How to Die Well

By Jessica Nutik Zitter

[I] first met Stephanie in the Intensive Care Unit. She was an urgent admission — in shock, her blood pressure was almost unmeasurable. Over the previous month, the rate of cancerous fluid building up around her lungs had increased. She had used the permanent drainage tube in her chest wall more frequently to manage her shortness of breath. But in the process, she had made her blood pressure dangerously low. She was unconscious and mumbling incoherently. Her kidneys and liver weren’t getting enough blood and were effectively dying. We worked quickly. And we were lucky enough to be able to rehydrate her before her organs became permanently damaged. Slowly, she woke up again. We had saved her.

Stephanie was a 60-year-old wife, mother and grandmother. She loved life. Wine tastings, gardening, spending time with her family — this didn’t stop when she was diagnosed. When she had learned that the cancer had spread to the other lung and brain, she took a deep breath and went back into the ring to fight. She signed up for more chemotherapy. If she worked hard, she thought, she could beat it.

I wanted to celebrate with Stephanie and her family — she was no longer in critical condition — but I couldn’t. Our “fix” wasn’t going to change the fact that her cancer would continue to worsen. And fast. More chemotherapy would not save this woman. I had to tell her the truth.

When I walked into the room, Stephanie’s daughter Becky was giving her a massage. I thought of a manager preparing his boxer to return to the ring. “We’re ready to get back in there and fight,” Becky told me. “Bring on the chemotherapy.” Stephanie looked tired, but nodded. I took a deep breath and sat on the side of the bed.

I explained that it was only a matter of time before Stephanie’s organs failed again. The next time, she probably wouldn’t be so lucky. The corners of Stephanie’s mouth pointed down, like two arrows, and I wasn’t sure if she was getting ready to cry or yell. “Please leave,” Becky said.

I had done the right thing, but nonetheless I felt ashamed. I wasn’t the doctor they had been hoping for. I wasn’t their hero.

We all know we will die. But somehow none of us believes it. This is a serious obstacle to dying well.

To start to find a way to experience a better end, we need to reflect on our own deaths and begin the process of accepting our mortality. This may happen through meditation, writing or conversations. Of course we should have hope if illness strikes us, but hope for perpetual life is blind. As we age or grow ill, the goal may switch from hope for longer life to hope for more attainable goals like healing relationships, living pain-free and enjoying a glass of Cabernet.

Simultaneously, we must prepare for this final stage of life. We must consider our preferences and values and shared them with our loved ones. Stephanie cared about being at home, with her family. What is most important to you? What would be most important to your loved ones? One day you might be called on to represent them. This conversation should happen repeatedly over the years, through the various stages of life and changes in health.

We must all — doctor, nurse, patient and family — also remember that these decisions require the collaboration of a whole team. The doctor is indeed the expert on the disease, but the patient is the expert on the patient. If you feel that you are not being included in decision-making for yourself or a loved one, or you don’t feel the team is communicating well, request a palliative care consultation, which brings communication expertise into the picture.

Two days later, I went upstairs to check on Stephanie and her family. I was no longer responsible for the case. Still, I worried that I had upset them, and I wanted to check in. I was dreading it.

But when I reached the room, there was Stephanie sitting in a wheelchair, smiling. She was going home that day. The family had had some time to absorb the news, and then they had changed the course of care. They had met with a hospice service. No more hospitals. No more chemotherapy.

Stephanie enjoyed the last two months of life with the support of hospice, her family and several bottles of good wine. Her funeral, which I attended, was replete with wonderful stories and not an ounce of regret. She died in my arms, Becky said, and it was as loving and peaceful a death as you could imagine.

Stephanie’s last couple of months might have looked very different. Like many of my patients, she could have died attached to machines. She could have been isolated from her family instead of in a cozy bed in the middle of the living room. And rather than the taste of wine and crackers, she could have had breathing and feeding tubes filling her mouth.

I’ve seen so many patients, so many lives, so many deaths. Far too few have the opportunity to live the life they would choose all the way through to the end. I believe deaths like Stephanie’s should be the rule, rather than the exception. And that is going to take some work from all of us — in the form of reflection, preparation and collaboration.

When it comes to death and dying, the answer is found in honest communication and human connection rather than technology and protocols. We’ve achieved amazing things in modern medicine. Our tools can serve to bring the dying back to life. But too often they take life away from the dying.

Complete Article HERE!

Hard Luck

From a bet gone wrong to the man suffocated by BOOBS…these are 8 of the most bizarre cases of people who died during sex

By George Harrison

[T]HESE are the shocking true stories of the unfortunate people who died whilst having sex.

