Dr. Terman's four day fast of food and water
I wanted to assure myself, from personal experience, rather than from only
the reports of others, that patients will not experience hunger and thirst if
they followed this book’s recommendations for Voluntary Refusal of Food
& Fluid. This would be especially important for those who cannot
communicate if they have discomfort—like patients with advanced dementia. So
I decided to experience it myself. How reasonable was this? Although physicians
most often treat patients with medications that they have never taken themselves,
there is also a history of scientific innovators who took the personal risk
by being the first to volunteer for their experimental methods. Of course, Refusing
Food & Fluid at the end of life is far from new. Prior to the modern era
of medicine, many people died that way. That’s why some refer to the method
using what at first listen might appear to be an oxymoron: it is the conventional
revolutionary method. Why does this make sense? Because we seem to have forgotten
how people usually died as we became enthralled with advances in modern high
medical technology. Although I was confident that my personal risk was low,
I did not reveal my plan to my two writing colleagues until my experiment was
almost completed. When I did, they informed my wife, only half in jest, that
they had no intention of finishing the book “post-humorously.”
So I spent four days Voluntarily Refusing all Food & Fluid
to experience first-hand, whether or not it was uncomfortable, and, I must also
confess this: Upon changing my role from a researcher/writer to a person committed
to Refusing Food & Fluid, I felt a sudden increased “need
to know.” I worried about pain and wondered, what could I substitute for the
oral medications that my orthopedic doctors had prescribed for my moderate spinal
stenosis? This question led me to embark on an intense review of an area of
the medical literature that I had previously neglected, one about which I thought
my readers would find useful—non-narcotic medication for moderate pain that
could be administered via the rectum. In addition, I learned so much more about
Comfort Care to the mouth that I started an additional web site, www.ThirstControl.com.
I thus discovered the difference between relying on meager accounts reported
in the literature and experimenting on myself to find out what works. By the
time my personal experiment ended, I was amazed at how much more information
I could share with readers of this book. Then, three new products came on the
market, most of which are in the photograph on page 104, which is reproduced
here.
Here is a summary of what I discovered:
First, medications per rectum were adequate to control my moderate pain. I used
two kinds of suppositories: one with Diclofenac (a medication similar to Ibuprofen
and Naproxen), plus another that contained acetaminophen. Patients who are suffering
from terminally illnesses might require more potent pain killers, and if so,
they should consider asking their physicians to switch from oral medication
to those that deliver pain relief through from skin patches.
Second, hunger was hardly a problem at all, which surprised me, even though
I was told that was what I should expect. Consider a “zero”
to “10” scale where “zero” means no hunger
at all, and “10” means feeling the most hungry I could imagine.
On that scale, I have often felt a “5” in the past; for instance
after I intentionally missed breakfast in anticipation of a special afternoon
buffet. Throughout these four days however, my hunger never exceeded “2”
on this scale. Most of the time, I did not think about being hungry nor was
I aware that I had not eaten—a zero. Only when I asked myself
how hungry I felt (or someone asked me) so that I had to think about it deliberately
did I score higher. But and even then, it never got over “2.”
What explains my minimal hunger? Probably, the increase in ketones—the breakdown
products of metabolism—which is Nature’s way to ease this source of discomfort.
(Ketosis also explains why overweight people on a diet that contains almost
no carbohydrates report very little hunger after a few days.)
Third, the symptom of thirst was definitely a problem. I was frequently thirsty—sometimes
as much as a “5.” To me, that means I was quite uncomfortable. But as I learned
which dry-mouth aids worked best to eliminate the feeling of thirst, they eventually
worked completely. Sometimes I had to apply these medications every half-hour.
I was surprised to like Lemon-Glycerin Swabsticks (McKesson). At first they
seemed like a practical joke—a lollipop with cotton inside—yet two swabs relieved
the dryness in my mouth. I also used one or two half-second sprays of Salivart
(Gebauer Co.) to refresh my entire oral cavity every hour. Some might prefer
instead Oasis (GlaxoSmithKline). A half-inch of Biotene’s oral lubricant, OralBalance,
spread around my mouth prevented night-time dryness. It may be a good choice
for mouth breathers. Chewing two pieces of
Biotene’s “Dry Mouth Gum,” and one or two Listerine FreshBurst Strips (Pfizer)
refreshed my mouth in between tooth brushing. Binaca FastBlast spray and Binaca
Gel Bursts (Playtex) had an intense flavor that some might find too strong.
Patients with mouth sores might welcome a generic “Sore Throat Spray similar
to
Chloraseptic” (Longs Drugs) containing phenol and menthol. To refresh my whole
face, I enjoyed brief sprays of “Rosewater and Glycerin” (Heritage Products).
I also used a saline nasal spray (Target Brand) and Lubricant Eye Drops (GenTeal)—other
areas that also become dry. I avoided sugary lemon drops since in theory they
could awaken my interest in sweets and increase my hunger by increasing insulin
levels; but some people might appreciate them. Knowing that the process can
be prolonged by too many ice chips, I was pleased to find that I had no need
for ice chips. There is one important exception: a small ice chip will help
some medications dissolve under the tongue, such as prescription Clonazepam
and Lorazepam for anxiety. The material for aromatherapy can be obtained from
health stores and may increase comfort and mood. A prescription artificial saliva
product, Aquoral spray (Auriga Pharmaceuticals), is now available [2007].
New products are being released all the time.
Doctors Schmitz and O’Brien offered these additional recommendations: Viscous
lidocaine (a local anesthetic) to alleviate oral discomfort. (Orajel by Del
Pharmaceuticals has benzocaine, which is similar.) Half-strength hydrogen peroxide
can be diluted with water or normal saline, or with baking soda and water for
oral hygiene. Room humidifiers can decrease dryness. Vaseline (or perhaps even
better, Aquaphor, by Eucerin) can keep the lips moist [1989]. (These references
are given in the book.)
Another component of Comfort Care is soothing music. Live harp music can reduce
pain and discomfort significantly, the proof of which can be measured by physiological
parameters [Terman, 1999]. Some organizations of harp therapists offer their
services on a sliding scale according to the family’s ability to pay. As an
alternative, a music system that plays harp or other soothing music may also
help.
So, with adequate Comfort Care, especially to the mouth, Refusing Food &
Fluid can be not only comfortable, but really peaceful. In part, ketosis and
other metabolic changes had an overall calming effect on me.
More information, especially on what to ask your doctor and hospice, are detailed
in The BEST WAY to
Say Goodbye: A Legal Peaceful
Choice at the End of Life.