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A great article in the NY Times: Hard Choice for a Comfortable Death: Drug-Induced Sleep. If you have hung out much in nursing homes with relatives or friends, watching them struggle in their last weeks, days, hours, waiting for death, you want to read this long and informative piece. It talks about something I'm very familiar with--we use to do "help people die" all the time when I was a hospital chaplain at Letterman Army Medical Center on the Presidio when Letterman was a full scale teaching hospital. If you understand hospice, they essentially do relatively the same, which I think is great. They simply increase the morphine and the terminally ill, who at this stage are not with us, other than still breathing, slip into the terminal sleep. According to the article, it is called terminal sedation, a treatment that is already widely used and as the article says, "vexes family and a profession whose paramount rule is to do no harm."

What is different about this article is that for the first time, at least as I've seen, the medical community admits that they do this and even talk about cases and drugs they use. Two popular related drugs are ativan and roxanol (to calm the patient). These two medications often lower blood pressures which may be more a product of the dying process than the drugs.

The American Academy of Hospice and Palliative Medicine has endorsed "palliative sedation to unconsciousness." The fact that we are talking about it is pretty remarkable. Is this euthanasia? I don't think so. How about helping the natural processes of life take over, which include dying. Politics and zealots have unfortunately entered the fray, not much to do about it. What irritates me is that most of the zealots have no "skin" in the game. Only the families do. So, us paratroopers would say to the zealots, f... 'em.

We all die and so to figure out how to do it as easy as possible is no small thing. Recently, I read about a doc, A Stone Freedberg, who is an example for us all. He made it to 101, quite surprising to him. His genetics weren't good: father died at 75and Mom at 60. And, get this, in 1939, the year I was born, Dr. Freedberg discovered a remarkable truth: ulcers were not caused by stress which was widely believed. At the time, he was forced to move on by his boss as the finding was more or less a theory. 70 years later, two doctors won the Nobel Prize for discovering the same thing. The good doc might have wallowed around in self pity. Not so. He went on to have a remarkable career and life. When he was closing in on his final days, he even catalogued his organ shutdowns for a friend. And, when death was at the door, Doctor Freedman said, "It is time to draw the curtain."

We simply don't do a good job of helping people die. There comes a time when someone is not going to get better, they are not going to recover so why not make the end the very best we possibly can. What is fascinating to me is how reticent people, even professionals, are to talk about the end of life. Why? is always confusing to me as we all die and yet is understandable.

Seeing folks at the end is so sad, most in their 90s and beyond. You would think that these "front burner types" who've lived long and rich lives would simply be "ready" beyond any doubt to hit the trail so to speak. Not so as the denial of the process is a big factor. A doctor friend of mine told me about his mother, 92, well educated, had lived a beautiful life according to him. He was convinced that when it came "time" she would opt for the, "no extraordinary means." Shaking his head still in disbelief, she allowed exactly the opposite, "do everything you can," she said. "I want nothing spared to keep me alive."

Presently, my wife and I are doing all we can to prepare a loved one to die because it is what she wants. After a debilitating heart attack, the now 89 year old's once vibrant life has been reduced to being almost helpless with wearing diapers which, for her, is the height of indignities. If anything happens, "no extraordinary means or anything else to keep her alive," are her wishes which she repeats constantly. God bless her and more power to her. I'm going to sign off with a HooAhhhh for her Mom who use to love this when I did it for her at the chapel and pleases Victoria no end. HooAhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

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