The tragic stories highlight a dangerous side to everyone’s favourite pastime, so remember to take care next time you get your rocks off.

This mountain of X-rated magazines crushed a man to death at his flat in Japan

Crushed by porn stash

One man recently met a sticky end after being crushed by a mountain of pornographic magazines.

The Japanese man, named as 50-year-old Joji, was found six months after his six-tonne stash of porn magazines fell on him.

Cleaners tasked with tidying his neglected flat found that the entire apartment was rammed with the explicit magazines.

It is unknown whether the man, a former car-manufacturer, had died from a heart attack and then fell into a stack of pornography, or whether he was crushed to death by his X-rated collection.

Plunge of passion

In 2007 a couple from Columbia, South Carolina, fell to their deaths after plunging naked from the roof of an office building.

The bodies of Brent Tyler and Chelsea Tumbleston, both 21, were found by a taxi driver in the middle of an otherwise-empty street at 5am.

The couple’s clothes were later found on the roof of a nearby building, where they were believed to have been having a risky outdoor romp before falling from the roof.

One man died after taking enough Viagra to get him through a 12-hour romp

Half-day romp ends in tragedy

A Russian man died in 2009 after completing a 12-hour orgy with female pals, who had bet him over £3,500 that he couldn’t keep going for half a day.

Minutes after completing the bet, mechanic Sergey Tuganov died of a heart attack, which had been caused by the huge quantity of Viagra he had guzzled to prepare him for the task.

A woman was mauled to death by a lion after having sex in the nearby bush

Eaten by a lion after romping in the bush

In 2013, a Zimbabwean news website reported that a couple were attacked by a lion after having sex in the bush.

The big cat killed Sharai Mawera after interrupting the couple, although her unidentified lover managed to run away before he could be killed.

After notifying the police, the male lover, who escaped wearing only a condom, found the woman’s mauled body at the scene of the attack.

Smothered to death by lover’s breasts

Donna Lange, 51, smothered her lover to death inside a mobile home.

The intoxicated woman, from Washington, claimed she didn’t know how the man died, although a witness claimed to have seen her crush his face with her chest.

A Chinese student died of a heart attack after making a donation to a sperm bank

Sperm bank heart attack

A trainee doctor, Zheng Gang, died of a heart attack in 2011 – after over-exerting himself whilst producing a sample at a sperm bank.

The 23-year-old was pronounced dead at the scene of China’s Wuhan University, where he had spent two hours inside a booth, having already visited four times that week.

Policeman cops it during a threesome

A cop died in 2009 when his heart gave out during a threesome – and his wife sued his doctor for not warning him against having sex.

William Martinez, a 31-year-old Atlanta police officer, died whilst having sex with another woman and a male friend.

But his wife won $3 million (£2.4 million) after suing his doctor for not warning him that he had a weak heart, and should avoid strenuous activities.

Death by neo-Nazi roleplay

A sick neo-Nazi roleplaying session ended in tragedy, after 38-year-old Simon Burley died when a sex game with lover Elizabeth Hallam went wrong.

The hanging-enthusiast had a noose fitted around his neck whilst his lover played the part of a Nazi executioner, who hanged him as part of a sex game they were playing.

Unfortunately, the knife she planned to cut him down with was blunt, and the man was left to suffocate to death at his house in Grimsby.

Complete Article HERE!

Northwest doctors rethink aid-in-dying drugs to avoid prolonged deaths

Doctors seeking to help terminally ill patients under state Death with Dignity laws have come up with a new drug mixture. It’s the latest alternative to one drug that suddenly got too expensive and a mixture that took too many hours to work.

Valium, also known by the name diazepam, is one drug used in a mixture of aid-in-dying medications.

[T]wo years after an abrupt price hike for a lethal drug used by terminally ill patients to end their lives, doctors in the Northwest are once again rethinking aid-in-dying medications — this time because they’re taking too long to work.

The concerned physicians say they’ve come up with yet another alternative to Seconal, the powerful sedative that was the drug of choice under Death with Dignity laws until prices charged by a Canadian company doubled to more than $3,000 per dose.

It’s the third drug mixture recommended by the doctors whose medication protocols help guide decisions for prescribers in the six U.S. states where aid-in-dying is allowed.

The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

“[Twenty percent] of the cases were three hours or more before death, which we think is too long,” said Robert Wood, a retired HIV/AIDS researcher who volunteers with the advocacy group End of Life Washington, in an email. “The longest was 31 hours, the next longest 29 hours, the third longest 16 hours and some eight hours in length.”

Patients and families are told to expect sleep within 10 minutes and death within four hours. When it takes far longer, family members get worried, even distressed, said Dr. Carol Parrot, a retired anesthesiologist who has prescribed drugs for dozens of aid-in-dying patients in Washington.

