Journey of the End of a Lifetime: Gently and With Laughter

by Joanna Smith on Jul 25, 2016

I was the first to arrive at P.S.’s house that morning, and talked with her Mom first. I then sat with P.S. and talked again about whether she felt sure she wanted this to be the day of her death. She said unequivocally “I’m ready. I’ve said my goodbyes and I’m ready to go.” She had had trouble swallowing some coffee this morning and was concerned she would not be able to swallow the medicine. I told her I was letting the doctor know this by text since he was on his way, and he would talk with her about this when he arrived. Thin liquids are harder to swallow than thicker ones, and most people do not realize this. The compounded “cocktail” medication, which she and I looked at in its bottle, was thicker than coffee, so she was reassured…

Her children arrived next and then the physician, followed by the nurse and the social worker from Hospice.
The physician very carefully went over her concerns about swallowing from the morning and reassured her that, based on his assessment, he felt that she would be able to do it. We experimented with how the medication would be taken, and ended up putting a straw in the bottle itself and putting the bottle in a cereal bowl, filled with black-eyed peas to stabilize the bottle since P.S. could not hold the bottle herself and by law the family cannot assist her. The physician went over the time lines for the medications and again talked with P.S. about whether she was ready. Forming words was becoming more difficult for her this week, but she carefully and laboriously said that she understood what she was doing and wanted to go through with it.

“Any music you would like to have playing?” the physician asked. She had a particular CD she had made, and her children found it and put it on. The music filled the room and she and her family laughed at some imperfections they heard in the playing……

The Process: first, Anti-nausea medications, then a medication to slow her heart and, finally, the cocktail. The nurse was able to grind the anti-nausea pills into powder (two spoons, nesting together, still make a perfect grinder) and P.S.’s Mom mixed them with pear sauce. P.S. was able to take them easily. Now the medication to slow her heart–“the point”, as the physician said “of no return. Once you take this, you will take the cocktail within 5 minutes.” P.S. took it with pear sauce and actually licked the spoon. We all laughed.

Five minutes later she took the cocktail. We could see from the monitor on her finger that her oxygen level fell immediately. She was able to tell us that the mixture wasn’t bitter on her tongue, because she had used a straw, but that it burned in the back of her throat. What a gift that will be for the future: pharmacists can keep working on the cocktail to improve it (or change it) so that the final taste experience of a lifetime is not a burning sensation…..
In four minutes she fell asleep.
In fifteen minutes she had died.
Gently, peacefully, quietly.
The end of the journey of the end of her lifetime.

Journey of the End of a Lifetime: Today’s The Day

by Joanna Smith on Jul 23, 2016

How does it feel for P.S. to wake us this morning knowing that today is the last day of her life? She knows the day she will die.
People have been writing and asking me to talk more about my personal reactions as I help P.S. and her doctor create this event? ending? closure? for her. I’m not even sure what to call it.
I have intentionally kept my personal thoughts to a minimum because this is about P.S., not me, but P.S. told me it would be ok to teach others about her experience, so I will, both in my classes at UC/Berkeley and in my training program for advocates. so part of that is about me–here goes.
Our dog jumped up on our bed at 6 a.m. this morning to wake us (“time to eat; time to walk”). I opened my eyes: today’s the day. I have been eating a lot of ice cream this past week! Somehow that has been calming. I have been gardening because the earth has felt good for my soul; I have walked the dog and meditated–all to help me focus on living while she is dying. I think a lot about how I wish this were a possible choice for people with dementia–but I know it is not. There is a part of me that doesn’t believe this is happening, while it is clearly happening. And I see the need to keep good boundaries in place so I can think and plan and reassure P.S. and her family that everything is in place. A tinge of anxiety, mostly very calm right now…..

What would you do if you knew it was the last day of your life? With certainty? That’s the odd part about this for me. I have watched many people die, either at home or in the hospital, but this is different. In those cases, we were waiting without knowing: with P.S., we know.
For me, this morning is a time to be calm and do the kinds of things that are relaxing for me so I can focus completely on P.S.and her family when I’m there. She has requested that the physician and I be the only two people in the room when she actually takes the medication. Once she is asleep (which will happen very quickly), she would then like her family to come in and out of the room, sit with her, hold her hand. We have a wonderful nurse and social worker from hospice who will be present in the house (they cannot be in the room when P.S. takes the medication–again, a different discussion), talking about what they see as P.S. dies, and helping the family understand the process. The physician and I will stay until she has died.
This is the day, and I hope it is a gentle death for P.S. She has thought and planned for this day, and now it is here.

The Funeral Advocate: A New Kind of Advoate

by Joanna Smith on Nov 18, 2010

What is one of the most vulnerable times in life?  It is when a family member is dying or has just died.  You may be distraught, confused and overwhelmed.  And what is one of the most immediate tasks at the time?  Considering and making funeral/memorial service and cremation/burial arrangements.  Now there is a new kind of advocate to help you at that time.

It’s so new, there isn’t a specific title to search for yet on the internet!  It’s an advocate who knows the funeral/mortuary process inside and out from working years in that field, and now wants to work directly for families, helping them through the decision-making and arrangements process while ensuring they are not spending unnecessary amounts of money and are receiving the services they want and need.  Perhaps there was a contract established for services years ago and you need someone to ensure that the contract is being fulfilled.  This advocate can do all that and more, giving you peace of mind at a time of high stress.

To find out about these advocacy services and more, contact Healthcare Liaison at 510-704-8476 or