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A Physician Explores 'A Better Path' To The End Of Life

Dr. Jessica Nutik Zitter, author of Extreme Measures, discusses the ethics of using medical assistance to hasten death. Zitter is the subject of the Netflix documentary Extremis.

21:30

Other segments from the episode on August 9, 2017

Fresh Air with Terry Gross, August 9, 2017: Interview with Dr. Jessica Nutik Zitter; Obituary with Glenn Campbell; Review of book "What She Ate."

Transcript

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. My guest is a critical care and palliative care physician who is among the health care professionals trying to find a more humane approach to helping people as they reach the ends of their lives. Dr. Jessica Nutik Zitter wants to help patients avoid what she describes as the end-of-life conveyor belt, where they are intubated, catheterized and die attached to machines, frequently without even knowing they're dying.

As a critical care doctor, it's her job to save lives. As a palliative care doctor, it's her job to decrease physical and emotional suffering. Some people see those two jobs as being at odds with each other. She doesn't. She works at a public hospital in Oakland, Calif. She's the author of the book "Extreme Measures: Finding A Better Path To The End Of Life." And she's the subject of the Netflix documentary "Extremis."

Jessica Nutik Zitter, welcome to FRESH AIR. You practice critical care and palliative medicine. Why is that considered unusual?

JESSICA NUTIK ZITTER: Well, hopefully it's becoming less unusual. And I'm meeting more and more people who are doing it. And I'm thrilled for that. I'm seeing definite changes in that. But you know, critical care - I mean I went into critical care because I really wanted to save lives. I wanted to rescue people from the jaws of death. And it wasn't until I got into it that I started to understand - and again, it was - for many years, it was very subconscious. It wasn't even a conscious thing. But I started to have this feeling that this activity was causing a lot of suffering.

And then eventually I was lucky enough to be exposed to the - a very early form of palliative care. It was before palliative care - it wasn't even called a palliative care team. It was called the family support team at a hospital that I worked at in Newark, N.J. And the nurse who headed that team was a palliative care practitioner, Pat Murphy. And she called it out like she saw it. She was very - you know, she didn't mince words. And she basically accused me one day of torture - torturing a patient who was dying.

GROSS: No, no, you got to tell this story because you tell this story in your book.

ZITTER: (Laughter).

GROSS: You were supposed to insert a dialysis catheter into the neck of a patient with metastatic breast cancer. And I take it that's a very painful procedure.

ZITTER: Painful, risky, you know, causes suffering during and after - you know, she has to lie under these drapes. Very - you know, her husband couldn't be with her. He had to go back to the waiting room. And this woman was so close to death. And we had been told, well, let's try cleaning her blood with - you know, because her kidneys were starting to fail. And I thought, OK, you know, I'll put in the catheter. We'll do dialysis through this catheter.

The procedure honestly, you know, has risks - small risks, but it could have killed her. It certainly causes discomfort. It's terrifying. Imagine lying - you're already so sick and feeling so ill, and you're lying underneath these drapes. And there's a whole bunch of doctors talking to each other - well, and you know, insert it through here, and push it this way. No, give it a little extra push, and twist it this way. And all of a sudden, I looked up, and I see this woman standing in the doorway. And it's Pat - you know, Pat Murphy, who's the head of this team.

And they had been in our ICU now for a few months because they had - this group had won this grant from the Robert Wood Johnson Foundation to study communication in the ICU. And I was like, who are these people? You know, I know how to communicate. I went to - I did my pulmonary fellowship. I did residency at a really great place. I mean I know how to take care of these patients. And I was kind of annoyed that they were always kind of looking over my shoulder, and I didn't really know why. And at this point, she's standing there, and she's tapping her foot. And she puts her hand up to her face like she's holding a pretend telephone. And she says, 911, call the police. They are torturing a patient in the ICU.

And all those years that I was telling you about before where I had sort of subconsciously been feeling, you know, just uncomfortable and a little bit of a moral crisis - like, oof (ph), I'm kind of hurting these people. I'm not really helping, you know, people who are dying. And all of a sudden, it just snapped into, like, complete focus for me. And I thought, oh, my goodness, she's right. You know what? What I'm doing is not helping this woman. And I just - it was a major shift for me from then on.

GROSS: But in that instance, you continued the procedure and inserted the catheter.

ZITTER: I did. And I certainly - as I say in the book, you know, that catheter did not change that patient's life, but it changed mine. I will never forget it.