The doctors say this can be addressed with larger doses of the three drugs they have been using — diazepam, often used to treat anxiety; digoxin, used to treat heart issues; and morphine, a narcotic pain reliever — plus another heart medication, propranolol, in a four-drug cocktail aimed at quickly inducing death, Wood said.

Parrot and Wood are part of a seven-member group of doctors in the Northwest who came up with the three-drug protocol after Valeant Pharmaceuticals Inc. acquired the rights to secobarbital, known as Seconal, in 2015 and raised the price sharply.

“We wanted the new drug regime to be safe, reliable and effective — and cost $500 or less,” said Parrot.

How long until death?

Since 1997, when Oregon’s Death with Dignity law became the first in the nation, doctors had relied on fast-acting, relatively inexpensive barbiturates — either secobarbital or pentobarbital — for patients with terminal diagnoses who sought aid in dying in Oregon, Washington, California, Colorado, Montana and Vermont. The practice also has been approved in Washington, D.C., but is being reviewed by Congress.

Pentobarbital became unavailable after drugmakers blocked its use in U.S. death-penalty executions.

Concerns about the overly long deaths surfaced last summer, Parrot said. Nearly all of the problems occurred in patients already taking high doses of opiates.

“We run into patients who are so tolerant or dependent on narcotics that even the astronomically high doses of oral narcotics in our prescription do not stop them from breathing,” she said.

If patients have diseases that slow or alter normal organ function, it can affect the speed and amount of drugs absorbed in the small intestine, metabolized in the liver and sent to the rest of the body. Very large patients, too, may require larger doses.

Deaths aren’t required to be supervised, and no doctor was present with the unidentified patient who took 31 hours to die, so doctors would only be speculating about the reason, Parrot said.

Not all patients — or doctors — experienced overly long deaths with the previous drug mixture. Dr. Lonny Shavelson, a Berkeley, California, physician who has supervised two dozen aid-in-dying deaths under California’s new law, said it worked fine.

“My personal experience is, I haven’t had long deaths with it,” Shavelson said.

And not all doctors think long deaths are a problem. In Oregon, even with fast-acting barbiturates, time to death has ranged from one minute to 104 hours during the 20 years the law has been in effect, state records show.

“I’ve heard stories where it took quite a number of hours to die, and it was fine,” said Dr. David Grube, an Oregon-based medical director for the advocacy group Compassion & Choices.

Scrabble, then lethal drugs in scotch

Scott and Amy Kreiter, of Wenatchee, didn’t know what to expect when Scott’s mother, Patricia Hansen, 69, decided to take the lethal drugs on Dec. 26, 2016. Hansen, a lively woman who once ran a gourmet ice-cream business, had endured frequent hospitalizations for end-stage kidney failure, congestive heart failure and other ailments.

“She said, ‘I want to listen to Willie Nelson, I want to play a game of Scrabble, I want to drink a Rob Roy or two, and then I want to be done,’ ” said Scott Kreiter, 47.

Hansen proceeded to “kick our butts” at Scrabble, her son said — including fulfilling a goal of getting a triple-word score with a dirty word. Then she mixed the drugs with scotch and drank the solution.

“She didn’t complain. She just took it,” her son recalled. “She said, ‘You thought I’d chicken out, didn’t you?’ ”

Within two minutes of downing the mixture, Hansen was asleep. Within 20 minutes, her breathing had stopped.

“We thought it would take one to two hours,” Amy Kreiter said. “It if had gone on for hours, we would have thought we did it wrong.”

Critics of aid-in-dying say growing reports of overly long deaths underscore their objections. Dr. David Stevens, CEO of Christian Medical & Dental Associations, which has tried to halt or reverse laws, said coming up with new drug protocols could eventually be a step toward Holland’s practice of allowing euthanasia by lethal injection “so the patient could be killed ‘humanely.’ ”

“We are heading down that same path,” Stevens said in an email.

But Parrot and other frequent prescribers of aid-in-dying drugs say they are looking for the best way to honor the wishes of patients in states where the practice is allowed. Doctors recently began using the newest drug mixture and will gather data about its effectiveness.

“We’re not experimenting,” Parrot said. “We are working with available drugs to provide dying patients a comfortable, peaceful death that is reliable and safe for them and comforting for their families as well.”

Complete Article HERE!

Obese people may get less ‘comfort care’ at the end of life

By Andrew M. Seaman

[O]bese people in the U.S. may not receive the same kind of care at the end of their lives as people who are thin or normal weight, suggests a new study.

