Transcript for the Piece Audio version of HEART-to-HEART Pgm I: Beyond Pain

HEART-to-HEART Pgm 1: Beyond Pain

" Narration 1: HEART TO HEART: CARING FOR THE DYING. FROM PUBLIC RADIO INTERNATIONAL. THIS PROGRAM -- BEYOND PAIN -- EXPLORES THE REASONS WHY SO MANY PEOPLE SPEND THE LAST DAYS OF THEIR LIVES IN PAIN -- AND WHAT WE CAN DO ABOUT IT.

?" MUSIC Theme music
(Up in the clear. Then fade down and run through Introduction.)

13" Ferrell: Sometimes people like me who spend most of our waking hours you know thinking about pain, talking about pain, seeing people in pain, writing about pain, we believe everybody already understands the problem of pain and they don’t.

" Narration 2: THAT WAS BETTY FERRELL ((FEHR'AL)). AND THIS STORY IS ABOUT PAIN. ABOUT DYING IN PAIN. IT'S A HARD SUBJECT TO FACE, BUT WHAT PEOPLE FEAR MOST ABOUT DYING IS BEING IN PAIN. BETTY FERRELL IS A NURSE AND RESEARCHER AT THE CITY OF HOPE NATIONAL MEDICAL CENTER IN LOS ANGELES. AND SHE SAYS THAT THERE IS GOOD CAUSE FOR THIS FEAR -- BECAUSE A LARGE PERCENTAGE OF AMERICANS DIE IN TERRIBLE PAIN. THERE IS ALSO REASON FOR HOPE: MUCH OF THIS PAIN IS UNNECESSARY. (beat) RICHARD BUIKE UNDERSTANDS THIS ALL TOO WELL.

5" Richard: I’m not in a hurry to die. I’ve got too much stuff to do. Period.

1" Narration 3: BUT RICHARD IS DYING.

16" Richard: I have small cell lung cancer, basically toward the right side. I was in bad pain and couldn’t breathe.
Anita: This particular cancer tends to wrap itself around the nerve endings and can be very painful.

5" Narration 4: RICHARD AND HIS PARTNER, ANITA SEGHETTI ((SEH-GE'-TEE)), ARE TRYING TO FIND A PATH TO A GOOD DEATH.

31" Anita: I had been concerned even before the pain started, because I...I wanted to make sure the last days of his life were not suffering and there was some way to... to make sure he didn’t wake up screaming in pain or be in pain constantly, and.....
Richard: My Dad went when he was 50. And it was not a pretty sight. Your Dad was.... 68, right?
Anita: .....It’s not a pleasant way to die. And I was very, very concerned. Because it’s really hard to watch somebody dying [crying] and...and in pain.

33" Ferrell: When you stop and think, "Oh my, what if it were me or my loved one, then, what do you want? You want a doctor who knows something about pain. You want a pharmacy down the street who will carry the drug that you need. If your mother goes to a doctor, and if that doctor says, well, you know I don’t really believe in the problem of pain, then, by golly, you want a medical board that you can turn to, to say, "What are you going to do about that?" Design this system to care for you and the more selfish you can be about this, I think the better you will serve your community.

" Narration 5: WHAT CAN WE DO -- AS FAMILIES, AS COMMUNITIES AND AS A SOCIETY -- TO HELP PEOPLE TO DIE WELL?

MUSIC out

" Narration 6: WHAT DOES IT MEAN TO "DIE WELL"? IN PART, IT MEANS DYING WITHOUT PAIN. THREE DOCTORS WHO WORK WITH PEOPLE FACING DEATH -- AND WHO KNOW A LOT ABOUT MANAGING PAIN AT DEATH -- ARE: CRISTINE CASSEL, STEPHEN PANTILAT AND RICHARD PAYNE. DR CASSEL IS DEAN OF THE SCHOOL OF MEDICINE AT OREGON HEALTH AND SCIENCE UNIVERSITY:

11" Cassel: The goal of treatment for a patient who is at the end of life is to improve the quality of that life every day, every week that is left.

" Narration 7: DR. PANTILAT IS AN INTERN'IST AT U.C. SAN FRANCISCO. AND DR. PAYNE IS A NEUROLOGIST AT MEMORIAL SLOAN KETTERING CANCER CENTER IN NEW YORK.

25" Pantilat: It’s really important for people who are dying to be pain free, because…… People who are dying have lots of things that they want to take care of. They want to say goodbye to their loved ones. They want to finish writing a book. They want to enjoy the time they have. And pain really grips the mind and doesn’t let go and doesn’t allow you to focus on the things that are, frankly, much more important uh than thinking about how much pain you're in.

12" Payne: So, there's a very practical issue of treating pain so that people can, in fact, get on with living the rest of their life while they’re dying.

?" MUSIC:

14" Pantilat: Unfortunately, in America we do a lousy job of treating pain in dying patients. We know from many different studies that people who are dying experience a lot of pain -- and not just a little bit of pain, but moderate to severe pain -- at the end of life.

17" Payne: I don’t think that there are any doctors, nurses or healthcare providers who are out there deliberately trying to avoid treating people adequately. But it’s just...I think it’s more of a matter that pain hasn’t been given a high enough priority.

32" Cassel: When I went to medical school and did three years of internal medicine residency training and two years of geriatric training after that, I never got a single lecture in pain management and pain control. And even to this day we are way behind in how we teach all of our physicians in training how to use pain medications. And who’s going to do this teaching? If none of us were trained very well in it, there are very few specialists who are really qualified to do this teaching.

MUSIC: Out

" Narration 8: WHERE A PERSON DIES HAS A LOT TO DO WITH HOW THEY DIE. MORE AND MORE PEOPLE ARE SPENDING THEIR LAST DAYS IN NURSING HOMES. BUT THE STAFF IN THESE INSTITUTIONS MAY NOT KNOW HOW TO HANDLE A DYING PERSON'S PAIN.

17" Payne: It was documented that many elderly residents in nursing homes who were reporting pain got either very little pain medication, for example, aspirin when they had really severe pain, or got no pain medications at all.

10" Cassel: Nursing homes face the problem that they are under-staffed often. The staff do not have the skills to provide this kind of sophisticated pain management.

" Narration 9: MANY OTHERS END UP DYING IN THE HOSPITAL, WHICH HAS ITS OWN SET OF PROBLEMS.

15" Cassel: People often panic at the last minute and do the worst thing, dial 911, and then the ambulance comes and this horrible sequence of events ensues. They put the person in the ambulance, the ambulance takes them to the emergency room.

