Wakil
We're really happy today to have a conversation with Twana Sparks. Twana Sparks, MD is a semi -retired ear, nose, and throat surgeon and writer.
 
 She's a native New Mexican and a 1986 graduate of the University of New Mexico Medical School and was the first ENT resident there. Dr. Sparks excels at oral histories mixed with scientific information. Her books on medical aid in dying in 2024 and tuberculosis treatment in 2013 blend the personal with the process.
 
 Annalouiza  
 She was raised in a large family in New Mexico, and by age 12, she had compiled a bucket list that included but was not limited to, to become a doctor, write a book, walk across the United States, go around the world and learn to surf. Due to a charmed and blessed life, she got to do it all and much more, which also includes standup comedy, an adoptive mother and grandmother, music maker and volunteer firefighter. In 2022, she began supporting those choosing medical aid and dying.
 
 Wakil  
 What a great bucket list. 
 
 Annalouiza  
 And welcome, Twana.
 
 Twana Sparks  
 I never thought I would get to do any of it.
 
 Wakil  
 So here we are. So we like to begin our conversations by asking you to talk about when you first became aware of death.
 
 Twana Sparks  
 That's a fantastic question. I don't think anyone has ever asked me nor have I thought about it. I lived in Arizona the first few years of my life in a neighborhood. It certainly wasn't a farm setting, but my parents were cotton farmers in Arkansas before. And one day they brought home a chicken. I had no idea that they were going to chop its head off and prepare dinner. And so sitting on the porch and I saw the poor animal running around with no head.
 
 And for years, I thought that's the way everything died. We just had our heads cut off and we wandered around for a while. It was pretty traumatic, but I was relieved to know that there were other ways to go.
 
 Wakil  
 Exactly.
 
 Twana Sparks
 I informed my grandmother while I was about four years old. I informed my grandmother after I figured some of it out. Hey, grandma, someday you're just going to fall over dead in the street. She was probably in her late 50s. And I don't think she liked me ever since I gave her that information.
 
 Annalouiza  
 That's silly.
 
 Wakil  
 Well, it's good that you would let her know that though.
 
 Twana Sparks  
 information.
 
 Annalouiza  
 Yeah. So.
 
 Yeah. So how does death impact your story?
 
 Twana Sparks  
 Well, my story is about death. That's all it's about at this point in my professional and personal life that we're talking about. And the story is intentional death, which is something different for me than I've ever done in the last 30 years when I've been practicing medicine. 
 
 And intentional death is is so different from what I have actually thought about it. And the terminology is so important when in medical aid and dying. People use these terms all interchangeably and they're not. This is not suicide. This is not homicide on my part. This is not euthanasia, which is when someone else offers a way to end a life. This is not mercy killing.
 
 So we need a new term and what we've come up with is originally death with dignity and now we've got medical aid in dying. Those terms are so important because that's the way I think that legislatures decide is this a crime or is this a human right? And the New Mexico legislature is the tenth state to make this legal. And there's Washington DC and that's all.
 
 Other states are still struggling with it. And I believe the struggle is about this overlying spiritual question of what does it mean to end a life? My Australian friends say, we're so glad we got the criminals and you got the Puritans because there's an enormous amount of our politics based on what we think is good or right or holy, even though we have a supposed separation of church and state.
 
 But our legislature came to be able to think of suicide as being done by a person who has an option to live. You don't want to live anymore, you kill yourself. And this is a completely different set of people. They are actively dying. And all we're helping them do is decide, are they going to actively die for six days or six weeks or six months?
   
 And I don't see any merit in suffering, although we have an enormous Catholic population in New Mexico. And I know that that faith teaches that suffering is for a reason and that you can offer it up for various purposes. 
 
 The way that we think about aid in dying is more in terms of the person taking control of the dying process so that they have the privilege of really two wonderful things. Many people with cancer or other terminal illnesses with great suffering, they just kill themselves. They can't tolerate it. With this method, we have the option of the person dying with someone. You can have your family around you. You can have loved ones around you.
 
 You don't have to go lay down under your car exhaust pipe or buy a gun and have some violent end. 
 
