A Death of Your Choosing

The Slow Walk Downhill

I met Nol ten years before I helped him die. He was 70 then, an active, cat-loving, retired professor of philosophy and religion. I had briefly dated his son.  When Nol (a nickname for Oliver) asked for an in-person get together, I was puzzled. But, he was an interesting man and I liked him, so I agreed.  He came to my home, and we shared stories about cats, African Grey parrots, travels, adventures, cabbages, kings … and then he asked if I was familiar with the Compassion & Choices organization. I was not, under its new name, but I had heard of them under a previous name, the Hemlock Society.

Fall landscape

Nol had thought deeply about aging in America, and he wanted no part of the common path our elderly walk. The slow walk downhill, the dependence on others for help with basic activities, the medical expenses that come in the final years.  He wanted to leave something for his family— his adopted son and his twin sister, who was still paying off her townhome.

A bachelor, Nol had adopted seven-year David from a Native American Indian reservation. This was some 40 or more years ago, when single men did not often successfully adopt children, Native American or otherwise. Nol broke ground when he needed to.

David once told me that neighbors stared—and some glared—at his 6’ 4” frame when,  on visits home, he stood by and watched his smaller, frailer father carry bags of groceries into the house. 

“I don’t care what they think,” David said, “This helps Nol stay strong.” David was willing to carry the groceries, all Nol needed to have done was ask,  but as long as Nol could do it himself, even if he struggled a little, he would be better off, said David, for carrying his own groceries.

On that afternoon when we got together, Nol brought his will and advanced health care directive. He explained that he had tried to talk to his sister and David about this and that they did not understand or support his decision to end his life when the time came. He wanted me to be his executrix. 

Wait, what? No.  That’s ridiculous. I don’t even know you that well.

“Why me?” I asked. Surely there must be someone closer, someone more competent.

Nol wanted to know if I filed my taxes on time.

I did. State and federal. I run a business and have an accountant do my taxes because I am afraid of making a mistake. I find the  regulations—let alone the interpretations—confusing. 

Criterion for Executing an Estate

Nol told me that the best indicator of who would be a good estate executor was whether or not a person filed their taxes on time. He ticked off on his fingers as he added reasons: I was  a caring person (he had noticed my cat-pleasing personality); his sister lived out-of-state, was as old as he and would be older still when the day came; his son had a brain injury that mostly obliterated his short-term memory; there was, apparently, no one else.

I agreed to think about this. I asked about his present health (good). Was he depressed? (No.)  Was he positive that there was no one else who could take this burden (yes, no one else). What would be involved? He had engaged a law firm and they would walk me through what needed to be done.

And years went by. Every time Nol updated his legal documents, he would bring me a new set.  We met several more times over the next ten years and had lovely, enjoyable conversations about everything but death.

And then, one year, on a beautiful late summer day, Nol came for his visit. I was expecting our usual delightful conversation, and was unprepared when he said, “It’s time.” My stomach flipped over.  I repeatedly asked if he was sure. He looked fine, spry even. He had lost some weight, but could still get on the floor to play with his cat and get back up without assistance.

He assured me that he was not depressed. He had, he said, three types of cancer. He sometimes bled puddles on the floor on his way from bedroom to bathroom. He no longer enjoyed reading because he found himself reading the same paragraph over three times, struggling to catch and remember the meaning. He was starting to have moments, while running errands when he didn’t know where he was or how to get home. If he sat for 5–10 minutes, the fog would lift. He had gotten lost in the way home from our last visit.

“What about doctors?” I asked. Had he considered second opinions? He looked at me as if I had not understood the words threeand cancer. He did not want to be a burden on his family, he reiterated, and he had once again tried talking to them, but they would not listen or take his concerns seriously.Even if he had more treatments (he had had some), he would not get well.

I offered to let him come live with me. I showed him the spare bedroom and said his cat was welcome too, of course. I had prior medical training and experience in caring for my mother. Caring for him would be no trouble. He smiled gently and handed me a list of instructions. People to call, and in what order. I was to let his Exit Guide know when he had succeeded. He included the paperwork donating his  body to science, saving his family the cost of burial or cremation.

He had arranged for someone from out of state to come and remove the helium tank (for filling party balloons) and plastic bag that would be the tools he used to cause his death.  After agreeing, at the last minute, that person backed out for fear of getting in trouble with the law. In our state, suicide is illegal. The police had been to Nol’s home to interview him previously, because they’d found his name on a list of donators to Compassionate Choices.

He had made an appointment to have his beloved and healthy cat euthanized.  I begged, reasoned, and used every form of persuasion I could muster.  Eventually, he gave me his cat. A few weeks later, he arrived, antique cat carrier in hand.  I remember that he had no trouble kneeling to poke his head under the bed to say goodbye. He whispered to his companion, telling him that he had been a magnificentcat.  

The last time I saw Nol, his eyes were brimming with unshed tears as he walked away from his beloved pet. We spoke on the phone after that. I was at the hospital—my mother, a year older than Nol, had reacted badly to a surgery intended to make her life better. I was distracted, but I was able to let him know that his cat, my cat now, was adjusting beautifully and would be fine.

Light in canyon.

Death by Natural Causes 

A few weeks later, Nol’s body was found by friends scheduled to meet him for dinner.  When knocking brought no response, the friends tried his door and found it open.  No plastic bag or helium tank were present. The police came. The officers were suspicious of the handwritten notes throughout Nol’s house explaining which light switches worked what lights or appliances, but in the end, the coroner ruled it death by natural causes. Nol was over 80 and had his share of health problems. I fulfilled his wishes and handled his estate. I loved that magnificent cat for five more years.

