2:00

That was the coolest feeling

2:02

ever. And, you know,

2:04

growing up watching ER and Fae

2:06

Wept, it's like, you

2:08

get the sense that you can go

2:11

and really save people's lives. And that

2:13

possibility just hooked him. I was like,

2:15

that's it, my next move now is

2:17

to become a paramedic. And so, go

2:19

to school for it, and for the

2:21

next decade or so, he's riding around

2:23

in ambulances, 25, one, Charlie, I

2:25

got me. Talking on the radio to the

2:27

dispatcher. Using the defibrillator paddles. Doing

2:29

CPR, pulling people out of car. He

2:31

was saving lives. I was like, living

2:34

my dream. And loving every minute of

2:36

it. Until... One

2:41

day, and one very particular call he

2:43

got. Yeah, so, I mean, I was

2:47

working part-time as a flight paramedic. A

2:49

flight paramedic? Yeah, I was working on

2:51

a helicopter in Toronto. Wow. We

2:54

picked up this woman who had been struck by a

2:56

dump truck. And for about

2:58

45 minutes, me and John,

3:00

my colleague that day, we worked our

3:03

butts off. We were drenched in sweat.

3:05

We were working as fast as we

3:07

could to pour more blood into her

3:09

as fast as she was losing it.

3:11

Try to keep her oxygenated. Like we

3:13

did everything. And we got to

3:15

this hospital, and we got into the

3:17

resuscitation bay. And this surgeon,

3:20

who I respect and

3:22

admire, puts an ultrasound

3:24

probe on her heart, and he says,

3:27

we're done here. And

3:34

it was the most

3:36

jarring moment I can think of in my

3:38

career. The

3:45

moment of him saying we're done,

3:48

it's like you just got hit by a

3:51

baseball bat. Like you're sweating. You

3:53

know, there's blood all over you. Your

3:56

heart rate's probably 130, right? Like

3:58

you have just been basically. running a marathon

4:00

to save this person's life, and

4:03

all of a sudden, it

4:05

ends. I

4:11

just remember feeling very

4:13

confused and sad that day. I

4:16

was like, I'm never going to let anybody feel the way

4:18

I felt that day. I was really impacted by it. And

4:21

so Blair became a doctor himself. Fast

4:25

forward a couple of years, he's on a fellowship

4:27

at Stanford University in the ICU in

4:29

2020. And

4:32

I end up locked in Stanford

4:34

Hospital during the pandemic, as

4:36

every ICU doctor and ICU fellow was, doing

4:40

our very best to save COVID

4:42

patients. And Blair says they were saving a

4:44

lot of people. The technology is amazing. What

4:46

we can do now that we couldn't do

4:49

even 10 years ago, 20 years ago, is

4:52

absolutely incredible. And it's why I'm a

4:54

physician. But also, he started to

4:56

notice this other thing happening, this thing

4:58

that as a paramedic, he had never

5:00

really been around long enough to see.

5:03

There comes this point where

5:06

after taking care of somebody for a little

5:08

while, you and everybody

5:10

around you starts to realize that they're

5:13

not getting better. And so

5:15

then I began getting a little bit uncomfortable of

5:18

how we were keeping technology

5:20

or even adding more technology

5:23

to people's bodies when it

5:25

was very clear that they were never

5:27

going to survive. Once

5:33

you're on life support, once you're on

5:35

those machines, it's

5:38

really, really hard for you to die. I

5:43

can adjust everything about the way

5:45

your body functions. I

5:48

can adjust your pH. I can adjust

5:50

your hemoglobin. I can adjust the

5:52

amount of air that moves in and out of your

5:54

lungs and how much oxygen is in that air. I

5:58

can adjust your blood pressure and your heart. rate.

6:03

I think over total control. And

6:07

normally there's a curve you get a bit thicker and

6:09

then you kind of plateau and then you get a

6:11

bit better and then we take off the life support

6:13

and then you go home. And

6:16

sometimes the life support intensity just

6:18

keeps going up and up and

6:20

up and up. And

6:23

there comes a point where you start

6:26

to feel like you're hurting instead of

6:28

helping. Where nobody around you,

6:31

none of your colleagues believe that this

6:33

person is going to survive. None of

6:35

the data suggests that they're going to survive. And

6:39

yet we're obstructing them from crossing that

6:41

finish line. And as

6:44

Blair spent more time in

6:46

the hospital, he

6:48

started to see more and more

6:50

extreme examples of this. I had

6:52

a mentor who had a patient

6:54

who was brain dead. And so

6:56

this patient is clinically dead. But

6:59

their family sued the hospital

7:01

to keep the patient

7:03

on a ventilator. And so for 400 days

7:06

that ICU bed was occupied

7:09

by a dead person. And

7:12

well, I feel for the family obviously

7:15

you would never want a family to

7:17

think that you've declared death inappropriately. I

7:19

think that's wrong on so many levels.