 And the second thing is that they get to go out in a peaceful manner, a very dignified, sweet, lovely, painless, just terrific way to go. And that's why I'm really privileged to be part of medical aid in dying because people get to die to get rid of their suffering and they get to do it with people around them and with a very pleasant way to go with no pain or anything but a bad taste in the mouth.
 
 Wakil  
 Yeah, yeah. Beautiful. Thank you for sharing that perspective. I think it's really important as people consider this and especially as, you know, not only our audience, but as, you know, different parts of the world and the country are considering it. I know in Canada, it's a nationwide law, but they're still having some conversations about, you know, when it makes sense and who can choose and under what circumstances. And so this is an ongoing conversation that is really important. So I really appreciate your perspective.
 
 Twana Sparks  
 Well, thank you for bringing up the rest of the world because we are really far behind in this whole process compared to a lot of other countries. Canada actually does have euthanasia available. If you don't want to drink the medication that causes your death, they will put it in IV and some caregiver will give you the medication. And that's true euthanasia, but it's just as easy to go out. And they have after they decided, okay, you're terminally ill, we will help you die if you wish. They then added, you have some untreatable, miserable illness such as rheumatoid arthritis or something else that makes your life very much compromised in terms of quality. And they added those reasons and those kinds of illnesses in order to let people use their form of medical aid in dying. And as of last month, they have added depression, which I think is a huge leap forward. 
 
 There are many kinds of mental illnesses that keep people from having any quality of life. They can't hold a job. They don't interact well. They're isolated. They don't want to be here anymore. They've taken every treatment available. I really admire Canada for expanding their list of possibilities. 
 
 And in Europe, Netherlands, Belgium, and certainly Switzerland are much farther along. And they are even considering such things as in Belgium, autism, you know, if you're autistic and your life is miserable, you can't function in society, you may access medical aid in dying. And if you are a quadriplegic, these are really, you know, borderline tolerable to even talk about in America, but in those places they're finding ways to offer it for, and I think appropriately for some people.
 
 Wakil  
 Yeah, yeah. I know the article I read about Canada said it's still pretty controversial there. There are still a lot of people, the depression or the mental health issues. There's still some conversation about how do you do that? How do you make that decision or how do you work with people who are in that state? Yeah, it's a very interesting conversation. 
 
 I actually had this conversation with a friend who's stage four cancer, but also is very depressed. And his point was when you find out you've got stage four cancer, you're probably going to be depressed and anxious. And for them to say that if you're depressed and anxious, you can't use medical aid in dying is just kind of absurd. Given that, I thought that was really an interesting way to look at it. So.
 
 Annalouiza  
 It is. And it's also interesting that we end up gatekeeping medicine, right, for people. And if we don't allow people to actually choose for themselves and have agency about their own health, I mean, what does it mean? Like there's so many, just as I'm sitting here, I'm thinking about all these different gatekeepers. You can't use M.A.I.D. if you're depressed or anxious, or there's, you know, there's certain things that you can't access if you're really sick and I don't know, it's just this gatekeeping culture around our health.
 
 Wakil  
 It kind of goes back to what you were talking about earlier, Twana, that we are beset by the Puritans, right? The Puritan paradigm, yeah.
 
 Twana Sparks  
 And I had hoped that some people could just go down to their local whatever store and say, I'm ready to go, give me that bottle. But then we would have enormous problems with using it inappropriately. You know, maybe I want that bottle to take care of my neighbor I don't like or get rid of my spouse or, you know, whatever. It could be it's a very, very powerful weapon to be used against someone. And so it needs some kind of gatekeeping or control. I guess medical doctors are the most logical at this point, but at some point it may be even some other person who allows the access.
 
 Annalouiza  
 That's also interesting. My sister who lived for 47 years with spina bifida was very much against medical aid in dying actually. And she said she would imagine feeling the pressure of others wanting her to just kill herself when things got really bad. And she lived with a lot of health issues for the latter part of her life. And you know that's interesting to think about that too. Like you're right, Twana. Like people might say, well, can I offer you this little beverage? Because it seems like you're really having a hard time and not having a quality of life. And yet that choice should only be with oneself and what one can take.
 