GROSS: Did the patient soon die in spite of the dialysis?

ZITTER: Oh, she died the next day. Yeah, she died the next day. I mean - and you know, wasn't surprising to anybody.

GROSS: So you tell a story in your book about a patient. And the decision had to be made about whether to send her for palliative care or to do a major intervention. And she was, you know, an older woman. She was an Auschwitz survivor and not only that. Like, she was the only person in her family to survive. She and her twin sister had been the subject of experiments done by the famous sadistic Nazi doctor, Dr. Mengele. Her sister did not survive those experiments, but your patient did. So what were you presented with in the final days of her life?

ZITTER: It was such a constellation of strange events. I was called in by the team to see this patient. And they said, look; you know, she's - she has no family. She's really deteriorating. She has pneumonia, and she's really decided that she does not want to be intubated. And we really would like to provide her with some palliative care and have you bring her to the palliative care suite and make her calm and comfortable. And I thought, oh, OK, wow, you know, this is great. This is such a different approach than what I usually do.

And so I went into the room, and I see this woman. And she's a beautiful woman. She looked to me like Anne Bancroft. And she was really struggling to breathe. And I could see she - her lips were blue, and she was really - her - the oxygen saturation read I think 78 next to her bed. It's supposed to be a hundred. So she was really, really - had a very serious pneumonia. And I thought, oh, wow, let's get her comfortable, and you know, let's get her upstairs. And we'll give her some morphine, which is a medication which really, really calms the center of the brain that feels the sense of suffocation or shortness of breath.

So I started to look through her chart, and I started to get this history of - this woman had had, you know, this abdominal experimentation. And she had multiple bowel obstructions and had been hospitalized at that hospital many times for bowel obstructions. And as I read through and - on this particular admission, she had had a bowel obstruction and had aspirated because she had been vomiting from the bowel obstruction. And so she had developed a pneumonia on the basis of this. And this wonderful hospital team had been trying to treat her very, very aggressively with antibiotics. And she just wasn't getting better fast enough, and she was starting to tire out.

And so the moment when I was learning that she had actually been an Auschwitz survivor and I see her number on her arm, something kicked in in me that was very emotional. I have many family members who were also in the Holocaust. And it was a very personal experience, and I'm sure that there was a personal drive and my ICU training to - oh, my gosh, let's save this woman. And I went to the team. And I said, wait a minute. If we intubate her, maybe we can, you know, really give her a little rest and treat her with antibiotics. And the attending said, wait a minute. I've just spent all this time with her, and she really, you know - I said to her, do you want us to put the tube in, or do you want us to keep you comfortable? And she said, keep me comfortable.

And at that moment, the respiratory therapist piped in. And he said, well, wait a minute. I'm not sure she totally understood because by that point, she was so low on oxygen. So there was this just going back and forth, and it was really a struggle for all of us. And I could imagine that this woman wouldn't want to be intubated after all she had gone through. But I didn't know, and I felt very emotionally driven to save her. And so the story goes that I basically proceeded to make a bigger mess out of this case. And I tried to do other types of things without putting the tube down her to kind of help her with her breathing. And it ended up making things worse.

And you know, I don't know what the moral of that story is. I think it's really that you can sometimes - you know, you have to be careful not to get personally involved. And you have to also not let your own history of training drive you to do things that may not be what the patient would want. And there are things that we do from our training that are sort of muscle memory. And we have to really be careful to try and keep the patient, you know, in our vision all the time.

GROSS: Once a patient is on a ventilator, is it hard to take them off of it? Like, say you know that they would die if they're taken off of it. How hard is it for the family or for the patient themselves to give the directive, like, stop. It will end life, but make it stop.

ZITTER: It's so varied and depends on the situation. There's so many variables involved here. First of all, you know, is this patient conscious? Is this patient not conscious? Let me tell you. You know, taking a person who only has a lung issue as the only sort of life-limiting illness and the rest of the body is healthy - the mind is healthy - I mean I had a patient like this, for example. It was a man with terrible, terrible COPD but otherwise really just a vibrant guy who's probably 60. And, you know, the question was whether or not - we were never going to get him off the breathing machine. And he wasn't, for a variety of reasons, a candidate for a lung transplant.

And, you know, we went - it was a few days that we talked - his son and I and the patient because he was alert - about whether or not he would want to be trached (ph), you know, have a permanent attachment through his neck to the breathing machine and really - discussing it really in depth and what kind of a person was he and how did he like to live and would it be acceptable for him to live the way he would probably have to live for the rest of his life on this machine? And he decided no. You know, I can't live that way. And we ended up extubating (ph) him.

