make the tough decisions and help my family understand. I think I need one of those too.

[Destiny Javier · Rating 4 out of 5]

4.5 out of 5

a very poignant and thought-provoking read; i don’t know if this book leaves me feeling lighter or heavier. blair, a doctor with canadian roots (woot woot), does an excellent deep dive into our death dilemma. an honorable mention goes to an equation he comes up with: technology + resuscitation glorification + death denialism = false hope.

the biggest tragedy is our society fearing the end of life and vilifying/nullify anything that allows it, which perpetuates our reluctance in acceptance to a timely and dignified death. the main takeaway from this book: death— talk about it, normalize it, accept it. def a recommended read!

[Katie Lo · Rating 5 out of 5]

I think this book would be suitable for anyone, however I highly recommend it to any of my healthcare colleagues. I especially recommend it if you are finding you are frequently questioning the ethics of the care you are providing, or perhaps need to feel a little seen in your struggles of seeing the death dilemma played out over and over.

[Kaylin McNeely · Rating 5 out of 5]

“ we must also find a space in us to desire a death that comes at the right time. A death that is without suffering or pain or anxiety. A death that is comfortable, meaningful and dare I say, beautiful”. God i loved this book.

[Marita · Rating 4 out of 5]

All of my nursing friends should read this. It was interesting to read about the “grey area” in between life and death that we often see our patients in.
Also will spark some conversations for me with friends and loved ones regarding death and what we want that to look like.

[Enid Wray · Rating 5 out of 5]

This book is fabulous… a(nother) must read title…

If you’ve not already read This is Assisted Dying by Dr. Stefanie Green, then you must. These two titles are perfect companion pieces.

This is Assisted Dying explains the journey - the process, the reality of the lived (!!) experience of choosing MAiD.

This title takes you behind the scenes and provides the context - the history - for how we get/got to this point…. how we came to be so removed from the experience of death as an inevitability, and why we have so much trouble deciding what death is and how to approach it.

Where This is Assisted Dying is all about MAiD… this title only actually ever gets to - explicitly - discussing palliation, and palliative care, in the final section (starting at p179). But the entire book to that point has brought the reader to what really are inescapable conclusions about the end of life through an interrogative process that questions all of our assumptions and beliefs about what it means to be alive.

Read this book! Make sure that you have an Advance Care Plan and Personal Powers of Attorney in place. Talk to everyone you know about your wishes. Host a Death Over Dinner dinner party. Support your local palliative care hospice.

[Faith · Rating 5 out of 5]

As someone who feels plagued by moral distress at work often due to the grey zone the author focuses on throughout the entirety of the book, I found this book fascinating. As not only an ICU nurse with an interest in palliative care but as a human being I think this book is a must read. It was so interesting to read every single part of this book, the evolution of healthcare in just the last 50 years as well as the authors impressive career- which includes time and stories from the hospital I work at, conversations with so many different professionals and insightful, thought-provoking information into the death dilemma. The book is so well written and inspiring!! Will recommend to everyone I know.

[Ernest Liang · Rating 5 out of 5]

Very insightful book. Appreciated the wide ranging information sources and experiences recounted. The structure of the book is mostly a collection of interviews and the conversational tone that Dr. Brigham brings is very accessible and easy to follow. Highly motivated to start asking everyone about their death plan now.

[Liz · Rating 5 out of 5]

More to come on this one soon.

[Macaela · Rating 5 out of 5]

Read this book to help sift out moral distress working in the ICU. I loved this- it helped put words to my feelings at work and brought me a lot of perspective from all sides of critical care. Bought this book to revisit and reread as needed.

[Katie Horton · Rating 4 out of 5]

A very important book that everyone, whether in the health care field or not, should read. Dr Bigham, who has worked and studied in both Canada and the US discusses the “Death Dilemma” and how with life expectancy increasing, often the quality of life is decreasing. In Western culture the vast majority are afraid of death, we don’t talk about it, we don’t think about it and when we’re faced with it, we do a poor job of coping. With the advancement of medical technology, we can keep people alive for weeks, months, even years in an ICU. Sedated, ventilated and with multiple machines acting as your vital organs to keep you alive, but is it worth it? If the person recovers, will they forever be in need of 24/7 care, bed bound in a nursing home or hospital, is that something your or your loved one would want? This book tackles an increasingly important conversation we should all be having with our family and friends. When the time comes, what are your wishes? It’s a quick read, that encourages you to think about these topics. It highlights the importance of a dignified death something that I have seen time and time again squandered by our Canadian health care system. Do your loved ones a favour, read this book and have a discussion. It may be uncomfortable, but it’s worth it in the end.

[Joyce · Rating 5 out of 5]

As a nurse, I have grappled with the issues in this book many times. As a family member, I have been there. Best book on the subject I’ve read, from both a professional and a personal perspective.

