When my last day finally comes — hopefully, not until I’m 105 or so — I want to be in full control of my own death. I do not want my last minutes on this agonizingly beautiful planet to be lost in a paralyzing morphine haze, devoid of food and water, diapered and gasping, until some final crescendo where every system shuts down. Ouch. Eek. No, no, no.

I’ve heard from so many readers who feel the same way — but, even though death with dignity has been the law of the land in California for nearly a decade, we remain mystified about how, exactly, to access this kind of care. Hospitals can, and do, refuse to provide it on moral and religious grounds. Doctors who object have no obligation to refer us to doctors who support it. And even with entire websites devoted to the law’s intricacies, finding an actual practitioner, near you, when you need it, can be a confoundingly baffling exercise, especially in the grief of the moment.

We’re going to fix that today. In this story, we’ll direct you to medical-aid-in-dying assistance in California (bookmark the pages in case you need them someday). We’ll tell you what it’s like from the physician’s vantage point. We’ll tell you how it works and what to expect — and we’ll hope that we all pass peacefully in our sleep at 105 and never need it.

Called to service

In 2016, when the End of Life Option Act became law, psychiatrist Jeff Levine was preparing for retirement. He had watched, broken-hearted and helpless, as his father suffered through his final days, “not being able to do what he wanted — which was to get it over with,” Levine said.

It’s a horrible, horrible feeling that I recently endured with my dad. But Levine was in a position to do something about it. Perhaps, he thought, he might be able to spare others that singular agony.

So he contacted Lonny Shavelson, the Berkeley emergency room physician/journalist who wrote “A Chosen Death: The Dying Confront Assisted Suicide” back in 1995 and was a leading proponent of the new law. “Extraordinary portraits of five dying people who contemplate ending their own lives, sensitively and movingly written by a physician who has thought long and hard about the issue of assisted suicide,” Kirkus Reviews said of his book.

Shavelson was organizing Bay Area colleagues to step up and fulfill the new law’s promise. Levine wanted to do the same for Orange County and Southern California.

“I started cold-calling doctors — and got a horrible response,” he said with something between a laugh and a wince. “‘We don’t kill our patients!’ ‘Haven’t you heard of the Hippocratic oath?’”

Why yes, yes, he had. But sometimes, the most humane and compassionate care a doctor can give at the end of life is to help fulfill a patient’s wish for the pain to stop. California’s lack of such a law in 2014 forced Brittany Maynard to leave her home in California for Oregon, where death with dignity was legal. She was only 29, but had terminal brain cancer. She feared pain, personality changes “and verbal, cognitive and motor loss” even with palliative medication. “Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind,” she wrote. “I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.” Maynard was the moral force pushing California’s End of Life Option Act over the finish line in 2015.

Levine had these conversations with doctor after doctor, and found an empathetic ear in Susan Gardner, a friend of a friend. She had recently retired after 35 years as an emergency room physician in Los Angeles. She had seen so many very elderly, very sick people who were, simply put, not allowed to die. “I love saving people,” she said. “But for some, especially for some very old people, it was torture for them. Literal torture.”

But this new law was uncharted waters. She worried. She tried to say no to Levine — numerous times — but, deep down, knew how important the work was.

“Let’s just do one case together,” Levine said. “Just one.”

Twist, twist, twist went the arm. Reluctantly, she agreed.

‘Scared’

Their first patient was a woman with metastatic breast cancer. She was, as the law requires, terminally ill, with less than six months to live. She was, as the law requires, of sound mind when she made her first request for the drugs. She was, as the law required, of sound mind when she asked for the drugs again two weeks later. (Since then, the period between the two asks has shortened to 48 hours.)

Interviews with patients typically start with a question designed to see how cognizant they are, such as, “Do you understand why I’m talking to you today?” The answer is usually something like, “Yes. You’re the doctor who’s going to help me get medicine so I can die.”

That’s really what you want? Why? The answers are often a catalog of miseries: debilitating pain that gets worse every day; an acute inability to sleep — tossing and turning through the night only to meet daylight with profound exhaustion; difficulties eating and drinking; mounting indignities. They’re just done, Levine said. They don’t want to do it anymore. They know they’re going to die, and soon, and they simply want to exert a little control over the bitter end to make it not quite so bitter.

There’s reflection. They’ve had good lives, people say. They’re grateful. They’re ready.

A combination of a cardiotonic, opioid and sedative drugs is the most common prescription for medical aid in dying, according to the California Department of Public Health. Patients usually drink it, and it has to be self-administered — which means, literally, no one is forcing their hand.

Their first patient set a date. Her whole family gathered a week beforehand to spend that time with her. When the day finally came, everyone crowded into the room, saying goodbye, good night, thank you, I love you. There were tears, but the patient was at peace.

Levine and Gardner, however, weren’t quite exactly at peace. It was, honestly, a bit scary.

Death does not come instantly. It takes hours for the body to shut down. The doctors made regular calls to Northern California to make sure that everything was unfolding as it should.

After the first hour or so, the woman’s family started telling stories. “Remember when…?” There was laughter. Soon, there were jokes. It wound up being an incredibly profound experience, the doctors said.

“Some thought they were going on to a better place, but many did not. Would I have the courage?” Gardner mused. “It was very inspiring.”

Peace of mind

Sometimes, patients were denied: It wasn’t clear their lives would end within six months, or they were of sound mind when they began the process but not when it was time for next steps.

And there were times, though rare, when the patient wanted the drugs but family members were vehemently opposed. Ugly things were said. The doctors had to calmly explain, often to adult children, that they weren’t the patient — their parent was.

Usually, though, those battles had been fought and settled long before the doctors entered the picture. Often, finding a doctor to help was such an ordeal that families met them with gratitude and relief.

When the law took effect in June 2016, there were more than 113,000 licensed physicians in California. Only 173 of them were writing prescriptions for medical-aid-in-dying drugs, according to data from the state.

In the first six months, 258 people started the process. Doctors wrote 191 prescriptions. Only 111 people used them and died.

Since then, the number of prescribing doctors has essentially doubled —  to 337 — but that’s still an incredibly small fraction of California’s 125,000 licensed physicians. And doctors can still be a challenge to find.

To make that easier, Levine created a website to help people access help in Southern California: socalendoflifeoptions.com, which is now run by another doctor. There’s also the Academy of Aid In Dying Medicine at aadm.org (click on the “For Patients and Families” tab, then “Find a Provider.” You’ll find a form there which will get you to a referral). And in Northern California, Shavelson’s Bay Area End of Life Options can be accessed at bayareaendoflifeoptions.com.

If you or someone you love is in a hospital or hospice and you ask for medical-aid-in-dying drugs but are refused — this happened to Marie-Noële Anne Tusler at Hoag Memorial Hospital Presbyterian in 2021 — these resources can direct you to the help you seek.

Meantime, California’s law is slated to sunset in 2031; a bill pending in Sacramento by Sen. Catherine Blakespear, D-Encinitas, would extend it indefinitely.

The doctors will be watching. They’ve retired from their retirement work, satisfied that they’ve provided peace of mind to people at the culmination of life — whether patients wound up using the prescriptions or not.

Mission accomplished, Levine said. But his friends joke that he’d better not die before they do.