 Twana Sparks  
 It's the most personal decision that you can make other than maybe you can marry or if you want to decide to have children, those kinds of giant decisions. And there's been a big outcry from the various quadriplegic associations in the country because of this very thing. Some quadriplegics say, why can't I have medical aid in dying because my life has no quality and then there's an argument from the other side saying, well, why doesn't your life have any quality? I'm a quadriplegic and I have a job and I have love me and I have joy. And that's what makes it so personal how each of us addresses what our experience in life is. And you're right. Who had the right to decide for your sister what her quality of life was? It's her life.
 
 Wakil  
 Well, big questions, big thoughts. Wow. This is really, yeah.
 
 Annalouiza  
 And also important thoughts that we share. And I'm so grateful to Twana that you're here having these thoughts with us.
 
 Wakil  
 Yeah. Yeah.
 
 Twana Sparks  
 Well, thank you so much for this great opportunity. It allowed me to put my entire last three years in perspective because I really hadn't spent any time thinking about what does this mean for me.
 
 Wakil  
 Mm -hmm. Mm -hmm. Well, good. That's a good segue to the next question, which is talking more about your current role, your current work. Tell us a little more about what you've been doing with medical aid in dying and anything else that you've been working on.
 
 Twana Sparks  
 Thank you for that question. I hadn't thought of it, but my role in medical aid in dying has two parts. The one we've already talked about, a hospice will call me or sometimes just a patient who's been told they have less than six months to live. They find out about me by word of mouth or by calling end-of-life options, New Mexico, or typing something simple in a search engine, even if it's inaccurate language. Assisted suicide in New Mexico and up will come the website of End of Life Options New Mexico who can locate me at any time. So I get a call and I immediately call the person back or the family member because I don't know if this is an emergency or just some information wanted and I usually will see the person within 24 hours because it's not something like well how about next Friday you know because it's something so serious that they've reached out about it. 
 
 And I go and I educate them and that's my second role. I say I'm going to come over and tell you what I have to offer. I am not going out to promote medical aid in dying. I am not trying to tell somebody what their quality of life must be in order to be eligible. It's all very straightforward. I say you have to have an opinion of someone that you have less than six months to live and then it has to be confirmed by another person. 
 
 I'm often the second person because hospice has already said so or family practice or whomever, they're oncologists like that. I'm often the second opinion. If two people agree that you likely have less than six months to live, are you over 18? Are you of sound mind or decisionally capable? Are you able to either drink or administer through a feeding tube or rectally the medication that takes for your life to go. 
 
 And if they meet all of those eligibility, then I ask them, you know, is this the way you would like to go? And almost everyone already knows I'm coming here to say these things. And some of them say, well, I'll pick a date in a month or two. Some of them say, have you got it with you today? I'm absolutely ready to go. I can't stand another night of no sleep and horrible pain and you know, this isolation or whatever it is that their issues are making their quality of life so intolerable. 
 
 So I start off as an educator and then I go ahead and become their prescriber. But in our community, because this is a relatively new law in New Mexico, people don't know about it. So I'm being asked along with my entire team who educated me on it. It's mostly hospice nurses, retired and just, you know, social workers and interested people in the community who've had some loved one experience a horrible death. 
 
 That team goes out with me to senior centers, to libraries, to death cafes, to adult education classes. We spend probably two or three episodes a month of just educating the public which has been a really fascinating experience because I've been afraid to go out and say, I'm doing this and have my community react negatively to me. I've only ever had one person say, you should leave that up to God. And I said, yes, I understand you're believing that because I used to believe that, but now I have the power to help stop suffering. And I feel like that is, you know, something that I should and will continue to do.
 
 Second, I had a question last week. Are you worried about karma? And I didn't have a conversation with the man because it was the end of the class. But I thought since then, is my karma going to be negative because I'm bumping people off before their time? Or is it going to be positive, if that's the way to think about karma, because I didn't make them suffer for six months when I had the ability to let them go out in a dignified, pleasant way. So those are my roles. 
 