But those kinds of cases are very, very difficult - you know, very sad, very, very difficult. We can, obviously, keep people very, very calm and comfortable as they die once we take the tube out, but it's a grueling choice. It's a grueling decision. You know, if you kept the person on the machine, they'd still be with us and alive but living a life that for this particular patient was not acceptable.

GROSS: My guest is Jessica Nutik Zitter, a critical care and palliative care doctor who works at a public hospital in Oakland. She's the author of the book "Extreme Measures." We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MOACIR SANTOS' "EXCERPT NO. 1")

GROSS: This is FRESH AIR. Let's get back to my interview with Jessica Nutik Zitter, a critical care and palliative care physician. She's the author of the book "Extreme Measures." What kinds of advance directives are most helpful to you as a critical care and palliative physician?

ZITTER: An advance directive is a really static form. It's a piece of paper. It's something that has a check, literally. If you look at it, in most states, they have a checkbox that's really, really high level very, very simplistic that says, if I'm not going to be restored to a quality of life that will be acceptable to me, I either - check box A - do want you to keep me alive on machines. Do everything you can to keep my body alive or, B, allow me to have a natural death. And it's a very important first order question. But the problem with it is it's not enough for a variety of reasons.

Number one, as people get ill, as people get old, their feelings tend to change. I mean, there's a lot of data on that. People start to change their own personal feelings and preferences and values about these things. So it's a dynamic evolving question for a particular person - how they're going to feel about that sort of high level, you know, approach. And second of all, you know, as the ICU doctor standing there when someone comes in to the hospital, if the check box says, if I'm not in a quality that would be acceptable to me, you know, let me die a natural death, that isn't helpful enough to me because I need so much more detail than that. What might be acceptable to one person, might be completely unacceptable to another. And so I need much more definition about what that means.

I once had a woman say to me, you know, my dad, he's a crusty old Italian. He told me, if I can't wipe my own behind, you better let me go. Well, I'll tell you. For me, I would be OK with someone else taking care of my personal hygiene if I couldn't do it. If I were cognitively and emotionally able to be part of this world, I think I could live with those physical limitations. But not everybody can. And so this is very personal. And it requires long years of recurrent conversation and communication with, not only your loved ones who will be the ones at that bedside making those calls, but also with your doctors.

GROSS: Do you have an advance directive?

ZITTER: I finally do. But it took me a long time to get it - to get it written. And I carried this yellow advanced directive - you know, state of California advanced directive form with me back and forth on so many trips, on so many airplane flights. Like, oh, my God, I'm going to do my advanced directive today. And it took me years because that section - you know, there are several things that are really quick and easy to fill out. Who's your surrogate? OK, I'll have my husband be my surrogate, you know? Do you want to be an organ donor? Yeah, I do.

But when it came down to that question about my instruction directive - the health care part of it - the - like, what exactly - what are my wishes? - I realized, like, I got to explain to you what these two check boxes mean. If I can't live in a quality with which - you know, to which I - and I started elaborating. And I was writing pages and pages and pages about what this meant. And then I finally realized, you know, just turn this thing in. And really, what this is going to be is conversation after conversation with my family, which we are now having more and more frequently. In fact, my kid just said to me - I don't know - few months ago, mom, can we ever have dinner without talking about death?

(LAUGHTER)

GROSS: So you just check the questions without writing essays attached to them?

ZITTER: Well, no. I actually did turn in my essay. But the truth - you mean, with the advanced directive? I turned - I turned in the many pages of extra stuff. But I'll be honest with you. What really is important is the conversations I'm leaving with my family members and the, you know, the - for example, OK, well, how do I feel about the Terri Schiavo case? And how would I feel in - you know, Aunt Mary, you know, and how she died. I mean, it's just really bringing this - these experiences into life and, you know, just continuing this ongoing conversation about who I am and what's important to me.

And, you know, I play this game with my son. We did this thing last weekend where we did this intergenerational dialogue about death and dying for one of the local hospices just to show us strategies for how you can actually sit and talk to your teenage kid. And I learned a bunch of stuff about my son I just did not know. I mean, he was so clear. He said, mom, if I cannot tell you if I want to be taken off of a breathing machine and I'm unlikely ever to be able to tell you, then I want to be taken off of a breathing machine. And that was really helpful for me.

