Thanks LB!  I don't usually see the Globe, and this looks like an excellent series.  I'll be back when I've read a bit more. 

Good Article

I saw my grandfather die in the comfort of his own bed at home , sooner or latter we all must go, i would rather be in my home that in a ward in a hospital or old home.

Last 3 yrs my mother in law has moved in with us, she is a very sweet woman, she’s 80, her only son wanted to put her in an old age home, it terrified her, i am close with her, so i promised her she will never see inside an old age home as long as God gives me strength, that she can die in the comfort of her own bedroom with us around . Needless to say my brother in law is furious at me , it came down to , she lives in my home, under my roof and I make the rules as long as she wants to live with me, i call the shots period.

I also find it good for my daughters to help with grandma, it helps with there development in regards to compassion and the elderly. 

Good for you Blackbelt. 

Although I will add a couple of things...

Caregiver burnt out is a serious problem.  People who are assuming such roles should investigate all options for support, including respite care.

There are some situations where staying at home is not in the best interests of the individual - these are not related to end of life btw.  In such situations the best thing for everyone, including the at risk individual, is to find a safe environment that allows for an enhanced quality of life.  There are very good places out there people just need to find them.

For the elderly isolation is a significant factor in decline, both physical and mental.  There are great programmes out there that will provide the socialization people need.

The goal in all cases should be to provide the best quality of life for everyone involved and care is always needed to prevent projecting one's own version of that life onto the other person.  Ask questions, listen to answers, ask more questions and truly understand the needs.

Hi LB -- very interesting and timely topic. Thanks for providing the link, and like Carolla, I'll  be returning to it.

I hope that given the scope of the articles you've pointed to it's appropriate for me to make assisted dying part of the conversation.

I've also been following some of the discussions on the cbc website of late, and among that readership anyway, there is overwhelming support for opening this controversial subject.

There's not space for me to go off on a lengthy rant -- I've got one -- but I'll just mention a couple of issues that I've been pondering.

Palliative care -- getting excellent palliative care (why wouldn't all of it be?) is much too difficult to access right now. I think in most cases, a person is lucky to be able to avail themselves of it in a timely way. That has to change very soon.

You mentioned the terrible isolation experienced by people at this stage, but what if there is no advocacy or meaningful connections? We should not have to be struggling with managing our care alone.

Hospitals and hospices need be training and enabling more staff and resources, and for that, many more dollars are needed. I don't even know if this is on the radar for health care spending.

I didn't know that "Thanatology" -- the study of dying -- is now offered at some universities as a degree programme. We need to understand dying in a much more global sense.

What also surprised me from reading comments. was that many of the people in favour of assisted dying cited as one of the attendant benefits, the lowered health care costs which are associated with hospital care in the last days, weeks, possibly months before dying. There was outrage, of course, but I was impressed that one can see how they fit together. I hadn''t made that association but I now feel it's valid. No one should think "being a burden" to the system or anyone else is a good reason to make such an important decision however IMO.

The other thing I want to comment on is the vocabulary used in these discussions. "Assisted Suicide" is inappropriate because suicide is a solitary and tragic event that could have possibly been prevented with adequate attention. To choose "when" for one's self  could not be a solitary decision, nor is it necessarily tragic. 

"Euthanasia" is also not accurate either. That describes an involuntary act. It's what we do for our animal companions since they can't convey their wishes. It's very important to clearly separate voluntary and self-directed from non-volitional actions. I believe the term "assisted dying" is clear, accurate and conveys exactly the consensual nature of the decision. It's the "extra" dose of morphine that would under current legislation make the prescribing physician or the person administering it, a murderous criminal.

Thanks LB, and I love the Charles Dickens Tale of Two Cities quote. I'm going to read that book again.

Conversations go where they need to go ...

[I'm becoming very Zen in my thinking these days ;-)]

Death like sex is one of those subject that need discussion, yet there is so much fear and ignorance that it becomes silenced.

Personally I always enjoy a good rant :-)

There are several options for palliative care that some may not have thought of; of course if no one is willing to broach the subject then those options will become difficult to access.  In the course of my work, particularly in the last year, I have been honoured - and I use that word specifically - to be part of the end of life of several people.

