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.