And still, we need a better way.  Nol died alone, when he needn't have. He may have been frightened.  He had not succeeded on his first try.  Maybe his heart gave out before he could try again. Nol was a thoughtful man. His Exit Guide received the news of his death and said she was happy for him. His family grieved for him.  I grieved for him. His sister was able to pay off her house.  She went through chemotherapy before succumbing to cancer a few years later.  

My mother, best friend, and inspiration died after her second significant stoke. Two days after the stroke, it “evolved catastrophically.”  Following her well-documented wishes, we brought her home to spend the last days of her life, medicated by pain killers and sedatives, without food or water, unable to speak. She died on a hospital bed, next to a floor length window with a view of her garden that she could not see.  Her greatest value, after love, was independence.  She had less than a week of hospice. She would have been pleased by that.  The hospice workers said she was not suffering. I want to believe that, but I am unsure and suffer from the uncertainty.  The hospice volunteer was more concerned, at the end, with collecting the narcotics and dumping the bottle and syringes into a baggie of cat litter than with the loss of a brilliant human being. 

We Need a Better Way

Nol died in accord with his beliefs. My mother died that way, too, but both suffered with the dread of not knowing if they would  be in control for the final steps of the walk downhill or how long those final steps would take. Neither wanted their loved ones to have to decide for them at the end.

In the spring of 2017, a friend’s mother, in her late eighties, decided to have an operation to relieve pain in her back that had made walking increasingly difficult. “We knew she might die,” her son said. “We expected she would either walk out of the hospital, or she would pass away during the operation.” Neither she, nor her children expected what came next.  She survived the surgery, but didn’t recover quickly, and her personality was adversely altered. She became dissociative. She complained to and about her long-suffering children, and even threatened to wring her son’s neck.  She spent the first six weeks in a nursing home.  Her son and daughter took shifts so that she was never alone. Her son bought a camping chair and brought it into the nursing home. He slept in the chair every night for the entire time his mother was there.

When his mother finally regained her sense of self and should have begun rehabilitation therapy, she was out of time.  To be eligible for physical therapy, she was required (by some medicare rule) to be able to walk 100 steps.  She could barely do five, which was five more than three days earlier, and she was finally herself, improving every day.  But there was no money for therapy.  There was money for relocating her to a small room where she would be helped to evacuate her bowels.

She went into an assisted living situation.  She quickly lost use of her legs. Five steps turned to no steps.  She became incontinent and spent her last six months in a tiny room in a home where she would see her daughter once a day.   Her son had returned to his home state, but the anger and frustration, the horror and the hopelessness—those stayed with him.  She died at the end of January in 2018. She had been miserably, critically ill for six weeks and hadn’t recognized her children for the last four.

The Cheap Thing or the Right Thing?

One of the arguments against death with dignity laws is that assisted suicide will create a duty to die.  Helena Berger, President of the American Association of People with Disabilities has said:

"In this profit-driven economic climate, is it realistic to expect that insurers are going to do the right thing, or the cheap thing? If insurers deny, or even delay, approval of costlier life-saving alternatives, then money saving but fatal measures become the deadly default. The truth is that assisted suicide as public policy is rife with dangerous loopholes and consequences, especially for the vulnerable in our society. We should reject laws that legalize the practice."

But isn’t what happened to my friend’s mother an example of insurers doing just that—the cheap thing, and not the right thing?  Who would choose to suffer, and to put their loved one through the healthcare hell they endured?

Winter landscape

In Switzerland, Nol had said, you can check into a peaceful room with a beautiful view, surrounded by loved ones. You can tell them you love them and then take a barbiturate cocktail that is swift and merciful. You don’t have to have your family change your diapers or watch your tongue swell and throat ulcerate, or deal with the guilt of nursing homes and their thousand small cuts to your dignity and humanity. That seems, to me, to be a better way.

As of 2019, nine jurisdictions in the United States allow some form of death with dignity: California, Colorado, District of Columbia, Hawaii, Maine (as of September 2019), New Jersey (as of August 2019) Oregon, Vermont, and Washington have death with dignity statutes. In Montana, physician-assisted dying has been legal by State Supreme Court ruling since 2009.

But in many states, a person commits the crime of manslaughter if he or she intentionally aids another person in committing suicide. In some states, a person who deliberately aids, or advises, or encourages another to commit suicide is guilty of a felony.

Recently, my father, who with some luck will turn 87 this year, was told by a cardiologist that he had a high-mortality, untreatable, heart condition. Two of the three nerve bundles that signal his heart to beat no longer function.  When the third one goes, he was told, he would die.  The doctor said it would be so fast that Dad would not have time to get to the hospital. Since there is no treatment, Dad could drop in an Emergency Room and it would make no difference.  At first, I thought this was terrible news; but I’ve since come to see it as a gift.  Dad may not know the day or hour that he will pass, but he has had time to put his affairs in order and he will not be in prolonged pain.  His mind will not pixelate with dementia.  He is still independent and strong— he walks for several hours every day, as he has for more than twenty years. 

As for me, I hope to be as lucky.  For now, I’ll just leave this here:

“May your death be swift and of your choosing, and may your enemies be consumed by the thousand mouths of Shub-Niggurath.”