 Educating lots and lots and lots of educating, which this whole podcast is a wonderful opportunity for me. And then just being the provider to tell people how it is that they can, I can walk them through this and help them, you know, change dimensions.
 
 Annalouiza  
 So to what I want to double back to your, your karmic load, whatever that might be. And I don't know about your faith traditions or practices, but I will say you sound like somebody who wants to support others in a loving and kind manner. And I think that at the end of the day, what we can respond, cause I've been called Dr. Kovorkian before, so I kind of know, like, I'm like, I don't think that's a bad thing.
 Right? And what I say to everybody is that I just want to extend the light of love to everybody because at the end again, it's everybody's choice. You know, like in the past, we might've seen people who in desperation use guns or barbiturates or like all manner of really tough decisions that they've made because the suffering is so intense. And here you are supporting everybody so that it isn't like a really hard decision to make alone, right? So if those questions come up to say, you know, I'm doing the best I can to love another human being.
 
 Wakil  
 That's right. That's right. Beautiful.
 
 Twana Sparks  
 That's what I've come to do. But I have an interesting question from the back of the room. Hey, what about your karma? I have no idea. I've never had anybody worry about my karma before.
 
 Annalouiza  
 Right. And you can always answer. It's like, it's a very personal response. So it's probably none of your business, but you know, so, I mean, I said, it sounds like that's a challenge, an occasional challenge that comes up your way. So what are other challenges that you are met with as you walk this world in support of people's choices?
 
 Twana Sparks  
 Well, when they first asked me, my team, would you be interested in being the prescriber? Because we basically have no one south of Albuquerque. There are 40 providers and I think 38 of them are in the northern part of the state. They asked me, would I be willing to do this? And my first thought was for myself, is this going to endanger me? Because I'm semi-retired, I don't have an office, which they could burn down.
 
 I don't have to worry about my reputation of people saying, well, you're a bad doctor. I'm not coming to you, which other people in practice, I think would have those challenges. But I'm really fortunate not to have those challenges at all because I'm at a new phase of my practice where this is all I do. I help people leave the planet. So that is not a challenge. But the challenge that I thought of when I first heard this question was, a quote from F. Lee Bailey or a paraphrase that any act we do means less with each repetition. And I don't know if he's right about that, but I can think of things in my life that have become less and less meaningful as I've done them for the 5,000th or 10,000th time. So at this point, I've done 33 assistances with death.
 
 And every single one still feels like the first one. I still know I am coming into a family, probably family situation, and I'm about to become a character in the worst day of someone's life, you know, someone they love is passing. Or maybe the person doesn't want to die at all, but they don't have any option. And here I am coming, you know, walking through the door.
 
 I had one lady with a great sense of humor. She said, is that you Grim Reaper? Come on in. And I thought, I am very careful for some people. And what I hope is as the, I see myself doing this for years, I hope as the years go by that I don't come to think of it as, well, I'm going to go do another one of those.
 
 And because it's very simple, I write a prescription, I say the same words, I bring it in, I watch a person go through the same thing, and yet it is so hugely profound. It is such an incredible transition for everyone who's there in the room, and I make a conscious effort. That's a challenge for me not to let this become a mundane procedure, just another thing that I do in my life because I want it to always be as impacting as I need it to be because of the seriousness and because of the intent that I have to actually ending something that's so horrifying for them.
 
 Wakil  
 Beautiful. Yeah. Wow. What an amazing way to consider this and what a wonderful thing to hold that sacredness and that beauty and that importance of every single time. So thank you for that. That's so important for all of us. I mean, you know, many of us, especially in this work that we are engaged in, as many of us that we talked to on this podcast are working in end of life, just to always hold that sacredness and uniqueness of each life and each death. So thank you, that's so important. 
 
 What do you need to be supported? What kind of support do you have in this or what kind of needs do you have to be supported?
 