GROSS: That strikes me as a really difficult conversation to have with a teenage son.

ZITTER: (Laughter) You know, once you start it, it's not as difficult as you think. What it was that was keeping me...

GROSS: How do you feel about asking your son to imagine his own death?

ZITTER: I feel good about asking him to imagine it because I used to feel - and I think on some subconscious level, I feel like so many of us do that, oh, jeez, you know, if we talk about it, maybe it'll be more likely to happen. Or, you know, if I talk about this with him, maybe it's going to make him feel like I don't love him. And the truth is it doesn't. It's about having somebody stand up and say, hey, this is what's important to me. This is what I care about. And it's about you saying back to them, hey, I love you. And I care about knowing that. That's really important information to me. Thank you.

You know, it feels like this taboo thing, like ew (ph). You know, I don't want to talk about that to my mother. That's going to make her think I'm looking for her money or what - who knows? - whatever a person's particular concern is. And in the end, I - you know, I've talked about this with more people than - you know, it's part of what I write about. So it's something that I really feel obligated to do. It's not like I like these conversations either. But every single time I've had them, they've turned out to be very helpful.

GROSS: So it's becoming more common now for critical care doctors to also be palliative care doctors. But when you started combining the two disciplines, that was considered pretty unusual. Would you explain what each position is and why some people see them as being in conflict?

ZITTER: Coming in as a palliative care doctor, there was this perception that what we were focusing on was stuff that was just, you know, fluffier and less important and, you know, emotions and communication and how people were feeling and even symptoms, none of which were really thought to be the essential meat of medicine. And that's why, especially in the early days when I would do palliative care consuls, I felt that we sort of had to be treading a little bit on eggshells at times. You know, I got fired from a couple of cases.

You know, one of the cases I write about is this case of a surgeon taking care of a guy who'd had multiple gunshot wounds to his stomach. And this patient was in the ICU. And he had been there for now going on - what? - six, seven months. And he was not only not getting better, but he was never going to get better because he had no gut left. He was, at this point, getting all of his calories through I.V. nutrition, which is really not a sustainable situation. And he was wasting away. He was a young man, and he was - really, there was just no future for him.

And I had been called in as a palliative care doctor to help with his - some of his pain. But I said, well, you know, does this guy who's got three young children understand that this is sort of a very limited prognosis, that we really don't have long-term ways to keep him fed and that he's - the real reason he's wasting away is because, you know, he's starving to death. And the surgeon said, look; I don't need you here taking hope away from my patient. And she essentially fired me from the case.

And so, you know, when you're a palliative care consultant and you've got people who are really focused on - I would almost call it hero medicine. I say it because that's how I sort of see it in the ICU. Yeah, I want to be doing this heroic stuff which I really care about. And I've seen it do such great things so many times in so many cases. And so you want to focus on that piece of it. And then, you have somebody coming around and saying, hey, wait a minute; maybe we should talk to your patient about the fact that we're not going to be able to do, you know, an 11th-hour save here. And people can bristle at that.

So it - there was, in the earlier days especially, conflict. I am lucky enough now to work in a hospital that really values palliative care. And as I said, most hospitals are starting to value palliative care as time goes on because the data really are irrefutable, you know, in showing its benefits to patients and to everyone else around the patient.

GROSS: Jessica Nutik Zitter, thank you so much for talking with us.

ZITTER: Oh, it was such a pleasure.

GROSS: Jessica Nutik Zitter is a critical care and palliative care doctor and author of the book "Extreme Measures."
TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. We're going to listen back to an interview with Glen Campbell. He died yesterday of complications caused by Alzheimer's disease. He was 81. Campbell had his biggest hits in the '60s and '70s, including "By The Time I Get To Phoenix," "Wichita Lineman," "Galveston," "Southern Nights" and "Gentle On My Mind," which was also the theme of his TV show "The Glen Campbell Goodtimes Hour." One of the songs he's most associated with is a "Rhinestone Cowboy."

(SOUNDBITE OF SONG, "RHINESTONE COWBOY")

GLEN CAMPBELL: (Singing) I've been walking these streets so long, singing the same old song. I know every crack in these dirty sidewalks of Broadway where hustle's the name of the game and nice guys get washed away like the snow and the rain. There's been a load of compromising on the road to my horizon. But I'm going to be where the lights are shining on me like a rhinestone cowboy, riding out on a horse in a star-spangled rodeo, like a rhinestone cowboy getting cards and letters from people I don't even know and offers coming over the phone.

