Doctor Takes Death Education To High School Classrooms

MICHEL MARTIN, HOST:

Obviously, in our line of work, we value people who can lead difficult conversations. And one of the most difficult has to be talking about death. But that's become Dr. Jessica Zitter's life work. She's a clinical and palliative care specialist at Highland Hospital in Oakland, Calif. Working in intensive care, Dr. Zitter was often confronted with the sick and dying, and she began to notice that when patients died, everybody involved - family, friends, the patients themselves - were often woefully unprepared.

So Dr. Zitter decided to try to open up the conversation about death and dying to make it easier to talk about. She's written about her experiences in the ICU for The New York Times and The Atlantic, and now she's taking the subject into high school classrooms. Last month, she made her first presentation about death to a group of ninth-graders in Oakland, and she's been invited back. So we wanted to ask her how these presentations are going. So she was kind enough to talk to us from Phoenix where she's attending a conference. Dr. Zitter, thanks so much for speaking with us.

JESSICA ZITTER: Such a pleasure.

MARTIN: When you say that you find that people were kind of woefully unprepared, what do you mean by that? I mean, is it that patients didn't really understand what was coming or that family members are in denial? What do you mean by that?

ZITTER: For me as an ICU physician, one of the biggest things I'm concerned about is that so many people tend to come into the ICU and get attached to machinery because they've really started to deteriorate - their physiologic function is dropping fast. And they're on these machines which are keeping them alive, but we'd never had - they had never had any conversations about whether or not it would be OK to stay that way in perpetuity, or at least until their bodies died on those machines.

MARTIN: How was it decided that this is a good conversation to take into the classroom?

ZITTER: Well, I've been thinking about this issue for a long, long time. But I taught sex ed to my kids' school several years ago, and there was no one else to do it. But I really felt that I wanted to be the one to do it so that I could really do it honestly and not sort of talk about it in euphemistic ways.

And as I've sort of built my career in helping people try to die better, I've also realized that this is no different a taboo. Why are we not talking to our children - our ninth-graders, our tenth-graders - about this idea of preparing for death, about learning about all of our preferences so we have this openness within families so that, you know, all of the high school students and 20-year-olds who I see at the bedsides of grandparents who are dying have some sense of who this person was that can be helpful to me as I'm trying to make decisions about whether or not the patient wants us to continue these life-prolonging machines.

MARTIN: You know, there's always this question with - when you're talking to kids about sensitive subjects, about what they want to talk about versus what some parents want them to know about.

(LAUGHTER)

MARTIN: And so, you know, I'm dying to know what some of the kids' questions were and how you handled things that have become politicized, like physician-assisted suicide and things of that sort.

ZITTER: We didn't talk at all about physician-assisted suicide. I think that's a - or physician-assisted death - that's something that's way off of the level of what I want to be talking about. I just want to give them basic understandings of this phenomenon. The kids, in the beginning, when we ask them - well, what did you think when you heard we were coming in to talk to you about death and dying? And couple of kids kind of said - well, gee, it seemed kind of silly to me. You know, what's the big deal? You live, and then you just die. And what's there really to talk about?

And so I think when they started to hear little bit more about the period of dying and how dying isn't just a moment - it can be a protracted period of time, and they started to understand that - they did start to ask different questions about how they would be able to live. You know - would I be able to live at home on that machine? - and how do you want to be kept clean? And they just started asking questions that were really, honestly about living, not so much about dying.

MARTIN: Dr. Zitter, I see your point here. But could it be that your efforts might be better spent on the people who are really more likely to face this, like, for example, midlife people who are taking care of kids and probably taking care of seniors?

ZITTER: I don't think people really want to talk about this as an optional thing. If they have to - if they have a sick one in the hospital, they'll come to it at that point. But by then, honestly, it's kind of a little bit too late because there hasn't been much preparation.

I really believe that if people start to have this opened up and into their lives at a time when it's really not as threatening, hopefully, for these children - that's not really a personal thing - but they've started to hear these terms and started to understand the landscape of what can happen - the good, the bad and the control that they can have, then I think that they're going to be using that much more productively and much more upstream. And that's the kind of thing that I think really starts to make change in our culture.

MARTIN: That's Dr. Jessica Zitter. She's an intensive care physician in Oakland, Calif. Her new book is "Extreme Measures: Finding A Better Path To The End Of Life." And she recently began teaching death education to high school students. We reached her in Phoenix, where she's attending a conference, and she was nice enough to step out for a few minutes to talk to us.

Dr. Zitter, thanks so much for speaking with us.

ZITTER: Thank you so much for having me.

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