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A WORLD OF HELP FOR THE FINAL CHAPTER

He had writhed in pain for 12 years before he reached for the gun.

Ronald Britton's COPD was killing him. He had lost much of his independence and required an oxygen tank. For the agonizing aches in his neck and legs, Britton popped two morphine pills and six oxycodone daily. He'd had operations and injections, but nothing helped. Most nights, the 70-year-old cried himself to sleep.

That's when doctors referred him to Suncoast Hospice. They told him he was dying.

When a hospice nurse came for a consult, he lashed out. Britton knew that nothing could save his lungs, but that's not what made him want to end it all. It was the relentless pain.

"I was ready to give it up," he said. "All I wanted to do was die."

Then he met Dr. Jay.

Kirksak Jay Poonkasem - Dr. Jay, his tongue-tied colleagues call him - runs Suncoast Hospice's Integrative Medicine Clinic, a place where patients can receive alternative therapies like acupuncture and Chinese cupping to complement their Western medicine treatments.

Hospice centers across the country offer similar therapies, but as far as the National Hospice and Palliative Care Organization can tell, the clinic at Suncoast is the first of its kind.

It is separate physically, but not financially, from the traditional hospice facilities and hospice patients pay no additional fees for treatment.

The clinic opened a year ago, but Poonkasem was offering the treatments to his individual patients before that. Foundations for the Scientific Study of Spiritual and Complementary Healing heard of the doctor's efforts and gave Suncoast a five-year, $50,000 renewable grant to create a separate clinic. Later, Wells Fargo awarded it a onetime $10,000 grant.

Many patients come to the clinic with chronic pain, asking not for a cure for their terminal illness but a way to die peacefully and not pumped full of narcotics. Some experience sickness from chemotherapy or pain from constipation as a side effect of medication.

As desperate as they are for relief, Poonkasem still spends a lot of time persuading.

"People think it's voodoo medicine sometimes," he said. "If it's not going to be harmful, what's it going to hurt?"

But he understands their reluctance. Poonkasem is Thai, and though he was introduced to alternative therapies early on, he aspired to be a doctor. He studied massage therapy for one year before attending the University of Florida College of Medicine. Poonkasem specializes in family medicine and hospice and palliative care and completed an integrative medicine fellowship at the University of Arizona. When he isn't seeing patients at the integrative medicine clinic, he does hospice consultations for Suncoast at Morton Plant North Bay Hospital.

He has always tried to balance his passions for both Western and alternative medicine.

Take acupuncture, the practice of inserting extremely thin needles into the skin to balance "the flow of energy or life force" through "pathways" in the body.

"You can treat the whole body through the ear," he said. If the body is a computer, he added, then the brain is the central processing unit. It needs a keyboard (the ear) to transmit instructions and someone (him) to punch the keys (his needles). When Poonkasem lightly taps them into the skin, he tells the brain to relieve the pain.

Once his patients let him poke their ears, he ventures south: wrists, abdomen, knees and ankles.

He's usually pretty convincing.

"Would it survive the test of time and multiple cultures if it didn't work?" he asked.

- - -

At first, Britton thought Poonkasem's treatments were a pile of malarkey.

But soon, he was a believer.

Britton limped with what felt like a baseball-sized knot on the bottom of his foot. He had backaches that shot down his right leg. He couldn't breathe and said his pain was a 15 out of 10.

After some acupuncture and electrode therapy, Britton said he walked out limp-free.

His painkiller intake dropped significantly. He started sleeping through the night and could once again sit comfortably in a chair. And the pain? Gone.

His disease, he knew, was still terminal, but Britton no longer wanted to cut his life short.

"He saved my life," he said.

- - -

Poonkasem dislikes telling patients there's nothing else he can do, because there almost always is.

He can't save their lives, but he can make their lives worth living. He doesn't dismiss Western treatments but believes the new and the old can work together.

"We tend to focus on the patient as a disease but not as a person," Poonkasem said. "You treat people, but are they really getting better?"

The work is rewarding but tough, he said, because all of his patients are dying. Poonkasem has seen people fight for months and others go quickly. His oldest patient was 100, the youngest a 3-year-old girl.

- - -

On Sept. 16, Britton had his 21st appointment at the Integrative Medicine Clinic.

He was carrying an oxygen tank and didn't have much of an appetite, but he had outlived his prognosis by three months.

"What was the best part of this week?" asked Shirley Spear Begley, a hospice nurse.

"Beating the Yankees last night," Britton said with a smirk.

He talked about what made him happy: For the first time in many summers, he has been able to watch his Rays from the stands of Tropicana Field. He even climbed the stairs himself. Britton spoke of the neighborhood boys he plays catch with sometimes and how they don't have involved fathers. He cried when Poonkasem asked about his own son, the one who took his life years ago.

Britton told Poonkasem that he was the first doctor he had ever enjoyed coming to see.

Then they went to work: massage, acupuncture, guided imagery, therapeutic touch.

"How are you feeling?" Poonkasem asked.

"Good." Britton said with a smile. "Alive again."

Contact Katie Mettler at kmettler@tampabay.com or (727) 893-8913. Follow @kemettler.

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