Radiolab - Death Interrupted

Episode Date: December 15, 2023

As a lifeguard, a paramedic, and then an ER doctor, Blair Bigham found his calling: saving lives. But when he started to work in the ICU, he slowly realized that sometimes keeping people (and their hopes) alive just prolongs the suffering. He wrote a book arguing that a too-late death is just as bad as a too-early one, and that physicians and the public alike need to get better at accepting the inevitability of death sooner.  As the book hit the best-seller list, Blair’s own father got diagnosed with a deadly case of pancreatic cancer. Blair’s every impulse was in direct contradiction of the book he just wrote. What should he do? And how can any of us know when to stop fighting death and when to start making peace with it?Special thanks to Lucie Howell, Heather Haley EPISODE CREDITS:  Reported by - Latif NasserProduced by - Simon Adlerwith help from - Alyssa Jeong-PerryOriginal music and sound design contributed by - Simon Adlerwith mixing help from - Arianne WackFact-checking by - Natalie Middletonand Edited by  - Pat Walters EPISODE CITATIONS: Books:  Blair Bigham, Death Interrupted: How Modern Medicine is Complicating the Way We Die (https://zpr.io/a33mEMW64X5h)   Our newsletter comes out every Wednesday. It includes short essays, recommendations, and details about other ways to interact with the show. Sign up (https://radiolab.org/newsletter)! Radiolab is supported by listeners like you. Support Radiolab by becoming a member of The Lab (https://members.radiolab.org/) today. Follow our show on Instagram, X and Facebook @radiolab, and share your thoughts with us by emailing [e-mail]. Leadership support for Radiolab’s science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation Initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

Wait, you're listening to Radio Lab from WNYC. Hey, this is Radio Lab. I'm Laptop Nasser. Today I want to tell you a story that, well, it started with a cold email that I got a few weeks ago from the person it happened to. Hey, Lutthif. Hey, good to see you.

Likewise, sorry I'm a bit late here. This is Blair Bigum. He is a doctor in Toronto and the email, it almost felt like a confession. This is like a very, it's a very vulnerable pitch. Yeah, thank you for saying that. It's been, it's been very weird. And I knew that I would want it shared.

I just didn't know when. And so I called them up to talk to them about it. Okay, well let's, okay, let's rewind back to the beginning. Sure. How did you get into medicine or even just this area in general? Yeah. So, I mean, swimming for me was my childhood. The memories that I have are going to the pool.

And what do you do as soon as you can when you're a swimmer, you go and you become a lifeguard? Right. And so that was my entry into, you know, chest compressions, defibrillators, the idea of saving a life. And I remember that feeling of jumping into a pool for the first time to pull somebody out who was struggling. I remember just being like, that was the coolest feeling ever. And, you know,

growing up watching ER and Baywatch is like, you get the sense that you can go and really save people's lives. And that possibility just hooked him. I was like, that's it. My next move now is to become a paramedic. And so it goes to school for it. And for the next decade or so, he's riding around in ambulances. He's talking on the radio to the dispatcher. Using the defibrillator paddles.

Doing CPR, pulling people out of cars. He was saving lives. I was like living my dream and loving every minute of it. Until one day and one very particular call he got. Yeah, so I mean, I was working part time as a flight paramedic. A flight paramedic? Yeah, I was working part time as a flight paramedic. A flight paramedic? Yeah, I was working on a helicopter in Toronto.

Wow. We picked up this woman who had been struck by a dump truck. And for about 45 minutes, me and John, my colleague, that day, we worked our butts off. We were drenched in sweat. We were working as fast as we could to pour more blood into her as fast as she was losing it. Try to keep her oxygenated like we did everything. And we got to this hospital and we got into the resuscitation bay. And this surgeon who I respect and admire puts an ultrasound probe on her heart and he says, we're done here.

And it was the most jarring moment I can think of in my career. The moment of him saying we're done, it's like you just got hit by a baseball bat. Like you're sweating, you know, there's a lot all over you. Your heart rate's probably 130, right? Like you have just been basically running a marathon to save this person's life and all of a sudden it ends. I just remember feeling very confused and sad that day. I was like, I'm never gonna let anybody feel the way I felt that day.