3" Ambiance: Ambulance siren.
(Fade up under last bite. Run in clear for one beat. Fade out under next bite.)

2" Narration 10: DYING IN THE ICU CAN BE A VERY PAINFUL END -- BOTH PHYSICALLY AND EMOTIONALLY.

2" Ambiance: Hospital Sound FX.
(Segue from ambulance siren to hospital effects.)

0" FX: Heartbeat in

41" Cassel: Intensive Care Units are places that are intended to try to save lives. And yet they are places where many, many people, because they are so critically ill, also die. So they will be trying to resuscitate you and they will be putting tubes in your throat, and they’ll be pounding on your chest and they will be starting IV's and putting catheters in your bladder. You'll be started on a breathing machine. Sometimes you need to be heavily sedated so that you don’t fight the breathing machine. And if you had a living will or an advanced directive, chances are that hospital won’t know it. So, it can end up being a nightmare for the patient and the family.

23" Pantilat: I think there are many doctors who believe that when patients die, it’s a failure. And the problem is that we have a system that wants to save lives at all costs and the reality that everyone is going to die. And knowing when to move that system from, "Save life at all costs" to "Recognize that someone is dying and provide them with palliative care," is part of the challenge.

23" Cassel: And a lot of the interventions that we use very appropriately in trying to prolong life are very painful and are totally unnecessary when someone is dying and what they need is comfort, and solace and dignity and not hardware and intrusive technology.

FX: Heartbeat out.

" Narration 11: THE FIRST STEP IN KEEPING PAIN UNDER CONTROL IS UNDERSTANDING HOW MUCH PAIN A PATIENT IS IN.

3" Cassel: Pain is a totally subjective phenomenon.

29" Pantilat: We don’t have a way of telling objectively who is in pain. If a patient says to me, "Doctor, I think my blood pressure is too high, I can check and I can tell them about their blood pressure. And in that way, I know more, if you will, about their blood pressure than they do. But when it comes to pain, we just don't have any way of measuring whether they're in pain or not. .There’s no tool. There’s no piece of equipment that will tell us. The only way to know if a patient is in pain is to ask. We simply have to ask the patient.

15" Cassel: It is both the case that patients are often not asked about their pain and when they report, they’re often not believed. Something that isn’t objective we don’t think is scientific. And therefore, we don’t take it as seriously.

7" Pantilat: The most important lesson in taking care of people who are in pain is to believe the patient.

8" Cassel: One of the really important approaches to changing this attitude is the idea of pain as the fifth vital sign.

" Narration 12: THIS IS A RELATIVELY NEW IDEA -- REQUIRING DOCTORS AND NURSES TO DO PAIN ASSESSMENTS EVERY TIME THEY TAKE A PATIENT'S VITAL SIGNS.

7" Cassel: If pain was charted, then you have some indication and you do something about it if it’s changed.

0" Ambiance: ECU in a hospital.
(Fade up hissy ambiance from ventilator in room.) [31" total]

6" Ambiance: (Hospital PA system) Dr. Tall is on line one, Robert, Dr. Tall is on line one. Beep. (Ventilator hiss in bkgrd.) [34' Total]

12" Pantilat: I like to use a zero to ten pain scale, because that helps me understand how much pain an individual is having. and the patient might say, "You know doctor, if we could get me to a three or four, that would be perfect."

50" Hildie: Hi George, I'm Hildie, I'm the clinical nurse specialist here. And, uh, I just wanted to see how you're feeling today. Are you uncomfortable? Are you comfortable right now?
Patient: (Mumble.)
Hildie: Little uncomfortable. I know, we just took the tracheal tube out. OK. Can you tell me where you're having pain?
Patient: (Mumble)
Hildie: OK, if you could rate your pain from 0 to 10. 0 being no pain and 10 being the worst pain that you've ever experienced. Where would it be on that scale?
Patient: 7.
Hildie: 7.
Hildie: OK. Has the pain medicine that your nurse's given you helped when you get extra injections?
Patient: Yes.
Hildie: OK. Do you need a little more right now?
Patient: Yes.
Hildie: Alright, we'll get you some pain medicine and see how well that works. OK?

" MUSIC: Graceful Passages for an intro beat.

" Narration 13: SO, ONCE WE'VE ACKNOWLEDGED THE PAIN, WHAT TOOLS DO WE HAVE TO MANAGE IT?

16" Pantilat: There is quite an arsenal of drugs that we can use. I often start with mild to moderate pain with acetaminophen, with Tylenol. It’s inexpensive. It’s easy to get. And if it works, it’s wonderful. But there are lots of other choices. Aspirin is a great pain reliever.

11" Cassel: There are also non-steroidal anti-inflammatory drugs. Sometimes neurological medications can be very effective against pain that comes from irritated nerves.

11" Ferrell: Much severe pain is treated with use of anti-depressants or anti-seizure medicine. So, when we talk about drug management, realize that it’s a broad focus.

?" MUSIC
(Begin "Graceful Passages" Music under following sequence.)

10" Cassel: In addition, there are non medication approaches. Things like injection therapy to numb a certain nerve that an anesthesiologist can do.

12" Pantilat: There’s heat and there’s ice and there’s bio feedback and acupuncture and chiropractic and massage and meditation, all of which in studies have been shown to work for one kind of pain or another.

?" MUSIC: Up in the clear

6" Ferrell: Music. There are wonderful music therapists that work with Hospice programs.

" Narration 14: MICHAEL STILLWATER AND GARY REMAL MALKIN PRODUCE MUSIC DESIGNED SPECIFICALLY TO HELP PEOPLE WHO ARE DYING. THIS PIECE COMES FROM A CD CALLED "GRACEFUL PASSAGES."

10" Cassel: The key to this mechanism is...is getting your mind off of where the pain is. And then you can sometimes reduce the amount of medication that’s necessary.

27" Pantilat: We have had family members in our palliative care unit play music for their loved one who is dying. One family from Samoa sang traditional Samoan songs. Another family that was very musical had a string quartet of the family members playing music in the patient’s room to comfort everyone really. I think it helped with the patient’s pain, but it was also incredibly soothing to the family. And in fact, the other patients on the floor.

?" MUSIC
(Bring up "Graceful Passages" music in the clear. Then down and out by the end of Pantilat.)

" Narration 15: THESE APPROACHES TO PAIN ARE ALL USEFUL. BUT THEY MAY NOT BE ENOUGH TO HANDLE EXTREME PAIN AT THE END OF LIFE.

9" Pantilat: The challenge is that when those don't work, we need to be willing to go to the next step.