GROSS: Before Campbell's solo career, he played guitar with the legendary group of LA studio musicians known as The Wrecking Crew. Here's a sampling of some of those recordings.

(SOUNDBITE OF SONG, "STRANGERS IN THE NIGHT")

FRANK SINATRA: (Singing) Strangers in the night exchanging glances, wondering in the night. What were the chances we'd be sharing love before the night was through?

(SOUNDBITE OF SONG, "BE MY BABY")

THE RONETTES: (Singing) The night we met, I knew I needed you so. And if I had the chance, I'd never let you go.

(SOUNDBITE OF SONG, "SURF CITY")

JAN AND DEAN: (Singing) Two girls for every boy. I bought a '30 Ford wagon, and we call it a woodie. You know, it's not very cherry. It's an oldie but a goodie. Well, it ain't got a backseat or a rear window.

(SOUNDBITE OF SONG, "I'M A BELIEVER")

THE MONKEES: (Singing) I thought love was only true in fairytales, meant for someone else but not for me.

(SOUNDBITE OF SONG, "VIVA LAS VEGAS")

ELVIS PRESLEY: (Singing) Viva Las Vegas. Viva Las Vegas. Viva Las Vegas. Viva, Viva Las Vegas.

GROSS: Glen Campbell also played guitar on many Beach Boys recordings and toured with them in 1964. Though his life at times seemed charmed, he battled drug and alcohol addiction and married four times. In 2011, he revealed he had Alzheimer's disease, but he continued to tour for another 15 months. Campbell spoke with FRESH AIR's Dave Davies in 2008, three years before his Alzheimer's diagnosis.

(SOUNDBITE OF ARCHIVED BROADCAST)

DAVE DAVIES, BYLINE: You grew up in a small town in Arkansas - a big family. Twelve kids - is that right?

CAMPBELL: Twelve kids - eight boys, four girls.

DAVIES: What kind of childhood did you have?

CAMPBELL: Working - you worked. As soon as you got old enough to milk the cows, you milk the cows. It was - (laughter) slop the hogs. We didn't have electricity when I was a kid. We had to watch TV by candlelight. No, (laughter) that's a silly joke. Really, I don't remember not playing a guitar. And Daddy - he made me a capo out of corncobs, you know, where you can, you know, clamp it down on the A position. And you can play C position with it, you know?

DAVIES: Right, that's where it's a - like, a capo - they actually make them now on guitars where it sits on the frets so you can shorten the strings, right?

CAMPBELL: Yeah, right.

DAVIES: And your first one was out of a corncob?

CAMPBELL: Yeah, it was out of a corncob with a nail through it. (Laughter) I'll never forget those days. That was - I must've been, oh, 7, 8 years old then.

DAVIES: And were you singing, too, at an early age?

CAMPBELL: We sang in church. It was amazing - the Church of Christ that we went to there. We had to go, you know. All of us were breastfed. And if you wanted anything to eat Sunday, you had to go to church with Mama (laughter). And that's really - that's the truth. And it was - and I loved the singing. I remember hearing the singing. But a lot of it was out of tune because the Church of Christ didn't have musical instruments.

DAVIES: I happen to know that, yeah. I went to the Church of Christ as a...

CAMPBELL: They sing acapella.

DAVIES: Yeah, yeah, yeah.

CAMPBELL: Yeah, that's a - but when I do something, I take my guitar and play for them. I go down to the Baptist church where Grandpa Campbell was. And I could play a guitar and sing down there.

DAVIES: Well, you must have had some talent because, you know, as you said, you ended up in Albuquerque. And I know that you joined the band The Champs, which had that famous song "Tequila."

CAMPBELL: Right.

DAVIES: So you made your way to Los Angeles.

CAMPBELL: Yeah.

DAVIES: And you became one of really a legendary group of studio musicians that did tracks for - what groups? I mean it's a long, long list, right?

CAMPBELL: Oh, well...

DAVIES: The Beach Boys.

CAMPBELL: Yeah, Beach - The Beach Boys, Jan and Dean, Nat King Cole, Sinatra and my buddy Dean Martin - just everybody really - The Mamas and Papas, The Blossoms. Everybody that - we played almost on every record that came out of Los Angeles. And that was the group called The Wrecking Crew. It was the best - what an incredible band. They all just - boy, it was the best musicians I had ever played with. And you got to be on your toes for session playing cause that's a - you're laying out a pretty good chunk of money there. And they don't want no overtime.

