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The Random Friday Question: Where to Die?

Time for another Random Friday Question: When Jack Valenti died last month, we were told that the hospital had done all they could for him and he had chosen to go home to die. It's a comforting, assuring image, and it hearkens back to a time when almost everyone died at home, rather than in a hospital or hospice.

The Question: Where do most people die?

These days, Valenti's end represents a rare privilege. Federal stats say that 56 percent of Americans die in hospitals, and 19 percent in nursing homes. That leaves only a quarter of us to die at home. A century ago, nearly everyone completed the task at home, surrounded by family.

Interestingly, there now appears to be a trend back toward dying at home, and it's not driven by the desire to be comfortable and in familiar surroundings. Rather, it's a matter of money: Medicare reimbursement rules push nursing homes to ship dying patients to hospitals, and also encourage hospitals to discharge patients once it becomes clear that they are in the final stage.

But individual choices are important, too: The portion of the population that dies in hospitals varies greatly from state to state. In Oregon, for example, there's an unusually small number of people who check out in a hospital, mainly because the state has a much more developed network of alternative places to die, mainly hospices.

Any thoughts on what influences where people die (assuming they have a choice)? Have you given this any thought or had any experiences, good or bad, with trying to determine where a loved one will die?

By Marc Fisher |  May 11, 2007; 7:30 AM ET
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Comments

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I want to be eaten by a lion in the Mara.

Posted by: Simba | May 11, 2007 07:53 AM

Where to die? Well, there's the old joke involving twin 18 year old redheads... But there are ladies reading this blog, so
I shall refrain from sharing it.

At Disneyland, surrounded by little tykes, who shall be forever scarred by the experience, perhaps?

Posted by: wiredog | May 11, 2007 08:01 AM

I want to die in a big tub of Dippin Dots

Posted by: DC | May 11, 2007 08:50 AM

Beside one of the waterfalls on Jeremy's Run trail in Shenandoah National Park.

Posted by: Woodbridge | May 11, 2007 08:56 AM

On the herding trial field running one of my collies in a sheep herding trial. And if that doesnt work out than I want to die like Nelson Rockfeller in the saddle with a beautiful sexy hot young lady 50 years my junior. Oh honey its has been this hard and stiff in a long time. Can you say "Rigor Mortis" baby!

Posted by: Dave | May 11, 2007 09:09 AM

On the herding trial field running one of my collies in a sheep herding trial. And if that doesnt work out than I want to die like Nelson Rockfeller in the saddle with a beautiful sexy hot young lady 50 years my junior. Oh honey its has been this hard and stiff in a long time. Can you say "Rigor Mortis" baby!

Posted by: Dave | May 11, 2007 09:11 AM

At my cob cottage or in the city where lots of friends and family are around and a really good bakery is near.

Posted by: | May 11, 2007 09:12 AM

On the herding trial field running one of my collies in a sheep herding trial. And if that doesnt work out than I want to die like Nelson Rockfeller in the saddle with a beautiful sexy hot young lady 50 years my junior. Oh honey its has been this hard and stiff in a long time. Can you say "Rigor Mortis" baby!

Posted by: Dave | May 11, 2007 09:14 AM

On the WW Bridge during rush hour, across all the lanes. I would definitely get my 15 minutes of fame.

Posted by: SoMD | May 11, 2007 09:22 AM

Where do I want to die? First of all, I don't really "want" to die, I guess I have to though. Something spectacular, like being decapitated (quickly and painlessly) in an unusual place that'll make for a quirky news piece and maybe a bootleg video on youtube!

Posted by: grim reaper | May 11, 2007 09:30 AM

I want to be attacked nd eaten by a Spider Monkey!

Posted by: J | May 11, 2007 09:38 AM

I like the thought of dying at home, but only if my wife had died already. I would not want her to associate our bed and bedroom with my death. But I hope we die together as I truly could not bear the thought of my life without her in it. So in that case, I'd like us to die while skydiving at age 92.

Posted by: Ryan | May 11, 2007 09:40 AM

Well, I think I want to go quickly and relatively painlessly -- so maybe somewhere that I decided to take a nap?

Failing that, somewhere quirky and spectacular, so as to make the evening news. Maybe draped over "The Awakening," statue, wherever it gets moved to? (Or for that matter, how about an art museum? Preferably in combination with the aforementioned nap, but without damaging any of the artworks.)

