[Right_to_die] Made all the preparations, died naturally

[World right-to-die news (nonprofit)]

The New York Times printed this on 11 November 2008:

Keeping a Promise When a Life Is Near Its End
By ELLEN D. FELD, M.D

“If something should happen to me, and I couldn’t help myself, would you 
be willing to help me?”

It is the question so many of us dread hearing. My mother asked it of me 
around her 75th birthday. Of course I didn’t need to ask what she meant 
by “something” or “help.”

She was a card-carrying member of the Hemlock Society. On her 
bookshelves were titles like “Final Exit” and “The Peaceful Pill Handbook.”

“Can I think about that?” I said, hoping she might forget to follow up. 
It was a ridiculous hope: she took as gospel my every medical comment, 
and she never forgot a single one.

My mother had been ready to die for years. Not that she was suicidal, 
but she had always been one of those people who found the cloud in every 
silver lining. For my mother, life’s positives outweighed its negatives, 
but just barely.

When she lost all but her peripheral vision to macular degeneration and 
could no longer read, drive or teach, the scales tipped in the opposite 
direction. Whenever an acquaintance died or received a diagnosis of 
something swift and painless, her reaction (often to the dismay of those 
around her) was “Oh, that lucky fellow.”

Her greatest fear was of a stroke or some other catastrophe that would 
force her to live on for unwanted years, unable to care for herself. Her 
own mother, after a stroke, had spent the end of her life in a 
nursing-home wheelchair.

In a phone call two weeks to the day after her initial question, my 
mother did follow up: “Did you get a chance to think about what I 
asked?” Of course I had. I had spent large chunks of time obsessing 
about it. So I gave the only answer I could stand to give, the only kind 
answer I could think of.

“Yes,” I said. “If you ever need my help, of course I will help you.”

Then I changed the subject, but not before hearing the immense relief 
and gratitude in her voice. Even though I was quite sure my definition 
of “help” did not match hers, to answer otherwise would have been cruel. 
What did it matter, I thought; she couldn’t possibly hold me to it, and 
with a little luck it will never come up. And in fact, the subject did 
not come up again for more than a decade.

A couple of months short of her 87th birthday, my mother began to 
complain repeatedly of being unable to work the remote for her 
large-screen television. Each time she said this, someone would 
painstakingly walk her through the steps. But a few days later something 
would go wrong and she would need help again. A few weeks later, when 
her shower faucet went on the blink, it finally dawned on me that the 
fault might lie not in the remote or the faucet but in their user. I 
persuaded her to see her internist, and I called to let him know my 
concerns.

The internist called me right after her appointment to tell me she was 
being admitted to the hospital. She was wheezing, and a chest X-ray 
showed pneumonia. In addition, the brain M.R.I. showed several lesions — 
strongly suggestive of a tumor.

Multiple scans and doses of antibiotics later, the pneumonia was 
reclassified as a lung tumor and the brain lesions as metastases. My 
mother was put on steroids, and after considering and rejecting brain 
irradiation, she left her home near Boston and moved into a hospice five 
minutes from my house in Philadelphia.

She lived three more weeks — three weeks during which the only help she 
ever asked of me was to bring her chocolate milkshakes (which I did, 
often several times a day).

The night she died, I sat with her. She was unconscious by then, 
seemingly comfortable but breathing more and more rapidly, her skin 
growing more and more mottled. As I held her hand and mopped the bubbles 
from the corners of her mouth, I remembered a conversation we had had in 
the hospital in Boston right after her doctor had given me the results 
of her chest scan. I had told him that I would give the news to my mother.

My mother knew there were “masses” in her brain (she herself was calling 
them tumors), so I expected the news not to be a great surprise and, 
more than likely, welcome.

When I finished speaking, she looked concerned and frightened, making me 
wonder whether all her talk of wishing to die had been just that — talk.

“What if I don’t go quickly?” she asked. “What if this takes forever?”

“It won’t, Ma,” I answered, relieved at such an easy question. 
“Everything’s going to be O.K.”

“Are you sure?”

“Yes,” I replied, with the certainty I knew she craved and trusted. “All 
the tests confirm that it won’t be long now.”

Tears filled her eyes. “Do you remember, years ago, you promised you 
would help me if I ever needed it?”

I nodded.

“Well,” she said, “you just did.”
--------------------
Ellen D. Feld, M.D., is an internist who teaches at Drexel University in 
Philadelphia.