Last Friday, I had the honor of being by the bedside of my partner's mother, Ann as she passed away. Fortunately, it all happened rather quickly. I say fortunately because she suffered from severe respiratory illness that could have made her passing quite uncomfortable. She spent only 24 hours in bed before leaving us. We attribute this "easy" exit largely to her being complete with her family, her readiness to go, her family's readiness to let her go, and to the loving support of our local Hospice organization.

I know that many baby boomers like us are now dealing with the long-term care or passing of our elder parents. During the two week's prior to her transition, we had an unsettling view into the ways our "health" care system feeds on the dying at the expense of the living.

Ann had been in and out of the emergency room many times over that past few months with severe respiratory issues, and with her lung capacity nearly exhausted, our hospice request was honored and we took her home after her last 10-day stay in the hospital. However, during her final week in the hospital, doctors discovered breast cancer and wanted to extract it. We questioned their reasoning behind an operation she probably wouldn't survive, not to mention the financial and emotional costs involved. We never got a coherent answer. So as a family, we politely declined.

Still, in the hospital, when her family was absent ( merely a coincidence?), doctors flocked to her. Not one, not two, but sometimes three or four in rapid succession. We only speculate of course when we infer the motives of this fleet of surgeons hovering around this ripe and dying Medicare candidate like hungry vultures. On one occassion, two came to her "aid" to convince her of surgery, while she lie vulnerable and semi-cogent. The first time she consented to surgery under their pressure, not thinking about the repercussions. After our discussions with her about the risk versus value of such a procedure at this time, she agreed it wasn't a good idea and canceled it. They came once more on the day of her discharge to try to convince her again. Early, we coached her to "Just Say No" to surgery, which she did in no uncertain terms.

Our complaints to the head nurse (the doctors never seemed to be around when we were, nor would they schedule appointments with us) received replies couched in "privacy act" language--being of sound mind, she is qualified to make her own decisions. It all felt very manipulative and, well, kind of "sick," in our opinion. After my recent experience of my own father's passing last October, this experience felt hauntingly familiar in a hospital in an entirely different town 250 miles away.

Our goal was to get her home and arrange for full-time care. If by some chance she did recover to the point of being independent, we would revisit the cancer issue. When we took her out of the hospital and got hospice involved, everything shifted. Ann was able to spend a couple of quality days at home with her family, her beloved cat Lilly, and her wonderful caregiver. This angel of a hospice worker helped us through the process and actually helped create a spiritual space that invited Ann to move onward and upward. She was a true Facilitator in every sense of the word. A Facilitator of the Final Act.

Reflecting on this experience, our concerns with the health care industry, and on our wonderful experience with hospice, one thing became very clear to Ginger, my partner, and I--hospice may be the only hope for our current health care system to survive.

With that thought, I did some research on medical costs around terminal illness. I discovered that 83% of people who die each year are eligible for Medicare and 27-30% of the total Medicare budget is spent in last year of life. The article containing this data also stated that: several studies suggest cost savings associated with the use of hospice care. In 1995, every dollar paid by Medicare for hospice patients saved the program $1.52 in Part A and Part B expenditures. (Lewin-VHI study, commissioned by the National Hospice Organization April 1995). The full text of this article can be found here.


Tips for Facilitating the Final Act with an Elderly Friend or Loved One.

- Beware of 'life extension" measures for an elderly person with a chronic illness who is ready to go. Solutions pedaled by the medical profession don't usually consider the quality of life whatsoever. Their only goal is to "prevent" death.

- Get complete with your loved one. Often times, they'd like to move on but they only hang around because of incompletions. If you can't speak to them to get complete, write them a letter. This will help you get clear and make sure your thoughts and feelings are heard by them. Click here to view an earlier issue of this journal that contains more on this subject.

- See death as a natural process. When my father was dying last year, I repeatedly heard the local pastor, of all people, advise him to keep "fighting" to live and to pray for health. At nearly 91 and ready to die, that seemed ironic to me. That is, that a person who on one hands speaks of a glorious afterlife urging another, who is ready for it, to avoid it at all costs! Facilitating the final act calls on those of us in the support role to embrace all of the stages of the dying process without false hope or denial of the obvious. This can help prepare a dying person and their family for the inevitable.

- If there's any question that your parent or loved one will live more than six months, urge them to get hospice involved. Hospice is a Godsend. They tailor their support based on your family's needs, and can be prescribed, cancelled, and represcribed as the patient's needs change. They not only provide unique medical attention, but they also provide counseling, and many other services. Hospice helps create a comfortable environment at home for the family and the patient to cope with the dying process. Pay them a visit in your community to find out more.

- Don't give doctors too much power. View doctors simply as one of many consultants on a team to assist the patient and their family with their healthcare decision making. Some doctors don't believe that any patient of theirs can possibly be terminally ill and hence by definition, not eligible for hospice. If the patient's instincts say that it's time to let the dying process proceed, support the patient in trusting their own instincts and wishes.

- Weigh life quality with life span. Our culture has created a medical system that keeps people alive at all cost...often at incredibly unreasonable costs. Conventional allopathic medicine's mechanistic view doesn't include the emotional and spiritual consequences of medical solutions. "Living" in the hospital on machines and drugs may allow one to live longer, but at what financial, emotional, and spiritual costs? Help your loved assess how the quality of life they desire will be impacted by proposed life extension measures.

- Support a "rituals withdrawal." Doctor William G. Bartholome, in his article, "Lessons of the Angel of Death," talks about how we need to recover and respect rituals of withdrawal for the dying. When one is ready to die, simply withdrawing from life and all interventions, will facilitate the process. In the eighteenth and nineteenth centuries, this was commonly referred to as "taking to bed." One would simply go lie in bed until dead. People at that time knew to respect this withdrawal as natural when someone's time has come. So if you're around a dying person, know that there may come a time when they want to be left alone, to process their life, withdraw from it, and go within. Honor this as a natural desire.

"Final" Note: After being at her mother's bedside for nearly 24 hours straight, Ginger slipped away for a much needed chiropractic adjustment. It seems Ann took her last breath while Ginger was in a meditative state on the chiropractor's table. In that moment, Ann's spirit visited her to say good bye, to let her know that dinner at "Steamers" tonight was on her, and that she was on her way to take care of other business while the office phone was ringing. Her sister was calling to let Ginger know that her mother had just passed away. To this she replied, "Yes, I know. She just told me."

Dying Well, by Ira Byock (M.D.)

I'm the kind of person whose eyes start to glaze over if I try to absorb more than a few pages of social science/self help type writing. I was steered to this book when I was helping my mother as she died. I had so little experience with death that I worried about doing the wrong thing. As I read the stories I was drawn in, absorbing each small "message" with each story. One, about a man whose final gift to his family was to allow them to help him as he died, touched me so deeply I read it to my mother in her last days. I wish I'd read this book earlier but I don't think it could ever be too late.
--James Dietsch, Albuquerque, NM