Posted by: | May 11, 2007 09:40 AM

Iwant to die at age 96, shot dead by a bullet from a jealous lover who has caught me in the act with someone else!

Posted by: Richard | May 11, 2007 09:46 AM

...too gorgeous a day to ask such a serious question, Fish. You should have seen this coming.

As for me, I want to die and be paraded around Busch Stadium in a giant Cardinals helmet sundae while the Legendary Shack Shakers crank out "Pine Tree Boogie." Yeah.

...or if that cannot be done, the Family Guy's version of "Shipoopi."
http://media.putfile.com/shipoopi

Posted by: Greg | May 11, 2007 09:58 AM

I would like to fade out while lounging on the couch in the back room on a sunny afternoon. My family is with me, the windows are open and I hear kids playing outside.

Posted by: Josey | May 11, 2007 10:01 AM

I would like to die somewhere remote outdoors in the Scottish Highlands and have my body consumed by Golden Eagles and other raptors.

Posted by: Jack | May 11, 2007 10:12 AM

It's a thought provoking question, and I'm suprised that most of the responses had such little thought put into their comments. If they did, well, I apologize. Then I'm taking life and death way too seriously.

I've always been a believer in making it possible for a loved one to die at home, as long as it's the most comfortable and painless of options. If a nursing facility becomes necessary, it's usually because the patient has acquired pneumonia, or has fallen and suffered a hip fracture, or has been newly diagnosed with cancer, and now requires that level of care in a skilled nursing home. From there, it's nursing care, treatments, and eventually hospice. Hospice care for dying patients provides patients and families with the choice of dying at home or at a hospice facility. It's a personal choice, one which should be discussed with the family before any serious illnesses are diagnosed. These decisions should be made and documented so that there is no family feud, and most importantly, because it is the patient's wish to die wherever he or she wants.

Posted by: angelina | May 11, 2007 10:14 AM

I want to die like the horse died in the movie "The Cell".

Posted by: Wes | May 11, 2007 10:34 AM

My mother died at home of cancer seventeen months after being told she was terminal. The greatest comfort to her at the time of her diagnosis was when I told her she could be at home, in her own bed instead of a hospital or a care facility.

Make no mistake this was a very difficult promise to keep in that I was the sole caregiver and wasn't aware of other care resources. I was lucky though in that I owned my own business which provided me flexibility to take the time necessary.

In the end she died as she would have wished without pain and with me holding her hand. It was my gift to her.

This is a difficult issue for families as we try to provide for our love ones. I would think an alternative care program that allows for people to stay in their homes would provide comfort and dare I say - cost savings to society. Hospice, although a great program, is not enough.

Posted by: Chris | May 11, 2007 10:40 AM

I want to die at home, listening to Corelli's Concerto Grosso #1 in D Major.

May I add that I am reminded of the Jack Handy "Deep Thoughts" quote, "When I die, I want to go peacefully in my sleep, like Grandpa, not screaming in terror like his passengers."

Posted by: Ralph Kass | May 11, 2007 10:40 AM

I would like to be in hammock, on a slightly breezy summer day, with all my yard chores done; just drift off and never come back. Ah, Paradise!

Posted by: steve | May 11, 2007 10:46 AM

I'd like to die in the hospital, hooked up to dozens of machines and monitors, pumped full of drugs that cloud my last thoughts and blur my memories. I'd prefer to have useless "heroic" methods used to prolong my suffering and leave enormous medical bills behind for my family. I'd like to be wearing hospital gown, reducing my dignity and increasing my fear and discomfort.

Oh wait, that's exactly how I DON'T want to die, but far too many people will end up this way.

Posted by: Ted | May 11, 2007 10:58 AM

I heard a great, apocryphal story once:

A flight attendant is telling the story in an airport bar. Someone has asked her who her favorite passenger ever was.

It was an old gentleman, she said, who seemed nervous, so I was chatting with him to calm him down a little. He told me that the last time he'd been on a plane, it was in the middle of the night over Germany, and he was to jump out and go kill some jerries. Then he'd shipped home, gotten a job, and never traveled again, though he had dreamed of it. Now that he was retired, he had bought a ticket to travel around the world. He was going to a dozen of the most exotic destinations he could think of. He showed me his travel guides, the notebook where he'd planned and revised his itinerary, written down recommendations he'd received over the years, the collection of newspaper and magazine clippings... forty years worth of planning for this big trip. We had a good talk, then I went to check the cabin for departure. Ten or fifteen minutes later, on my last pass before takeoff, I stopped to make sure the old gentleman was wearing his seatbelt. I thought he was sleeping, so I gave him a shake to wake him up... he wasn't sleeping. He had very quickly and quietly died in his seat.

