Interview with the author: Blair Bigham

In Death Interrupted, Blair Bigham reflects on how advances in modern medicine have complicated the way we die. Bigham weaves together conversations with end-of-life professionals and his own experience as a paramedic, scientist, emergency medicine physician and journalist. It delves into the tension created when doctors can call on previously unimaginable technologies to keep our bodies alive but have also widened the grey zone between life and death.

Healthy Debate sat down with Bigham, a member of our deputy editorial team, to talk about his experience writing Death Interrupted. This interview has been edited for length and clarity.

Q: What inspired you to write Death Interrupted?

A: The book is based on an essay I’d written for the Walrus in May 2019. It was inspired by a colleague who was peripherally involved in two cases of brain death that simultaneously went to court. The families disagreed with the physicians about the definition of and validity of brain death when it came to withdrawing technological support. I found that really interesting and problematic.

As somebody who was interested in being an ICU doctor, I wanted to pursue it. After it ran, I got really lucky. House of Anansi, my publisher, saw the article and asked if I would like to write a book on it. I didn’t think I’d ever write a book, but the opportunity to expand on some of the challenges that I had found in reporting for the Walrus seemed worthwhile.

Q: You definitely wear a lot of hats. You’re a journalist, now author, physician, teacher, you’re also on Healthy Debate’s deputy editorial board, just to name a few. What drew you to these roles? How did you decide to blend, for example, journalism and medicine?

A: I was a drama kid in high school. I worked in community theater for a bit and realized that it wasn’t much of a lifestyle and eventually decided I wanted to pursue a science career instead. After I met a couple of paramedics at a party, that seemed like a cool option. I started a joint program in paramedicine at the University of Toronto, and I fell in love with paramedicine and left theater behind.

As a paramedic, I got really interested in resuscitation, which led me to do my Master of Science. Later, I pursued advanced training to work on helicopters, which largely deal with interfacility transports and highway accidents. The transports are ICU to ICU most of the time, so I became really interested in critical care.

We tend to see a lot of problems as paramedics that aren’t necessarily scientific conundrums but are rooted in social disparities. It can be frustrating when often your only avenue to help people is to drive them to the hospital. Eventually, I started medical school under the presumption that I would be able to fix some of the challenges I couldn’t as a paramedic. I gravitated toward emergency medicine but early in my residency, I realized that the emergency department is also a revolving door. The same things that frustrated me as a paramedic frustrated me as a physician.

In medicine, we use the term “advocacy” for many different things, including trying to elevate the voices of people who are marginalized or people who suffer from systemic disparities within health care. Journalism has similar principles around speaking for those who are affected by wrongdoing and holding people in power to account. I decided to enroll in a journalism program at the Munk School at University of Toronto – and things kind of took off from there. I was able to blend that artistic part of my brain that I had abandoned years ago with my love of science and medicine.

Some of my stories led to huge policy announcements. It felt rewarding to affect change through my writing. I began blending my medical work with my journalism. That continued through my emergency medicine residency and then in my ICU fellowship at Stanford. That’s where I really had the opportunity to answer a question I’d had for a while, but was made more urgent by the pandemic: “How can we better engage, train and inspire physicians to contribute to the public discourse that journalism can provide an avenue for?”

“How can we better engage, train and inspire physicians to contribute to the public discourse that journalism can provide an avenue for?”

From there I began working on an education curriculum. I come from a family of teachers, so teaching is in my blood. Now things have evolved so that rather than doing beat reporting, I’m trying to inspire and train an army of physicians who want to engage with journalists and the public (ed. note: a program to be launched in conjunction with Healthy Debate). The goal is that we won’t have the blunders we’ve seen in the pandemic repeated in other health crises; it will take an army to counter the swell of misinformation in the modern media ecosystem.

And along the way, I had an opportunity to write a book on something that I really felt was a complex, timely and serious conundrum for society to grapple with. So, all of these skill sets sort of came together for this book and interact with all of my different hats. It’s one mission: to do my part to create a world where no one dies too early or too late.

Q: What did you find to be the most challenging part of writing this book? 

A: As a journalist, you really have to challenge all of the things that you assume to be true. In health care, we’re trained to be confident and know what we’re doing. In journalism, you have to second guess yourself and really look for proof, even disprove some things that you’re pretty sure are true. It’s always hard to ask yourself, “Wait a minute, is what I think is true actually true?”

It’s something that I didn’t learn as a physician. We’re supposed to be self-reflective and double-check our thought processes to make sure we’re on the right track. But we probably don’t do it as well as we could. As a journalist, I was taught to take everything I thought I knew and turn it upside down and assume it’s not true. Some interesting things shake out when you do that.

The other tricky thing is that I didn’t really know how this book was going to end when I started writing it. It can be hard to keep things in context and stay on track when you don’t know where the track goes.

Q: Was there a part of this book that stood out to you as particularly meaningful?

A: In Chapter 10, I write about a conversation I had with Randy Curtis, who’s one of the most famous ICU and palliative care doctors in the world. He basically wrote the predecessor to my book. It’s much smarter and more academic than mine. I spoke to him shortly after he was diagnosed with ALS and listened to his perspective on how intensivists should conduct themselves during these moments of uncertainty, these grey zones. It was humbling to hear.

The bottom line of his advice is you don’t know when someone’s going to die the way that you think you do. You think you know when somebody’s futile, but you really don’t. And the longer you practice critical-care medicine, the more you see it work when you don’t think it’s going to.

Q: What do you hope that readers will take away from Death Interrupted, both in the general population and among medical professionals?

A: I didn’t think this book would appeal to medical professionals. I thought this would be more interesting for general readers to help them contemplate what they and their family might be willing to tolerate toward the end of life when they’re in these grey-zone situations. I’d hoped it would spark conversations among family members and that could help guide their wishes in critical situations.

But I’ve been overwhelmed by the nurses and physicians who have gotten in touch with me to say, “Wow, your book really resonated with me.” I think it’s given people some relief that this is being spoken about. It may also highlight a bit of anxiety around our own biases in medicine; where our own preferences and fears get projected onto the patients we care for. I hope this book will help to open the lines of communication between families and their health-care providers.

Q: Can you tell me a little bit about the excerpt that you’ve shared with us?

A: It’s the opening of Chapter 5. It highlights the moment I knew the death dilemma was a big problem. In one of the courtroom scenes I describe, I realized “Oh, fuck. We’ve got physicians on one side and family on the other.” It just feels so dirty and so wrong.

The physicians were right. There was no question in my mind that the woman was dead. She was braindead. The courtroom – that’s not where you solve these problems. It just felt awful and got dragged on for well over a year. It was truly terrible. I think the courtroom scene emphasizes that just ignoring the death dilemma, ignoring this question of resuscitate versus palliate is not the right answer. I don’t necessarily have an answer at the end of my book, but I think everyone who practices in this setting worries a great deal about knowing when to flip the switch.