" Narration 16: THIS IS WHERE OPIOIDS COME IN. OPIOIDS ARE PAIN KILLERS, LIKE MORPHINE AND CODEINE, WHICH ARE MADE FROM THE OPIUM POPPY. OTHERS, LIKE METHADONE, FENTANYL ((FEN'-TAH-NIHL)), OXYCONTIN AND PERCOCET, ARE SYNTHETIC DERIVATIVES.

MUSIC out

26" Payne: The opioid medications are the only class of medications that can treat very severe pain. Morphine, for example, has been known for centuries to be effective in controlling pain. And that is why they are an essential part of the treatment strategy for patients who have terminal illnesses.

" Narration 17: RICHARD BUIKE AND ANITA SEGHETTI ARE WORKING WITH RICHARD'S DOCTOR, DR. JENNIFER HEIDMANN, TO KEEP RICHARD'S PAIN AT A TOLERABLE LEVEL. RICHARD TAKES FENTANYL -- A MORPHINE-LIKE DRUG -- THROUGH TIME-RELEASE PATCHES.

96" Heidmann: So, how is the pain?
Buike: Uh, no worse than before.
Heidmann: And is this pain interfering with your ability to function during the day?
Buike: Exactly.
Seghetti: The 300 seemed to have helped. Going up to a Fentanol patch of 300 seemed to help. Uh ….
Buike: Yeah, I believe we're close to doing the job.
Heidmann: OK. You certainly could go up on the patch safely. I mean I could probably give you another.…… give you another fifty microgram patch.
Anita: Within a week or so it's going to change. And why not just stay ahead of the pain?
Buike: Whatever. You’re the doctor.
Heidmann: But you’re the boss. So….
All: (Laugh)
Heidmann: So, if that sounds good, I mean it's, it’s certainly easy enough to do.
Buike: Do it.
Heidmann: OK, So, I think the easiest way to do it would be three hundred patches and one fifty. And ….do you have enough patches to get through the week, or do you want me to call some more in?
Seghetti: What's today? Thursday, Friday, Saturday, Sunday, Monday, yeah. give me another box. Then I don't have to worry about running short or paging you or something.
Heidmann: Your insurance presumably is….
Buike: Does not pay for….
Seghetti: No it only covers 25% or the prescriptions. And only up to a certain limit and the limit is small.
Buike: Very small. Very small.
Heidmann: I don't understand. so how…….? Um….. I'm sorry it's costing so much. I just think that's just the easiest thing to use.
Buike: We'll handle it.
Heidmann: So, I'll call it in and let me know if there's any problems with it, but it shouldn't be a problem.

" Narration 18: RICHARD'S FENTANYL PATCH IS A VERY EFFECTIVE -- AND VERY EXPENSIVE -- PAIN TREATMENT -- WHICH HIS INSURANCE REFUSES TO PAY FOR. BUT MANY PEOPLE CAN'T GET IT AT ALL, BECAUSE OPIOIDS ARE SEVERELY UNDER-USED BY DOCTORS TREATING DYING PATIENTS. THERE'RE MANY REASONS FOR THIS, INCLUDING THE MYTHS SURROUNDING ADDICTION.

13" Pantilat: Patients and families have a lot of problem with taking opioids. They know them as narcotics. And they associate all the negative stereotypes we have of drug addicts to the morphine that grandma is taking care for her cancer.

0" Ambiance: Street ambiance.
(Run under following sequence as needed for continuity.)

18" Vox Pop: Man-on-the-street comments about the word "addiction".
Man #1: For me the word addiction means a loss of control.
Woman #1: Not being able to quit something you know is bad for you.Man #1: I think of drugs, drug addiction.
Woman #1: Snorting coke in the bathroom
Woman #2: Alcohol.
Man #2: Crackheads, drug addicts, sex addicts.
Woman #2: Addiction is a loaded word.

11" Pantilat: People think, "Well, if I’m using these drugs, I must be a drug addict." I've had several patients to whom I was thinking of prescribing Methadone say, "Well I don't....that's for junkies. Methadone's for junkies. I won't use that."

11" Vox Pop: Man-on-the-street comments about the word "addiction".
Woman #1: A lot of times I associate that with violence.
Man #1: Usually something negative.
Man #2: Like weakness and stuff like that.
Woman #1: Maybe sadness and despair. Disappointment.

10" Pantilat: And then I had a patient tell me a story where he took the Methadone prescription to the pharmacy and the pharmacist looked at it and said, "Methadone! What are you a junkie?" Out loud. To the line of people waiting.

22" Cassel: There’s a real fear in the United States about in particular about opiates, which we call narcotics. And in medicine we try not to use this term narcotics anymore because the public is so frightened by the term, because they think that they will become junkies, they will become drug addicts if they take these medications. Nothing could be farther from the truth.

5' Richard: I've never taken drugs in my life. but, now I don't care.

14" Anita: What difference does it matter if he’s on narcotics? He’s got a terminal illness. What? I mean you're watching somebody suffering, waking up in the middle of the night, can’t sit down, pacing around, and there...they’re hurting.

60" Narration Break I: YOU'RE LISTENING TO HEART TO HEART, FROM PUBLIC RADIO INTERNATIONAL. YOU CAN PURCHASE A COPY OF THIS PROGRAM OR LEARN MORE ABOUT HEALTH CARE FOR THE DYING, AT OUR WEBSITE, "HEARTTOHEARTRADIOdotORG".

" Narration 19: ANITA AND RICHARD ARE MORE CONCERNED ABOUT CONTROLING RICHARD'S PAIN THAN ABOUT ADDICTION. BUT DR. STEPHEN PANTILAT SAYS THAT MANY PEOPLE DON'T REALLY KNOW WHAT ADDICTION IS:

56" Pantilat: Unfortunately, a lot of people confuse psychological addiction with a physical dependence on the medicine. Physical dependence will happen if you take opioids for a long time. And if you abruptly take it away, if you just stop all at once, the body will go through withdrawal. But we see this with a lot of medicines. We see this if you take Valium, if you stop prednisone, that people use for rheumatoid arthritis and asthma. Certain anti-depressants will cause a withdrawal syndrome. So, there’s lots of them that have this physical dependence. Psychological addiction is when people’s need for the medicine overtakes other things in their lives. They’ll spend all of their money to get it. They’ll get in trouble with the law in order to get it. They will lie in order to get it. It interferes with their social functioning. And what we know is that for people who have chronic pain, their chances of becoming addicted are less than one in a thousand.