DAVIES: Well, now, you were never trained to read music, right? I mean was that an issue?

CAMPBELL: No, it wasn't. I learned to read chord charts, you know, and their time signatures. But I never learned to read notes. That was always so hard for me. I didn't - of course I can pick up a sheet music and play it, you know, but not necessarily the melody.

DAVIES: So you played rhythm on a lot of these tracks, right?

CAMPBELL: Yeah, that's what I played, rhythm, because of my capo. You know, I could - if it was in E-flat, I could play C position in E-flat. It drove the guys who - the readers - it drove them nuts (laughter). How can you read like that? And I said, well, I'm just going to pretend I'm in C when I'm actually in E-flat with my Capo on it playing open-chord rhythm.

DAVIES: You know, I'm just picturing. This is back in the early and mid-60s, and you're putting in long days in the studio, right?

CAMPBELL: Yeah.

DAVIES: One producer after another, and what's happening is you guys are putting in music which then becomes hit records for other groups. Did you feel ripped off?

CAMPBELL: No, that was the most money I'd ever made. (Laughter) You know, it beat the hell out of picking cotton. I can tell you that. It was just - I had more - I think that was probably the part of my life that I'll remember as sitting down and playing with the best musicians in the world, literally.

DAVIES: Well, you had these great years as a session musician with this group called The Wrecking Crew. And then you went solo. Did you always see yourself as going out and having a solo career?

CAMPBELL: Yes, it did. I just waited it - I waited for it to come to me. I was making records, you know, here and there, like "Turn Around, Look At Me" in 1962. But I loved the studio work.

DAVIES: And what you said about doing solo - you wanted to wait until it came to you, what do you mean?

CAMPBELL: Before I didn't have - I wouldn't go out - I didn't really - I was at a position where I didn't have to go out and knock on doors. Everybody - and there was a lot of people didn't even - the guys didn't even know I could sing.

DAVIES: (Laughter).

CAMPBELL: And when I started, I got more kidding from the musicians because the same guys that I was playing with on all those sessions, they all played on my stuff - you know, whether it was "Rhinestone Cowboy" or "Wichita Lineman," "Galveston." It was the same guys. And it was so much fun in the studio with them because, hey, old big shot's back with us, boys, you know (laughter) especially after - during the TV show. I went and did sessions with people after - when I was doing the TV show.

DAVIES: And they weren't jealous.

CAMPBELL: Yeah, I just missed the camaraderie with the musicians.

(SOUNDBITE OF ARCHIVED BROADCAST)

DAVIES: Oh, you mean when you were a big star, had the TV show, you would go back in and just do some session work on other people's stuff?

CAMPBELL: Yeah, just to see the guys, you know, see what was happening in the end of it. It was fun.

GROSS: We're listening back to the interview FRESH AIR's Dave Davies recorded with Glen Campbell in 2008. Campbell died yesterday at the age of 81. We'll hear more of the interview after a break. This is FRESH AIR.

(SOUNDBITE OF AVISHAI COHEN'S "GBEDE TEMIN")

GROSS: This is FRESH AIR. We're remembering Glen Campbell, who died yesterday at the age of 81. Let's get back to the 2008 interview that FRESH AIR's Dave Davies recorded with him.

(SOUNDBITE OF ARCHIVED BROADCAST)

DAVIES: Well, you know, your breakout hit was "Gentle On My Mind" with Capitol Records. I guess this was 1967, right? You want to tell us a little bit about recording that song?

CAMPBELL: Oh, I heard the song. John Hartford - he did the song. And I said, boy, that's - it takes too long to get to the next verse. That's slow. And I just did it to - I got a comfortable time on the song, you know, whether to do it slow, medium. And I just got it to where I could talk the song. Like, (singing) it's knowing that your door's always open and your path is free to walk. I just put it in a tempo that was comfortable like I would be talking it without singing the melody.

DAVIES: Well, let's hear it. This is "Gentle On My Mind" by Glen Campbell.

(SOUNDBITE OF SONG, "GENTLE ON MY MIND")

CAMPBELL: (Singing) It's knowing that your door is always open and your path is free to walk. That makes me tend to leave my sleeping bag rolled up and stashed behind your couch. And it's knowing I'm not shackled by forgotten words and bonds and the ink stains that are dried upon some line. That keeps you in back roads by the rivers of my memory. It keeps you ever gentle on my mind.