I was really impacted by it. And so Blair became a doctor himself. Past four to a couple of years, he's on a fellowship at Stanford University in the ICU in 2020. And I end up locked in Stanford Hospital during the pandemic. As every ICU doctor and ICU fellow was, doing our very best to save COVID patients. And Blair says they were saving a lot of people. The technology is amazing. What we can do now that we couldn't do even 10 years ago, 20 years ago, is absolutely

incredible and it's why I'm a physician. But also, he started to notice this other thing happening. This thing that, as a paramedic, he had never really been around long enough to see. There comes this point where, after taking care of somebody for a little while, you and everybody around you starts to realize that they're not getting better. And so then I began getting a little bit uncomfortable of how we were keeping technology or even adding more technology to people's bodies when it was very clear that they were never going to survive.

Once you're on life support, once you're on those machines, it's really, really hard for you to die. I can adjust everything about the way your body functions. I can adjust your pH, I can adjust your hemoglobin, I can adjust the amount of air that moves in and out of your lungs and how much oxygen is in that air. I can adjust your blood pressure and your heart rate. I take over total control. And normally there's a curve, you get a bit sicker, and then you kind of plateau, and then you get a bit

better, and then we take off the life support, and then you go home. And sometimes the life support intensity just keeps going up and up and up and up. And there comes a point where you start to feel like you're hurting instead of helping. Yeah. Where nobody around you, none of your colleagues believe that this person is going to survive. None of the data suggests that they're going to survive. And yet we're obstructing them from crossing that finish line.

And as Blair spent more time in the hospital, he started to see more and more extreme examples of this. I had a mentor who had a patient who was brain dead. And so this patient is clinically dead. But their family sued the hospital to keep the patient on a ventilator. And so for 400 days, that ICU bed was occupied by a dead person. And, uh, well, I feel for the family, obviously, you would never want a family to think that you've declared death inappropriately. I think that's wrong on so many levels. He felt like it's just a waste. It doesn't make any sense. You know, of time, of money.

It costs over a million dollars a year to keep someone in an ICU bed. But more importantly, nobody wants to die that way. No one has ever told me I want to die attached to a bunch of machines sedated and unaware of my surroundings. And as Blair thought about this case and other ones like it, he started to notice this kind of contradiction. You know, he'd gotten into medicine to save people's lives, to keep them from dying too early. But that very desire was causing some of his visions to die too late.

And that can be as great a tragedy as people dying too early. Sometimes. The most humane thing we can do, the most loving thing that we can do for this patient, is to stop applying ourselves to them and let nature take its course. So Blair has this realization in September 2022. In his new book called Death Interrupted, How Modern Medicine Is Complicating the Way We Die? He writes a book about it.

Dr. Blair Beckham joins us now in studio. Welcome. Thank you. And it gets a bunch of attention. I did a decent amount of media. It made the two bestseller lists here in Canada. Started a lot of people across the country talking about it, including his own family. I mean, my mom was like, oh my god, we need to Started a lot of people across the country talking about it, including his own family.

I mean, my mom was like, oh my God, we need to have a power of attorney and we need to talk about all of this. Did that ever happen? Or it was just a conversation like, oh, we should do this. Yeah, yeah, it was all talk. I'm in the same place as my parents, I feel like right now, yeah.

Yeah, it's not, I mean, I fucking wrote a book saying, oh, you have to have this conversation and I'm like, oh my God, I haven't had the conversation with my own parents. Um, anyways, two months after my book comes out, you know, I've gone on the speaking tour. I've been like, yeah, we used too much technology. Sometimes it's okay to let people die.

And uh, my mom called me and said, your dad, like, there's something wrong with your dad's stomach. He's been complaining about it for a couple of days, and my life got turned upside down. That's when we come back. I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more

I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going to be a little bit more I'm going toop Nasser, this is Radio Lab. Just before the break, I see you, Dr. Blair Bigum, on the heels of a book tour advocating

for less intervention at the end of life, got a phone call from his mom. Are you the one in your family that when anyone is sick or whatever they call you? Every doctor will lament about if you're the only health care or nurse or paramedic, any health care professional. If you're the only one in the family, you're getting these text messages and photos of rashes and questions about baby spivers. And it's all coming to you. And so I didn't think too much of it when my mom calls and says, oh, like something's really wrong with your dad's stomach. And I said, all right, well dad's 75

and he's having abdominal pain. He needs to go to the emergency department and get a CAT scan period. And of course he doesn't. And then a few days later, my mom calls me back and I say, well, what did the cat, like, what did the doctor say? Oh, he hasn't gone. Yeah.

