Death With Dignity

After two and a half decades of heart attacks, strokes, heavy drinking, chain smoking, and, finally, cancer, my grandfather decided to end his life at 76. The whole family gathered to watch.
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(Illustration: Jef Thompson/Shutterstock)

(Illustration: Jef Thompson/Shutterstock)

My grandmother suffered something of a typical death from cancer: sad, slow, sick. At the end, her children put their hands on her shrunken body, eaten from the inside. My aunt, my mother, and my uncle opened a cedar chest full of items from her life. They showed her the keepsakes—baby clothes, portrait, letters from her family. She smiled, and then she was gone.

When my grandfather died nothing was typical. He left behind no keepsakes. He had two shelves of books and CDs; a few wool sweaters, shirts, and slacks; and an embarrassingly empty bank account, used only to deposit monthly social security checks.

He had not taken care of much during his life. Not his family and not himself. Somehow he had survived nine years after my grandmother’s death.

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In November 2008, I voted by absentee ballot in Washington state’s election from my college dorm room. I left one circle blank: whether or not to approve a referendum called “Death With Dignity” which would allow physician-assisted suicides for the terminally ill. I wasn’t sure how I felt about the idea of controlling death in any manner. I meant to do some more reading before answering, but in my excitement to cast my vote for then-Senator Obama, I forgot to fill in that last dot before I licked the envelope closed and dropped it in the mail.

It is difficult to see a bowl of applesauce as a force great enough to stop a heart, a brain, a set of lungs; great enough to move someone from a body to another place. But that white powder, the barbiturates lacing the sauce, was enough to constitute an overdose

When the referendum passed, Washington joined Oregon to become the only two states to have laws legalizing the practice. Vermont passed a similar law four years later. Today, few people have ended their lives the way the laws allow: using drugs obtained from doctors. In Oregon, 752 terminally ill people have done so since the law’s inception in 1997. In Washington, 359. Vermont hasn’t released any numbers.

In 2009, 95 prescriptions for life-ending medication were written in Oregon. Of these, 53 used the medicine to end their lives. One of them was my grandfather.

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The day before he died, my mother, my aunt, my uncles, my brothers, and me arrived at his apartment in the low-income housing project in North Portland. Our gathering could have been mistaken for a birthday party, a reunion—anything other than what it was, really.

This was not the first time we thought he would die. He had his first stroke at 52. Two and a half decades of heart attacks, strokes, heavy drinking, and chain smoking followed before the cancerous cells in his lungs began to grow. He had been dying since before I was born.

We wandered around the apartment, picking things up, putting them down. My brother’s fidgeting fingers took a photo out of its frame: our grandmother’s senior portrait. Soft light glowed on her sepia-toned, perfectly coifed hair. On the back was a note, to him.

No matter where you are, know that I’ll always be with you.

She’d written it decades before, as a girl, smitten with the older boy she’d met while cutting class to smoke cigarettes in the park between their Catholic high schools in Spokane, Washington. It could have been written the day she died—a different kind of promise.

After her high school graduation, my grandmother was shipped off to live with her favorite sister in California, while my grandfather was stationed at Fort Lewis. She started dating a med student that her family loved, the exact opposite of my grandfather, who had flunked out of high school and joined the Army. When he heard a rumor that her new beau was considering popping the question, he beat him to it. She received a telegram from Fort Lewis, asking her to move back to Washington and marry him.

She did.

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I once wrote a short story from a man’s perspective. I based this man on a younger version of my grandfather: the husband and father I imagined him to be from the stories his children told me, and the relationships they had with him. These relationships were not fatherly. My grandfather was a man who left it to his wife to make a living while he chased uncertain business opportunities, indulged in vices, told his children they were not good enough to be who they wanted to be, and even gambled away the family car.

I did not quite understand the man they talked about, because he had been grandfatherly to me. He called me princess when I was young. He asked me how my violin playing was going. He told me stories about the things he read, the ugly truths of the world: the genocide of Native Americans; the society he grew up in, split between black and white; the unfair health care system; wars carried out for money and power and oil. He was always on the side of the persecuted.

My classmates who read the short story said I had done a good job empathizing with such a despicable character. They said I both hated and loved him. I thought I must have gotten something across correctly, some complexity in his spirit.

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In trying to understand my grandfather’s choice I spent a lot of time reading the Death With Dignity website. I learned that as with most medical procedures, in order to end his life my grandfather first filled out a form titled “Request for Medication to End My Life in a Humane and Dignified Manner.” It reads, in part: I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

The day we witnessed his death, we did the things families do. We cried and laughed, ate and drank, told stories and fell silent. I thought about how he wanted us all to be there.

The form is one page long. Four requirements: Adult. Of sound mind. Oregon Resident. Terminal. He fulfilled all of them: 76 years old, no mental illness, decades-long Oregon resident, terminal lung cancer. I wondered if my grandfather filled out his form alone at his kitchen table, or with my brother, or at the doctor’s office. Had he left it in a drawer for a few days—or had he been certain of his choice immediately?

The written request must be submitted after the patient makes two verbal requests to his doctor, at least 15 days apart. Twice that summer my grandfather walked to the bus stop in front of his apartment and waved down the city bus that took him to the doctor, where he said: “I would like to die.”