 Twana Sparks  
 Since I have been in medicine for so many years and seen so many lives come in and go out from existence, I really thought, well, I'm used to all this. I don't need any big support. But then my team said, we need to meet every month to make sure that Twana is supported. I thought, well, that seems like overkill, for lack of a better word. But because I go and meet with them and I found them to be incredibly important in dealing with what I really wasn't even looking at. 
 
 And I see how empowering it is for me to tell my stories and how wonderful it is for them. Every time we meet, I say, well, I've had three deaths this month. And thank you to every single one of you because I'm standing on the shoulders of giants. You are the people who got this law passed. You are the people who assist me when I need witnesses or someone to hold the hand of a person who has no family or friends.
 
 You are the ones who made it all possible. And I'm just here to report back of what I, as the point person, have had the privilege to do this month. And I tell the stories, I tell the sad parts, I tell the funny parts, I tell my reaction, and they give their views on all of it. And it's very consoling and it's very reassuring that I am doing something that is really necessary.
 
 Wakil  
 It's great to have that team.
 
 Annalouiza  
 Yes, that is a very beautiful aspect of the work that you do. So Twana, what frightens you about the end of life?
 
 Twana Sparks  
 I may be one of the few people, at least in my circle, who doesn't have any fears about dying. And it took me a long time to get to that point because I was raised in a very fundamentalist evangelical religion that says you knock on doors and tell people they have to believe what you believe or they're going to hell and that sort of thing. 
 
 And when I was able to grow past that, I really have no fear at all about leaving this place. And what I do fear is I don't want to prolong painful death. I don't want to be tortured. I don't want to burn to death. I don't want to drown. I don't want to go through the agonies that take a life. But as for what happens after, I have no clue. I don't even give it any thoughts anymore. What you can't know, what you can't know. So.
 
 I'm doing the best I can and if we're part of a greater consciousness, good. Maybe I'll get to have an interesting post-life. And if we're not, I'll never know the difference. And I've also learned from my oncology associates, there are things that are worse than dying. Like alienation from your loved ones comes to mind. And I've gone through some of that and I think, well, I lived through that awful experience and it gave me a perspective on sometimes death will be welcome if you're in enough pain or if you don't have people in your life who you need. So my fears at end of life are not about dying itself. It's only about the mechanism of how that will happen. I picture getting run over by a beer truck and you know, in my Corvette when I'm 95, a glorious exit.
 
 Annalouiza  
 yeah, that's wonderful.
 
 Wakil  
 I love that. 
 You spoke about your team and I think that's such a good insight and so important. Is there anything else you do? Do any practices that you have that help you keep yourself resourced?
 
 Twana Sparks  
 Well, it seems kind of silly, but when I come home from doing a death, particularly one that's been really, really difficult, I turn on a funny movie. I think that's a Norman Cousins technique. I have lots of feel -good movies that I have in my stacks. And I put one in and I try to go somewhere else, somewhere that's cheerful, somewhere that's positive, somewhere that takes me out of my mind for a little while. I don't know that that's a particularly healthy resource, but I've discovered it works really well for me.
 
 Annalouiza  
 If it works, it works. And that's all we need. Just little touchstones to bring us back into our own lives.
 
 Wakil  
 Yeah, I think that's really makes a lot of sense to me. It's one of my go -to's as well.
 
 Annalouiza  
 So, Twana, I would like to ask, is there something that you wish we had asked you that you would like to share with us?
 
 Twana Sparks  
 Yes, something comes to mind if you had asked me, have there been any surprises in your work? Because there have been quite a few surprises. To my amazement, I thought I knew everything about this business. And what I didn't know or what I didn't consciously process is that people die how they live. 
 
 And if they lived angry, they're going to die angry. And if they lived controlling or indifferent, that's how they're going to go out. But I never thought about people going out humorously. If that's the way they lived, then sometimes, you know, then they are able to turn it into just, you know, the great big laugh fest at the end. 
 
 My very first person I helped pass away, it was just him and me because he had no family. He had no friends. He was new in the community and got a terminal diagnosis.
 
 So they all take an anti -nausea medicine 30 minutes before the medical aid in dying medication. And so in those last 30 minutes, they're not altered in any way. And I say, you know, this is the last 30 minutes of your life, and I'm helping you with one of the most intimate things that could happen. And I don't even know you. So you have to tell me what you would like for the last 30 minutes.
 