" Narration 20: WHEN RICHARD WAS FIRST PUT ON OPIOIDS, ANITA WAS WORRIED ABOUT THESE DRUGS:

11" Anita: I wondered if it would cause any kind of hallucinations. But it doesn’t. It doesn't cause any kind of high. It just ameliorates the pain.

" Narration 21: HOWEVER, FEELING SLEEPY CAN BE A REAL ISSUE FOR SOME PATIENTS ON HIGH DOSES OF MORPHINE, ACCORDING TO DRS.CHRISTINE CASSEL AND RICHARD PAYNE.

8" Cassel: The fear of getting doped up is much more prevalent, much more common and is realistic in some ways.

24" Payne: Sedation and drowsiness are known side effects of treatment with opioids, but they’re not inevitable. We can change the way in which we give the medication. We can change the schedule in which it’s given and sometimes that can help. And sometimes even adding medications to counteract side effects. So there are many strategies.

22" Anita: There was a concern about his being able to function, being able to drive. But I noticed right away that it...that was moot. And I asked the doctors and it seems like the fentanyl patches are...are made so that once you start them, within twenty four hours you...I don’t know what happens, but you’re back to...your alertness is pretty much back to normal.

16" Payne: Our goal is not to exchange pain for sedation, but that in fact, we don’t consider that we’ve got a successful pain treatment unless the patient can actually function better when their pain is reduced.

" Narration 22: DOCTORS THEMSELVES ARE NOT IMMUNE FROM THESE STEREOTYPES AND FEARS.

18" Pantilat: Doctors have the same fears and carry the same myths that patients do. They worry about addiction. They worry about side effects, that they’re going to depress the patient’s respirations, the patient is going to die, that the patient will be too sleepy. All the things that patients worry about, doctors worry about also.

" Narration 23: EDUCATION OFFERS THE BEST HOPE FOR UNTANGLING THE PAIN PROBLEM. DR. JOANNE LYNN IS PRESIDENT OF AMERICANS FOR BETTER CARE OF THE DYING.

19" Lynn: There should be an expectation that, of course, you teach this in medical school. You know we wouldn’t let people come out of medical school and not know how to do elementary childbirth. (laugh) You know and yet almost none of them are going to do childbirth ever again except in an emergency situation. And yet most of them are going to take care of dying patients.

26" Ferrell: Most medical students in this country enter practice having never stepped foot on a palliative care unit, having never seen a patient in home in a Hospice program. In many instances the faculty don’t know it themselves. Therefore, it’s very important to begin with providing resources so that faculty members themselves can gain the knowledge and the skill to teach the students.

22" Cassel: And the teaching has to occur at the bedside and in the clinics when you see the patient. It’s not enough to just give a one hour lecture. You have to learn these medications, what to look out for, for side effects, how to modulate the dose and that kind of thing. And that’s called clinical training. And you learn that side by side with a senior physicians as you’re seeing the patient on rounds.

" Narration 24: THE REST OF US NEED TO BE EDUCATED TOO -- TO KNOW OUR OPTIONS AND OUR RIGHTS.

27" Ferrell: We have in this country fine examples of how the media has really promoted health concerns. Billboards that say, you know, "Drink milk," you know, "Don’t smoke, get your kid immunized." And yet never will you see a billboard that says, "If you are in pain, seek help." We need to have social messages that say, "Pain management is important. If you’re a person in pain, you have a right to pain relief."

24" Lynn: There have to be gems. Programs, hospitals, nursing homes, pain treatment centers, whatever that people can point to and say, "They know how to do it." That we can put on the bus posters and put on the evening news and say, "Isn’t it marvelous that in our community we’ve got a program that is this good." You know, so people can say, "Yeah, it really can be done."

" Narration 25: ONE OF THESE GEMS IS THE "COMFORT CARE SUITE" AT SAN FRANCISCO'S MOFFIT HOSPITAL WHERE DR. STEPHEN PANTILAT IS PUTTING THESE IDEAS INTO PRACTICE:

0" Ambiance: Hospital ward.
(Start ambiance under previous narration. Continue as necessary through scene.)

8" Pantilat: We opened these rooms about uh two years ago now. And we have very sick patients who are very close to the end of life.

" Narration 26: DR. PANTILAT IS CONSULTING WITH THE ON-DUTY NURSE, MARIZ ((MAHR-IHZ')) MORALES:

30" Pantilat: Hi. Dr. Pantilat.
Nurse: Hi.
Pantilat: You’re taking care of Miss Bryan?
Nurse: Yeah.
Pantilat: How’s she doing?
Nurse: Actually, she’s not complaining of any pain right now. But the morphine drip is like on three milligrams per hour.
Pantilat: OK. Dr. Raybo's note said she was in a little bit more pain yesterday. Do you know....?
Nurse: They started the morphine on 1, but increased it....
Pantilat: And now it's up to 3 in response to her symptoms. Yeah. And I agree she looks very comfortable. So, we’re going to leave the morphine drip right where it is for now. Perfect. OK.

?" MUSIC: up and under

" Narration 27: WHY DOESN'T EVERY DOCTOR IN EVERY HOSPITAL TREAT PAIN MANAGEMENT THIS SERIOUSLY?

8" Pantilat: It doesn’t help that we have a war on drugs in this country. That everyone is focused on drugs being this evil thing that‘s going to undermine the fabric of society.

4" Announcer (at press conference): Ladies and Gentlemen, the President of the United States:

21" President Reagan (at press conference): Good afternoon. I pledged that fighting drug abuse would be a major goal of our administration. And that's why I'm here today, to call for a national crusade against drugs. A sustained, relentless effort to rid America of this scourge, by mobilizing every segment of our society against drug abuse.

8" Nancy Reagan (Public Service Announcement): Hello, this is Nancy Reagan. If you just say no to drugs, you'll be saying yes to a whole lot more.

22" President Reagan (at press conference): If we're to defeat this enemy we've got to do it as one people, together. So, starting today, Nancy's crusade to deprive the drug peddlers and suppliers of their customers, becomes America's crusade. We will get the message to the potential user that drug use will no longer be tolerated. That they must learn to Just Say No.

22" Payne: One of the slogans in the drug war was to, "Just Say No." And that tends to also reinforce a basic sort of feeling or really a myth that maybe you did something that you shouldn't have done. And this disease is a punishment for what you've done. -- Particularly if you're talking about something like HIV/AIDS, you know. -- And so you're supposed to suffer.

" Narration 28: THE "WAR ON DRUGS" WAS INITIATED BY PRESIDENT REAGAN. AND IT'S BEEN PROMOTED BY SUBSEQUENT ADMINISTRATIONS -- STATE AND FEDERAL, REPUBLICAN AND DEMOCRATIC -- OVER THE PAST TWO DECADES.