The single greatest problem is projection - others projecting their feelings on the individual facing end of life.  I will share one example but emphasize this situation occurred in each case:

A senior was diagnosed with cancer.  He chose not to proceed with treatment.  His wish was to die at "home" (home in this case was a retirement facility).  He was given extra care by both staff and outside agencies including hospice trained staffers.  Everyone involved made efforts to meet his special needs - a meal with his favourite food was served, favourite books read, special arrangements for a birthday. 

There was only one real problem and that was that some of the people involved in his care kept pushing for more invasive action; actions that were against the expressed wishes of this man.  They wanted to send him to hospital.  They wanted to force him to take medications he did not want.  They wanted...

his end to be what they wanted and in doing so tried to put pressure on every one in the circle to impose this desire onto the person. 

Fortunately there were people involved who spoke for the man.  People who reiterated his wishes.  In the end it was a sad but a "good" bye.

The isolation I mentioned above was not related to end of life but the isolation that many elderly or disabled people experience being literally trapped in their homes.  However....

No one ages or declines alone.  There are health care professionals involved and such professionals should be ethically bound to advocate on behalf of those in their care.

Training is always cost effective.  The greater the knowledge the greater the efficiency (there's that Zen thinking again).

I have said this before, and few people really understand what I mean when I say it but I will say it again.  I don't really care what the motivation is as long as the end result is the patient gets what the *patient* wants.  It is patient rights that is paramount and those rights include getting *or* refusing treatment.  Imposition of one or the other is the root of the problem not the options.

Hospitalization is expensive and alternatives need to be found.  Hospital staff are also trained to "save" lives and that training becomes instinctual.  It is very hard to relinquish that instinct and I personally do not believe that hospital staff should do so because it may lead to a swing to imposing the other alternative on those that *do not* want it.

Instead palliative care should be removed from "traditional" hospitals.  Processes for choosing home, hospices, retirement facilities, even specialized wings within hospitals are options.  As I said there are numerous, in place, solutions that will not increase operating costs that can be utilized if people are willing to look for them.

Our language defines us....

People use the words they are familiar with and, again, it is up to those professionals to educate others in the proper use of words.  However if those professionals are locked in their own language this will not occur.  Again, it is the projections of others onto the individual that must be avoided.

Just this week one of our oldest residents died.  This person lived a very long life and the ending was what was desired, quick and with dignity.  My emotions are mixed, as emotions always are in death.  I am sad to lose this person from my sphere but I am very proud that I was part of a process that ensured those desires were met.

Dylan Thomas wrote "Do not go gentle into that good night, Old age should burn and rage at close of day; Rage, rage against the dying of the light." and people interpret that sentiment to fight the end at all cost.  But one must read the rest of the poem to recognize that Thomas was writing about two struggles.  The first struggle is universal to us all; to keep the good in life, to not succumb to despair, to die before one has lived.

The second struggle is found in the final verse where the motivation of the author is revealed "And you, my father, there on the sad height, Curse, bless me now with your fierce tears, I pray.  Do not go gentle into that good night.  Rage, rage against the dying of the light."  This is Thomas' real lament, the motivation of fear in the losing of his father and he projects that fear onto the dying man.

We can reconcile those two struggles.  First by accepting when a person says 'I've lived.  I've earned the right to make my choices', then by respecting both proclamation and choice and finally participating in providing that choice.  In doing so, the fear and rage are diminished, the light restored and the inevitable is good.

This is an issue that concerns me greatly.

Firstly, I'm with you all the way LBJ ,  when it comes to the person deciding on their own course of action.

Often it's the only decision left that they can make for themselves - it's cruel to deprive them of what little power they have.

Someone close to my family has inoperable pancreatic cancer. He has been prescribed morphine - but is still in a lot of pain.

Thus, I would like to raise the issue of palliative care..........

Just how good is it, when it comes to pain control?

Generally, I've been disturbed by comments from friends that -particularly in the last week of life - that pain control just doesn't happen. 

One man told me of his  mate dying from lung cancer who was screaming out in pain. When he asked the nurse "to do something" she replied, "I'm pumping morphine into him - I can't give him anymore".

Specifically, when my sister was dying of ALS, she was in a lot of pain. (ALS affects the motor - but not the "feeling" neurons).

