Will We Ever Arrive at the Good Death?

[Dover]

Will We Ever Arrive at the Good Death?

By ROBIN MARANTZ HENIG
Published: August 7, 2005

The death rattle is what's so unnerving. People who sit beside someone who is close to death, someone in a stage the experts call ''active dying,'' might hear a sound that's not quite a snore, not quite a gurgle, not quite a rasp. It doesn't hurt; it probably isn't something the dying person is even aware of. But it sounds terrible.

''Once the so-called death rattle starts,'' says Charles G. Meys, a hospice nurse with the Visiting Nurse Service of New York, ''that's usually an indication that the person is not coming back.''

The sound, made with each intake of breath, is merely air moving across phlegm. ''Healthy people can cough it up or spit it out or swallow it,'' Meys says, but a dying person is just not strong enough, so the secretions collect in the upper airways. ''And as they breathe in and out, it makes that sound -- that sound that we have learned to fear.'' To those watching, the person seems to be gasping for breath, asking to be saved.

Meys tells family members that he can offer atropine to dry up the airways and soften the death rattle, and most of them ask for it. ''But it's not for the dying person,'' he says. ''It's for the family.''

Charles Meys is the vanguard of dying in contemporary America. He's a hospice nurse of the kind that people in pain wish for: compassionate, soft-spoken, dedicated. He doesn't look the part of a nurse: he's 50 years old and a skinny 6-foot-3, with intense brown eyes and a long, graying ponytail. His mission is to help people get ready to die -- even if it means, as it does surprisingly often, allowing them to deny that they're dying.

Hospice today is as different from its grass-roots origins as Charles Meys is from Florence Nightingale. It began in the 1960's as an antiestablishment, largely volunteer movement advocating a gentle death as an alternative to the medicalized death many people had come to dread. People still dread those deaths; surveys show most of us want to die at home, not in a hospital, and want to die naturally, not hooked up to life support. But in recent years, hospice itself has become institutionalized, and it no longer means quite what most people take it to mean. Today there are hospice patients on ventilators, hospice patients with feeding tubes, hospice patients getting pacemakers, hospice patients receiving blood transfusions and cardiopulmonary resuscitation, hospice patients who panic when they can't breathe and call 911...cont'd

http://www.nytimes.com/2005/08/07/magazine/07DYINGL.html?incamp=article_popular