DAVIES: And that was my guest Glen Campbell with his breakout hit "Gentle On My Mind" from 1867. That was a huge hit. How did it change your life and career?

CAMPBELL: It changed everything. We did "The Summer Brothers Smothers Show." That just exploded everything. EMI had the pressing where they press the records. They had every person - (laughter) every guy that could press record doing Glen Campbell records because I'd had such a backlog of it. And then you come out, and people see you on TV. TV is just an incredible media. And when I did...

DAVIES: You mean after - yeah, when people saw you on TV, suddenly the demand for the records just shot through the roof, you mean, yeah, yeah.

CAMPBELL: Yeah. And that was timing again. And I had all that - and the - that I had recorded and it - they did middle of the charts, something, you know? Some of them didn't even get in the charts. But everything - it didn't matter what it was after the TV show. Everything got in the charts. And almost all of them went to number one. It was just amazing.

DAVIES: Well, you know, one of - one of them was "Wichita Lineman," which is just - was a great, old favorite. And I just think this was such a wonderfully evocative tune of, you know...

CAMPBELL: Oh, it wasn't that good.

DAVIES: ...Of just - we've all had the experience of working a shift, you know, at a - in a hospital or on a warehouse or wherever and thinking about - pining for a love. You want to talk a bit about this, recording this song?

CAMPBELL: Well, I just do a track first. And then I sing it three or four different times. And actually I will put some song that you did on track one - put words there and just change it around until I got it like I wanted it. But when the TV show hit, they were just - everything - it didn't matter what I put out. It sold.

DAVIES: Well, let's listen to a little bit of "Wichita Lineman." This is our guest, Glen Campbell.

(SOUNDBITE OF SONG, "WICHITA LINEMAN")

CAMPBELL: (Singing) I am a lineman for the county. And I drive the main roads, searching in the sun for another overload. I hear you singing in the wire. I can hear you through the whine. And the Wichita lineman is still on the line. I know I need a small vacation.

DAVIES: That was "Wichita Lineman" by our guest, Glen Campbell.

(SOUNDBITE OF GUITAR MUSIC)

DAVIES: Glen, you have your guitar there.

CAMPBELL: Yeah.

DAVIES: You want to play us a little something?

CAMPBELL: Yeah, what do you want to hear?

DAVIES: You tell me.

CAMPBELL: (Laughter) Oh, I don't know.

DAVIES: You want to play something from the new album?

CAMPBELL: (Singing) I've been out walking. (Singing) I don't do too much talking these day. These days

That's - there's some good songs in this album.

DAVIES: Right. Now, that was an old Jackson Browne tune, right?

CAMPBELL: Yeah, Jackson Browne.

DAVIES: Do you - yeah. You became a TV star when you got associated with the Smothers Brothers that had that really edgy comedy show that eventually was taken off by CBS.

CAMPBELL: (Laughter) Right.

DAVIES: And that led you to getting your own musical variety show...

CAMPBELL: Yes, it did.

DAVIES: ..."The Glen Campbell Goodtime Hour." And one of the things that was interesting about that was that the - you know, the Smothers Brothers were always pushing this - pushing the edge with anti-establishment, anti-Vietnam War comedy - think of you as maybe not so political. Were you comfortable with, you know, the kind of edge and tone of what they were doing?

CAMPBELL: Not really. I thought they was - when I listened to their show, it was - I thought it was a little edgy, you know? I don't think I'm in the music business to, you know, to try to save the world or to focus my opinion. And Tommy - then that's why they got threw off CBS. He was a - he was - he stepped over the line a little bit I believe. And that shouldn't even be a factor in it as far as music goes, you know? There's a war going on. Well, it's - you know, your life's got to go on.

DAVIES: Well, I wish you the best with the new album. Thanks so much for speaking with us, Glen.

CAMPBELL: Hey, thank you.

DAVIES: All right, take care.

CAMPBELL: (Singing) She'll be coming around a mountain when she comes. She'll be coming around a mountain when she comes. She'll be coming around a mountain. She'll be coming around the mountain. She'll be coming around the mountain when she comes.

GROSS: Wow - Glen Campbell speaking with FRESH AIR's Dave Davies in 2008. Campbell died yesterday of complications from Alzheimer's.

After we take a short break, Maureen Corrigan will review the new book "What She Ate: Six Remarkable Women And The Food That Tells Their Stories." This is FRESH AIR.