Well, mom, you just have to put him in the car and take him to the hospital and you tell the emerged doc that your son is Blair Brigham. He's an emergency doctor and he says, you need a cat scan. Right. And so they go to the emergency department and the says, you need a CAT scan. Right. And so they go to the emergency department and the doctor doesn't order a CAT scan. And my dad is not the type of person who's gonna go in and say,

my son's a doctor gives me a CAT scan. So he probably said something passive. I also have one of the polite Canadian parents so I know how that goes. Yes. And my dad, I know my dad, my dad just would have wanted to get the hell out of there, right? He doesn't want to be in a big crowd at emergency department. Right. Sure.

Anyways, my mom calls me back, right? Oh, it's still really bothering. Okay, mom. I Pull up my schedule. I say tomorrow at 10 a.m. my friend Scott starts his shift at my emergency department. You're gonna go tomorrow at 10, and you're gonna ask for Scott McGilvery, and you tell them your Blair Biggum's parents, and Scott's gonna take very good care of you. And I shoot Scott attacks, and I say, my dad's coming in with belly pain,

he's already been on a PPI, like figure it out. And I have, I don't think anything is gonna show up, right? And then the next day, I met work in the ICU, and my phone rings phone rings and I look at it and it's Scott's number. And I say, okay, so I kind of start walking out of the ICU because like I'm gonna have a conversation. And I answer the phone and Scott says, I'm really sorry, Blair, but I have some really bad news for you. And then he starts reading the radiologist report. Yeah. There's a four centimeter pancreatic mass invading the stomach.

The minute Scott started reading, I said fuck. That's a fatal pancreatic cancer. The reason pancreatic cancer is so famous and so deadly is because it grows silently until it's too big to cut out. And so the people who survive pancreatic cancer, it gets picked up before it becomes symptomatic through some sort of a good luck situation because they got a scan for something else.

But in the case of Blair's dad, it seemed like it was probably too late. And his cancer was of the type where you're talking about months, not years. And so I was just, I don't even know. The next 12 hours of my life are a total blur. I just, I couldn't leave the service that I was on. I had to keep caring for people, but I was just, I have no idea if I did a good job at work that they are not. I just could not think of anything.

An hour or two later, I called my dad, and I said, did Scott talk to you? He said, yep. I said, do you have any questions? And he said, no, not right now. And I said, okay, dad, I'm getting you into a surgical consult because we need surgery. If it's not operable, like then you've only got a year to live. Like we have to get you surgery.

And so then I did the most irrational stuff. I called the best pancreatic surgeon in the country and harassed his administration staff to get me in touch with him and said, I need you to see my dad tomorrow because I had hope that even though the odds were slim, that that surgeon was gonna say, I can cut this out of you.

And that yeah, you might need a bit of chemo after, but you know, like this is survivable. Like that's what I was waiting for. And so within a couple of days, there they were. Blair and his parents sitting in this doctor's office. And the surgeon came into that room and was clear as day. There is no surgical option. And we were just silent. We were just sitting there. Because I had set the expectation, I said like, like, if it's not surgical, then it's going to kill you. And I had told him that before the meeting. And so I remember sitting in that clinic office when the surgeon said, I cannot cut this out of you. And my dad just looked at me.

I remember his facial expression of just being like, there it is. It was, that was the moment that he knew that he was going to die of pancreatic cancer. And then I remember sitting in the Tim Horton's coffee shop with my mum and dad immediately after meeting with this top surgeon. And even though I knew that there was nothing they could do, because I've seen so many people die of pancreatic cancer, I was just so spun. I just went down that rabbit hole of what else can we do here? Can we do genetic testing on the tumor to see if it's susceptible to some special study

drug? You know, like I've kept having ideas of like, well, what about this? What about that? What about this? It's almost, it's from the outside to hear you tell this story, like you have all of this training, you've gone through this a million times, and then it happens with your family and it's like, none of that counts for anything. Like you're just... None of it.

No, like, I'm just spinning about all the ways my dad could die. Right. And so, despite everything. He started chemotherapy. And whenever I would propose this that or the other thing, my dad would say something like, yeah, yeah, yeah, yeah, okay, we'll do, okay, we can do another CT scan. Okay, yeah, we can do that.