At first she took morphine - but it made her feel so "out of it" she decided to try and do without it. (She had four daughters under thirteen - and wanted to spend as much time with them as she could).

When the young country doctor came to see her, I accosted him in the driveway. I asked him if there was anything that was better than morphine - and didn't impair on her ability to interact with her daughters.

"Yes , heroin. But it's illegal in this country."

This was back in the late 1980's......

I understand that now heroin (diamorphine) is prescribed for terminally ill patients in the U.K. and a handful of other countries.

I don't know about Canada?

So, to my questions.......

Is heroin a better drug - when it comes to both pain control and being "aware", than the morphine that is presently prescribed? 

Does anyone know of someone who was prescribed heroin for a terminal illness?

What's the truth about palliative care - when it comes to pain control? (I'll be blunt here - flowers in my room, nice music -even a hug won't cut it with me if I'm in a helluva lot of pain.)

It seems to me if palliative care was effective in pain management - there would be no need for euthanasia. (At least in the area of physical pain - there is still psychological pain and the desire for some to control their own destiny).

In its legal name - diamorphine - yes: Several and not just for terminal illnesses. 

In the past two years I have been involved with 3 end of life situations; all three were dying from some form of cancer.  Two of the individuals refused most pain medication, they were uncomfortable but not displaying anymore distress than others in our building.

Pain is a difficult barometer to apply in these situation.  Each individual feels and reacts differently not just to pain itself but to medications.  I have seen some people react well to morphine and its sister drugs while others do not.  This again is why the individual must be seen in the treatment.

I can't speak to the "truth" only of my experience.  In the three situations they all personally expressed their gratitude for their care; two of these individuals were not emotionally expressive individuals, some would call them curmudgeons actually.  Yet each one thanked us for making them comfortable and doing "those little extras".  In one case, a very isolated individual, there was gratitude for "all the love from my girls".

Dying can be a messy business, particularly a long lingering one.  What palliative care - properly trained and effective - does is provide dignity to that mess.  It grants permission to the individual to make choices without judgment or recrimination - 'you want to eat only ice cream - ok'.  I believe that by giving the individual that control over their final days or months lessens the pain.

I believe there will always be some cases where there is a need for euthanasia.  Long term debilitating illness, particularly those that have been managed with pain killers, ultimately leads to decreasing the effectiveness of pain medications and thus in the end the pain becomes excruciating.  At that point there is only one choice, short of euthanasia, drugging the individual into unconsciousness and when that happens one really needs to ask the question 'is this the right thing to do, is there a difference between induced unconsciousness and death?'

There is also more to pain management than drugs and this is where there is a greater need for awareness and additional treatment plans.  Therapeutic massage by properly trained masseuses is beneficial to alleviating the pain that comes from extended confinement in beds.  Exercises that get the blood flowing and loosen constricted muscles will help reduce pain.  Reducing isolation and providing mental stimulation also helps.  For one of those individuals I mentioned above simply getting their hair done provided relief.  So you are very correct, palliative care should, and in some cases does, provide more than flowers, music and hugs; although in my experience it is the hugs that the individual remembers and holds on to.

What is essential to all of this, whether it is long or short term, is for caregivers - family and professionals - to truly see the individual, to *hear* what the individual says about their pain.  Sometimes the hardest pain to overcome is the loss of control over one's own life.

The worst pain a man can suffer: to have insight into much and power over nothing.

     Herodotus ( 484-430BC)

Thanks LB, you're a  person here I can always rely on to reply to questions that  others prefer not to think about......... (Such a pity that what often concerns  us the most isn't discussed).

I've had a wee chat with Mum and a few of her friends at the retirement complex and the general feeling is that excruciating pain - rather than death itself - is their biggest fear.

At this stage of their life they have experienced the death of parents, siblings, close friends and children.

Whilst not welcome, death is familiar - like an unpleasant Aunt you know will one day pay you a visit...........

Methinks spoken like a man not in excruciating physical pain at the time............

When applied to politics, philosophy, psychology, religion - a resounding yes!

Often pain management is a problem because in the beginning stages of the disease doctors over prescribe medications You can get Oxycotin for a sprained ankle in the local ER.  They also often start with the strong stuff and there is no place left to go later. This results in less effective treatment later.

