January 4, 2012

Sleep No More

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Okay I get it now. It took a few days, but I get it. And now that I have, I get that it wasn’t about figuring it out. “It” is a show in Manhattan “Sleep No More.” For three hours I moved with the audience through a dark labyrinth of rooms, masked à la Stanley Kubrik’s Eyes Wide Shut, following ghost-like characters as they dance and pantomime their way through a hazy, broken Shakespearean plot line. The audience is transformed into a dream state where meaning and logic are illusive.

The title is from Macbeth who likens sleep to “the death of each day’s life.” And the experience is like a sleepless night, one where you are coming in and out of dreams. So, I get it, death is likened to a mysterious sleep state.

There is no proof of this, but the idea has been around for a long time. Shakespeare used the line “sleep no more” earlier in Hamlet. Remember?

To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;

So let’s skip a few steps and take the Bard’s word for it. Sleep is like death. And sleep has become more and more illusive. Recently, the New York Times reported that 84% of all women suffer from insomnia and that “mother’s little helper of the new millennium may in fact be the sleeping pill.” Arianna Huffington’s campaign to “Sleep Your Way to the Top” warns women that sleep deprivation “is, literally, killing us.” We put ourselves to sleep with Ambien, Lunesta, Melatonin and wine. Michael Jackson’s use of Propofol landed him in “the sleep of death.” We put our pets “to sleep,” and conclude our yoga practice with Savasana, the corpse pose. As the social commentator, Fran Liebowitz, concludes:

Life is something that happens when you can’t get to sleep.

Clearly, the relationship between sleep and death persists today. So why, if we medicate ourselves to sleep, do we all not have the right to medicate ourselves to die? The right to die at our own hand is now legal only in Oregon, Washington and Montana. Legislation is pending in nine more states. Do we think “‘tis nobler” to die suffering? Doesn’t look like it. Hospice and palliative care put us out of our pain at the end of life through opiates, like morphine, to bring us to our final sleep. In the three states where it is now legal to put ourselves to sleep, it is done with a prescription for a high dose of a sleeping sedative. “Palliate” means to reduce the suffering at the time of death. It is done by medicating us to an unconscious state, a sleep state called TS (Terminal Sedation.) Even Catholic hospitals maintain the practice. The Catholic writer Mary DeTurris Poust summarizes that “a patient can receive pain treatment even if that treatment could hasten death.” Over a half century ago Pope Pius XII condoned the use of narcotics for End-of-Life care.

Is the suppression of pain and consciousness by means of narcotics (when it is demanded by a medical indication) permitted, by religion and morality, to the patient and the doctor (even at the approach of death and when one foresees that the administration of narcotics will shorten life)?’ One must reply, ‘If there exist no other means and if, in the given circumstances, it does not prevent the fulfillment of other religious and moral duties’ — Yes.

The salient difference between palliative care practices, even those authorized by the Vatican, and the Right-to-Die legislation is the administrator. Palliative care is prescribed and administered by a physician. In states where the Right-to-Die is legal, large doses of sedatives are prescribed by a physician but self-administered by the dying. If there is an important distinction here, I just don’t get it.

It is easy to see a not so distant future when it will not exist at all. This is an “eyes wide shut” moment. We are aware but not fully aware. Our desire to die without the nightmare of pain, by our own hand, in our own home is slowly being unmasked. It is a big responsibility, but one we can figure out. In the past we may have been content to place this responsibility in the hands of physicians and medical institutions. Death itself remains as mysterious as our dreams. But, how we die need not be so. We are not a generation used to giving our power over to authority. We are a DIY population, waking up to how we die. On this issue, we can “sleep no more.”

June 15, 2011

Rites

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Kevorkian saw himself as King or Mandela. I saw him as more creepy than courageous. I didn’t understand that he was intentionally provocative. In the HBO documentary Kevorkian, he says, “Someone has to go to jail for change to happen.” And he did, and change happened.

He died as he intended, quietly and without pain. Just the way he intended for all of us to die, as we choose, and with dignity. But his was not a quiet life. His New York Times obituary confirms the controversial paradigm shift Read the rest of this entry »

May 25, 2011

What To Expect

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We don’t want to feel pain. For over a century, science and medicine have been devoted to the reduction of it. This movement can be tracked in the history of child birth practices, and a similar movement, bringing consciousness to the process of dying, is in its infancy. First a look at how we come in.

In 1900, 90% of birth was at home. Fifty years later, 90% of births were in a hospital under general anesthesia. As a result, Read the rest of this entry »