A planned end: A ter­mi­nally ill woman de­cides to die on her own terms.

A woman with a ter­mi­nal ill­ness takes mat­ters into her own hands, with the same sangfroid she ex­hib­ited through­out her life.


MMy friend Carol was a plan­ner, both pro­fes­sion­ally and per­son­ally. A public works man­ager by trade, she was de­scribed by her chil­dren as a take-charge, go-into-ac­tion-mode per­son at home.

“Her mind was re­ally busy,” said Ken­dra, the old­est of Carol’s three chil­dren. “Be­fore we even got to an event, she would have thought through every­thing 15 times.”

So it was to­tally in char­ac­ter for Carol to plan her own death, af­ter she was di­ag­nosed in 2011 with pro­gres­sive supranu­clear palsy, sim­i­lar to Parkin­son’s dis­ease. The sad di­ag­no­sis came at a time when her life was on the up­swing af­ter find­ing late-in-life love with Dale,

a re­tired physics pro­fes­sor and a friend of mine.

Both re­cently wid­owed, they met in 2007 at a bird­ing trip in Ari­zona. Af­ter a whirl­wind email and long-dis­tance ro­mance (Carol lived in Kirk­land, Wash­ing­ton, Dale in Glen­dale), they mar­ried in Fe­bru­ary 2010 and di­vided their time be­tween Kirk­land, Glen­dale and their va­ca­tion home in Tuc­son.

I met Carol here shortly af­ter she and Dale be­gan dat­ing. She loved to hike in the woods look­ing for birds, es­pe­cially at Hori­con Marsh and Haven-woods State For­est. She loved a cold mar­tini, light on the ver­mouth. She loved “Big Bang The­ory” and in­sisted I watch it. She was in­ter­ested in just about any sub­ject and was an in­tense lis­tener.

The di­ag­no­sis came af­ter a se­ries of falls that re­sulted in a va­ri­ety of com­pli­ca­tions: bruised tail­bone, deep cut above her eye­brow and dis­lo­cated shoul­der.

“Af­ter the di­ag­no­sis, I did not see much emo­tional change,” Dale re­called. “It wasn’t a big shock that threw her into dark­ness.”

That’s prob­a­bly be­cause Carol al­ready knew what she wanted to do. She had watched her own mother suf­fer a dread­ful death from breast cancer – at a re­li­gious hos­pi­tal that would give only limited mor­phine for fear pa­tients would be­come ad­dicted.

The ab­sur­dity of let­ting a ter­mi­nal pa­tient suf­fer, for fear she might de­velop an ad­dic­tion, was not lost on Carol. Af­ter that, the idea of dy­ing and not be­ing in con­trol – of be­ing trapped in her body and a bur­den to ev­ery­one – scared her. “I don’t want sit-in-a-chair drool­ing,” she said.

She shared her thoughts with her chil­dren. “We said we would sup­port Mom in what­ever de­ci­sion she made,” said her older son, Eric. “It was an em­pow­er­ing ex­pe­ri­ence for her to make that choice.”

The drug car­bidopa-lev­odopa did lit­tle to al­le­vi­ate Carol’s symp­toms de­spite in­creased doses. Her con­di­tion wors­ened – she could not stand up, could not uri­nate with­out a tube, could barely lift a glass to her lips. Her voice be­came high and squeaky, dif­fi­cult to un­der­stand.

When she de­cided to end her life, Carol asked both her per­sonal doc­tor and her Parkin­son’s doc­tor to help her die (Wash­ing­ton is a right-todie state). Nei­ther would agree to par­tic­i­pate. The fam­ily thinks this was be­cause Carol had re­ceived medical treat­ment in three dif­fer­ent cities and had not de­vel­oped a deep or long-term re­la­tion­ship with ei­ther doc­tor.

She then sought coun­sel from Com­pas­sion & Choices, a rightto-die group. Her death coun­selor de­scribed what sui­cide would be like, which re­as­sured Carol. The coun­selor’s brother, a phar­ma­cist, cal­cu­lated how much mor­phine, based on Carol’s weight, would be needed to end her life. She be­gan stock­pil­ing.

Her fam­ily had been warned to be ex­tremely care­ful so they could not be im­pli­cated in her death. Tim­ing was crit­i­cal: Carol needed to be able, on her own, to lift the mor­phine cock­tail to her lips and swal­low it.

I last saw her in Glen­dale four months be­fore she died. I wouldn’t let my­self cry at the thought of los­ing my won­der­ful new friend, so I forced my­self to lis­ten as she calmly talked about her demise.

“Dale is quite at­trac­tive and de­sir­able,” she said. “Af­ter I go, there will be plenty of women bring­ing him cov­ered dishes to help him get along. You should think about it.”

Taken aback, I thought to my­self: So like Carol to plan for Dale, even though she’s dy­ing.

On Feb. 6, 2013, Carol woke up and said, “To­day’s the day.” Dale, Ken­dra and younger son Tim were with her as she drank the liq­uid mor­phine di­luted in or­ange juice to dis­guise the taste. Upon see­ing her loved ones cry, Carol’s last words were, “You don’t need to cry for me. I’ve lived a won­der­ful life, and now I’m not afraid to die.” Af­ter three hours, she stopped breath­ing.

In his im­por­tant book Be­ing Mor­tal: Medicine and What Mat­ters in the End, Atul Gawande writes, “Peo­ple die only once. They have no ex­pe­ri­ence to draw on.” True, Carol died just once, but in choos­ing how to die, she drew on a life­time of shap­ing her own ex­pe­ri­ences. If I’m ever in a sit­u­a­tion like hers, I hope I have even half of her fore­sight and re­solve.

Tim­ing was crit­i­cal: Carol needed to be able, on her own, to lift the mor­phine cock­tail to her lips and swal­low it.

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