Blair Bigham’s new book “Death Interrupted” asks: how do we know a patient’s dead and what does that mean for care? Read an excerpt

WhatsOn Sep 22, 2022 by Blair Bigham Toronto Star

What does it mean to die? While the answer might seem obvious, modern technology can keep our bodies and organs alive almost indefinitely. What does that mean about how we make decisions about health care in life and death cases, for our loved ones and for ourselves? Those are some of the questions Dr. Blair Bigham explores in his new book “Death Interrupted: How Modern Medicine Is Complicating the Way We Die,” which begins with a simulated life-or-death disaster.

“What about this one?” Rakesh hollered at me across the auditorium-turned-emergency room. He was pointing at a stretcher two paramedics were rolling past him.

“She’s dead dead,” I yelled back, before returning to triaging the tidal wave of medical students made up with smoke-streaked faces, red-dyed corn syrup blood, and paper mâché burns.

We were about thirty minutes into a disaster simulation in my medical residency at McMaster University, a test of our hospital’s emergency department, and of us as senior residents, to handle an unexpected influx of injured patients. The script was predictable: a nearby soccer stadium had been attacked with improvised explosives, and concerns about chemical weapons were being reported by various sources.

Judges in black T-shirts hovered around with clipboards, detailing our actions for the debriefing that would follow. Over 100 patients in 100 minutes had to be sorted and attended to, and it was my job to assign one of four priorities to each of them and place a index-card-sized triage tag around their necks with a colour to indicate my decision.

Green was good: it meant they could walk and talk and sit in a chair for hours while we tended to the sickest patients. Yellow was pretty much okay too: they could wait but had the potential to deteriorate. Red was bad: they had injuries like bleeding arteries and collapsed lungs and required immediate treatment to save their lives. And blue was the worst: they were dead. In the old days, those tags used to be black, and the phrase “black tagged” had become synonymous with “dead.” That was why we’d changed the code to blue: so as not to freak anyone out by slapping a black tag on their friend.

Here’s the thing, though. The criteria for a blue tag in a mass casualty situation isn’t what you’d think. It doesn’t mean you’re dead, though you might be. Blue technically stands for expectant — meaning that even if we treated you, you’d still likely die. The tricky part for me, as the triage officer, was that the odds of someone dying was tied to the availability of doctors, nurses, ventilators, surgeons, blood, chest drains, CT scanners, and all the other things that make a hospital tick. If resources were in good supply, the patient was a red — and a trauma team would do everything possible to save their life. But if someone was a blue, they were off to the morgue.

It was up to Rakesh and me, randomly assigned to the two most critical roles in the exercise, to save as many lives as we could. We were both fifth-year residents, and when we weren’t training together in the hospital, we often hung out at Synonym or at Truth, two indie coffee shops on gentrified James Street, where we basically camped out for entire days to study or gossip with a constant stream of overpriced caffeine.

If you didn’t know him any better, you’d think Rakesh wasn’t that interested in being a doctor, but he’s just a super mellow guy, which is one of the reasons he became my best friend in residency. So it gave me some amusement to see him amped up during the simulation, yelling at me from the mock trauma bay he was assigned to. It was a sign the simulation was working: we were feeling the heat in the disaster we’d been thrown into by the simulation team.

Rakesh had just opened up a space for another critical patient when he asked me about the body being wheeled past on the stretcher. I’d given her a blue tag. To the many observers, it would appear that he was asking if she was dead. But I knew he really wanted me to say how dead I thought she was, whether she was worth the precious resources he was allocating. And not for the first time in my career, I declared the odds to be zero. She was “dead dead,” I told him.

When the phrase came out of my mouth, I took a pause. It wasn’t so much an intellectual moment, because there was no time for those. In the chaos of the emergency room, instinct and gut decisions reign. It was more an acknowledgement that “alive” and “dead” aren’t black and white. It’s not binary, at least not anymore. And for doctors like me, that presents a dilemma of enormous magnitude.

Treating dead people is just part of the job when you’re a paramedic or an emergency room nurse or an intensive care doctor. Restoring a heartbeat requires nothing more than solving a physiological riddle. Life requires very little for it to chug along: oxygen, glucose and heat are the only ingredients needed for the power plants in your cells. As long as you can get those three ingredients from the environment into your body, and circulate them to your nose and toes and everything in between, you can be kept going.

You might hope scientists and doctors could see life and death in a black and white way: a binary construct with clear definitions. I certainly did in my life as a paramedic, where the calls I responded to with lights and sirens blaring had clear-cut stakes: there were those who could be saved, and there were those who proved to be beyond chest compressions, epinephrine, and blood transfusions, who couldn’t be saved, no matter our desire or skill or brilliance. The dead dead.