The bar crowd leaned in. "What did you do?"

I buckled him in for his last, big trip, and I sat down for takeoff.

Posted by: WDC | May 11, 2007 10:59 AM

Chris: So sorry for your loss. My father died at home in his bed only two months after diagnosis of pancreatic cancer. We only had two months to prepare but it still came as a shock when I got the phone call one morning right after I got to work.

As for myself, I'd like to time it very carefully. When I know that day is here I'll get dressed, go to my local Starbucks, and just after I take that first sip of the worst coffee in the world shout "Oh, my God Starbucks did me in!" then let my survivors sue them cross-eyed.

Posted by: Southern Maryland | May 11, 2007 11:03 AM

I like Tom Robbins' thought to be shot out of a cannon with streamers on my feet above all my friends and loved ones who are sitting in a meadow drinkinig wine and eating watermelon.

Posted by: Bethesda | May 11, 2007 11:15 AM

Retired and sitting at the Rock bar at Seacrets in Ocean City Md and watching the sunset over the bay towards DC and happy that I never had to die in DC.

Posted by: Falls Church, VA | May 11, 2007 11:19 AM

WDC, GREAT STORY!!! I was going to post the wish of dying at the hands of a jealous lover who caught me in the act at age 102, but Richard beat me to it by 6 years and a few minutes. ;-)

The Tub if Dippin Dots is another great wish.

Posted by: Butthead | May 11, 2007 11:22 AM

At Good Guys on my 103rd birthday.

Posted by: Reston, VA | May 11, 2007 11:37 AM

I'm reminded of my uncle, a brewery worker who died when he fell into a vat of lager. They pulled him out three times, but he kept jumping back in.

Posted by: Tom T. | May 11, 2007 11:42 AM

There are 2 gigantic outdoor Miller Beer brewing vats east of L.A. right off of the freeway. It would be heavenly with my last few dying breaths to swan dive into that liquid ocean of malt & hops!!

Posted by: a.k. | May 11, 2007 12:00 PM

preferably, soon after I have just used the "facilities" so as to avoid the messiness that happens after one's passing. nevermind having my wife associate our bed and bedroom with my death, she'd have to buy a new mattress!

Posted by: OD | May 11, 2007 12:08 PM

In bed asleep at a very old age but still in good shape or as an extra bonus, in bed, awake, at a very old age but still in good shape while making love to beautiful women at least 100 years younger than me.

Posted by: katman | May 11, 2007 12:10 PM

sorry, you guys, but the "shot by a jealous lover" quote is Eubie Blakes, which he used when asked how he thought he would, he answered "at 99, shot by a jealous husband".

I'd like to take a nap at the beach on a warm afternoon, listening to the waves, and just glide away.

Posted by: lestm | May 11, 2007 12:35 PM

At home napping on the couch. It's one of those warm spring days where the house is open, too cool for air conditioning and too warm for heat. I am dreaming of family and I notice that we are having an out-door barbecue. All of my old friends, family, and pets that have been long gone are there. I am so happy to see everyone and everyone is so happy to see me, it's like we've never been apart. I realize that I've died, but I also realize that my life has just begun for real.

Posted by: JB | May 11, 2007 12:47 PM

Dave - why did you drop the "va_herder" handle? Did you think people might start taking your ignorant comments seriously again? I see you've been on the food chats too under a different name, predictably endorsing the Organic Butcher and belittling anyone that doesn't eat meat any chance you get.

Posted by: | May 11, 2007 12:55 PM

Happily - in a big open field surrounded by mixed-breed puppies licking my face, falling and jumping all over me.

Posted by: Tazza | May 11, 2007 01:00 PM

EVERYONE deserves to go as they please. What a sad story out of TN when the executed prisoner requested that his last meal-a pizza- be delivered to a homeless person. The prison refused to comply with his request. What a bunch of coldhearted jerks-what do they preach in churches these days anyways? I haven't been in awhile-it used to be forgiveness.

Posted by: last wishes | May 11, 2007 01:31 PM

I want to die like my grandmother in her late eighties, in relatively good health when she died.

