ZWEI ALLEIN (TWO ALONE)


The man was adamant.  “My wife will not have chemotherapy.  We survived the concentration camps, and we will both go together.”  His wife had cancer metastatic to the brain, and other than radiation, there wasn’t anything else we were going to be able to do except control brain swelling.  I had the sense the man was challenging me, but I wasn’t about to fight them, not a pair of concentration camp survivors fighting their own losing battle.

A few weeks later, I read in the newspaper that there had been a murder-suicide in an elderly couple.  The name was familiar, and I knew exactly what had happened.

I watch German videos online every day.  I no longer spend 3-4 hours daily learning vocabulary, memorizing lists, or studying grammar.  I did that for a few years, but I moved on to other interests, as I knew I would.  I like exploring the world; there is so much to see and do, and I find the time short.

Today, I listened to a video where the ending was not perfect, unfinished.  It was real. It was powerful. The plot was simple enough.  A woman, Henriette, and her sister were walking in a park, when suddenly a robber jumped out, stole the sister’s purse and shot Henriette in the abdomen.  The sister was unhurt and got help, but Henriette died in the hospital during surgery.  There had been 4 murders in the park in the past several months, so this appeared to be another.

Benedikt, her husband, was a bus driver.  The next day, he went to work, confused, and drove the bus past people waiting, through a red light, and was pulled over by the police.  When they learned his wife had died the day before, they told him they would take him home.  Benedikt suddenly left the bus and took a cab, not home, but by places where he had spent time with his wife.  For the next several days, he acted like a grieving man. Flashbacks were shown, one finally showing the Henrietta with him, months earlier, suddenly collapsing from abdominal pain.

It dawned on me that perhaps this shooting was intentional.  Indeed, it soon became obvious.  The woman had visited a gynecologist and had a malignancy, likely ovarian cancer, although it was not stated.  She and Benedikt had discussed her disease, decided against further treatment.  The police in the meantime, had discovered the perpetrator, but the latter stoutly denied anything to do with this murder, even as he laughingly admitted to the others.

At the end, it was obvious that Benedikt had shot his wife, with her prior consent.  His sister-in-law finally discerned the truth and watched helplessly at the end, as Benedikt held a gun to his chin.  He suddenly fired the gun at the sky, at God, he said, and the movie ended. There was no “closure,” a term that needs to be used less, since many seem to believe that candlelight vigils and other memorials will help speed closure.  They don’t.  Closure takes time, and Americans, for whom time is precious, want to speed up something that has its own schedule.

In Oregon and four other states, Benedikt’s wife and the woman with metastatic cancer could use Death with Dignity.  Both women were had a life expectancy fewer than 6 months, mentally competent, and would have qualified for a prescription, if two physicians, one of whom could be the individual’s personal one, agreed that she were terminal. Two requests have to be made 15 days apart.  This is not a “I want it tomorrow” issue.   The prescription is then taken to a specific pharmacy, filled by a specific pharmacist, because some pharmacists refuse to fill it.  Then, at a time of the patient’s choosing, the patient takes the pills, becomes unconscious and die.  No gun, no jail for the spouse.  It is terribly sad, but the individual is in control of the dying process, which was going to occur soon regardless.

Do we think that people don’t know they are dying?  Do we have to let the soon-to-come death come on its terms, rather than on a patient’s terms?  Oh yes, there is palliative care, and while it is good, if I have pancreatic cancer or a glioblastoma I don’t want death on death’s terms.  I don’t want to lose half my weight, become jaundiced, lie in a bed for weeks, slowly dying, even with pain control, seizure control, and being kept clean, all a very tall order, because not all palliative medicine is the same.  There won’t be a sudden miracle, and anybody who practices medicine as I have is far more an expert than those who live in a dream world of fluff and unicorns, where there are happy endings.  No, I wouldn’t want to die.  But I would not take my life, the disease would.  If it is a matter of one day vs. a few weeks, why should I not have control?  Isn’t that a civil right of mine?  What is more private to an individual, more of a right, than their right to exist?

Oh, I know the arguments.  Hospice can do this, except there are hospices that don’t do it, and I don’t want to end up in one of them.  One charged Barbara Mancini for murder when she handed her father morphine that he asked her for.  It wasn’t even clear he wanted to end his life then.  He wanted it for pain and was taken to the hospital against his wishes and given naloxone to reverse the morphine.  He died a few days later, the way he did not want to.  About $100,000 later, jail time, and national press, Ms. Mancini was acquitted, with a 42- page scathing report written by the court against the prosecutor, who may now be in Congress.

I am not on a pedestal shouting this to the world.  Or maybe I am.  In any case, the slippery slope that the Catholic Church and others predicted would happen in Oregon didn’t.  The thousands of people predicted to die every year hasn’t reached one thousand yet, and the law has been on the books for 17 years.  A third of the people who get the drug never use it.

I say all this as a former neurologist who spent 17 years practicing in a Catholic hospital, where I had no trouble pulling tubes and stopping feeding of those on whom I diagnosed irreversible brain injury and the family told me “he never wanted to be like this.” I wasn’t playing God.  The Church and I had no disagreement about discontinuing futile treatment.  Many of my colleagues disagreed with me, and I wasn’t popular, although a dozen referred their families or themselves to me, even if they didn’t refer me patients.  The ICU nurses, who frequently dealt with death, respected me.  That respect mattered.

The probability we will live to 90 in great health and suddenly die is highly unlikely.   I’ve seen and dealt with the reality.  We need to remain compassionate, accessible to families, and allow in all 50 states this final civil right.  It isn’t suicide, and it isn’t forced.  It’s humane, sacred, and its time has come.

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