99 Ways to Avoid Death: Lessons from Author and ER Physician Dr. Ashely Alker

Key Podcast Moments

• Dr. Ashely Alker, emergency physician and author of 99 Ways to Die and How to Avoid Them, reflects that she remembers her lost patients more vividly and permanently than any save she has ever made and that asymmetry is what drove her to write the book.
• Ashely is direct that most Americans say they want to die at home but most die in hospitals connected to machines, because the conversation about end-of-life wishes never happened before the emergency did.
• Ashely makes the public health case for vaccines with a single striking figure: 156 million lives saved over 50 years, 101 million of them infants under one year old and argues that the invisibility of that number is precisely why vaccine-preventable diseases are coming back.
• Ashely closes with the core message she wants every physician to take from the book: what you do every day matters beyond the science and medicine you're practicing, and the ability to communicate with patients saves lives just as surely as any clinical intervention.

When Dr. Graham Walker introduced his guest as an emergency physician who had just come off a shift, he wasn't just establishing rapport. He was setting up a conversation that most podcasts don't have the stomach for. One about death, what it actually looks like up close, and what years of watching people die teaches you about how to live. Dr. Ashely Alker, emergency physician, founder of Meaningful Media, and author of 99 Ways to Die and How to Avoid Them, doesn't flinch from the subject. She has been thinking about death since long before she ever stepped into an emergency department.

Ashely didn't arrive at emergency medicine through a straightforward path. Her family had no one in medicine when her mother was diagnosed with lymphoma shortly after Ashely was born. Her mother survived through a now-abandoned mediastinal radiation protocol, but spent the rest of her life managing the consequences. Ashely watched her family navigate a medical system they couldn't read, in a language they didn't speak.

Graham reflects that most people in their twenties have been to only one or two funerals. Emergency physicians are, as he and Ashely agree, statistical outliers. But volume doesn't mean familiarity in any comfortable sense. Ashely is candid that she carries her lost patients with her in a way she doesn't carry her saves. Ask her about her greatest save and she struggles to recall it with clarity. Ask her about the patients she lost and they stay with her permanently, in full detail. That asymmetry, she says, is part of what drove the book. The things she couldn't do something about are the things she kept returning to. And the book became her way of saying: here are 99 things science and medicine have already solved. Here is the way out. You just have to be willing to take it.

The conversation moves naturally into one of the most pressing but underaddressed issues in emergency medicine: end-of-life planning, or the near-total absence of it. Ashely and Graham both describe the same scene, played out in emergency departments across the country — a patient arrives in crisis, their family is in the waiting room, and nobody has ever had the conversation about what this person actually wants. The default is resuscitation. The default is intervention. And so patients who never wanted aggressive measures receive them, not because anyone made a decision, but because no one did. Ashely is clear that this is not a failure of medicine. It is a failure of communication, and it is one that starts long before anyone ends up in the ER. Most Americans say they want to die at home. Most die in hospitals. The gap between those two facts is a conversation that didn't happen.

The second half of the conversation broadens into territory that Ashely has spent her career trying to occupy: the space where medicine and public communication intersect. She founded Meaningful Media as a nonprofit specifically to connect Hollywood productions with medical experts, and she has spent over a decade consulting on television and film/The Pit comes up, and Ashely and Graham agree that its success is inseparable from its authenticity. Audiences know when medicine feels real. They can't always say why, but they feel the difference. And when it's real, it does something that a clinical encounter or a public health campaign often can't. It builds empathy for experiences people haven't lived themselves.

Ashely is equally direct about the information environment those stories are competing against. Misinformation, she notes, spreads six times faster than truth — not because people are foolish, but because novel, emotionally charged information is exactly what algorithms are designed to reward. You don't grieve the measles encephalitis that didn't happen to your child. And so the case for vaccination has to be made over and over, in language that reaches people before fear does. That, she says, is why physicians who stay out of the public conversation are making a mistake. The vacuum doesn't stay empty. It fills with whoever shows up.

The episode closes on a note that is quieter but no less important. Ashely describes writing the book as something that began as catharsis. Stories from residency that were too painful to publish but that she needed to write anyway, as part of processing what the work was doing to her.She says it made her a better doctor, in the same way that writing a careful clinical note sometimes surfaces something you missed in the room. The reflection is the point. And the book, ultimately, is a letter to her patients, to the general public, and to everyone who has ever sat across from a physician and not understood a word they said.

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Every episode of How I Doctor surfaces ideas that are worth sitting with long after the conversation ends — and this one is no exception. Below are the four takeaways from Ashely and Graham's conversation that we think matter most for physicians, whether you work in emergency medicine or not.