Depression is often never addressed in death dying. Pain is far worse when one is already depressed. There still exists a stigma on mental illness and people think they should be able to handle it.

Religion plays a part. Those told death is "going to meet God" and that they should somehow be happy about it or the "God does not give us more than we can handle" baloney...  feel less able to express fear, doubt, anger, etc. The inability to confide, share, mourn.... the bottling of emotions means the pain can seem more severe.

People play stoic. They refuse pain meds and the pain level gets such that it is harder to treat effectively.

Physicians and patients (along with their family) minimize the role relaxation plays. Comfort is more than a fluffed pillow and a nice room. It is being able to "escape" the illness and the mind to just clear. A stressed out person feels pain more acutely than someone who is not stressed.

Doctors fear addiction(yes even in those near death) and  "bringing on death". Likely, because that could open them up to lawsuits. They may not prescribe medication in a manner required for pain management during death acompanied by pain.

We have medications that would let you cut an elephant's leg off without it waking up. There is no need for patients to be in pain at the end of life.

My advice, if you or anyone you care about is in pain in a pallative stage find out why and if your doctor is not willing to help ease your transition from living to dead, find another doctor.

such a good thread.  For sure, there are so many layers to that whole experience of dying,  as referenced above. 

I'm reading a book right now -  "Late-Stage Dementia - Promoting Comfort, Compassion, and Care" by Dr. Michael Gordon with Natalie Baker.   Dr. Gordon (medical professor, ethicist, geriatrician) spoke at  my hospital recently, which is what twigged me to purchase his book.  Anyway ...right off the top he talks about the lack of acknowledgment of dementia as a terminal illness - and how many folks are put through difficult interventions in the late stages - something I have witnessed many times ... so it is refreshing to see it addressed thoughtfully.   He certainly encourages lots of discussion between patients & family & caregivers re values & future planning. 

Re palliative care & pain relief - In my experience, much depends on who is prescribing.  A trained specialist in palliative care will use different meds, in different combinations and at different doses than many family docs in a similar situation.  And those who administer those meds (often nurses) have an influence too - those not trained in palliative care may hold back on doses they consider to be 'too frequent' or 'too high'.   And then of course the family comes into play with their thoughts ... it's pretty complex.

I do agree that palliative care is so specialized that it really is best offered outside of a hospital setting - or if in a hospital, in it's own very special unit.  We don't have that - our 'palliative beds' are interspersed & it is not optimal at all, for a great many reasons.  Over the decades, I've also seen lots of change in how 'palliative' is defined in terms of timelines - used to be a few months anticipated until death, now the timeline is very much shorter - and the declaration determines access to some services, which is unfortunate.   

But back to LB original stuff from the Globe - I found the videos quite interesting (and to see a newspaper going that route! changing times!) One of them actually featured a minister (UCC if I recall correctly) speaking about honouring his mother's wishes.   Makes me think I need to get some stuff written down & have more discussion with my own family ...

There is certainly a fear of excruciating pain at the end of life......

Dr. Philip Nitschke is an advocate for euthanasia in Australia. He prescribes Nembutal - and to keep within the law he advises terminally ill patients to just take one a night.........

Folks used to travel to Mexico - but many now import online........

He reported something interesting - that most patients who were prescribed the drug died before taking it. They felt psychologically better knowing that they could control just how much pain they were willing to experience. ("it's nice to know I've got the tablet - just in case".)

Which strongly suggests that it's often the fear of excruciating pain - more than the actual pain experienced.

I do have sympathy for doctors - often siblings have a different point of view - when, say, they have a parent in a coma.......

My thinking now is that I would, if faced with a terminal illness, opt for palliative care in a hospice.

I'd be mindful of passing time -and thus would want to be in a position to enjoy what I could - hopefully visited by loved ones - who were not burdened 24/7 with caring for me..

And, I would also like the added assurance that I had a tablet hidden away - such as nembutal - "just in case the pain became unbearable"...

LB, thanks for sharing your experiences, I find it very interesting.

I've had my share of disease and chronic pain (not excruitating thank goodness!), but I don't fear death yet.  I'm too young and stupid I guess :)

I've been lucky, of close relatives during my life only 3 great grandparents have died. All 4 of my grandparents are living, my great grandma died when I was in my mid twenties, and doctors told her she would live past the age of 10.  A few of my friends around my age have died, but it was people I had lost touch with and those were freak things.