20" President Clinton (in his weekly radio address): Good morning. We have worked hard to keep drugs away from our boarders, off our streets and out of our schools. Now we must take the next step and give our children the straight facts. Drugs are wrong, drugs are illegal and drugs can kill you. Tell our children the truth. Show them that drug use is really a death sentence.

?" MUSIC: out

11" Payne: Looking at the big picture, prescription drug diversion as a part of the overall drug abuse problem in the United States is really a very, very small component of it.

" Narration 29: BUT ABUSE OF PRESCRIPTION DRUGS IS BEING CONFUSED WITH OTHER ILLEGAL DRUG USE. AN EXAMPLE OF A PRESCRIPTION DRUG THAT'S BECOME DEMONIZED BY THE MEDIA RECENTLY IS OXYCONTIN. THIS IS A SYNTHETIC, LONG ACTING FORM OF MORPHINE. AND, IT IS A VERY EFFECTIVE PAIN KILLER. HOWEVER, OXYCONTIN HAS BECOME A RALLYING CRY IN THE WAR ON DRUGS.

4" MUSIC: Nightly News Musical Zing
(Start in clear for a few beats. Then fade down and run under News Headlines. Fade out with Reading.)

" Dramatic Reading:
(each bite fades under the next.)
Male Newscaster: OxyContin, the killer drug of the millennium, is sweeping the nation like an F4 tornado, causing a wide path of destruction …….(that has resulted in the overdose of .....)
Female Newscaster: "OC" or "the poor man's heroin," as it is commonly referred to, is one of the most deadly and dangerous drugs.... (hitting the country with devastating force.....)

MUSIC out

38" Ferrell: I turned on the television. There on the eleven o’clock news was the story. What do they show? They show people selling drugs. They show, you know, the weeping mother whose son died from, you know, taking this drug on prom night. Nobody shows the woman who is now for the first time able to get out of bed and take care of her children because her pain is relieved. Nobody shows the man with prostate cancer who wanted to kill himself last week, but this week he’s going to go to church. I mean, it’s so pathetic that the cancer patients that I see everyday are paying the price for the media blitz on OxyContin.

14" Pantilat: I suppose when you’re a law enforcement official, you think everyone is diverting their medications. When you’re a doctor, I see that almost no one is diverting their medicines. And so I think this problem is blown way out of proportion compared to all the prescriptions that I write.

14" Cassel: A media blitz like the OxyContin story hits and immediately there is this chilling affect. And you see a drop in prescriptions, you see a nervousness. "Am I going to get investigated for prescribing this medication?"

12" Dahl: A nurse in Virginia told us that one of her patients who has advanced cancer and is being very well controlled on OxyContin came in and said, "I don’t want to take this addicting drug anymore."

" Narration 30: THAT'S JUNE DAHL, PROFESSOR OF PHARMACOLOGY AT THE UNIVERSITY OF WISCONSIN MEDICAL SCHOOL:

6" Dahl: And I’ve had clinicians say to me quite pointedly, "I won’t prescribe that drug."

" Narration 31: DOCTORS FEAR THAT PRESCRIBING OPIOIDS WILL MAKE THEM TARGETS -- ACCUSED OF MALPRACTICE BY GOVERNMENT AGENCIES.

23" Pantilat: Doctors mostly worry about, I think, losing their license by over prescribing. And even if you don’t lose your license, what a hassle to be charged by the medical board or worse, by the DEA, for example, for over prescribing medicine. Even if you’re absolutely in the right, it’s going to be countless hours. It’s going to be lawyers' fees to be exonerated in the end.

12" Dahl: Many docs call this the $10,000 letter that they get from the board, because they can’t possibly move forward unless they hire an attorney because they really don’t understand the charges that are being leveled about them.

29" Cassel: I’ve had colleagues of mine who really have had to go to court to defend their use of medication in the care of dying patients and had their names plastered over the newspaper and major scandals and had to change their phone numbers. And in some cases essentially had their practice destroyed because for a physician, your reputation is all you’ve got. And once there’s any doubt cast on that, you may as well leave town.

30" Payne: When I’ve talked with members of medical boards and law enforcement, they often say, "Well, I don’t understand why doctors have this problem, because if they’re doing the right thing, we won’t investigate them, we won’t come after them." I call it the "State Trooper Syndrome." When you’re driving down the highway and you see a state trooper, you get nervous even if you’re not speeding. This is a natural concern when there is someone sort of looking over your shoulder.

17" Dahl: Perception is 99.9% of reality. So, physicians have the perception that if they prescribe controlled substances for pain control, they’re going to be scrutinized by medical boards and also that the DEA is going to come after them.

9" Ferrell: And you know it only takes one case. It only takes one physician who has been wrongly accused of abuse of abuse to then turn off every other physician.

14" Narration 32: SO, DOCTORS HAVE TO CONTEND WITH THE MYTHS SURROUNDING ADDICTION. AND THE CONFUSION BETWEEN ADDICTION AND DEPENDENCE. THEY HAVE TO DO BATTLE IN THE "WAR ON DRUGS". AND THEY FACE STILL ANOTHER ROADBLOCK: COMPLICATED AND RESTRICTIVE LAWS DESIGNED TO CONTROL WHAT ARE CALLED "SCHEDULE TWO" DRUGS -- INCLUDING MANY OPIOIDS.

36" Cassel: Some states there is no renewal of any Schedule Two controlled substance. Limits on the numbers of pills that you could actually give. The inability to ever phone in a prescription, so that the patient actually had to come to your office and get it and could only get three days supply. So, here they are dying and you have to keep giving them a prescription every three days and they have to go to the pharmacy. The pharmacy doesn’t want to get in trouble and all of this administrative apparatus is costly, so half the pharmacies don’t even carry these medications.

20" Lynn: There really is a real cost to having to go back to the pharmacy every four or five days. If you’re you know eighty-two years old and in a second floor walk up, and you’re relying upon a neighbor to bring in your groceries and your drugs, you know of course, it’s going to foul up and you’re going to suddenly find yourself you know on a Saturday evening with...unable to get anything more till Monday.

28" Cassel: And in New York the only report that came out after all of these new laws had been instituted about ten years ago was a report showing the dramatic decline in the prescriptions written for narcotics. And that was declared a big success. Nobody studied the effect on pain, the number of people who died in pain and suffering. They just counted how many fewer prescriptions were written

" Narration 33: THE RESULT OF ALL THIS IS THAT DOCTORS FIND IT EASIER TO JUST STAY AWAY FROM OPIOIDS ALTOGETHER.