She woke up that day at her usual time, had her usual breakfast, went about her usual business for the day. She lay down for her daily siesta after lunch, and just never woke up.

Posted by: TonyO | May 11, 2007 01:36 PM

In bed with my married lover and time it just as his wife walks in on us.

Posted by: | May 11, 2007 01:52 PM

Almost the same story as TonyO - I'd like to go the way my grandma went - she went to bed one night and never woke up.

Posted by: Milwaukee | May 11, 2007 01:57 PM

After seeing my grandmother die in a beautiful and comfortable way at home after a 4 day illness, surrounded by family, I realized that hospice is an incredible resource. That same month, my great-uncle died in a hospital attached to dozens of tubes and in terrible pain, etc. It was so cold and impersonal, and his care was mechanized and outrageously expensive. His illness was incurable and his painful death was only prolonged by being in the hospital. Afterwards his wife agonized over how much he had suffered and wished they had chosen hospice. Even though they had plenty of notice with his fatal cancer, they had avoided making decisions about end-of-life care and ended up choosing the path of least resistance.

I think our society does not know how to deal with death. We totally avoid it or joke it off (see most of the above responses). It is also why we have unsustainably high health care costs in this country-- 85% of health care costs are in the last month of life, and most of that is for terminal, incurable diseases. Why not let these folks die with dignity and in the comfort of their own homes? Too few people know about or understand the hospice option.

Posted by: Neighbor | May 11, 2007 02:22 PM

It would be great to die like my grandmothers, both of whom had that ideal quiet passing in their sleep one night when they were very old but still in good death.

But if I die like my father, of a serious illness, I'd frankly rather be in a hospital where there are nurses and staff to help my loved ones take care of me. The hospital staff made it possible for my family to concentrate on our father and each other, rather than on keeping the linens changed and the IV working. They left us alone with him as much as we wanted, but they were there in a minute when we needed help.

I think people sometimes overlook that practical side when they get sentimental about the idea of dying at home.

Posted by: Nick | May 11, 2007 02:26 PM

Fishing.Sitting in my lawn chair surf fishing,listening to the waves and sea birds. Finally, hooking the big one and dragged out to sea never to be seen again.

Posted by: Dimbulb | May 11, 2007 02:59 PM

I'd like to die on the toilet, like Elvis.

Posted by: Kenneth | May 11, 2007 03:15 PM

Before all of my loved ones so I do not have to live without them. Hopefully in my sleep while dreaming of my wife and kids or enjoying my wildest fantasies...floating away into the emptiness of space and time with all the answers to the greatest questions in the history of our world.

Posted by: gwt301 | May 11, 2007 03:23 PM

Which recording of Corelli? Biondi? Marriner?

Interesting call there, and I'm seriously interested to know.

Posted by: Q for Ralph | May 11, 2007 03:38 PM

Um, Dave/vaherder, you can't fool us by posting under another ID because your rube-like mentality is still showing.

Posted by: Educated | May 11, 2007 03:56 PM

Neighbor is right on. We just dont handle death well in this country. That is so odd since it is inevitable.

Please, also, parents of younger children (under 25) think about making sure you have enough money to bury a child. I worked with a guy whose kid lost his 17 year old girlfriend in a car accident. The family did not have enough money to bury her. This is not acceptable. As we have seen with Virginia Tech tragedy--NONE of us really knows when we might go and we need to be financially prepared.

Posted by: Southeast | May 11, 2007 03:57 PM

My Step-Father past away on May 1st, he was schedule to come home on the 30th of April from the Nursing Home he had been in for the past 3 months due to a health issue with my mom. So I have given this alot of thought lately, I know for a fact I do not want to die in a Hospital I would chose a Hospice Facility if given my drothers. I do remember when my sister past away a few years ago at the Hospice it was peaceful and the people there were very considerate and caring of the patient and family needs and gave as much comfort as possible to all of us. But if God grants me the choice of the place and time of my passing, and as other posters have stated there wasn't a set of twins around, or a jealous lover involved, I would like to pass away surrounded by the beauty and majesty of the out doors, and laid to rest as is the custom of early Native Americans, atop a platform with my eyes open and gazing into the clear blue sky, or laid to rest in a Norseman way, yes burning boat and all. That is a romantic view of a real part of life, and as it is I hold that no matter how or where death may find me I am comforted by my faith that to be absent from the body is to be present with the Lord.