I fear losing my grandparents, and even my parents, some family friends around their ages have passed away in the last few years, one quite recently.  Even with all my health issues, I'm not worried about myself quite yet.

Sorry, I just went back to the original post and realized how far away I got from that.  I'm tired, I'll try to respond with something a little more on topic soon.

In an excellent post I highlight this comment...

The addiction fear at end of life is one of my, for lack of a better word, favourite oxymorons and highlights the imposition of opinion onto another person.  There is another irony at play here as well; doctors prescribe addictive pain medications then with hold them on an arbitrary scale that may cause the individual to experience withdrawal pain. Both creat a situation where health care professionals apply their own dogma to the detriment of the patient and it is a hard nut to crack.

In reading the comments in this thread, mine included, a constant becomes clear; the major impediment is fear.  Fear of pain, fear of dying, fear of addiction, fear of interfering with some Divine Plan and behind all those fears is the fear of the unknown.

We can never eliminate the unknown from our lives, with every decision that we make it will lurk in the corner until the decision ends in the result and even then there will be that niggling question, 'was I right'.  It is that shadow that creates the fear, the debates among caregivers and treatment plans.

Ultimately what is needed is trust.  Trust that the decisions being made are in the best interests of the individual in need.  Once that trust is established fear retreats and as SG points out so does the stress that is often part of the pain.

Pilgrims Progress thought Herodotus was talking about politics, and possibly he was although he lived to be an old man during a time that was not sterile and painful death common, but I used that quote specifically because I believe that when control over important decisions about one's personal destiny, such as life and death, is taken away the pain becomes greatest.

We all want to have that pill in our drawer.  The comfort comes not from taking it but knowing that we can if want.

We cannot banish dangers, but we can banish fears.  We must not demean life by standing in awe of death. 

      David Sarnoff

My home, being filled with elderly folks, saw death happen frequently. For all my mom's flaws and faults, she had a huge dose of the good side of humanity also.

They were not "patients" or "clients", they were family. It started because my mom had a ton of nursing home experience and a doctor who knew her phoned from the ER. He had a "dump" and since my mom had quit working to be a full-time mom, would she take this person home until they found a place? Ed Lofgren moved in that day in 1968 and died "at home" in 1979.

There was no fear, in them, in mom, in us....

Maybe it was my mom's mental illnes,s or maybe her personality, but she was a truth speaker. It meant talking about dying. She was their advocate. She made sure the meds that could be used were used. She asked questions. Who do I call? What do you want done? I recall mom talking to a man who was in the final stages of emphysema about "the end".

My mom also assured them that if it was anything other than a death in their sleep or something so sudden it could not be helped, they would not be alone. She also said nobody would find them in a state. I recall watching my mom (hiding at a crack in the door) as she gently washed and spoke to Emily who had passed in the night.  

I recall my mom coming in from the hospital so angry she was shaking. Bernice had left "home" for the hospital.Mom had been on a vigil for days. Bernice's death had happened and was not good. My mom then started crying. something alien to me, my mom's emotions swang but she never, ever cried... "How come I can take the dog to the vet and have it put down and those %$#$%# would not just let her glucose levels take her gently?"

It is why when Ed died taking his afternoon nap, a man who had lived in our home as long as I had memories... and nobody was there but me (mom was doing her weekly shopping). I went in to wake him, realized he had passed. I ran out and ran into the bathroom sobbing. I then immediately regained composure. I went in the kitchen and called the docto, the coroner, and the funeral home (he had no family to call). Then I went in and made usre nobody found him in "a state". I had only weeks earlier entered my teens.

Talking about end of life decisions, pallative care and euthanasia (good death) became some of my pet projects as an adult.

I must have worked in some pretty good facilities, because I have witnessed many dying with dignity and the doctors were wonderful if we made the call to ask for an increase or change in medication. Patients that were still capable of pushing the button are given pain pumps to self administer for regular dosages and break through pain. We are always given orders for breakthrough pain between regular doses and constantly remain on the lookout using various techniques, to see if there's a need to increase the pain medication.