17" Cassel: It’s not surprising that many physicians totally refuse to take care of pain patients, because they don’t even want to put themselves at risk of that kind of investigation. So, it has a kind of chilling affect on doctor’s willingness to learn how to use these medications and to treat their patients adequately.

34" Ferrell: You know I’m a citizen. I’m a mother. I care as much about drug abuse as anyone in this country. And yet, what I also know is that most people in these positions of power and authority are really focused only one half of the equation, and that is the avoidance of drug abuse. So, until it is you, until it is your mother, until it is your friend who is laying there in pain, you don’t really understand the other side of the equation.

12" Narration 34: FOR ANITA, DOCTORS' FEAR OF PRESCRIBING OPIOIDS IS NOT JUST THEORETICAL, BUT A DAILY CONCERN. WHAT MATTERS TO HER IS HAVING RICHARD LIVE A FULL LIFE FOR AS LONG AS HE CAN. AND OPIOIDS HELP HIM DO THIS.

21" Anita: Without it, he certainly wouldn’t be functional. If he was in a lot of pain, he certainly wouldn’t be functional.
Richard: Oh absolutely not. No.
Anita: I mean, you have no pain. You're at least able to focus and concentrate and do things and go to work and do what you have to do. If you're in pain, there's no hope for that.
Richard: It helps with everything. It just lets me function.
12" Anita: The thought of him not being able to have it. I mean 300 milligrams of fentanol patches is a lot. But this man couldn’t function. I mean it would be, oh, I don’t...I don’t want to think about what it would be like without it.

9" Narration 35: BUT, WHAT DOES "BEING FUNCTIONAL" MEAN IN REAL TERMS? FOR RICHARD BUIKE, IT MEANS THAT HE CAN STILL GO TO WORK AT THE MODEL TRAIN STORE HE OWNS AND RUNS.

4" Ambiance: Toy trains running. Train whistle.
(Start ambiance half-way through last narration. Bring up in the clear. Then down and under scene.

80" Woman: Oh, what a great store. Oh, my goodness. (laugh) Oh, this looks like fun. My late husband was a great train lover. And, um, this store would have been heaven for him.
Richard: You want to get rid of a train?
Woman: I think it's a Big Boy? And it's solid bronze. Brass. Brass. Yeah. And I wanted to sell it.
Richard: We'll be here. Come back and see me.
Man: Hi. How are you?
Richard: Jerry come sit down, rest your bones.
Man: Haven't run into you for a while Rich.
Richard: Oh, we've been here. What's up?
Man: Could be interested in some road railers.
Richard: Well, I may know something tomorrow afternoon, you know, as to generally when things are going to show up.
Man: Yeah. Good.
Richard: Alright.
Richard: And I'm going to check on a couple of basic blacks.
Man: Sounds good.
Man: Ill see you later.
Richard: Take it easy. Every day above ground's a good day.
Woman: So Richard, do a lot of people come into the store?
Richard: Old cronies, you know.
Dad: Lots of times on Friday evenings, guys come by. And they all have pizza or Chinese food. And there's kinda a little round robin group in the back. ..... Guys just talk trains and new products.
Richard: You know, I played with trains since I was 10. Always a hobby. Anyway. It's just time to run the S-gauge.
Man: OK (Laugh)

1" Ambiance: Train whistle. Train ambiance. (Fade out under next bite.)

MUSIC Transition

13" Pantilat: We think of people on these drugs as being less functional, as being strung out, but in fact, the exact opposite is true. They get more functional. They can actually go back to work. They can take care of themselves. They can take care of their families.

60" Narration Break II: YOU'RE LISTENING TO HEART TO HEART, FROM PUBLIC RADIO INTERNATIONAL.

7" Narration 36: HOW DO WE GET DOCTORS TO TREAT PAIN? SOME SAY THERE HAVE TO BE PENALITIES FOR UNDERTREATMENT AS WELL AS OVERTREATMENT.

23" Lynn: Boards of medical examiners and boards of nursing need to say you know, "It is not alright to walk away from bad pain." You know, all of the actions have been in the reverse, removal of license because somebody seemed overly aggressive or overly sloppy in their use of these drugs. And we need some actions on the other side that say, "Well, no, actually you really can’t just let a person be in pain for the whole weekend."

11" Ferrell: If this is your husband who is dying in pain, if this is your wife with breast cancer, metastatic to her bone, I mean how are you going to feel when she gets sent home with a non-steroidal drug instead of the opioid she needs?

10" Cassel: In a couple of states, a patient has a right to bring action against a physician who has under treated pain and not treated the pain appropriately.

" Narration 37: THIS APPROACH WAS TAKEN RECENTLY IN CALIFORNIA BY BERVERLY BERGMAN ON BEHALF OF HER FATHER.

?" MUSIC: In

11" Bergman: My dad, his name was William Bergman, and he was 85 uh when he died. And we didn’t know he had lung cancer until uh we took him to the hospital.

7" Tucker: Bill Bergman was admitted to the hospital and his chief complaint was excruciating pain.

" Narration 38: KATHERYN TUCKER IS DIRECTOR OF LEGAL AFFAIRS FOR AN ORGANIZATION CALLED COMPASSION IN DYING.

10" Tucker: Never during his stay at the hospital did his pain really come under control, where he was getting good relief and was free of pain.

9" Bergman: The nurses would be charting, you know pain level, seven, eight, nine or ten on any given time or day.

8" Tucker His doctor at the hospital was Wing Chin, who had been in practice for almost 30 years.

11" Bergman: Dr. Chin said he would go into my father’s room in the morning and say, how you doing, Mr. Bergman? And that’s how he assessed my father’s pain. He didn’t pay attention to the nurse’s notes.

12" Tucker His family, they would come into the hospital, they’d find their father in terrible pain, just clutching this triangle bar suspended over his bed and just gripping it with white knuckles.

7" Bergman: That was just awful. My dad was moaning all night long in pain. It was just ridiculous.

8" Tucker: So, he ended up having an unnecessarily painful death, uh with his family, his adult children at the bedside witnessing this.

8" Bergman: I was really angry. You know, Dr. Chin is not going to get away with this. And he shouldn’t be able to do this to anybody else.

MUSIC: Out

" Narration 39: AFTER WILLIAM BERGMAN DIED, BEVERLY WENT TO COMPASSION IN DYING FOR HELP.

10" Tucker The first thing that I suggested to the family was that we go to the California Medical Board with a complaint seeking uh the board’s involvement in disciplining Dr. Chin.

6" Bergman: And their response was, "The doctor was inadequate in providing pain management, but we’re not going to do anything."