(SOUNDBITE OF MUSIC)

TERRY GROSS, HOST:

This is FRESH AIR. Laura Shapiro is a celebrated food historian and writer who's published books and articles on subjects ranging from Julia Child to Jell-O. Shapiro's latest book is called "What She Ate." And our book critic Maureen Corrigan says that after reading it, she's already hungry for more.

MAUREEN CORRIGAN, BYLINE: Back in the late 1980s when I was first starting out as a critic for The Village Voice, one of the books I was assigned was Laura Shapiro's "Perfection Salad," a social history of the home economics movement during the turn of the last century. I can't recall many of the other books I reviewed in those days, but "Perfection Salad" has remained indelibly with me. Shapiro helped break new ground by taking the history of women, housework and cooking seriously, even as her witty and vivid writing style was decidedly unsolemn.

Now some 30 years later, Shapiro has done it again, this time breaking new ground in the art of biography by taking the adage you are what you eat literally. Shapiro's fascinating new book is called "What She Ate," and it focuses on the lives of six women from different centuries and continents, all prominent to different degrees. Among them are Dorothy Wordsworth, the poet's shy, worshipful sister; Eva Braun, Hitler's mistress and eleventh-hour wife and Helen Gurley Brown, the whippet-thin, legendary editor in chief of Cosmopolitan.

All six women have been the subjects of earlier biographies. But as Shapiro points out, biography as it's traditionally practiced still tends to honor the old-fashioned custom of keeping a polite distance from food. In contrast, Shapiro likens her method of biographical research to standing in line at the supermarket and peering into the other carts. In the resulting portraits, Shapiro, like a consummate maitre d', sets down plate after plate of the food these women cooked, ate or thought about. And an amazing thing happens. Slowly, the more familiar accounts of each of their lives recede, and other, messier narratives emerge. As Shapiro says, our food stories don't always honor what's smartest and most dignified about us. More often, they go straight to what's neediest.

Take the chapter, here, on Eleanor Roosevelt, certainly one of the most chronicled women in history. The common wisdom is that food was mere fuel to Eleanor. Shoring up this official story is the fact that Eleanor hired as her White House chef Mrs. Henrietta Nesbitt, whom Shapiro calls the most reviled cook in presidential history. Here's a sampling of the regularly repeated White House luncheon menu always made from leftovers. There were curried eggs on toast, mushrooms and oysters on toast, broiled kidneys on toast, braised kidneys on toast, chipped beef on toast and a dish called shrimp wiggle, consisting of shrimp and canned peas heated in white sauce on toast.

Shapiro surveys the well-mined trove of Eleanor's letters, memoirs and newspaper columns and spots a striking pattern. Inside the White House, Eleanor was apathetic about what was on her plate. Outside, she discovered the delights of appetite, enthusing, for instance, over the popovers she made for her beloved bodyguard Earl Miller in the 1930s or a delicious Arab dinner she enjoyed in Beirut in 1952. As Eleanor herself said in looking back on her White House years, I had erected someone outside myself who was the president's wife. Shapiro's astute reading of Eleanor's food trail testifies to Eleanor's distaste for that official role.

The Eva Braun chapter here is practically the insane inverse of Eleanor's and every bit as illuminating. Since Braun's existence as Hitler's mistress was kept secret from the public, she gloried in her private and very feminine role as hostess of the meals at Hitler's mountain retreat where high-ranking Nazis feasted on the righteousness of their cause.

Shapiro opens Braun's life story with its chilling end late-April 1945 when she and Hitler were hiding in the Berlin bunker where they would commit suicide. Braun welcomed architect Albert Speer to the bunker for a frantic goodbye visit. And as he recalled in his memoir, Braun, ever the enthusiastic hostess, radiated an almost gay serenity. How about a bottle of champagne for our farewell, Braun asked, and some sweets. I'm sure you haven't eaten in a long time.

As Shapiro says, the guilt-free zone in the heart of Hitler-dom (ph) that Braun helped create through gourmet meals held fast to the very end. Several times throughout "What She Ate," Shapiro repeats what surely is one of her life's mantras - food talks. But somebody has to hear it. How lucky for us readers that Laura Shapiro has been listening so perceptively for decades to the language of food.

GROSS: Maureen Corrigan teaches literature at Georgetown University. She reviewed "What She Ate" by food historian Laura Shapiro.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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