The question of addiction is pretty well moot when facing extreme pain. The pain itself actually "absorbs" some of the addictive qualities of the drug depending on how much you need.  Once pain is under control it is possible to function with mental clarity. This is also because you may not need as many of the other drugs that were needed to deal with such things as anxiety that may actually contribute to sedating you. It's important not to delay the medication and wait for the pain to return before you receive the next dose. The goal is to stay ahead of it, if possible.

I actually had one lady go into complete remission of her cancer that was on death's door just weeks prior. It's was amazing to witness. It did not take that long to "wean" her off her medications.

I have found that anyone that tends to "scream" when they receive morphine, it's more because they are having vivid and very scary hallucinations (possibly allergic) When they are given an alternative pain medication (and there are alternatives) this is usually resolved.

We have way too few hospice facilities in Ontario, (you can count how many probably with two hands) and each place can take only around 10 people at a time. The two that I am familiar with are amazing places for the patient and the family to be.

There should not be a question of forcing food,medication or disrespecting a patients wishes or instructions on anyone due to the Patients Bill of Rights in Canada and yes, sometimes you do need a good advocate to back you up using this information.

This is very valuable advice - and something I, and I'm sure many others, don't realise......

I've assumed (wrongly) that is was better to put off taking strong meds for as long as you could. (keeping them in reserve).

I will make sure this gets to the attention of our friend with inoperable  pancreatic cancer - as he is stoic by nature.

(Reminds me of when I broke my leg and I was given one of those self-administering morphine pumps. I discovered that if I kept still the pain was bearable -so didn't use it. During a very long night the nurse came in and told me to use it - as  the physio would have me out of bed and onto a walking frame the next morning, and I would regret not using the pump...............)

Thanks for your post Waterfall, it had a calming influence on me. Your patients were lucky to have you.........

Pilgrim, alot of time people do put off using the stronger medication often because it does have a sedative effect at first. But don't forget it relaxes you enough to sleep now that you don't have pain. As the body builds a tolerance and adjusts to less pain and you are able to catch up on those sleepless nights, you become more able to function and return to a more normal existence.

Back in the day when my mother died, nurses were under strick orders not to deviate from the every four hours thingy for pain meds. I am happy to say that this is old school thinking.

Also, bear in mind that death doesn't always include pain or even narcotic medications for pain.

What I am proud to say is that i have always worked with a great team of nurses and HCW's that go the extra mile to ensure dignity right up to the last breath. We play soft music, dim the lights, massage feet, paint their fingernails, brush their hair, moisten their lips, continue talking to them, etc..... Heck, we've even taken people outside for them to have a smoke on our breaks, if it makes them feel better. I am often humbled how some go out of their way.

(In keeping with my wacky personality, I will attempt a little humour on a serious subject.)

Er, Waterfall, can I make a pre-booking?

One small favour, when you take me outside for a cigarette, can we make it a marihuana joint instead?

It  would be a nice way to go out - a great reminder of when I was so full of life and passion................

I think Pilgrim that you and I are close enough in age that we would probably be wheeled outside together. You can enjoy your joint and I'll just sit there and watch all the young men go by.

Naa - you definately need to smoke a joint.

Not only will all the young men look "oh so good" - but I can guarantee that you'll think everything they say is hilarious...........

Excellent points but I highlight only two

This is an area that needs to be monitored very closely and recognize the individual.  I've seen first hand how some people respond very differently from others to medications and in one case it took way too long for everyone to get on board that the medication needed to be changed. 

There needs to be greater education in this area particularly with staff.  As I am sure most have figured out I am a strong supporter of individual rights and because of that I stay up to date with changes in legislation.  I also have a reputation for pointing out the law whenever I see a policy or behaviour that runs counter to it (yes, this often gets me in trouble but that never stops me).

There also needs to be a recognition of the many faces of "force"; sometimes it is not a physical act but a subtle application of pressure from one or two people applied to the individual, other staff and family.  I've been the recipient of that pressure.  It often takes the shape of an accusation - 'you are heartless'.  The pressure persists even when it is pointed out that this is what the person has asked.  This force is never applied with malice, it always comes from people with "good intentions" but it is force nonetheless and I believe that only through discussion and education can it ever be minimized.

I will also say we are all inclined do this - I as much as anyone else.  That is why it is so very important to keep not just an open mind but open ears and really listen to what the person is saying, to not shut out their opinions because they run counter to your own, to make "forceful" arguments that support your opinion and not theirs.  This is their life, ultimately it will be their death, not mine or yours.  Hear them.

