Death Interrupted: How Modern Medicine Is Complicating the Way We Die
by Blair Bigham, MD, reviewed by Lara Stewart-Panko
With his training and experience as a journalist, paramedic, scientist, and emergency room and intensive care unit physician, Blair Bigham has done an excellent job providing a thorough yet accessible examination of how contemporary medicine has made death more challenging for patients, families, and care providers alike.
With Death Interrupted: How Modern Medicine Is Complicating the Way We Die, Bigham intertwines personal experiences with facts and others’ anecdotes, openly discussing his process in his “…pursuit of learning how to save people’s lives—and addresses my sense of discomfort around what to do when saving a life is unrealistic.” With a candid yet caring tone, he speaks to the impacts of the do-everything mentality at end-of-life, gives a window into the realities of an ICU, and communicates clearly his value of peaceful, timely, dignified death.
He details fascinating, key aspects of medical history and typical experiences of dying in generations past, noting pivotal moments in advances in treatments that would come to change the landscape of living and dying. Bigham’s survey is sweeping and engaging. He addresses factors in the fields of science, technology, bioethics, law, and economics that all play into how end of life is handled. Eye-opening statistics are sprinkled throughout the book, right alongside pearls of heartfelt wisdom. While most of the content focuses on the United States and Canada, there are some meaningful references from other countries as well, and rich, insightful interviews with leaders in the world of dying.
In addition to discussing various definitions of death from both medical and religious perspectives, Bigham deepens the conversation by exploring organ donation through several medical and cultural lenses. He gives the reader a window into medical culture, showcasing legal and stylistic differences between regions and facilities, illustrating how lack of consensus in areas of medicine—including end of life—can lead to unnecessary suffering for patients, their loved ones, and caregivers. He even delves into the politics between different branches of medicine.
Bigham shares powerful stories from his time both as a student and as a practitioner regarding the importance of relationships between caregivers, their patients, and families. He emphasizes skillful communication and the benefits of slowing down to allow relationships to deepen before discussing goals of care, and he articulates how mainstream entertainment about medicine and death sometimes complicates the public’s understanding of what is and isn’t possible. With compassion and wisdom, Bigham introduces relevant concepts, such as “flipping the plan,” and he gives beautiful space to the role of palliative care. There are explicit examples of helpful and unhelpful types of communication that can transpire between caregivers and loved ones, highlighting the challenge of balancing choice, guidance, ethics, and mercy in situations that are highly emotionally charged.
Not surprisingly, Bigham advocates for the creation of advance directives, and he champions an approach to death that emphasizes it as a part of life. There is some exploration of MAiD and other ways medicine may facilitate dying, and a modest foray into technologies that aim to prolong life in impractical ways. At the conclusion of the book, the reader is offered some concise parting instructions, perhaps the most important being: “Live your life. As an emergency doctor, I am reminded daily that death is inevitable but far from predictable. Live well.”