10" Tucker: And so that was very disappointing to the family, of course, as you can imagine. Particularly as the board had rather candidly acknowledged that there had been a problem.

" Narration 40: SO, THEY DECIDED TO TAKE THEIR COMPLAINT TO COURT.

10" Tucker It’s the first time that a complaint was brought where the sole allegation was against a physician for failure to treat pain.

4" Drager: I'm not convinced that Dr. Chin did anything wrong.

" Narration 41: DR. SHARON DRAGER HAS BEEN A SURGEON FOR OVER 25 YEARS.

15" Drager: Dr. Chin has practiced in this area for many years and has been a well respected physician , and um, this was a difficult case in many ways. It was not nearly as straight forward as pointed out…. as portrayed in the press.

" Narration 42: MANY LOCAL DOCTORS CAME OUT IN DEFENSE OF DR. CHIN DURING HIS COURT CASE. DR. DRAGER WAS PRESIDENT OF THE LOCAL CHAPTER OF THE MEDICAL ASSOCIATION AT THAT TIME.

25" Drager: The Medical Association was quite concerned and did go public. He had testimonials from grateful and happy patients and they physicians in the community supported him. We wrote letters to the community. I represented our thoughts on this at various public meetings as well. We took a stand saying that this doctor was wrongly singled out.

" Narration 43: THE JURY'S VERDICT MADE HEADLINES IN THE PRESS.

4" MUSIC: Nightly News Musical Zing
(Start in clear for a few beats. Then fade down and run under News Headlines.)

23" CNN news report: William Bergman's children said they knew the odds were against them in court. But a jury found the doctor who treated their father in his dying days was reckless and liable for elder abuse, because he didn't prescribe enough pain medication. Advocates for terminally ill patients say under-medication for pain is a widespread problem James Attorey, CNN, San Francisco.

2" Bergman: The jury came back very strong.

10" Tucker: The jury came back with a verdict for the family, finding that the physician had been reckless in failing to adequately treat pain, and awarded $1.5 million.

" Narration 44: THE PENALTY WAS REDUCED TO $250,000 -- THE LEGAL MAXIMUM FOR PAIN AND SUFFERING AWARDS. BUT THE JURY'S VERDICT WAS A CLEAR INDICTMENT OF WRONG-DOING -- AT LEAST FOR SOME PEOPLE.

18" Drager: I don't think it was fair that this doctor was singled out and vilified in this way. I mean, When you put one doctor up there and say, "You're the arch enemy and you are evil. You were out to hurt my Dad," um, it's very, very painful and it makes doctors frightened.

12" Tucker: And really the family’s goal was to see that no other patient suffered as Bill Bergman had, and no other family would have to witness a loved one suffer as they were dying.

8" Drager: I think if someone is acting in good faith, they shouldn't go after that person. But, you know, litigation is the American way.

4" Bergman: Sometimes when you [laughter] hit people’s pockets, they pay attention.

12" Drager: Once you have an adversarial situation it's, you know, your side, my side, you did wrong, no, you did wrong. This doesn't lead to any kind of dialog . It just leads to marshalling your forces.

" Narration 45: IN ANY CASE, THE BERGMAN LAW SUIT DID NOT PROVE TO BE A MAGIC BULLET. THE FOLLOWING YEAR, LESTER THOMLINSON -- WHO LIVED ABOUT 30 MILES FROM WILLIAM BERGMAN -- DIED UNDER SIMILAR CONDITIONS.

16" Bergman: Lester Tomlinson's story is so similar. Lung cancer. Aged. Not getting the proper pain management. It was heartbreaking to hear that this is still going on after all the publicity that happened around that case. Maybe I’m naive. You know I think things should change quicker.

" Narration 46: HOWEVER, REACTION BY THE CALIFORNIA MEDICAL BOARD TO THIS CASE SHOWS THAT THINGS MAY BE STARTING TO CHANGE..

24" Tucker: The Medical Board in California did file formal charges. And in March of 2003 what’s called an accusation was filed by the California Attorney General’s Office against Dr. Whitney on for his failure to provide adequate pain management to Lester Tomlinson. And I think that the Medical Board of California, to its credit, learned from the Bergman case.

" Narration 47: IN BOTH THESE CASES, THE DOCTOR WAS REQUIRED TO TAKE CLASSES IN PAIN MANAGEMENT. IN FACT, THE BERGMAN CASE WAS INSTRUMENTAL IN GETTING A NEW LAW PASSED IN CALIFORNIA REQUIRING ALL DOCTORS TO TAKE PAIN MANAGEMENT CLASSES.

15" Tucker And since its passage, we have seen that the courses on pain management in California now are very well attended. And there really is a huge increase in physician interest in taking this kind of training.

9" Bergman: Having sued a doctor is not easy to go through. But I think it’s worth it because uh I think that doctors do pay attention.

" Narration 48: SOME SAY IT'S UNFAIR TO SINGLE OUT THESE DOCTORS IN LAW SUITS. OTHERS SEE LITIGATION AS A POWERFUL TOOL TO FORCE A CHANGE IN THE SYSTEM. CERTAINLY THERE ARE NO EASY ANSWERS HERE.

14" Lynn: A doctor who claims to be in regular private practice and won’t prescribe them, it seems ought to be rather like a doctor who won’t you know prescribe antibiotics. I mean it’s just part of what you have to do to be a doctor.

" Narration 48A: DAVID JORENSON, WHO IS THE DIRECTOR OF THE PAIN AND POLICY STUDIES GROUP AT THE UNIVERSITY OF WISCONSIN, SEES THE OTHER SIDE:

15" Joranson: I do, however, hesitate to use disciplinary action as a primary way of getting physicians to do a better job of pain management, because I think that that would put physicians in the middle feeling like, if you will, they are damned if they do and damned if they don’t.

22" Drager: Many physicians feel that there is some kind of squeeze on them between being sued for not giving enough pain medication to some patients and on the other hand people complaining that they are writing too many prescriptions for narcotics. So I think there is some feeling that you could get stuck.

13" Lynn: They don’t have to be, you know, sending people off to jail or lifting their licenses. But even just to say, "No, this really is a black mark against your record and, you know, you should have continuing education or you should work under supervision or you know something of the sort."

" Narration 49: IT'S A BALANCING ACT: REGULATING DOCTORS WHO PRESCRIBE OPIOIDS, WITHOUT THREATENING THEM.