Posted by: JED | May 11, 2007 04:10 PM

I want to reiterate what some other posters have said about Hospice. My 74-year-old mother suffered for several months in a nursing home with various illnesses. Finally, after an epic battle with her doctor, I was able to go over his head and get her certified for hospice care in the nursing home. Within 24 hours after starting morphine, she had slipped peacefully away, without pain for the first time in ten years. I was at her side and was able to spend a few minutes with her after she died, brushing her hair one last time and talking to her (she had gone into a coma almost immediately after starting morphine. The hospice nurse said this is common--pain is the only thing that keeps some people alert and alive.)

Our current medical system that keeps terminally ill patients alive at all costs, especially to the patient, is cruel and should be re-evaluated.

Posted by: Scott | May 11, 2007 05:42 PM

Don't forget to prepare the simple papers that articulate where and how you want to be treated (or not treated) when you become seriously ill. Power of Heathcare decisions, etc. They're easy to fill out, then share your wishes with a friend or relative, and leave a copy with your things (or lawyer) Best to do it now, while you're feeling chipper...
Then, find the twins. Or the music or the beach....

Posted by: EmMi | May 11, 2007 06:07 PM

HOSPICE can be a place. It can also be a program offered in a hospital,
and it can be services provided at home. All these share the philosophy of care for family as well as for patient, and (if not perfectly) insurance can often cover: Folks -- check it out, so jokes & romance aside, you'll know you have options.

Posted by: elaine | May 11, 2007 06:07 PM

Thanks for the hospice advice but in keeping with Marc's intentions of a Friday light-hearted blog, I want to die with a ice cold beer in one hand and a grilled burger in the other hand while drifting down a fairly clean river on an inflated raft. No boulders in the middle of the river, please. I just HATE obstacles!

Posted by: Mmmmm, burger | May 11, 2007 06:21 PM

Not being in control is the only thing that worries me about getting old and sick.
If I had the choice of ending my life in a civilized way when my good life is over I would feel much more relaxed about old age.
In some states and countries this is regarded as a human right, as it should be.

Posted by: Larry | May 11, 2007 06:49 PM

My grandmother died a couple of years ago, in Oregon. She was in the nursing home she'd been in for years because she had Alzheimers. She was under the care of hospice, having been discharged from the hospital a few days earlier (the actual cause of death was congestive heart failure). It was a reasonably good way to go, but she would probably have prefered never going to the nursing home. Unfortunately it wasn't financially feasible.

Posted by: | May 11, 2007 07:39 PM

My wife died at home after a long bout with lung cancer With three minor childre who observed her months of pain. With was with HOSPICE Help. I can not think of anything more cruel. My choice for dying is in a quiet atmosphere at home. In a hospital a Doctor told me I would die if I did not agree with their procedures with in 24 hours. I walked out and am still alive. At least I think I am.

Posted by: Obie | May 11, 2007 07:48 PM

I did not give anyone permission to allow me to be born. So thus, no one really cared about how I had to survive, nor will they care about where I die. Reality is greater than percepiton.

Posted by: Mt-Bob | May 11, 2007 09:43 PM

My wife, who will no doubt out live me, knows to shove me off into the Back Bowls at Vail on my longest skis. She is not to report me missing until the spring thaw. Well, that is the idea anyway. I suspect I will go by self delivered euthanasia meds with my family having said "good-bye" and my dogs on my bed, with Eva Cassidy singing Somewhere Over the Rainbow on the CD player.

Posted by: Mountain Man | May 11, 2007 10:05 PM

A few years back on a warm April night I stopped along a gravel road over looking the Colorado River to sleep. I was on my way to a job interview at a remote marina below Las Vegas. I took a short walk around the car before, reclining the car seat to sleep, and smelled freshly turned dirt in the dessert under the moon less night with every star in the sky. The stone on the grave said he was 22 and died several days ago. Several days later, at my new job on the river, I learned of those whom knew the deceased sole. Why, why do so many people choose to die in their cars by not paying attention? It was boredom in this case. Let's see how fast we can take the only curve in the 14-mile road to the casino.
What a joy it is to be able to write about where you want to die or even to live to know that you're time is near. My sole died there that night, but my body continues on.

Posted by: Mt-bob | May 11, 2007 10:35 PM

Where would I like to die? Don't worry, everything is taken care of. I've left detailed instructions with Halle Berry and Scarlett Johannsson.