But as I transitioned from the field to the emergency room and then the intensive care unit, I began to lose clarity around diagnosing death. The line became blurry. And sometimes I didn’t really know if a patient was dead or not. That’s a problem for a physician. As I explored a contemporary definition of death, I realized this might help you too. Because like it or not, everyone you know will die. You will die. I will die. And it’s time we stop pretending that isn’t the case.

This isn’t about terrorist attacks or pandemics, the times when there isn’t enough medicine to go around and, like Rakesh and me, we have to prioritize precious resources to those most likely to live. It’s about the day-to-day struggle caused by too much medicine, the new grey zone caused by the ever-expanding suite of technological and pharmaceutical choices available to doctors that delay a person from being dead dead but might do little to restore life.

This is about a place worse than death. A place where doctors despair at the hope families cling to as we poke and prod the patient, pandering to our own egos, afraid to acknowledge that we have failed in our role as life-savers. It is about the space between alive and dead, a space I hope never to occupy personally, but one I am guilty of filling, over and over again, with others I’m tasked to care for.

Excerpted from “Death Interrupted: How Modern Medicine Is Complicating the Way We Die” copyright (c) 2022 by Dr. Blair Bigham. Reprinted with permission from House of Anansi Press. www.houseofanansi.com

Blair Bigham’s new book “Death Interrupted” asks: how do we know a patient’s dead and what does that mean for care? Read an excerpt

“Alive” or “dead” is no longer black and white — for doctors, that presents a huge dilemma on allocating care, and allows us some control of when and how we die.

WhatsOn Sep 22, 2022 by Blair Bigham Toronto Star

What does it mean to die? While the answer might seem obvious, modern technology can keep our bodies and organs alive almost indefinitely. What does that mean about how we make decisions about health care in life and death cases, for our loved ones and for ourselves? Those are some of the questions Dr. Blair Bigham explores in his new book “Death Interrupted: How Modern Medicine Is Complicating the Way We Die,” which begins with a simulated life-or-death disaster.

“What about this one?” Rakesh hollered at me across the auditorium-turned-emergency room. He was pointing at a stretcher two paramedics were rolling past him.

“She’s dead dead,” I yelled back, before returning to triaging the tidal wave of medical students made up with smoke-streaked faces, red-dyed corn syrup blood, and paper mâché burns.

We were about thirty minutes into a disaster simulation in my medical residency at McMaster University, a test of our hospital’s emergency department, and of us as senior residents, to handle an unexpected influx of injured patients. The script was predictable: a nearby soccer stadium had been attacked with improvised explosives, and concerns about chemical weapons were being reported by various sources.

Judges in black T-shirts hovered around with clipboards, detailing our actions for the debriefing that would follow. Over 100 patients in 100 minutes had to be sorted and attended to, and it was my job to assign one of four priorities to each of them and place a index-card-sized triage tag around their necks with a colour to indicate my decision.

Green was good: it meant they could walk and talk and sit in a chair for hours while we tended to the sickest patients. Yellow was pretty much okay too: they could wait but had the potential to deteriorate. Red was bad: they had injuries like bleeding arteries and collapsed lungs and required immediate treatment to save their lives. And blue was the worst: they were dead. In the old days, those tags used to be black, and the phrase “black tagged” had become synonymous with “dead.” That was why we’d changed the code to blue: so as not to freak anyone out by slapping a black tag on their friend.

Here’s the thing, though. The criteria for a blue tag in a mass casualty situation isn’t what you’d think. It doesn’t mean you’re dead, though you might be. Blue technically stands for expectant — meaning that even if we treated you, you’d still likely die. The tricky part for me, as the triage officer, was that the odds of someone dying was tied to the availability of doctors, nurses, ventilators, surgeons, blood, chest drains, CT scanners, and all the other things that make a hospital tick. If resources were in good supply, the patient was a red — and a trauma team would do everything possible to save their life. But if someone was a blue, they were off to the morgue.

It was up to Rakesh and me, randomly assigned to the two most critical roles in the exercise, to save as many lives as we could. We were both fifth-year residents, and when we weren’t training together in the hospital, we often hung out at Synonym or at Truth, two indie coffee shops on gentrified James Street, where we basically camped out for entire days to study or gossip with a constant stream of overpriced caffeine.

