Vilma Medrano has been speechless for 18 months.

These months since Lou Gehrig's disease stole her voice have been the worst of the illness's five-year assault.

Most words she would have chosen to talk about death, and her 43 years of life, have gone unsaid.

Words to describe the taste of death approaching - enchiladas pureed into brown paste to help her eat as the disease thickens her saliva and makes it difficult to swallow, choking her.

Words to express her fear of pain.

Words for what she misses most, trapped in a body she can't move. Things like hugging her son and daughter, who are 7 and 9. Her old government job in Austin, Texas. And seeing and hearing the surf break at Padre Island.

Medrano deteriorates week to week. Her lungs lose pressure; her neck grows weaker, her breathing more labored.

Vilma Medrano celebrates the seventh birthday of her son Carlo, left, with her daughter, Natassia, 9, right.

But as death swallows her, Medrano's friends and family are silent. She is unable to speak about death; her family won't.

Medrano already has lived a year and a half beyond doctors' predictions. She could stop breathing any day, and she would die.

She knows that in her bedroom, with its angel statuettes and flickering Jesus candles on the dresser. Friends and family react by keeping the harsh reality of some words out of the home.

In houses across America, the language of death becomes a vocabulary of denial. We substitute gentler words. We say "passed away" instead of "died." "Deceased" instead of "dead."

In Medrano's bedroom you don't hear "die" or "dead," words about caskets or goodbyes. Such conversation is confined to talk over glasses of iced tea at the kitchen table down the hallway.

Vilma Medrano can only smile or frown to react to her son Carlo, 6.

Medrano would rather these words be spoken in front of her.

"There is a sense that I have acquired since the beginning of this illness," she communicates silently, one letter at a time, through an alphabet board held by somebody else.

"I'm more sensitive. (My) hearing (is) also," she says. Sometimes she even hears the kitchen-table discussions.

To signal what letter she wants on the alphabet board, Medrano raises her eyebrows. The listener taps rows of letters with the tip of a ball-point pen. These conversations are tedious, tiring. Medrano chooses words precisely, like a poet. She speaks in silent, free verse.

"Some people are afraid of death," she says. When they enter her room and see her propped up against the pillow, she says, "(It's) in their eyes, the energy around them."

Medrano repeatedly has compelled her best friend, a close soul since childhood, to discuss funeral plans. "She didn't want to talk about it," Medrano says. "I'd force the subject. She'd say, `We're not playing rehearsal.' So she still doesn't want to talk about it."

Medrano understands. There is no cure for amyotrophic lateral sclerosis, the disease that has ravaged the motor neurons of her spinal cord, crippling her muscles. But she wants to debate the virtues of cremation vs. a traditional burial.

Talking of this, she tries to inhale deeply. She manages only a labored sigh.

If she could just talk.