26" Ferrell: Medical boards need to be accessible. Because the truth is that every physician in the country who ever has a doubt about a prescription they're about to write should be able to pick up a phone and call the local medical board and say, "I need to talk to you about this case," and needs to feel that you have some protection. You know the medical board should not be the enemy of the physician who is trying to do it right.

8" Jorensen: It’s a relatively simple process of increasing the communication so that physicians understand that they really don’t have anything to be afraid of.

16" Drager: Communication is one of the most important things in medicine and in dealing with people in pain and in need. And not only do we need communication, I think we need franker communication, so that there aren't going to be misunderstandings.

" Narration 50: BOTH WILLIAM BERGMAN AND LESTER TOMLINSON DIED IN PAIN. BUT RICHARD BUIKE WAS ABLE TO LIVE HIS LAST DAYS FREE OF PAIN.

?" MUSIC under Anita

35" Anita: (Click) We found an old photo of when he was like twenty or twenty one. (Click) He's in a, it looks like a train office. And there’s an old manual typewriter, a hole punch press. There’s a watchman’s lamp. And looks like an old tuner, some shelves and stuff. He was...he was a dispatcher or a telegraph operator. Anyway, that was nice to find. (Click)

5" Ambiance: Toy train running on track. Train whistles.
(Start in clear. Fade under next bite and run throughout scene.

6" Narration 51: RICHARD BUIKE'S MODEL TRAIN BUSINESS WAS A SECOND CAREER. HIS FIRST WAS WITH THE SOUTHERN PACIFIC RAILROAD LINE AS A DISPATCHER ((DIS'-PATCHER)). THE GUYS DOWN AT THE STORE LIKE TO REMINISE.

63" Richard: Worked there for 30 years. Diesel electric. Yeah. Wasn't anything romantic to tell.
Man: Dispatcher, Southern Pacific, Northern California, Southern Oregon. And he ran trains out of the Sisquious and in Southern Oregon.
Man: Good stories. That's what I understand., that he started out telegrapher up in Oregon someplace. and uh, spent 30 years with the SP.
Man: Dispatching and controlling trains.
Ann: Everybody that loves railroads, that's their dream is to do that.
Man: Tells some wild stories too, every once in a while.
Man: He can tell some good stories.
Richard: What's to tell?
Man: He has a lot of stories that will be gone when he goes. And uh.....
Richard: Did what you had to do to keep them on the track and on time. Playing God.

1" Ambiance: Toy train running on track. (Up for a beat. Then down again.

?" MUSIC under Anita

30" Anita: He had a shop for seven years, and…he loved it. I mean there’s aspects of it that he really loved. He liked the guys. The guys used to hang out there. It was like a bar or something where people hang out. And he would have...Fridays he would have food for everybody who came in. And he would sit out there and hold court. He had a wonderful sense of humor. And you know he would...he would crack jokes. And his personality is really what uh kept that business going more than anything.

1" Ambiance: Toy train running on track. (Up for a beat. Then down again.

15" Woman: Well, Richard it was wonderful meeting you. I hope I can find my train and bring it back and have you take a gander.
Richard: We're open Wednesday through Sunday.
Woman: OK. Well, great. See you next week then.
Richard: Just call. Cause I may not be here. But I hope to.

" Narration 52: THIS TURNED OUT TO BE RICHARD'S LAST DAY AT WORK. HE DIED ONE WEEK LATER.

?" MUSIC under Anita

30" Anita: (Click) We had the uh memorial in….There’s a train yard out in Hunter’s Point where they refurbish old trains and run them. And (Click) this was a 1930s or 1940s dining car with a round bar, and seats still in place, and uh it was wonderful. Richard would have liked that. (Click)

" Narration 53: THERE ARE INDIVIDUALS AND ORGANIZATIONS WHO ARE TRYING TO CHANGE THE WAY WE TREAT PAIN FOR THE DYING.

26" Dahl: There are a number of groups that are working very hard to improve end of life care. Last Acts, the Project on Death in America, the Community State Partnerships, the State Cancer Pain Initiatives, all of these are dedicating their efforts to improving quality of life by reducing suffering from pain at the end of life.

10" Lynn: There are some very good Web sites. There are good Web sites on pain. There are good web sites on end-of-life care. What the very best minds are thinking and what kinds of activities are really taking off.

" MUSIC: Theme Music in here.

" Narration 54: RICHARD'S STORY IS REMARKABLE, BECAUSE HE WAS ABLE TO REALLY LIVE -- ACTIVE AND INVOLVED --ALMOST UNTIL THE DAY HE DIED.

55" Anita: Man he was going up until the week before he died. And that’s only because of the medication. He could hardly talk. His voice was really scratchy and croaky. He had lost a lot of weight. He couldn’t wear his hat anymore. His clothes were hanging on him but he was still going. And it gave him hope. This gave Richard something to do. He had a purpose. He had to be there. He had to check the store. He had to see the guys. He had to make sure things were running. He had to make sure the money was coming in. It gave him a purpose, and only because of the pain medication could he do it. (Voice cracking. sigh. Blows nose.) As it was, he died with his...you know with his shoes on kind of thing. He died the way he wanted to and was able to keep his dignity and…… .his dignity.

" Narration 55: BUT RICHARD IS ONE OF THE "SUCCESS" STORIES. TOO MANY PEOPLE ARE STILL DYING IN PAIN.

11" Ferrell: This is not rocket science. These are some pretty fixable problems. Because, you know what? This is your mother. It’s your father. It’s your neighbor. And it’s going to be you too.

" Narration 56: HEART-TO-HEART: CARING FOR THE DYING. BEYOND PAIN. THIS PROGRAM WAS PRODUCED AND DIRECTED BY CLAIRE SCHOEN. MUSIC BY STEPHEN SAXON, DAVID NORFLEET AND JIM QUINN. TECHNICAL SUPPORT FROM SCOTT KOUE. SPECIAL THANKS TO LINDA DAVIS, JERI SPANN AND VICKI WEISFELD ((WIYS'-FELD)). FUNDED BY THE ROBERT WOOD JOHNSON FOUNDATION. SUPPORT FOR THIS PROGRAM ALSO COMES FROM THIS STATION AND PUBLIC RADIO INTERNATIONAL STATIONS NATIONWIDE, AND IS MADE POSSIBLE IN PART BY THE PRI PROGRAM FUND. YOU CAN PURCHASE A COPY OF THIS PROGRAM OR LEARN MORE ABOUT HEALTH CARE FOR THE DYING, AT OUR WEBSITE, "HEARTTOHEARTRADIOdotORG"
IN MEMORY OF RICHARD BUIKE. I'M CLAIRE SCHOEN.

?" MUSIC out

" TOTAL 58'00"

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