Two different doctors must check all four criteria on the form; they are both also required to inform the patient of his options: “feasible alternatives” to ending his life with a large dose of prescription barbiturates. Of course, the alternatives when one has a terminal illness all end in death.

The pharmacist must complete another form when filling the prescription. When the bottle was finally in his hands, my grandfather gave the pills to my oldest brother, who lived nearby and was the closest thing to a caretaker our grandfather had. His children were too far away, emotionally and otherwise. He told my brother to hold onto the pills until he was ready.

A few weeks later he called, wanting the pills right then, but my brother couldn’t come right away and said he would bring them later. My grandfather called back. “You better bring them over soon or don't come over again,” my brother remembers him saying. Then my grandfather called a social worker who in turn called my brother to say he needed to bring the medication. My brother explained that he had not denied our grandfather’s request, just that he wasn’t able to drive over that minute, and that our grandfather was overreacting as he did every so often. Then my brother called my grandfather back to say he would give him another chance to communicate his feelings without delivering an ultimatum, and that maybe he should sleep on this decision anyhow and they could talk about the pills again tomorrow. My brother is an attorney, and the oldest of five children. He is used to being a mediator.

My grandfather did sleep on it, and changed his mind for then. It wasn’t until a month later that my brother sent an email to our small extended family to tell us that our grandfather would “exercise his rights under death with dignity early on the morning of August 26, 2009—a week from today.”

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August 26 was the day my grandmother’s body had succumbed to cancer, nine years before. He chose to tie himself to his good wife, the one who took him back after he left her, who held a full-time job and raised their children, and who loved him even when others saw him as unlovable. Maybe relying on her one more time made death less frightening.

When the day came, his three children and five of us grandchildren were there. We asked him again if he was sure.

“Yes,” he said.

Then two women from hospice arrived and asked him if he was sure.

“Yes,” he said again.

In the kitchen the women from hospice took the capsules from an orange bottle and broke them open. They dumped the powder over a bowl of applesauce—the same brand of applesauce he had been eating recently to practice swallowing quickly. He needed to be able to get a bowlful down within a matter of minutes. My grandfather sat in the corner by the only window of the small living room in his favorite La-Z-Boy recliner. My family was packed in, some of us on the floor, some on chairs pulled in from the kitchen. I sat on a plastic folding chair, temporary overflow seating for this family event.

The day before he died, we arrived at his apartment in a low-income housing project. Our gathering could have been mistaken for a birthday party, a reunion—anything other than what it was, really.

The night before, my brother had told me what to expect. We would show up to say goodbye, the women from hospice would be there, and then our grandfather would mix the pills with the applesauce and eat it. He said we could leave for this part, go to a park or something. But now that we were here I could not look away.

When one of the women from hospice handed him the bowl of applesauce, ready for consumption, we each leaned in to him and said goodbye. Then he raised his bowl of applesauce with shaky arms and toasted us. “Skol.”

It is difficult to see a bowl of applesauce as a force great enough to stop a heart, a brain, a set of lungs; great enough to move someone from a body to another place. But that white powder, the barbiturates lacing the sauce, was enough to constitute an overdose—the kind that should warrant the seeking of immediate medical help according to standard warning labels. I had never considered how to respond to such an emergency when the person overdosing has done so intentionally, legally, and with a doctor’s permission.

While he ate, our eyes were on him, but also darting away, at the floor. It seemed a strange breach of privacy, to watch someone kill himself. Should we hope he couldn’t get it down? Pray for success?

After several bites, his body was beginning to visibly sag, his hand, poised on the spoon did not seem able to lift again to his mouth. One of the women from hospice crossed the room and looked at the almost-empty bowl resting on his lap. “That’s enough. OK, that’s enough.” She patted his knee and took the bowl back to the kitchen, leaving us with him.

Our own functioning nervous systems became hyper-alert to the one failing before us. We could hear his raspy breath, though it seemed to slow with each exhalation. I do not know how long it took, several minutes I think, until his eyes grew too heavy to stay open, so he closed them. Several minutes more until the rattle in his lungs became inaudible.

The woman from hospice held her finger briefly to his wrist and said, “He’s gone now.”

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Whenever he used to visit the house where I grew up, he would sit for most of the day in the rocking chair in the living room with a heavy book on his lap and read and drink. We could count the number of beers he had by the way that he opened them, tapping the metal top twice before cracking open the tab, tap-tap-pssshhhttt.

When the ambulance arrived to move his body from the La-Z-Boy into a black bag I was at the grocery store, buying a 24 pack of his preferred brand. When I came back, we made the cans go tap-tap-pssshhhttt, and clinked them together. Later, we went to the bookstore. We weren’t sure exactly what we were doing there—shopping, saying goodbye, honoring his escape mechanism—just that it felt right.

The day we witnessed his death, we did the things families do. We cried and laughed, ate and drank, told stories and fell silent. I thought about how he wanted us all to be there. I wondered whether he and my grandmother were together. I did not think about my blank ballot until much later.

The Weekend Essay is a Saturday series edited by Leah Reich.

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