Posted by: dc | May 11, 2007 11:22 PM

My mother died in a hospice program with complications of cancer a few days ago. The hospice program wasn't at all what we were told it was. To be in the insurance-funded hospice program, my mother had to agree to not seek curative treatment while in it. Even though the program said the hospice care would only leave untreated the incurable disease, that wasn't actually the case. They treated no problems at all, except for pain. The pneumonia, crippling constipation from the morphine and starvation due to nausea, all went untreated despite our requests for relief. As it was explained to me off the record, anything we did to improve her condition (apart from pain relief) was only prolonging her existence and her suffering. A death that is as quick as possible wasn't what the literature and marketing actually described to us. There is, I think, a concept known as "palliative" care, humane care without curative treatment. The hospice program instead turned out to be "as mercifully quick a natural death as possible, treating no medical problems except for pain". If there is a culture of "humane quickness" to the death that isn't quite consistent with how hospice is marketed. There should be some way to communicate that there is possibility of death-by-neglect, when patients sign up for the program. Some patients aren't seeking natural euthanasia and want more time. My mother did.

Posted by: amk | May 11, 2007 11:34 PM

About five years ago, I remember someone I met briefly who described a hospice that was ran by a culture of death angels. Her warning about the place was not to ever let someone you know go there because they will make sure they never wake up and most likely won't make it thru the first night. I had forgotten the name of the place, but I knew when I found myself experiencing it first-hand. At this hospice the warning signs that were mentioned as signs that someone was close to dying was cold knobby knees and flaccid earlobes.
My father was diagnosed with lung cancer. It had advanced into the bones of the ribs. The last day in the hospital, he had been cleared for discharge to go home. He was on a low dose of morphine, but was alert and sitting up. He was watching the time and ready to go home about 1:30. Because of how weak he was, we were concerned that it would be hard to sleep in a regular bed and needed some time to prepare an adjustable bed at home. He knew his condition was terminal, and was weighing the options related to hospice care because of the pain management it could provide. He made it clear what he wanted was more time with his family to talk to them and tell them goodbye. He called his nurse over and said today he was having some times when he is good and other times when he felt weaker. She sat in a chair beside his bed and held his hand and looked him in the eye and said, "What you need is hospice. They will be able to help you manage your pain better than we can treat you here. They have special formulations of drugs to treat different kinds of cancer. They have a special formulation for the treatment of bone cancer. They have X number of nurses available, so they will be able to be more responsive to your needs than we can here." He agreed to change his release orders to go to hospice for respite care while we prepared a place for him at home. Here is where the treatment of a hospice bound patent drastically changed. Before he left the hospital, about 4:00pm a large extended release dose of morphine IV was given to him (we were told 60 mg) along with four quick release morphine tablets. After receiving this dose he slept with his eyes open and his only movement was rhythmic breathing. His bed was wheeled to the Odyssey Hospice with no change in his condition.
When we first arrived at the hospice at 6:00 pm, the first thing that happened was a long period of the hospice staff "assessing him." It was made very clear the family was not allowed in the room at that time.
About an hour later, at 7:00pm a nurse came in with a dose of morphine and told us that he was scheduled for another dose of 40mg. We told them, " No, he does not need it. Look at how he is already in a drugged out sleep." This is when it was explained to me that they could see he didn't have much time left. They explained, "Can't you see he is in pain? I see the unconscious signs to look for. See how he is twitching? He doesn't have much time left. I see a lot of hospice patents and I can see that. Feel his knees see how cold they are and look how knobby they are." I saw him asleep on too much morphine about a month before and he looked the same now as he did then. His knees looked the same as they have looked for the past three months as we have seen him laying in other hospital beds. "Look how flaccid his earlobes are. That is a sure sign." When he was alert in the hospital, he was coughing up phlegm. Now that he was in a deep sleep, he was not resisting the buildup of phlegm. I asked about drainage. The answer was, "we have medication that takes care of that." I should have asked more details about this. Now I believe it is taken care of by allowing it to accumulate in the lungs.
It took three meetings, but I explained that he had been on morphine briefly about a month before and the result was constantly sleeping. He did not like the morphine. We want him to be able to make his own pain management decisions. If he wants more pain medication, he can ask for it. If he is unconscious, he can't ask for less. His wish is to be interactive with his family. (My grandmother died in a hospice where she had a morphine pump and if she wanted more, she could push a button. It's not an unreasonable request. I told them we were making plans to move him home in a day or two. We need to get a hospital bed and work out a schedule of 24 hour care. This is only a brief stay. About 8:45 pm, after these discussions, the head nurse came back. I asked about him receiving his evening schedule of pills. She seemed startled by the question. She said she didn't know anything about his other meds and if we wanted him to take them, we should bring them from home. Some of the other medications were for regulating his heart and to prevent the accumulation of fluid.
They administered a dose of medication that was described as a steroid to prevent inflammation. The answer she had received from the hospice doctor who will now be in charge of all medical decisions for him said he thinks that morphine is most definitely the best treatment for him, but based on the family's refusal of pain medication, methadone could be used instead. I asked about the pain management specifically tailored for cancer in bone. "Yes, that's morphine." They insisted he still needs a dose soon to maintain a consistent level of pain management. It was reluctantly agreed to let them administer the dose, which is placed under the tongue. At some point in the evening, I overheard them discussing the issue at the front desk. What I know I heard was, "They are planning to give this man a slow painful death at home. That's just not right." I am not sure of the next line, what I remember hearing was "This would be better for him." At the time, I wanted to believe they meant in-patent care. Now I believe it was a discussion of the morphine and other medication overdose they were in the process of doing.
At 9:15 I had to leave. When I left, the staff was discussing a DNR (Do Not Resituate) order with my mother. I am assuming she signed it. My mother stayed with him thru the night. I asked her what else happened later. She said at midnight they came in with another dose of morphine, which she refused again. His condition was unchanged. Later they brought in another dose of the medication to prevent inflammation and another dose of methadone.

