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I'm Latif 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, Latif. Hey.

Good to see you.

Likewise. Sorry I'm a bit late here.

This is Blair Bigham. He is a doctor in Toronto. And the email, it almost felt like a confession. This is like a very vulnerable pitch.

Yeah. Thank you for saying that. It's been very weird, and I knew that I would want it shared. I just didn't know when.

And so I called him up to talk to him about it.

Okay, well, 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 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 growing up watching Er and Baywatch, it's 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 goes to school for it. And for the next decade or so, he's riding around in ambulances, talking on.

The radio to the dispatcher, using the defibrillator paddles, doing CPR, pulling people out of car.

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 on a helicopter in Toronto, and, 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 base. 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.

It.

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 blood 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 going to let anybody feel the way I felt that day. I was really impacted by it.

And so Blair became a doctor himself.

Fast forward 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 ten 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, 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, well, a 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 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. 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 patients 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, and 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 Bickham 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 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, it was all talk.

I'm in the same place with my parents.

I feel like right now.

Yeah, 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. Anyways, two months after my book comes out, I've gone on the speaking tour. I've been like, yeah, we use too much technology. Sometimes it's okay to let people die. And 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.

Usually. My name.

Lattif Nasser. This is Radiolab. Just before the break, ICU, Dr. Blair Bigham, 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 healthcare or nurse or paramedic, any healthcare professional, if you're the only one in the family, you're getting these text messages and photos of rashes and questions about baby's fevers, and it's all coming to you, right? And so I didn't think too much of it. When my mom calls and says, oh, something's really wrong with your dad's stomach? 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 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 emerge 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 doctor doesn't order a CAT scan. And my dad is not the type of person who's going to go in and say, my son's a doctor, give me a CAT scan. So he probably said something passive.

I also have very polite canadian parents, so I know how that goes. Yes.

And 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, crowded emergency department. Right.

Sure.

Anyway, so my mom calls me back, right? Oh, it's still really bothering. Okay, mom. I pull up my schedule. I say, tomorrow at 10:00 a.m. My friend Scott starts his shift at my emergency department. You're going to go tomorrow at ten and you're going to ask for Scott McGilvery. And you tell them you're Blair Bigham's parents and Scott's going to take very good care of you. And I shoot Scott a text. And I say, my dad's coming in with belly pain. He's already been on a PPI. Like, figure it out. And I don't think anything is going to show up, right? And then the next day, I'm at work in the ICU, and my 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 I'm going to have a conversation. And I answer the phone, and Scott says, I'm really sorry, blur, but I have some really bad news for you. And then he starts reading the radiologist report. Yeah. So, there's a four centimeter pancreatic mass invading the stomach. The minute started reading, I said, fucking the common bile duct.

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 couldn't leave service that I was on. I had to keep caring for people. But I have no idea if I did a good job at work that day or 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? And 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, then you've only got a year to live. 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 ods were slim, that that surgeon was going to say, I can cut this out of you.

And that, yeah, you might need a bit of chemo after, but this is survivable. 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, if it's not surgical, then it's going to kill you. And I had told them 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 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 Hortons coffee shop with my mom 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? I 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 seen, 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.

None of it? No. 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, okay, yeah, 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 and you're 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 hepatobiliary 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 post pyloric feeding tube? 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, can we switch to full fox? Can we switch chemotherapy regimens?

And my dad yelled my name in, like a very gruff way and said, I just want to 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 whackadoodle son that I'm so 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.

Yeah. 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.

Okay, so we've got a bunch of candles here.

On December 23, just before Christmas, my fiance Fernando and I got married.

So Fernando, place this ring on the third finger of Blair's left hand. Blair, I give you this ring. Blair, I give you this ring as a symbol and pledge of the covenant we've made between us. Fernando, I give you this ring.

Fernando, I give you this ring. And my dad, with a nasogastric 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.

Of the.

Covenant we have made between us, ladies.

And gentlemen, I present to you the married couple, Fernando. And.

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 Alyssa Jung Perry. It was edited by Pat Walters. And we had mixing help from Ariane 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 is 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@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 Radiolab archive. Ad free is pretty fun. Radiolab.org join for yourself for a holiday gift for a loved one. I guess for an enemy too. Why stop at loved ones? That's all. Thank you so much. Catch you later.

Radiolab was created by Jad Abumrad and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co hosts. Dylan Keefe is our director of sound design. Our staff includes Simon Adler, Jeremy Bloom, Becca Bresler, Aketti Foster, Keys W. Harry Fortuna, David Gable, Maria Paz Gutierrez, Sindhu Nyana Sambadam, Matt Kilty, Annie McEwen, Alex Neeson, Alyssa Jong Perry, Sarakari, Sarah Sambach, Ariane 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 Radiolab Science programming is provided by the Gordon and Betty Moore Foundation Science Sandbox Assignments Foundation Initiative and the John Templeton foundation. Foundational support for Radiolab was provided by the Alfred Peace Loan Foundation.