Before they died, obese patients were less likely to enroll in hospice care, spent less time in hospice and were less likely to die at home than thinner people, researchers found.

End-of-life care was also more costly for obese people.

“People with obesity deserve high-quality care, but may not be receiving it at the end of life,” said lead author Dr. John Harris, of the University of Pittsburgh School of Medicine in Pennsylvania.

More than a third of U.S. adults are obese, according to the U.S. Centers for Disease Control and Prevention.

Harris and his colleagues note in the Annals of Internal Medicine that aside from health risks, obesity may present technical and logistical challenges during physical examinations and certain medical procedures.

Previous research also shows that stigma about weight affects how doctors and patients behave, they write.

To see how body weight is linked to healthcare at the end of life, the researchers used data collected between 1998 and 2012 from 5,677 people on Medicare, the U.S. government’s health insurance program for the elderly and disabled.

None of the participants were living in nursing homes or other institutions. The data were drawn from the last six months of their lives.

Based on body mass index (BMI), a measure of weight in relation to height, 7 percent of participants were underweight with a BMI of 18.5 or below, 44 percent were normal weight with a BMI of 18.5 to 24.9, 31 percent were overweight with a BMI of 25 to 29.9 and the rest were obese or morbidly obese with a BMI of at least 30.

A 5-foot-5-inch person weighing 120 pounds would have a BMI of 20, in the normal range. A person of the same height who weighed 240 pounds would be morbidly obese, with a BMI of about 40. The National Heart, Lung and Blood Institute provides a BMI calculator online (

The researchers found a 38 percent probability that people with a BMI of 20 would enter hospice care toward the end of life, compared to about 23 percent among people with a BMI of 40.

Hospice care, which can be provided in home or at a facility, provides physical support, including pain control, and emotional support for patients and families dealing with terminal illnesses.

When people with a BMI of 40 did receive hospice care, it was typically for a shorter time than normal-weight people.

“It’s looks like people weren’t getting enrolled, and they got there later if they were enrolled,” Harris told Reuters Health.

The researchers also found that obese people had lower odds of dying at home, which is a typically a wish for people at the end of life. Their likelihood of dying at home was 55 percent, compared to 61 percent for normal-weight patients.

Gaps in care generally rose as BMI increased, the researchers found.

“It seems like people with obesity are getting lower quality of care at the end of life,” said Harris.

The cost of care was also higher when BMI was higher, they found.

The study can’t say why these gaps exist, but the researchers suggest it may have to do with obese people looking less gaunt toward the end of life and not being referred for hospice. Or, they may be unable to find a hospice program that can accommodate their healthcare and family’s needs.

The healthcare systems needs to make sure it’s offering everyone the same level of care, said Harris.

His overarching goal, Harris said, is to improve the quality of care for people with obesity.

 Complete Article HERE!

How to Find Meaning in the Face of Death

The time between diagnosis and death presents an opportunity for “extraordinary growth.”


By Emily Esfahani Smith

[T]he psychiatrist William Breitbart lives at the edge of life and death. As chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center in New York, Breitbart specializes in end-of-life care for terminally ill cancer patients. For many of his patients, the most pressing question isn’t when they’ll die or how painful death will be. Rather, it’s what makes life meaningful. They are in search of a meaning that cannot be destroyed by death.

Is there one?

Breitbart has spent the better part of his career trying to answer that question. His ground-breaking research shows that while the specter of death often leads people to conclude that their lives are meaningless, it can also be a catalyst for them to work out, as they never have before, the meaning of their lives.

When people believe their lives are meaningful, according to psychologists, it’s because three conditions have been satisfied: They feel their existence is valued by others; they are driven by a sense of purpose, or important life goals; and they understand their lives as coherent and integrated. Psychologists and philosophers say that the path to meaning lies in connecting and contributing to something that is bigger than the self, like family, country, or God.

Meaning and death, Breitbart believes, are the two sides of the same coin—the fundamental problems of the human condition. How should a human being live a finite life? How can we face death with dignity and not despair? What redeems the fact that we will die? These questions roll around Breitbart’s mind every day as he works with patients facing life’s end.

Breitbart’s interest in meaning took root in his childhood. Born in 1951, Breitbart grew up on the Lower East Side of Manhattan. His parents, Jews from eastern Poland, narrowly avoided Hitler’s death camps. When they moved to America, they carried their memories of the war years with them. Breitbart’s childhood was steeped in that tragic past. Every morning, his mother would ask him at the breakfast table, “Why am I here?” Why, she wondered, did she live when so many others had died?

