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End-of-Life Reformer Jessica Nutik Zitter Wants to Make Death Ed the New Sex Ed

Because teens are not too fragile to talk frankly about grief and dying.  

Highland Hospital physician Jessica Nutik Zitter.

This is "Think Tank," an occasional series of conversations with Bay Area power players, conducted by San Francisco editors. Interviews have been condensed and edited for clarity.   

Name: Jessica Nutik Zitter
Occupation: Critical and palliative care physician at Highland Hospital, Oakland
Age: 51
Residence: Oakland

San Francisco: Your book, Extreme Measures, has sparked a lot of discussion around end-of-life care. What made you want to bring that topic into high school classes?
Jessica Nutik Zitter: I taught my kids sex ed, another taboo we don’t like to talk about, and I thought, Why am I not talking to these same kids about death and dying? I can’t tell you how many teenagers I see around the bedsides of grandparents and even parents in my ICU. For us to think that a 15-year-old is going to faint at the thought of talking about death, it’s just not borne out in reality. I called my kids’ very progressive school, Head-Royce in Oakland, and asked if they’d be interested in having a death ed curriculum. To my surprise, they said, “Sure, come on in.”

How did the kids respond?
We taught 90 kids in the first class, and they were terrific and asked great questions. We created this two-hour curriculum taught over a week. There are so many things you could talk about—grief support, bereavement, the role of faith. We showed a clip from Grey’s Anatomy of a very unrealistic resuscitation and then debunked it. The kids loved hearing from a real ICU doctor going, “Hey, guys, this isn’t really how it works.” Then we gave a gentle picture, one appropriate for ninth graders, of what chronic critical illness is—basically being tied to machines until death—which is unfortunately becoming more prevalent.

Isn’t that a little heavy for teenagers?
It’s not easy stuff to hear, but the kids stuck with us. We tried to make it fun along the way. I think they came out of the class feeling empowered and not scared. 

What do you see as the biggest breakdown with end-of-life care?
This is a very complex area. We are dealing with humans at the most vulnerable time in their lives. If I had to pick the biggest culprit, it’s communication gaps: people not being fully informed about their situation and their options. As a doctor, it can feel cruel to talk about these realities—about what life prolonged on machines looks like—but if we don’t tell people, how can they make decisions about what they really want? 

In your book, you refer to yourself as an “accidental evangelist.” What do you mean by that?
Well, I love medicine. I love saving lives. I love technology and the miracles of modern science…. Most of my colleagues have been incredibly compassionate people. And yet we were taught to focus on things that were not necessarily human-centered. They were organ-centered. I feel like we were led astray.

You’ve written about our cultural unwillingness to confront death and all these euphemisms we use to talk around it. Were the ninth graders willing to go there?
They were more willing! My co-teacher, Dr. Dawn Gross, and I were astounded by their willingness to talk. I have to tell you, we actually caught it on film, and it’s beautiful. These kids, who are at a narcissistic age, talked about not wanting to ever be a burden on their family. It was heartfelt and quite touching. Instead of there just being this person lying in a bed in the hospital, you can remember, “I had this conversation with Grandpa, and I know what he really cares about,” and it becomes less likely for families to end up in situations that they realize, later on, their loved one would not necessarily have wanted. What it starts is the process of thinking, This is a person, not a body.

Sex ed and the availability of birth control contributed to a drop in STDs and unwanted pregnancies. If death ed were to be widely embraced, what kind of changes would you want to see as a result? What metrics would you use?
The most basic sign of success for the kids involved would be that they’re engaging in or even initiating conversations with their parents and grandparents. More broadly, I would want to see much more concordance between the care people are receiving at the end of life and what they say they actually want. 

So which was more uncomfortable, sex ed or death ed?
There were some very definite similarities and giggles in both. We used a lot of candy in death ed, by the way. We broke open some Skittles to try to show the kids how death is a reality and how ubiquitous it is. We passed around a jar and put in candies for what they had experienced—purple for pets who died, yellow for immediate family members, red for more distant family members. Then we passed it around, a third filled. The point was just that this is a human experience, something we all share, a part of all of our lives.


Originally published in the July issue of San Francisco

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