Choosing your Death

After passage by Californians at the ballot box, legal challenges, religious opposition, then finally the support of long-time opponent the California Medical Association, the California End of Life Option Act was signed into law by Governor Jerry Brown on October 5, 2015, and took effect the following year. 

On a recent November morning in 2019, I had a front-row seat in a close friend’s living room. I was honored to sit quietly in a circle around Jeanne’s hospital bed, say good-bye and tell her how much I loved her, and to share her closely considered assisted death under the conditions of our state’s hard-won new law. 

Jeanne was diagnosed with Stage IV pancreatic cancer 18 months ago, and like every other cancer patient I have known, hoped for a miracle that would reverse the stark survival stats of this virulent and relentless disease. This brings us to the first fork in the road: go home and get your affairs in order or enter what I call Cancerland. Jeanne chose Cancerland.

Once you enter Cancerland your life as you’ve known it ends. Since Jeanne had Medicare and high-end private gap insurance, it was a full-court press. Five days a week were filled with appointments with oncologists, psychiatrists, end-of-life physicians (there is only one in our wealthy suburban area who will take it on) and a small army of techs who performed PET scans, cancer-marker blood tests and whatever else the medical/pharmacological industries have dreamed up. We even went to UCSF, where’s there’s a wing devoted just to pancreatic cancer. The dimensions and breadth of this business are staggering. It’s no wonder we’ll never see single-payer in our lifetimes.

Then one sunny day chemo began. Because her cancer had metastasized to other organs, Jeanne’s chemo contained a series of brand-new, uniquely super-aggressive chemicals. She felt sick all the time, lost her hair, pretty much couldn’t eat, and had chronic diarrhea. Her skin was so dry she couldn’t touch her arms without touching off an avalanche of dry flakes. Her regular scans continued, of course, and one day the cruelest thing imaginable happened to my friend: a scan showed that her tumors had shrunk into near non-existence. Hope – that sneaky deceiver – returned. Maybe she would beat the odds, maybe she’d see her grandkids graduate from high school, maybe a new medical break-through would save her, maybe she’d feel healthy again, maybe she’d even rejoin the blithe and unconscious ranks of the still-well. 

It all suddenly seemed possible. She would be the exception who beat it, cancer would take her off its kill list. In a rush of new optimism she discounted the cautious tone in her oncologist’s voice when he told her that her response to chemo was unprecedented and truly remarkable but…still… she had Stage IV pancreatic cancer, which basically hides out in your body, waiting patiently for chemo to end so it can burst forth into full bloom.

And she did get a few more months, though there were a couple of scares. There was the spot in her breast, which proved to be benign but became the first chip in her hope for a full recovery. Waiting, always waiting. Then she started to feel sick, really sick, and her abdomen filled up with so much liquid that she couldn’t fit behind her steering wheel. Finally she was admitted to the hospital for a week, where she couldn’t move at all and had to be belted into a chair. The cancer was everywhere. She’d hit the wall.

When I visited her she was wearing her red DNR wristband and said she wouldn’t live like this, that she had watched her own mother die in agony from the same cancer and promised herself she wouldn’t suffer through that and put her kids through it. Her voice was strong, clear, determined. She knew what she wanted. Jeanne finally went home with hospice, where she lay stiffly like a graying statue in another hospital bed, this time at home. 

Jeanne’s end-of-life doctor, an activist in the “Death with Dignity” movement, prescribed the so-called “cocktail” of chemicals that would kill her in her own living room less than half-a-week later. She had just taken three anti-nausea pills when I arrived at her house with two other close friends. We sat in a sort of semi-circle around her bed, where we waited a little more than half an hour for the next drugs, which I think relaxed her in some way. Jeanne’s nervous little black-and-white rescue dog periodically walked up to her bed, her black claws clicking and clacking on the hardwood, before retreating to the back of the room. She knew something was up. The drugs that would stop Jeanne’s heart were still about half an hour away. 

