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1 pharmacist in Vermont provides lethal medications that hasten a patient's death

MICHEL MARTIN, HOST:

In Vermont, there is a pharmacist who drives for hours all across the state to deliver a specific type of medication. It's for terminally ill patients who ask him to bring it to hasten their death. Mikaela Lefrak from member station Vermont Public accompanied him during one of his deliveries.

MIKAELA LEFRAK, BYLINE: Steve Hochberg stands outside an apartment building in Williston, Vermont. He's waiting for his patient Edie Novicki to let him in.

EDIE NOVICKI: Hello.

LEFRAK: Hi there.

NOVICKI: Come on in.

STEVE HOCHBERG: All righty.

LEFRAK: They settle in at her table, and Hochberg opens up a brown paper bag.

(SOUNDBITE OF PAPER BAG RUSTLING)

HOCHBERG: And...

LEFRAK: Inside is a prescription strong enough to lead to death. He starts with a disclaimer.

HOCHBERG: To begin with - lots of reasons why it doesn't get used. And you know you are not under any pressure or any rule that says you have to use it.

NOVICKI: OK.

HOCHBERG: It's totally up to you. OK?

LEFRAK: Novicki nods. This is what she wants. She has stage 4 stomach cancer and just a few weeks left to live. After getting two doctors to confirm her terminal diagnosis and making a written request, Novicki got this prescription. Vermont is one of just 10 states and Washington, D.C., where medical aid in dying is legal.

NOVICKI: My doctors are supporting me. My family's supporting me.

HOCHBERG: That's great.

NOVICKI: Yeah.

HOCHBERG: That's great.

NOVICKI: They're still in denial, thinking it's - I'm not going to be using it for a long time.

HOCHBERG: Right.

NOVICKI: But they're not here with me.

LEFRAK: Hochberg's family business, Smilin' Steve Pharmacies, is the only pharmacy in Vermont that fills prescriptions for medical aid in dying. He hand-delivers almost every one, no matter where in the state the person lives.

HOCHBERG: I don't mind the driving, and I think this is way too personal of a medication to just drop it in the mail to you.

NOVICKI: Yeah.

LEFRAK: Hochberg starts methodically explaining the process to Novicki. He's patient but frank.

HOCHBERG: You're going to start with these pills.

NOVICKI: OK.

HOCHBERG: There's two of one and one of another.

NOVICKI: And the purpose of these two?

HOCHBERG: Those two are going to help for nausea, vomiting and swallowing. We obviously don't want this coming back.

NOVICKI: Right.

LEFRAK: Whenever she takes the pills, Novicki will then ingest a lethal dose of a couple different drugs mixed into a powder. The medications have to be mixed at a compounding pharmacy. There's only one other one in Vermont besides Hochberg's. He recommends that Novicki mix the powder with apple juice to help her swallow, and he reminds her of an important rule.

HOCHBERG: You have to be the one to hold that vessel.

LEFRAK: That's part of Vermont's medical aid in dying law. Vermont's a small state - just 650,000 people. Demand for these prescriptions isn't very high. Since it became legal in Vermont in 2013, fewer than 200 people have used medical aid in dying, and Hochberg filled most of those prescriptions. At Edie Novicki's apartment, he finishes explaining the medication.

HOCHBERG: Once you finish this, within a couple of minutes, you will be unconscious. You will not wake up. That's - you'll be at peace at that point. OK?

LEFRAK: Novicki sits quietly with this for a moment.

Let me know if this is too personal. But when you think about taking the medication, how does that make you feel?

NOVICKI: Sad. I'm too young.

HOCHBERG: It's a very difficult choice to make.

NOVICKI: Well, the choice wasn't difficult. The cancer was.

HOCHBERG: Yeah.

LEFRAK: Conversations like this one are exactly why Hochberg drives for hours across the state to deliver these medications.

HOCHBERG: And, you know, we go to school to learn how to help people. There's no other - that was always my view of what pharmacy is. This is the ultimate of help.

NOVICKI: Yeah.

LEFRAK: Once Novicki assures him she has no more questions, Hochberg hugs her goodbye. Then he heads outside to his red pickup truck to make the hour and a half drive back home. He has another delivery tomorrow.

For NPR News, I'm Mikaela Lefrak in Burlington.

(SOUNDBITE OF MUSIC)

MARTIN: Now, if you or someone you know is in crisis, if you may be considering suicide or otherwise hurting yourself, please call or text 988 to reach the Suicide and Crisis Lifeline. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Mikaela Lefrak is WAMU’s Arts and Culture reporter. Before moving into that role, she worked as WAMU’s news producer for Morning Edition.Lefrak is a Northern Virginia native and a graduate of Middlebury College in Vermont. She received a master’s degree in broadcast journalism from Boston University, where she had the honor of working as the graduate assistant to renowned New York Times media columnist David Carr.Prior to working at WAMU, Lefrak was an editor at The New Republic, where she produced politics and culture podcasts. She has also produced at PRI’s The World and WGBH Boston, and served as an AmeriCorps VISTA volunteer in Oakland, California.