7:22

He felt like it's just a

7:24

waste. It doesn't make any sense. You

7:27

know of time, of money. It costs over

7:29

a million dollars a year to keep someone

7:31

in an ICU bed. But more

7:33

importantly, nobody wants to die that way.

7:36

No one has ever told me I

7:38

want to die attached to a bunch

7:40

of machines sedated and unaware of my

7:43

surroundings. And as Blair thought

7:45

about this case and other ones like it,

7:48

he started to notice this kind of contradiction.

7:52

You know, he'd gotten into medicine to

7:54

save people's lives, to keep them from

7:57

dying too early. But that very desire

8:00

was causing some of his patients to

8:03

die too late. And

8:05

that can be as great

8:07

a tragedy as people dying too early.

8:10

Sometimes. The most humane thing we can do, the

8:12

most loving thing that we can do for this

8:15

patient is to stop applying

8:18

ourselves to them and

8:20

let nature take its course. So

8:22

Blair has this realization and

8:25

in September 2022... In

8:28

his new book called Death Interrupted, How Modern Medicine

8:30

is Complicating the Way We Die... He writes a

8:32

book about it. Dr. Blair Bickham joins us now

8:35

in studio. Welcome. Thank

8:37

you. And he gets a bunch of attention. I

8:39

did a decent amount of media.

8:42

It made the two bestseller lists here in Canada.

8:44

Started a lot of people across the country talking

8:46

about it, including his own family. I mean, my

8:48

mom was like, oh my god, we need to

8:50

have a power of attorney and we need to

8:53

talk about all of this. Did that ever happen?

8:55

Like it was just a conversation like, oh, we

8:57

should do this. Yeah. Yeah.

9:00

It was all talk. Yeah.

9:03

Yeah. It's such an... And

9:06

I'm like, oh my god, I haven't had a conversation with my own

9:08

parents. Anyway, two months after

9:10

my book comes out, you know, I've gone on

9:12

the speaking tour. I've been like, yeah, we use

9:14

too much technology. Sometimes it's okay to let people

9:16

die. And

9:19

my mom called me and said, your

9:22

dad, like, there's something wrong with your dad's stomach.

9:27

He's been complaining about it for a couple of days and

9:33

my life got turned upside down. That's...

9:41

When we come back. Thank

9:56

you. not

14:00

yours. And

14:02

so I was just, I

14:07

don't even know. The next,

14:11

the next 12 hours

14:13

of my life are a total blur. I

14:17

just I had I couldn't leave the service that

14:19

I was on. I had to keep caring for

14:21

people, but I was just I

14:24

have no idea if I did a good job at work

14:26

that day or not. I just could not think of anything.

14:31

An hour or two later, I called

14:33

my dad and I said, did

14:35

Scott talk to you? And he said, yep. I

14:37

said, do you have any questions? And he

14:39

said, no, not right now. And I said,

14:42

okay, dad, I'm getting you into a surgical

14:44

consult because we need surgery. If

14:46

it's not operable, like then you've only got

14:48

a year to live. Like we have to

14:50

get you surgery. And so

14:52

then I did the most irrational

14:55

stuff I called the best

14:58

pancreatic surgeon in the country and harassed

15:00

his administration staff to get me in

15:02

touch with him and said, I need

15:05

you to see my dad tomorrow because

15:07

I had hope that no that even

15:09

though the odds were slim that that

15:11

surgeon was going to say, I can

15:13

cut this out of you. And that yeah, you

15:15

might need a bit of chemo after but you know, like

15:17

this is survivable. Like that's what I was waiting for. And

15:20

so within a couple of days, there they were

15:23

Blair and his parents sitting

15:26

in this doctor's office. And the

15:28

surgeon came into that room and

15:30

was clear as day, there

15:35

is no surgical option. And

15:37

we were

15:40

just silent, we were just sitting there. Because

15:43

I had set the expectation I said, like, like,

15:45

if it's not surgical, then then it's going to

15:47

kill you. And I had told them

15:49

that before the meeting. And so

15:51

I remember sitting in

15:53

that clinic office, when the surgeon

15:55

said, I cannot cut this out of you. And

15:58

my dad just looked at me. I remember his

16:00

facial expression of just being like, there it is. It

16:03

was that was the moment that he

16:06

knew that he was going to die

16:08

of pancreatic cancer. And

16:11

then I remember sitting in the Tim

16:13

Hortons coffee shop with my mom and

16:15

dad immediately after meeting

16:17

with this top surgeon. And

16:21

even though I knew that there

16:23

was nothing they could do, because

16:25

I've seen so many people die of

16:27

pancreatic cancer. I

16:30

was just so stunned. I

16:35

just went down that rabbit hole of

16:38

what else can we do here? Can

16:42

we do genetic testing on the tumor to see if

16:44

it's susceptible to some special study drug? You

16:48

know, like I kept having ideas

16:50

of like, well, what about this? What about that? What about that? It's

17:00

almost it's from the outside to

17:02

hear you tell this story. Like you have all of

17:04

this training. You've gone through this a

17:06

million times. And then

17:08

it happens with your family and it's like none

17:11

of that counts for anything. Like

17:13

you're none of it. No, like I'm

17:15

just spinning about all the ways my dad

17:17

could die. Right. And

17:20

so despite everything, he started

17:22

chemotherapy and and whenever

17:24

I would propose this, that or the other thing,

17:26

my dad would say something like, yeah, yeah, yeah,

17:28

okay. Yeah, we'll do okay. We can do another

17:30

CT scan. Okay. Yeah, we can do that. Okay.