Jeanne was mostly alert as we all chatted. She was an introvert and appreciated peace and contemplative quiet. But people can be funny when they’re uncomfortable or nervous and soon the group was bantering across the bed about how many cup holders there are for the kids in a large SUV, who had the first VW Beetle, what a granddaughter’s theatrical production was like at camp. I realized that many people are uncomfortable, perhaps even fear silence. I hope that anyone reading this will remember that if and when he or she finds him or herself sitting in a living room in a similar circumstance. It’s OK to just be quiet and hold someone’s hand. The dying person doesn’t need to hear the latest joke, how cold it is on the East Coast, how expensive it is to live in the Bay Area. Jeanne was way, way past those meaningless temporal concerns. She wasn’t afraid. But she knew she was staring Death in the eye and that Death wouldn’t be the first one to blink.

Under the law, a dying person choosing assisted suicide must take all end-of-life meds him or herself. So someone in the kitchen would prepare the meds, mix them with lemonade, and hand them over with a bowl of sorbet to cut the bitter taste. 

Her son finally handed her a heavy white ceramic coffee cup, the kind you see in diners, with the third and final drugs that would end her life. After the first taste Jeanne’s face was a mask of horror; the taste must have been awful. But determined as I knew her to be, she took a few bites of sorbet, gamely picked up the white cup and drained it. Within only a few minutes her eyes rolled back in her head so only the whites showed. Her son kept trying to close them. We thought for sure it must be near the end. But then things became uncertain as Jeanne’s breathing seemed to stop before starting again with a sharp gasp. How would we know when she was really dead? After about half an hour she just wasn’t breathing anymore and it was over.

There’s no moral here. Had Jeanne not chosen the terms of her death and gone naturally into a coma, her final hour could have been much the same. But she had a choice, and that is what made all the difference. If it were possible for her to come back…just for a minute…to tell us so, I know she would say she chose her own, best path without regret.

13 Responses to "Choosing your Death"

  1. E.L.   November 21, 2019 at 9:16 am

    Thank you, Marylin. Today of all days, thank you for this. My husband did not live long enough with his pancreatic cancer to avail himself of the end of life option, dying only 2 weeks from diagnosis. But he was so grateful that he lived in a state that offered it. He did not want to go through the suffering in treatment that your friend did. Thank you for sharing this beautiful and sobering story.

    Reply
  2. Bradley Williams   November 21, 2019 at 1:57 pm

    Corruption is rampant in the medical industrial complex. This is no time to issue licenses to kill seniors.

    If the euthanasia monopoly would allow the means for an ordinary witness to the flaunted so called “self-administration” it would bring needed transparency to the covert Oregon type death laws. But they will not. Why? Because they have to protect their donors, predatory corporations and others.

    All is not well where covert Oregon type death laws exist..

    Consider that Yes 60% favor the concept but 95% reject legalizing euthanasia after they read the legislation and learn the extent of wrongful deaths allowed. This is based on 1,000’s of interviews. 
    Potential for abuse abounds with laws allowing euthanasia.

    These laws do not assure a peaceful and rapid death. Induced premature deaths are neither peaceful nor rapid 25-72% of the time according to a study by Bill Gallerizzo. 

    The Oregon type death laws are promoted as “choice” for us individuals but are written to empower predatory corporations and others over our individual choices. 
    An extrapolation of Oregon statistics reveals that 17-21% of the participants are forced to satisfy their facilitators. 

    Examine the language of these death laws and dismiss the promotional sound bites.
    Respectfully,
    Bradley Williams 
    Care Giver….

    Reply
    • George Hollister   November 26, 2019 at 4:29 pm

      From my experience the profit motive actually can work in the other direction, and corporations are a red herring. If a care facility is making a profit from keeping someone alive, at times, they will go against the will of the patient and provide unwanted end of life treatment. I have seen it happen.

      Reply
    • Harvey Reading   November 26, 2019 at 6:09 pm

      If I was a Millennial, I would encourage killing seniors. Get us old bastards, including the Gen X-ers, out of the way. All we did was screw things up, probably beyond repair, and they deserve at least a chance at fixing things. Beats bad-mouthing them from our Boomer and “greatest generation” perches. They’ll go down fighting instead of losing themselves in delusions of grandeur and self-love. Besides, they are ‘way smarter than we ever were.

      Reply
      • Sue McKeown   December 3, 2019 at 10:06 am

        Not all of us “screwed things up”. We were part of the group that fought for civil rights for people of color and equality for women. We were instrumental in ending the war in Vietnam. Many of us are more than willing to pay our fair share of taxes, even in retirement (raise mine, please!). We don’t all submissively ask “How high?” when Trump shouts “Jump!”.