The evil that is in the world almost always comes of ignorance, and good intentions may do as much harm as malevolence if they lack understanding.

     Albert Camus quotes 

It seems I am not alone in fearing dying more than death, especially if it involves a lot of pain.  Both my parents died unexpectedly, no pain, no drawn out process.

But no one knows what the future holds for them....

Oh, dear - I was just about to leave for church this morning when I received a call from the daughter of the man who has inoperable cancer.

He was having trouble breathing, so she took him to hospital where he was admitted to intensive care and had his lungs drained.

Naturally, she was very upset - and coupled with no sleep -  was in tears most of the time.

As she put it, "Why do we treat our animals better than those we love? I feel so helpless...."

After we'd talked for a while  and she sounded  a little calmer I got an opportunity to ask her if she thought her Dad was holding back on his morphine? She thinks it's a possibility  - so I relayed Waterfall's advice...

She added that he's now in the hands of a palliative specialist - and that she and her sisters accept that he's dying......

Life sucks at times.......

IMO, life sucks most of the time but...

There are times each of us is given an opportunity to really shine, a time where we can really live love as a verb;  end of life is one of those moments.

Reduce pain by not adding the burden of regret, recimination and guilt.   Ask questions and listen to answers.  Act on requests.  Take the time to tie up loose ends so the person has no worries about their affairs, give them the comfort that everything will be alright once they are gone. 

Instead of seeing only the end, look to the life.  Instead of focusing on the reasons to cry, focus on all the things that make each other laugh, the time to share all that is good in a person's life, seek out and provide what will bring joy not sadness.  Truly live life for the time.

They would find a quiet place and
there make prayers to the Great Spirit,
thanking him for life they enjoyed.

They would sing their song,
and they would die.

       Sun Bear and Wabun

How's your friend doing Pilgrims?

Not the best - I visited him today in hospital.

Tonight I feel tired and emotionally drained.

In his matter of fact manner he said to me that there was no hope - and he just hoped he didn't have to suffer for too long.... He said there's talk of sending him to palliative care....

He's 86 - and he's my mother's partner.

Mum wanted to go and see him, and, as she's also 86, I went with her.

 When we walked into his room, his face lit up, and he said to the nurse, "This is my girlfriend."

He insisted on getting out of bed  -so the nurse and I got him into a chair. Apart from needing oxygen, he coped well enough.

I noticed he hadn't eaten his lunch - so I was pleased when he had a cuppa and a piece of carrot cake with Mum and I...........

I spoke to him about his pain levels - which he said was okay now, as long as they kept the medication up.......

Like every man I've known in his situation he shed some tears, some smiles, some memories, and some disbelief at finding himself in this position.......

Although Mum had previously told me, I asked him to tell me about his and Mum's first date eight years ago.

It seems when he saw Mum and went over to her, she was literally shaking. He forgot his own nerves then, and said to her, "Let's find a table and sit down  - we're 78 - not a couple of teen-agers."

Apparently Mum replied, "Yes, but I haven't been on a date since I was a teen-ager!"

I admire their courage. A widower and a widow who wanted a companion - and found each other.

I said to Mum, "I'll be back in fifteen minutes." 

He grinned and attempted a wink, "Can you pull the curtain across, love?"

"No way mate", I said -"Just half across -  you're in enough trouble as it is. I can't risk you having a heart attack from excitement on my watch".

On the way home in the taxi, Mum held my hand the whole way....... 

It made me think of my first day at school, when I held her hand the whole way...

Thank you, PilgrimsProgress. for showing us a glimpse of him, of your mom, of you...

My heart is with all of you.

Mmmm, spending time, sharing stories, holding hands on the way home, being supportive, sharing a laugh......can it get any better than that? I think not!

Pilgrims, thanks for sharing.

Thanks, folks,,,,,,

How hard for you Pilgrim, and for your friends and relatives.  I have you in my prayers and thoughts.  

Does anyone have any experience or knowledge about using marijuana to offset chemo side-effects?   I saw this in the NYT

http://www.nytimes.com/2011/12/10/opinion/medical-marijuana-and-the-memo...