CS,

A not so funny thing happened on the way to a cure-it's taking a lot longer than many of us would have thought. I haven't been on this board since January, but I couldn't sleep and logged on to find your familiar moniker.

Having lost AJ's mother and step dad, and my own mother, along with a few PD pals and a couple of non-PD friends in the last two years-yes, it's been raining death around the Wasson house lately-we've seen our share of departures. And at 16+ years out, we have had enough aches and pains to provoke a few "what if" conversations to be filed away for future reference should we mutually decide that the game is no longer worth the candle. Hopefully that day is quite a ways down the road, but having been a Boy Scout, I like to be prepared.

I can't imagine this comes as news to you (weren't you a chemist in a previous life?), but after witnessing a few passings and discussing the location and use of the "emergency exits" with a couple of doctors, I think at least here in the US it would go something like this.

To be plain, it seems that there are three ways out: (I) passive assisted suicide, (II) assisted suicide, and (III) good old-fashioned suicide, unassisted.

I think we see a lot of the first in respite, nursing home, and hospice care, although it is not discussed openly. Unless we are among the fortunate few who fall down the stairs or bonk their heads and lose consciousness and never wake up, there is usually a substantial amount of pain associated with the end-of-life for PWP's. Strong painkillers like morphine and its derivatives are still used to make patients comfortable. There comes a point, which I've seen in several instances, where the issue is whether to increase pain meds and take the "risk" that the patient's breathing will be suppressed by the sedation and cause his or her death. The "upside" of this is that you can make it known to those near and dear to you, that should that choice present itself you would like to vote by proxy for over sedation. I know nurses and doctors who in their private moments acknowledge that they have increased pain medications at the request of relatives knowing the probable outcome. I think it happens all the time and it doesn't hurt to let those around you know that you would appreciate a push beyond a simple DNR request.

Assisted suicide seems to be a lot easier to come by than I would've thought, especially nowadays. If one seriously want to find the exit, and wants to avoid both additional pain (gun, rope, bridge, etc.) and the possibility that he or she will botch the job and wake up with end stage PD AND scrambled eggs for brains, one can simply start asking around and sooner than later find a group dedicated to making the exit as easy and pleasant as possible. I don't know the cost, but my understanding is that the patient buys the raw materials, including the proper mix of medications and simple hardware to effect their delivery, and the assistants help you set up the rig. The patient uses a plunger or some device to begin the flow of medications through an IV (that makes it the patient's choice), and after determining that the patient has departed, the assistants simply walk out the door and notify someone so that no one mistakenly walks in on a scene they did not expect.

Unassisted suicide is apparently quite easy as well, but involves a little more planning and risk. My understanding is you want to get the mix of medications absolutely right, to avoid pain or unpleasant sensation, and ensure that you make it all the way out. If the Internet isn't full of reliable information on this I would be flabbergasted, but if you can consult a sympathetic medical professional to talk to off the record, I certainly would.

As you said CS, most PWP's don't take a bow and leave the stage voluntarily. Like most of the population, we cling to life under the most extraordinary circumstances. And, to my mind, this is as it should be. Occasionally I have days where not a single comfortable or pleasant moment has intruded on the misery. But then at the end of the day, or sometimes late at night talking with AJ, I will find myself laughing at a joke or circumstance, or looking into the eyes of a friend, or simply notice that the medications have finally kicked in for few moments of blissfull relief, and that is enough to make me want to wake up the next morning and see what life brings.

The end stage of Parkinson's is pretty unpleasant, so I'm told and so I've seen. But so far I'm content to wait as long as possible to find out. Not particularly believing in an afterlife, I find the prospect of eternal oblivion scary, though if it is eternal oblivion how I would ever know is beyond me.

If there is one thing PD has taught me it is that the human spirit is stunningly elastic. It can bend and bend and bend and still not break. Whether this is simply a result of a chemical mix in our brains, or truly a testament to the resiliency of the human spirit, I can't say. But to those of you who remember him, I will quote the words of an old Braintalk comrade - "if you want to keep moving, keep moving." If you don't, make sure you know what you're doing and think at least twice about giving up the only thing any of us has ever known - life.

Greg