Specialists say death will be quiet process

PINELLAS PARK, Fla. -- Terri Schiavo's body, after seven days without food or water, is rapidly burning through stored protein and fat. Waste products are likely building up in her bloodstream, placing cells throughout her body under enormous stress, said end-of-life care specialists. Her organs are likely beginning to sputter, with her kidneys the first expected to go.

This descent into death by starvation and dehydration can be painless and even peaceful, the specialists said. And the end, they said, may come with a massive heart attack -- quick and sudden. Any sense of discomfort is not likely: She is not conscious and probably cannot feel pain, and certainly cannot contemplate that her death is approaching.

''She has no consciousness, so she's not going to experience the psychological part of this," said Dr. Timothy Quill, a professor of medicine and director of the Center for Palliative Care and Clinical Ethics at the University of Rochester.

Protesters gathered outside Schiavo's hospice yesterday accused the courts and her husband, Michael Schiavo, of barbarism and torture on par with Nazi atrocities. Many prayed intensely, occasionally weeping, as they imagined her wasting away.

But specialists said their concerns were misplaced.

''There's nothing inherently painful about this process," said Quill. ''It is not the harsh process people are making it out to be."

Depriving patients of food and water to hasten death is not uncommon in hospitals or hospices, as patients with terminal illnesses such as cancer or Lou Gerhig's disease elect to refuse further treatment. For many, the process can be peaceful, a time for closure with family and loved ones. For some, the effects of starvation even cause feelings of euphoria, according to studies.

But Terri Schiavo has been in a persistent vegetative state for more than a decade, meaning she feels little or nothing, with virtually no chance of recovering any function. Thus, specialists said, hunger, thirst, pain, and euphoria are not part of her world.

''It's important to separate what's happening to her body from what she's experiencing," said Dr. Perry G. Fine, anesthesiology professor at the University of Utah medical school and vice president of the National Hospice and Palliative Care Organization.

Death by starvation and dehydration typically takes one to two weeks, though young and athletic patients can last up to three weeks.

During the first week, ''there's generally less activity. People become still, more sleepy, more sedate," said Quill.

After a week, patients' urine output decreases because of a lack of fluids. The kidneys begin to fail, causing toxins to build up in the bloodstream.

Eventually, kidneys shut down, muscles break down, and breathing and the heartbeat grow erratic. ''The cause of death would be cardiac arrest," said Fine.

It is not clear which stage Schiavo is in. No public updates of her medical status have been given, though her father, Bob Schindler, yesterday said her eyes were sunken and skin dried and cracked. Family members said she sleeps at uneven intervals. But the hospice does not have sophisticated equipment to monitor her vital signs; the purpose of a hospice is to ease patients into death, not revive them. The end will likely come quickly, specialists said.

''We're at one week now, and I think we'll start to see significant changes," said Fine. ''But it's very difficult to predict when it will happen."

Raja Mishra can be reached at rmishra@globe.com.