“I grew up with a sense of responsibility to justify my parents’ survival and to create something in the world that would be significant enough to make my life worthwhile. It’s no coincidence,” he laughed, “that I ended up at Sloan Kettering.”

Breitbart began working at the hospital in 1984 during the height of the AIDS epidemic. Young men his age were dying all around him. As he tended to them, “They were constantly asking me to help them die,” he said. He was also working with terminal cancer patients. “When I walked in the room, they would say, ‘I only have three months to live. If that’s all I have, I see no value or purpose to living.’” They told him, “If you want to help me, kill me.”

If death means non-existence, Breitbart’s patients reasoned, then what meaning could life possibly have? And if life has no meaning, there’s no point of suffering through cancer.

By the ’90s, physician-assisted suicide was a hot topic in Breitbart’s circles and beyond. The doctor Jack Kevorkian had helped his first patient end her life in 1990. As the United States debated the ethics of assisted suicide, other countries were taking steps toward normalizing the practice. In 2000, the Netherlands became the first nation to make physician-assisted suicide legal. Today the practice is legal in the United States in California, Vermont, Montana, Washington, and Oregon.

As Breitbart heard more stories of assisted suicide, he began to wonder what specifically was driving the terminally ill to give up on life. At the time, he was doing research studies on pain and fatigue at the end of life, so he tacked onto those studies some questions that asked his subjects whether they felt a desire for a hastened death. What he discovered surprised him.

They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life.

The assumption had been that the ill chose to end their lives because they were in terrible pain. But Breitbart and his colleagues found that wasn’t always the case. Instead, those who desired a hastened death reported feelings of meaninglessness, depression, and hopelessness. When Breitbart asked patients why they wanted a prescription for assisted suicide, many said it was because they had lost meaning in life. Unlike clinical depression, which has a specific set of diagnosable symptoms, meaninglessness was more of an “existential concern,” Breitbart said—a belief that one’s life has little value or purpose and is, therefore, not worth living.

Breitbart knew he could treat depression—there were medicines and well-developed psychotherapies for that—but he was stumped when it came to treating meaninglessness. Then, in 1995, he began to see a way forward. He was invited to join the Project on Death in America, which aimed to improve the experience of dying. Breitbart and his colleagues on the project—including philosophers, a monk, and other physicians—had long conversations about death and the meaning of life, “peppered with references to people like Nietzsche and Kierkegaard and Schopenhauer,” Breitbart said. “What I suddenly discovered,” he explained, was that “the search for meaning, the need to create meaning, the ability to experience meaning was a basic motivating force of human behavior. We were not taught this stuff at medical school!”

Breitbart became convinced that if he could help patients build meaning, he could decrease their suicidal thoughts and make their lives worth living even to the very end.

He developed an eight-session group therapy program where six to eight cancer patients come together in a counseling workshop. Each session, in one way or another, helps build meaning. In the first session, for example, the patients are asked to reflect on “one or two experiences or moments when life has felt particularly meaningful to you.” In the second session, patients respond to the question “Who am I?” to tap into the identities that give them the most meaning. One woman responded saying, “I’m somebody who can be very private … [and] have been working on accepting love and affection and other gifts from other people.” In subsequent sessions, they share their life story with the group and think about the role that love, beauty, and humor played in their lives.

In the final session, the patients reflect on the part of them that will go on living even after they are dead—their legacy. That could be their soul, or it could be something they helped to create that will continue to exist—their children, a work of art, or an organization. They present a “legacy project” to the group, generally something they do or create that represents how they want to be remembered. One man brought in a woodcut of a heart sculpted into a Celtic Trinity. “This is what I will teach my children,” he said, “that there is eternal love, and that I will be there for them, far beyond my passing.”

Breitbart performed three randomized, controlled experiments on the meaning-centered psychotherapy. When he analyzed the results with his colleagues, Breitbart saw the therapy had been transformative. By the end of the eight sessions, the patients’ attitudes toward life and death had changed. They were less hopeless and anxious about the prospect of death than they were before they began the program. They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life. And, of course, they found life to be more meaningful. These effects not only persisted over time—they actually got stronger. When Breitbart followed up with one group of patients two months later, he found that their reports of meaning and spiritual wellbeing had increased, while their feelings of anxiety, hopelessness, and desire for death had decreased.

The time between diagnosis and death, Breitbart has found, presents an opportunity for “extraordinary growth.” One woman, for example, was initially devastated by her diagnosis of colon cancer—but after enrolling in the therapy program, she realized, “I didn’t have to work so hard to find the meaning of life. It was being handed to me everywhere I looked.” And that realization ultimately brought her—and Breitbart’s other patients—some measure of peace and consolation as they faced life’s final challenge.

Complete Article HERE!