 Do I step outside? Do I do a one-act play? Shall I turn on some music? Do you want to tell me about your life? And the very first person I helped said, you know any jokes? And I said, well, you are really in luck because I do stand-up comedy to help raise money for different things. So do you care if they are off-color or about death? He said, oh no, that would be even better than not. So we spent 30 minutes telling you jokes that were just not at all at all in all my world that I could have expected someone to ask. And I said, why did you, why did you want this when it was time to take the medicine? He said, because I've always thought, wouldn't it be fun to die laughing? And the only way to do that is to be laughing all your life, I guess. 
 
 Wakil  
 I love it.
 
 Annalouiza  
 Yeah, that is so beautiful.
 
 Twana Sparks  
 And then the lady who I already mentioned, I came to knock on her door and she said, is that you Grim Reaper? And I just, and then she just cackled and I thought this is gonna be a really fun exit, I think. And actually it was. That's something I never expected, but I think I learned something from them. Yeah, if you gotta go, you gotta go. So why not do it in a way that's got a little bit of style and a little bit of leave people with a good memory instead of, that was just miserable.
 
 Wakil  
 Yeah.
 
 Annalouiza  
 I just love that people die how they live.
 
 Twana Sparks  
 Yeah, we do. So the second surprise I've had is that people of late have been calling me and saying that they've learned about VSED, which is voluntary stopping eating and drinking. And that's not something that I have in the past had any experience with. I've sort of had this vague idea, well, if I want to die, I'll just lay down and not get up for two weeks.
 
 And it turns out that it's a rather complicated process. And because I'm in this other related vein of medical aid in dying, I'm getting calls almost daily from people who want to pass away by stopping eating and drinking. And the most common group to call me is people with early dementia, they are still able to make decisions about what they do with their bodies, but they're not terminal.
 
 I have nothing to offer them in terms of medical aid in dying. Their body will be fine six months from now, but their mind may be long gone, and that's very frightening. So there's a woman who I think may be up in your neighborhood, Wakil. At any rate, her mother wanted to pass away by stopping eating and drinking and she wrote a book about it. 
 
 And the very first thing she says, as I recall, is you can't do this by yourself. You know, five, six, seven days in, you're [garbled] will get out of whack and you'll get up and wonder what you're doing and cook yourself a hamburger because you're delirious. Or you will get up and you're weak and you fall and break a hip and your neighbor calls the ambulance and they take you to the hospital and put in an IV. So the the first thing I learned from her book, which is called the VSED Handbook, was that you can't do this by yourself. 
 
 And the second thing is, of course, then you need a team. If you don't have family and friends who can be there for you, you can make it very expensive by hiring round the clock aides or nurses. Or my team who helps with medical aid and dying is certainly willing to help monitor people when they're passing away from voluntary stopping eating and drinking. And it's a long, long process.
 
 It can take week or two, a lady in Santa Fe took three. I think it's a terrible way to go, but if it's the only option that allows people to be around you and be comforting to you, then it certainly has been a surprise to me to be asked to participate in that.
 
 Annalouiza  
 Twana, I was just going to say there's a movie about a gentleman who did this maybe about 10, 15 years ago because I was trained by a woman in Boulder and she was the one who shared this movie with me. It's a gentleman who decided to do that. He stopped eating and drinking and they had told him it'll probably take a week. He did live for two weeks and they documented it for the entire time. They had people just with him 24 seven and it was really, really fun for him. He had a lot of guests come through and you know, yes, it did take a team. 
 
 And I've also worked with folks who have stopped eating and drinking and I have not had a bad experience with that. It's actually been, it's given those folks a lot of agency without a lot of intrusion from, you know, the medical aid in dying. And this was before we had that rule here when I was working at hospice. So I'm glad you brought that up because I will find that movie. I have it on DVD here in the house somewhere. So I will bring it up and share it with folks who want to see this process.
 