[Rukhsar (rukhsandbooks) · Rating 4 out of 5]

I had the pleasure of attending Dr. Blair Bigham’s workshop at a conference last year. Dr. Bigham was an amazing presenter and workshop facilitator so I was very excited for his book. My expectations were high. He lived up to these expectations and provided a thought provoking, well researched, digestable read (also, he knows so many people and knows them enough to just call them up!).

Telling my friends I was reading this book allowed me to have many open and honest conversations with some of my loved ones. We talked about our experiences with death, my plans, their plans (or lack of) and had both serious and fun chats. Yes, I would like y’all to wear sequins and cowboy boots to my funeral. Yes, there will be music and a photographer, and please don’t be afraid to laugh out loud and hug lots. No, I don’t want to be connected to a bunch of machines as I float off into whatever comes next.

A wonderfully written book that I look forward to visiting again. I just might do my leadership fellowship on palliative care. I certainly can’t wait till planning our own journeys through end of life is a more acceptable, normal, and well supported topic.

[Riley Tubaro · Rating 5 out of 5]

What a great read for both people in and out of the medical field. For those who aren’t, this book will make you view death with a different perspective or even hopefully have you start thinking about decisions you want when dying (even if you think that’s not going to happen for a while, you should have the conversation now).

For those in the field, especially ICU nurses I feel this book summarized most of my ethical dilemmas and frustrations into one. I appreciate the way Bigham tries to work backwards on the problem and took into consideration religion, false hope, lack of education, and more. I felt this was very thorough and you were able to read similarities or slight differences between Canada and the US which I found interesting as well.

[Niki Monague · Rating 4 out of 5]

4/5 ⭐️
Absolutely loved this book and the way it’s written.
Dr. Blair Bigham tells the story of Life and Death from the POV of someone who used to work as a paramedic and the limited tools we had in our toolbox to “save lives” and compares to now, as a Physician who has more tools in the toolbox to prolong life. But.. when do you draw the line? How much is too much? Not only that but why is death such a taboo topic.. every single one of us is going to die eventually.

[Suepfeff · Rating 5 out of 5]

This is a book that everyone should read. Dr. Bigham writes with humour, passion, humility and curiousity. He takes an unusually frank look at death and dying, and a presents a call to action to individuals to openly discuss their wishes for end of life care with their families well before they think they need to do so. Death Interrupted will make you think long after you've finished the final page. Highly recommended.

[Emma MacDonald · Rating 5 out of 5]

I’m so glad I stumbled across the book. As a HCP myself I often struggle with the fine line of doing everything I can and knowing when doing everything is actually more harmful. Blair did an absolutely wonderful job of exploring every side of what he describes as the “death dilemma.” I couldn’t recommend this read enough!

[Christine · Rating 4 out of 5]

A topic we all need to think of (we all die) and the importance and meaning of what it is to be human and what it means to live. Heavy topic but a human centred heartfelt message that we can make the inevitable dying process less painful and more dignified. Will be passing this one out to friends, absolutely!

[Breanne Link · Rating 5 out of 5]

A must-read for people working in health care. I got hooked in the beginning with the fascinating history of CPR and defibrillators. And my interest grew with his summaries of interviews with palliative care specialists. Dr.Bigham does a fantastic job of analyzing the push and pull between family, physicians and machines and makes suggestions on how physicians can improve their ability to communicate with families when death is the most likely outcome.

[Jennifer · Rating 4 out of 5]

I think this is an important conversation to have, and I've also learned a few things with this book.
I do think it dragged on a bit at times, and I found myself rereading the same paragraph multiple times or skimming the pages. But overall super informative.

[Kathy Jonker · Rating 5 out of 5]

This is an excellent book. After I finished it, I very clearly told my husband my end of life wishes. Check! An intriguing read. I highly recommend it

[Kaitlyn Veneruz · Rating 5 out of 5]

Highly recommend this read to all my healthcare friends - especially if you’ve ever struggled with moral dilemmas surrounding death in the hospital.

[Connie · Rating 5 out of 5]

This book is eye-opening and essential.The author has experience as a paramedic and a doctor in intensive care. He gives an insider perspective on the difficulties and dangers of resuscitation when patients are in the grey zone between life and death. He doesn’t hold back on the ambiguity medical staff can experience on whether drastic life saving attempts are the best thing for patients who may have far worse lives as a result. He also gives an honest account of the confusion and terror of families who don’t know what to do when confronted with a seriously ill or injured loved one in intensive care.
If this book doesn’t motivate readers to put in place an advance care plan and talk about death with their families, then nothing will.

[Hannah Loomis · Rating 5 out of 5]

What a necessary reflection