If you didn’t know him any better, you’d think Rakesh wasn’t that interested in being a doctor, but he’s just a super mellow guy, which is one of the reasons he became my best friend in residency. So it gave me some amusement to see him amped up during the simulation, yelling at me from the mock trauma bay he was assigned to. It was a sign the simulation was working: we were feeling the heat in the disaster we’d been thrown into by the simulation team.

Rakesh had just opened up a space for another critical patient when he asked me about the body being wheeled past on the stretcher. I’d given her a blue tag. To the many observers, it would appear that he was asking if she was dead. But I knew he really wanted me to say how dead I thought she was, whether she was worth the precious resources he was allocating. And not for the first time in my career, I declared the odds to be zero. She was “dead dead,” I told him.

When the phrase came out of my mouth, I took a pause. It wasn’t so much an intellectual moment, because there was no time for those. In the chaos of the emergency room, instinct and gut decisions reign. It was more an acknowledgement that “alive” and “dead” aren’t black and white. It’s not binary, at least not anymore. And for doctors like me, that presents a dilemma of enormous magnitude.

Treating dead people is just part of the job when you’re a paramedic or an emergency room nurse or an intensive care doctor. Restoring a heartbeat requires nothing more than solving a physiological riddle. Life requires very little for it to chug along: oxygen, glucose and heat are the only ingredients needed for the power plants in your cells. As long as you can get those three ingredients from the environment into your body, and circulate them to your nose and toes and everything in between, you can be kept going.

You might hope scientists and doctors could see life and death in a black and white way: a binary construct with clear definitions. I certainly did in my life as a paramedic, where the calls I responded to with lights and sirens blaring had clear-cut stakes: there were those who could be saved, and there were those who proved to be beyond chest compressions, epinephrine, and blood transfusions, who couldn’t be saved, no matter our desire or skill or brilliance. The dead dead.

But as I transitioned from the field to the emergency room and then the intensive care unit, I began to lose clarity around diagnosing death. The line became blurry. And sometimes I didn’t really know if a patient was dead or not. That’s a problem for a physician. As I explored a contemporary definition of death, I realized this might help you too. Because like it or not, everyone you know will die. You will die. I will die. And it’s time we stop pretending that isn’t the case.

This isn’t about terrorist attacks or pandemics, the times when there isn’t enough medicine to go around and, like Rakesh and me, we have to prioritize precious resources to those most likely to live. It’s about the day-to-day struggle caused by too much medicine, the new grey zone caused by the ever-expanding suite of technological and pharmaceutical choices available to doctors that delay a person from being dead dead but might do little to restore life.

This is about a place worse than death. A place where doctors despair at the hope families cling to as we poke and prod the patient, pandering to our own egos, afraid to acknowledge that we have failed in our role as life-savers. It is about the space between alive and dead, a space I hope never to occupy personally, but one I am guilty of filling, over and over again, with others I’m tasked to care for.

Excerpted from “Death Interrupted: How Modern Medicine Is Complicating the Way We Die” copyright (c) 2022 by Dr. Blair Bigham. Reprinted with permission from House of Anansi Press. www.houseofanansi.com

Blair Bigham’s new book “Death Interrupted” asks: how do we know a patient’s dead and what does that mean for care? Read an excerpt

“Alive” or “dead” is no longer black and white — for doctors, that presents a huge dilemma on allocating care, and allows us some control of when and how we die.

WhatsOn Sep 22, 2022 by Blair Bigham Toronto Star

What does it mean to die? While the answer might seem obvious, modern technology can keep our bodies and organs alive almost indefinitely. What does that mean about how we make decisions about health care in life and death cases, for our loved ones and for ourselves? Those are some of the questions Dr. Blair Bigham explores in his new book “Death Interrupted: How Modern Medicine Is Complicating the Way We Die,” which begins with a simulated life-or-death disaster.

“What about this one?” Rakesh hollered at me across the auditorium-turned-emergency room. He was pointing at a stretcher two paramedics were rolling past him.

“She’s dead dead,” I yelled back, before returning to triaging the tidal wave of medical students made up with smoke-streaked faces, red-dyed corn syrup blood, and paper mâché burns.

We were about thirty minutes into a disaster simulation in my medical residency at McMaster University, a test of our hospital’s emergency department, and of us as senior residents, to handle an unexpected influx of injured patients. The script was predictable: a nearby soccer stadium had been attacked with improvised explosives, and concerns about chemical weapons were being reported by various sources.

Judges in black T-shirts hovered around with clipboards, detailing our actions for the debriefing that would follow. Over 100 patients in 100 minutes had to be sorted and attended to, and it was my job to assign one of four priorities to each of them and place a index-card-sized triage tag around their necks with a colour to indicate my decision.