 Wakil  
 Yeah, we'll put that in the podcast notes and I'm going to add it to my resources in my class too. Thank you. That's really important. I've also, when I was doing some research on it, and I try to note this when I'm talking to people about it, that there are bad experiences as well. People do have a hard time. It can be really painful. So it's, it's worth kind of really knowing all of the ins and outs. It sounds like that book would be a really good one for people to have access to if this is something they're interested in considering.
 
 I was kind of circling back and thinking about one thing you said earlier, and I don't know if you want to share any of these, but you shared the beautiful stories of the kind of the fun, happy laughing parts. But at one point you said you sometimes come home from a really difficult one. And I don't know, are there any stories that you'd want to share about difficult times that you've had?
 
 Twana Sparks  
 Certainly, and Wakil before I go there, the name of that book is the VSED handbook by Kate Christie.
 
 Let's see. Difficult cases. I have had several of them because the person who was passing away was a friend of mine because we're in a very small community and I've lived here the majority of my life and people have known me here forever. And I've gotten called twice to help people pass away who were very dear to me. I hadn't had much contact with them off and on through the years.
 
 But when I realized they're the person who needs to go, it was quite an honor. But in that time, I moved from being the educator and the prescriber to just being one more mourner in the room. We were having to say goodbye to this person. And I don't know that it was comforting for me to be there for them. I hope so. But it was devastating to watch people fade away who had been so vital and some of them so important in my life. 
 
 So that is difficult. And I've had several people who, although they agreed and they insisted it was time to go, they were not ready and they didn't want to. So they were in tears for the hour before. They were angry. They were abusive of their family members. They were victimized by why me, why do I have to go out in this way, and to hear the terror and the horrible emotional pain they were going through, and I have nothing to offer except to end that, which is a conflict for them. They want it and they don't want it simultaneously. Those are a little harder to deal with because I don't have any answers for all of the miserable time that they're having now and the awful thing that they're going through except to help them end it. And so those take me two movies instead of one to get over.
 
 Wakil  
 Right, right. Thank you for sharing that. That's deeply moving. And yeah, what  amazing work you do and thank you for doing it. And thank you for sharing not only the beauty but also the sorrow. I mean, this all goes together. And that's one of our kind of consistent messages in this work. We have to be able to hold both.
 
 Annalouiza  
 And I just shared the name of that movie was the dying wish media .com and it's about a doctor who did stop eating and drinking.
 
 Wakil  
 Yeah, those will go in our links.
 
 Annalouiza  
 Yes, he was a physician.
 
 Twana Sparks  
 What work have you done? Are you a doctor or nurse because I hear you talking in medical terms?
 
 Annalouiza  
 No, I've just volunteered for the, for a hospice for a long, long time. And I've gotten a lot of training around, like home care funerals. And I lived with my sister who was, who spent her life with spina bifida, lots and lots of medical issues. So yeah, I feel like I've always just been kind of adjacent to all this, but now I, I term myself a, a death midwife and I'm an herbalist and you know, death positive supporter and spiritual director. Yeah, so I do a lot of a lot of care of folks when they're at this point of life.
 
 Twana Sparks  
 Thank you so much. Thank you for that work.

Wakil
OK we'd like to say thank you to you Twana, as well. Twana has offered to sing a song. We usually like to do a poem at the end, but she has offered to sing a song that really means a lot to her. And we are really thrilled to have her do that. Its called I Am Weary Let Me Rest, an Appalachian traditional song. Thank you so much Twana... please.

I Am Weary Let Me Rest - an Appalachian traditional song

Kiss me mother kiss your darlin'

Lay my head upon your breast

Throw your loving arms around me

I am weary let me rest

Seems the light is swiftly fading

Brighter scenes they do now show

I am standing by the river

Angels wait to take me home

Kiss me mother kiss your darlin'

See the pain upon my brow

While I'll soon be with the angels

Fate has doomed my future now

Through the years you've always loved me

And my life you've tried to save

But now I shall slumber sweetly

In a deep and lonely grave

Kiss me mother kiss your darlin'

Lay my head upon your breast

Throw your loving arms around me

I am weary let me rest

I am weary let me rest