I woke up at 3:00am disturbed by the things I had experienced at the hospice and was determined to get him out of there first thing this morning. I received a call at 6:00am.

As the night progressed, his breathing grew shallower and shallower. About 5:30 my mother called the nurse in to ask about it. They told her that he was taking his last breaths. They ended at 5:45 am. Friday May 11th, 2007.

Posted by: Amarillo | May 12, 2007 04:10 AM

I want to die on the can, right in the middle of taking a dump.

Posted by: Fred | May 12, 2007 01:57 PM

I think I want to be near Washington DC when God decides I am done with this earthly project. I live in Tampa, that's too far south for this native born Washingtonian. I want to smell the air of a warm spring day just one more time in DC. I want to see the Redskins get their act together just one more time, and I want the NFC Championship played in the old stadium and going into the 3rd quarter 63-0 Redskins and Dallas is down to their last quaterback, because the Skins just beat the hell out of the last one.....

Posted by: Pete Mirones | May 13, 2007 12:45 AM

There was a contest among journalists for which cliché they would least like to have in the report of their death. Some opted for "horrified onlookers" and "still-smoking remains", but I think that would be a better way to go than "no fixed address" and "foul odor".

Actually I would like to die in the bed I shared with my late husband, listening to a recording that we made there.

Posted by: Owl | May 15, 2007 06:43 PM

The print version, published May 15, may leave the impression that hospices are institutions with beds for terminally ill people.

Actually, 80% of hospice care is home-based. A person enrolled in hospice is eligible for home visits from doctor, nurse, social worker, religious counselor, and volunteer. In Oregon, both hospice enrollment and deaths at home are higher than in other states, just as deaths in hospital and nursing home are lower.

The Oregon Death with Dignity Act, now in its 10th year, allows physicians to prescribe medication to hasten death in some cases. Only about 30 per year actually occur that way: the DwDA assures outstanding palliative care and most of those eligible for physician-aid-in-dying ultimately die of natural causes. For more information:
www.compassionandchoices.org

Posted by: E. James Lieberman | May 17, 2007 06:47 PM

The print version, published May 15, may leave the impression that hospices are institutions with beds for terminally ill people.

Actually, 80% of hospice care is home-based. A person enrolled in hospice is eligible for home visits from doctor, nurse, social worker, religious counselor, and volunteer. In Oregon, both hospice enrollment and deaths at home are higher than in other states, just as deaths in hospital and nursing home are lower.

The Oregon Death with Dignity Act, now in its 10th year, allows physicians to prescribe medication to hasten death in some cases. Only about 30 per year actually occur that way: the DwDA assures outstanding palliative care and most of those eligible for physician-aid-in-dying ultimately die of natural causes. For more information:
www.compassionandchoices.org

Posted by: E. James Lieberman | May 17, 2007 07:13 PM

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