Okay, yeah, we can do that. And then for the month of February, he actually felt pretty good. And then in March, I got another phone call from my mom that he's vomiting. And when you have pancreatic cancer in your vomiting, there's only one thing that's going on. And that's the mass in your stomach has blocked off where the food exits your stomach. And so your stomach can't drain. And that's what happened to my dad. And later that night, the hepato biliary surgeon called me and said, there's nothing I can do for your dad. There's nothing else that I can do. And so then I started saying things like, well, what if we did

a postpiloric feeding tube or can we, and he said, Blair, stop. I'm telling you that there's nothing that we can do right now. And then I remember we were talking with the surgeon around the bedside and I kept saying, well, what about like, can we switch to full fox? Like, can we switch chemotherapy regimens? And my dad yelled my name in like a very rough way and said, I just wanna be comfortable. We're done here. And I looked around the room and I was just like, okay, this is that moment. I'm the crazy Wacadoodle son that I'm still used

to seeing in the ICU where I work. And then that was it. Then it was palliative care and he died three weeks later. I was in that zone. I was in that physician scientist zone of like, fix this. I couldn't just sit there beside him. It was, I just found it infuriating to just sit there, knowing that this cancer was just growing in his abdomen. I couldn't handle the idea that there was nothing left to do here. I just couldn't get comfortable with that. Even though I promote it so often, I wrote a book about how people should value palliative care in the ICU, and here I was saying,

but not with my dad. The question that I have is like, oh my God, if Blair can't let go in this moment, if you can't do it, how can anyone else? How can anyone else? I don't know. I mean, I have been, I have seeped myself in this topic for four years now, and I don't have the answer yet. I want to end this story about endings with a beginning. A beginning that Blair's dad gave to him in his final days of life. On December 23rdrd just before Christmas might be on say for Nando and I got married. So Fernando

place this ring on the third finger of players and I'm gonna play a player I give you this ring as a symbol and pledge of the covenant we've made between us. For an end, oh, I give you this ring. For an end, oh, I give you this ring. And my dad, with the nasal gastric tube, shoved down his nose, draining his stomach into a bag with a rubber band around his arm, officiated. Whoa.

As a symbol and pledge. It's a symbol and one of the color we have made between us. It's a company. It's a company. Ladies and gentlemen, I present to you the very couple, Fernando and Blair. The wedding is how I'll remember my dad.

So I mean, yeah. That's it for this week. This episode was reported by me with help from Simon Adler, and it was produced by Simon Adler with help from Alssa Jung Perry. It was edited by Pat Walters, and we had mixing help from Arianne Wack, special thanks to Lucy Howell and Heather Haley. One very last thing. For the lab members out there,

we just dropped a bonus earlier. I think you should check out. It's an interview I did with one of our fact checkers, Diane Kelly. She's so fun and funny and good at her job. It was such a pleasure to do, and I think it'll be fun to hear. If you are not yet a lab member,

you can become one at RadioLab.org slash join. You get those kinds of bonus drops every once in a while, as well as exclusive swag, access to the entire radialab archive ad free. It's pretty fun. radialab.org slash join for yourself for a holiday gift for a loved one. I guess for an enemy too, if you why stop at loved ones.

That's all. Thank you so much. Catch you later. Radio Lab was created by Chad Abumrad and is edited by Soren Wheeler. Lulu Miller and Lotta Fnir are our co-hosts. Dylan Keath is our director of sound design. Our staff includes Simon Adler, Jeremy Bloom, Becca Bressler, McKetty Foster Keys, W. Harry Fortuna, David Gable, Maria Paz Gutierrez, Sindu Nyanosambadam, Matt Kielte, Annie McEwen, Alex Nieson, Alyssa John Perry, Sarrakari, Sarah Samback,

Arianne Wack, Pat Walters, and Molly Webster. With help from Timmy Broderick, our fact checkers are Diane Kelly, Emily Krieger, and Natalie Middleton. Hi, this is Ellie from Cleveland, Ohio. Leadership support for Radio Lab Science Programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, Assignments Foundation Initiative, and the John Templeton Foundation. Foundational support for Radio Lab was provided by the Alfred P. Sloan Foundation.

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