Getting Ready to Die

A good, but difficult article in the New York Times about hospice care, palliative care and how people approach their deaths.

The basic questions:

How do we let go of a life? How much intervention is too much? When do all the small fixes stop making sense? How does a person know when to say, ''O.K., so this is what I'll finally die of''? We rarely ask such questions, because we don't believe, in our bones, that a terminal disease will end in an actual death. We don't want to cut short a closing life by even a matter of days. We want to be able to say that we did everything we could.

A story about a man dying of cancer. He had initially refused care, but had been taken to the hospital by his son after a seizure:

Readmitted to Mount Sinai, the man was sedated by a combination of antiseizure medication and the cancer itself. He was plagued by delirium and was only sporadically alert. He was in no position to reiterate his earlier decision to refuse therapy. The doctors decided that the only way to get food into the man, who was having trouble swallowing, was through a feeding tube, which has to be inserted through the nose, down the throat and into the stomach. It's uncomfortable to get it in and to have it in, and the patient kept pulling it out. The doctors restrained his hands. He pulled it out with his knees. They restrained his feet. Still he somehow managed to dislodge the tube 17 times, and each time the hospital staff replaced it.

Why, Meier asked the intern in charge of the man's care, do you keep reinserting that tube, when it's so clear the patient doesn't want it?

''He looked at me, and I will never forget this young man's face,'' Meier told me. ''And he said, 'Because if we don't do this, he'll die.'''

On death's unpredictability:

Death generally comes for most of us ''with unpredictable timing from predictably fatal chronic disease,'' Lynn wrote in ''Sick to Death and Not Going to Take It Anymore!'' But since the diseases are ''predictably fatal,'' why do we so often feel blindsided by death, even the death of an elderly person suffering from a long-term condition? Because the hardest thing to do is to really, deeply believe that we or our loved ones will die.