17:33

Yeah, we can do that. And

17:36

then for the month of February, he actually

17:38

felt pretty good. And then in March, I

17:40

got another phone call from my mom that

17:42

he's vomiting. And

17:44

when you have pancreatic cancer in your vomiting,

17:46

there's only one thing that's going on. And

17:48

that's the the mass in your stomach has

17:50

blocked off where the food exits

17:52

your stomach. And so your stomach can't drain.

17:55

And that's what happened to my dad. And

17:58

later that night, hepatobiliary

18:00

surgeon called me and said, there's

18:03

nothing I can do for your dad. There's nothing

18:05

else that I can do. And

18:08

so then I started saying things like, well, what if

18:10

we did a post-pyloric feeding tube or can we, and

18:12

he said, Blair, stop. I'm

18:16

telling you that there's nothing that we can do right now.

18:21

And then I remember we

18:23

were talking with the surgeon

18:25

around the bedside and I kept saying, well,

18:27

what about, like, can

18:29

we switch to full fox? Like, can we

18:31

switch chemotherapy regimens? And my dad yelled

18:34

my name in like

18:36

a very gruff way and

18:39

said, I just want to be comfortable. We're

18:42

done here. And

18:45

I looked around the room and I

18:47

was just like, okay, this

18:51

is that moment. I'm

18:54

the crazy wackadoodleson that

18:56

I'm so used to seeing the ICU where I

18:58

work. And

19:01

then that was it. Then it was palliative care and he

19:03

died three weeks later. I

19:15

was in that zone. I was in

19:17

that physician scientist zone of like, fix

19:20

this. I couldn't

19:22

just sit there beside him. I

19:25

just found it infuriating to just sit there knowing

19:28

that this cancer was just growing in his

19:30

abdomen. I couldn't

19:32

handle the idea that there was nothing

19:34

left to do here. I

19:38

just couldn't get comfortable with that.

19:42

Even though I promote it so often, I wrote

19:44

a book about how people should value palliative care

19:46

in the ICU and here I was saying, but

19:49

not with my dad. So,

19:57

the question that I had was, The

22:01

wedding is how I'll remember my dad. So,

22:05

I mean... Yeah.

22:10

Yeah. That's

22:30

it for this week. This episode

22:32

was reported by me with help

22:34

from Simon Adler, and it was

22:36

produced by Simon Adler with help

22:38

from Alyssa Jung-Perry. It

22:40

was edited by Pat Walters, and we

22:42

had mixing help from Arianne Whack. Special

22:45

thanks to Lucy Howell and Heather

22:48

Haley. One

22:50

very last thing. For the lab members

22:53

out there, we just dropped a bonus

22:55

earlier. I think you should

22:57

check out. It's an interview I did with one of

22:59

our fact checkers, Diane Kelly. She's

23:02

so fun and funny and good at her job.

23:04

It was such a pleasure to do, and I

23:06

think it'll be fun to hear. If

23:10

you are not yet a lab

23:12

member, you can become one at

23:14

radiolab.org/join. You get those kinds of

23:16

bonus drops every once in a

23:18

while, as well as exclusive swag,

23:20

access to the entire Radiolab Archive

23:22

ad free. It's

23:24

pretty fun. radiolab.org/join

23:29

for yourself, for a holiday gift for a

23:31

loved one. I

23:34

guess for an enemy, too, if you... Why stop

23:37

at loved ones? That's

23:39

all. Thank you so much. Catch

23:43

you later. Thank you. Keith

24:00

is our director of sound design.

24:02

Our staff includes Simon Adler, Jeremy

24:04

Bloom, Becca Bressler, Kettie

24:07

Foster-Keys, W. Harry

24:09

Fortuna, David Gable, Maria

24:11

Paz Gutierrez, Sundu Nyana

24:13

Sambadam, Matt Kielty, Annie

24:15

McEwen, Alex Neeson, Alyssa

24:18

John Perry, Sara Kari, Sarah

24:20

Sambach, Ariane Wack, Pat

24:22

Walters, and Molly Webster. With help from

24:25

Timmy Broderick. Our fact checkers

24:27

are Diane Kelly, Emily Krieger, and

24:29

Natalie Middleton. Hi,

24:33

this is Ellie from Cleveland, Ohio. Leadership

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support for Radiolab science programming is

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24:42

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