Green was good: it meant they could walk and talk and sit in a chair for hours while we tended to the sickest patients. Yellow was pretty much okay too: they could wait but had the potential to deteriorate. Red was bad: they had injuries like bleeding arteries and collapsed lungs and required immediate treatment to save their lives. And blue was the worst: they were dead. In the old days, those tags used to be black, and the phrase “black tagged” had become synonymous with “dead.” That was why we’d changed the code to blue: so as not to freak anyone out by slapping a black tag on their friend.

Here’s the thing, though. The criteria for a blue tag in a mass casualty situation isn’t what you’d think. It doesn’t mean you’re dead, though you might be. Blue technically stands for expectant — meaning that even if we treated you, you’d still likely die. The tricky part for me, as the triage officer, was that the odds of someone dying was tied to the availability of doctors, nurses, ventilators, surgeons, blood, chest drains, CT scanners, and all the other things that make a hospital tick. If resources were in good supply, the patient was a red — and a trauma team would do everything possible to save their life. But if someone was a blue, they were off to the morgue.

It was up to Rakesh and me, randomly assigned to the two most critical roles in the exercise, to save as many lives as we could. We were both fifth-year residents, and when we weren’t training together in the hospital, we often hung out at Synonym or at Truth, two indie coffee shops on gentrified James Street, where we basically camped out for entire days to study or gossip with a constant stream of overpriced caffeine.

If you didn’t know him any better, you’d think Rakesh wasn’t that interested in being a doctor, but he’s just a super mellow guy, which is one of the reasons he became my best friend in residency. So it gave me some amusement to see him amped up during the simulation, yelling at me from the mock trauma bay he was assigned to. It was a sign the simulation was working: we were feeling the heat in the disaster we’d been thrown into by the simulation team.

Rakesh had just opened up a space for another critical patient when he asked me about the body being wheeled past on the stretcher. I’d given her a blue tag. To the many observers, it would appear that he was asking if she was dead. But I knew he really wanted me to say how dead I thought she was, whether she was worth the precious resources he was allocating. And not for the first time in my career, I declared the odds to be zero. She was “dead dead,” I told him.

When the phrase came out of my mouth, I took a pause. It wasn’t so much an intellectual moment, because there was no time for those. In the chaos of the emergency room, instinct and gut decisions reign. It was more an acknowledgement that “alive” and “dead” aren’t black and white. It’s not binary, at least not anymore. And for doctors like me, that presents a dilemma of enormous magnitude.

Treating dead people is just part of the job when you’re a paramedic or an emergency room nurse or an intensive care doctor. Restoring a heartbeat requires nothing more than solving a physiological riddle. Life requires very little for it to chug along: oxygen, glucose and heat are the only ingredients needed for the power plants in your cells. As long as you can get those three ingredients from the environment into your body, and circulate them to your nose and toes and everything in between, you can be kept going.

You might hope scientists and doctors could see life and death in a black and white way: a binary construct with clear definitions. I certainly did in my life as a paramedic, where the calls I responded to with lights and sirens blaring had clear-cut stakes: there were those who could be saved, and there were those who proved to be beyond chest compressions, epinephrine, and blood transfusions, who couldn’t be saved, no matter our desire or skill or brilliance. The dead dead.

But as I transitioned from the field to the emergency room and then the intensive care unit, I began to lose clarity around diagnosing death. The line became blurry. And sometimes I didn’t really know if a patient was dead or not. That’s a problem for a physician. As I explored a contemporary definition of death, I realized this might help you too. Because like it or not, everyone you know will die. You will die. I will die. And it’s time we stop pretending that isn’t the case.

This isn’t about terrorist attacks or pandemics, the times when there isn’t enough medicine to go around and, like Rakesh and me, we have to prioritize precious resources to those most likely to live. It’s about the day-to-day struggle caused by too much medicine, the new grey zone caused by the ever-expanding suite of technological and pharmaceutical choices available to doctors that delay a person from being dead dead but might do little to restore life.

This is about a place worse than death. A place where doctors despair at the hope families cling to as we poke and prod the patient, pandering to our own egos, afraid to acknowledge that we have failed in our role as life-savers. It is about the space between alive and dead, a space I hope never to occupy personally, but one I am guilty of filling, over and over again, with others I’m tasked to care for.

Excerpted from “Death Interrupted: How Modern Medicine Is Complicating the Way We Die” copyright (c) 2022 by Dr. Blair Bigham. Reprinted with permission from House of Anansi Press. www.houseofanansi.com