        And most of us are too smart to fall for assisted suicide when it is legally available to us. It’s not popular among people of color, those who lack higher education, and those with lower incomes. Maybe those who think themselves better than the “common people” could learn something from their wisdom.

        And Millenials and Gen X’ers really ‘way smarter’ than we ever were? What about the rise in cohabitation, which hurts women and children a whole lot more than it does men. Have seen it a lot happen in my extended family among the younger people.

        Reply
        • Harvey Reading   December 3, 2019 at 10:41 am

          Dream on.

          Reply
  3. Marilyn Davin   November 21, 2019 at 4:47 pm

    I don’t ordinarily respond to comments about my articles but can’t in good conscience let yours go unchallenged. Your charge that a terminally ill patient can somehow be coerced into voluntarily ending his or her life is not only untrue; it is an insult and a disservice to the men and women who thoughtfully choose to end their suffering in this way, as well as to the overwhelming percentage of citizens who voted to legalize it. The notion that some corporate hobgoblin is somehow orchestrating and promoting assisted suicide would be laughable were it not so patently gratuitous and untrue. What corporation could possibly be the beneficiary? The claim is ludicrous and flies in the face of all logic. Worse, some readers may be tempted to actually believe it. I suspect that you have never been involved, or have witnessed, the lengthy legal process and peaceful death that I shared, every step of the way, with my close friend who was dying of end-stage pancreatic cancer. Right up to the moment when she took the drugs that ended her life, her children, her hospice caregiver, and her physician asked her if she was sure she wanted to go through with it. Having watched her mother succumb to the same deadly cancer, she did not want to spend her remaining time on Earth suffering the same fate. And she never wavered in her resoluteness. Not once. I wouldn’t want readers facing this difficult and painful decision with a dying loved one to believe your ridiculous “extrapolations of statistics” or your unsubstantiated claims based on “1,000s of interviews” to add to their grief and suffering. Most importantly, if you don’t believe in the choice to end your life, you don’t have to do it. You’re free to choose your own path, whatever it may be – just as others are free to choose their own.

    Reply
    • Bradley Williams   November 21, 2019 at 7:47 pm

      It is not like that for everyone…you are the fortunate one…Respectfully, Bradley Williams

      Reply
  4. Lazarus   November 22, 2019 at 4:08 pm

    A life long friend’s wife was dying of breast cancer, she too had gone through the cancer drill. Momentary respites in the disease only for it to return with a more insidious version.

    Finally, her regular physician, who actually did house calls, quietly gave her husband a syringe and a small bottle, my friend had no idea what was in it, and apparently, never ask. The Doctor’s instructions were simple though. When the pain becomes uncontrollable, with morphine, I’m assuming, give her the whole bottle and call me immediately.

    As it worked out she died later that night with family in the house. My friend said, “she just died…”

    This was over 30 years ago, and I suspect in those days it was more common than one might suspect.

    It rarely ends well, for any of us, in my opinion…

    Laz

    Reply
    • Louis Bedrock   November 23, 2019 at 4:42 am

      Hi Laz:

      “It rarely ends well, for any of us, in my opinion…”

      Funny, my cousin Norman said almost the same thing a while ago. He observed, “Life doesn’t end well.”

      My mother died of metastasized cancer that had gotten into her bones. It had started as breast cancer.

      She wanted to die. I would have ended her life with an overdose of the morphine that the hospice had prescribed but there was another sibling involved.

      I hope my death is easier than hers. I’m glad that physician assisted death is coming to NJ.

      I thank Marilyn for this article.

      LB

      Reply
      • Louis Bedrock   November 23, 2019 at 4:47 am

        Bradley Williams is entitled to his opinion–even if he is badly informed and his views sound like recycled propaganda from the Catholic Church.

        As the popular bumper sticker says,
        “If you’re against abortion, don’t have one.”

        I don’t want anyone’s obsolete superstitions to impose a painful death on me.

        Reply
    • George Hollister   November 26, 2019 at 4:35 pm

      You are right. Morphine overdose is a common means to a better end. That is likely what was in the bottle.

      Reply
  5. Joan Hansen   November 23, 2019 at 12:50 pm

    I am a retired R.N. and for years I have felt the choice of death should be personal and legal. If one is terminal or in severe pain it is logical. I would not let my fur baby suffer.

    Reply

Leave a Reply

Your email address will not be published.