American Way of Death

The subject is death. Or, as National Public Radio readily acknowledges at the opening of a major new series beginning Monday, it’s about that painful, emotional, difficult to talk about and, yes, hard to hear about issue that sooner or later confronts us all.

Titled “The End of Life: Exploring Death in America,” the series will continue sporadically through next year, but it’s the first five pieces, airing next week, that immediately plunge the listener into the heart of the matter.

Produced by Sean Collins, senior producer on “All Things Considered,” the opening broadcasts deal with how people prepare to die, hospice versus hospital care, palliative care, advance directives, living wills, how families cope and grief.

The programs will air Monday through Friday at 3:30 p.m. on KPCC-FM (89.3) and 4:30 p.m. on KCRW-FM (89.9) (with a repeat at 6:30 p.m.), during the second half hour of “All Things Considered.”

The first program is “a talking-heads piece,” Collins says, “that lays the groundwork--that it is now recognized in this country that there’s a problem with the way people die. That people still die in pain, that people still die separated from their families [in intensive care units], that some people die in denial, that they’re not given a chance to get their life in order.”

He encountered a better way with his mother, who died of lung cancer five years ago in a hospital palliative care unit, where the emphasis was on her comfort instead of on an aggressive attempt to maintain life.

“It really changed not only the way she lived her last three weeks,” notes Collins, 36, “but the way my brother and sister and I have been able to live in the five years since. She made it so much easier for us to go through bereavement. Because we knew that she knew what was happening to her.”

The series goes beyond the medical and bioethical experts to ordinary people preparing for and coping with death.

“It seemed to me,” Collins explains, “that if we could present the audience with stories of people who don’t have any special expertise on this, then they might hear in those experiences themselves, and gain the confidence that they’re going to be able to deal with it.”

One such story unfolds Tuesday and Wednesday with leukemia patient Helen Payne and her family. In a plaintive moment, one of her daughters, Glenda Crabbe, tells NPR’s Linda Wertheimer: “I don’t know how to wait on nobody to die, I really don’t. . . . But just to see her, you know, be so sick and then still be here. . . .”

As it turned out, NPR had to wait too.

Originally, the opening pieces were planned for a late summer broadcast. Payne--a devout Baptist and former domestic--had been found to have acute leukemia in January and was expected to have died before then. She had agreed to let the NPR staff share her final months, Collins says, “because she said she hoped it would help people.”

But Payne held on longer than anticipated, until the last week of August. Her survivors include six daughters, two sons, 28 grandchildren and 47 great-grandchildren. She was 81.

“She had such a sense of strength,” Wertheimer remembers, “and had the kind of faith that helps [people] face death with equanimity.”

Next Thursday’s show takes listeners to Missoula, Mont. It focuses on Dr. Ira Byock, a hospice physician, and his “Missoula Demonstration Project.” Now in the first year of a 15-year study, the project hopes to transform the city into a place where, the program notes, “ordinary people . . . approach dying as a life-enriching experience.”

Byock, president of the American Academy of Hospice and Palliative Medicine, believes that “physicians don’t do a very good job of being honest with their patients about their prognosis,” Collins says. “And he wants to show that a community can change its attitudes. He’s involved physicians, nurses, schools, churches, synagogues, old folks’ homes.”

In the course of the program, listeners meet hospice patient Russell Haasch, in his 80s, an outdoorsman for much of his life, who built log cabins. “But he smoked too much,” Collins says, “and is now paying the price [with emphysema]. He told us a year ago that he considered suicide, that the symptoms were just too unbearable. Then he said he got in touch with these people and found out there was another way of approaching the end of his life.”

And on Nov. 7, “End of Life” looks at the place of palliative medicine, which focuses on patient comfort and pain management when the effort to cure is futile. In Britain, where the hospice movement began, palliative care involving doctors, nurses, social workers and clergy is its own specialty. The program asks if that shouldn’t be the case in the United States as well.

Other stories that will air in the months ahead on NPR newsmagazines, under coordinating editor Deborah George, include: “The Good Death,” showing changing attitudes over the decades on the subject; “Rites of Death,” from Irish wakes and Jewish shivas to the new rituals that have sprung up around AIDS deaths; two programs on suicide; and “Thanomusicology,” on the use of so-called prescriptive music to bring comfort to patients and families.

“The End of Life: Exploring Death in America” emerged from conversations between Collins and Ellen Weiss, executive producer of “All Things Considered.” A 1994 book by Dr. Sherwin B. Nuland called “How We Die” got them thinking about the issue, then a 1995 study in the Journal of the American Medical Assn., reporting deficiencies in end-of-life care, helped shape their approach.

Although NPR does not express a point of view about what is the best approach for end-of-life care, it does present a variety of alternatives to traditional hospital care. As Weiss explains, it’s “the issue that’s out there, that advances the story.”

Collins clearly advocates, on a personal level, getting the issues out in the open so that people can make informed choices about how they and those close to them die.

“Somebody said to me in the course of the reporting that if we don’t talk to the dying about their death . . . you basically condemn them to deal with it all on their own--as if it’s a hard, bitter little nut they have to work on all by themselves. And that’s fundamentally inhumane.”

Talk show hiatus: Former California Gov. Jerry Brown and Pacifica Radio have agreed to suspend Brown’s talk show, “We the People,” while he runs for mayor of Oakland. Gail Christian, director of Pacifica national programs, said the decision was made in fairness to other mayoral candidates; it also avoids having to give them equal air time on the company’s Bay Area outlet. Brown’s weekday show has been airing locally on KPFK-FM (90.7) from 4-5 p.m. since January, 1996. “It caught us by surprise,” KPFK General Manager Mark Schubb said Wednesday. Until replacement programming is lined up, KPFK will be airing “best of” Brown shows for several weeks.

BE THERE

“The End of Life: Exploring Death in America,” the first five programs in the sporadic series will air Monday through Friday at 4:30 and 6:30 p.m. on KCRW-FM (89.9).