My Exit



 

Henry Bair1

Perm J 2019;23:18.283 [Full Citation]

https://doi.org/10.7812/TPP/18.283
E-pub: 09/20/2019

ABSTRACT

This short story is based on and told from the perspective of a patient the author encountered as a medical student. The story explores the thoughts of an elderly patient, who is hospitalized because of multiple organ failure, as she contemplates the voluntary refusal of food, fluid, and antibiotics. The patient weighs these options in light of her beliefs and experiences, and in the face of seemingly futile medicalization.

My grandson likes futuristic things. You know, like those transformer toys with all their gadget parts and sophisticated-looking electronic doodads. He’s a pint-sized glutton for anything with a flashing light, I’ll tell you. He sees these things on the TV, and he’s immediately all over his mother and father to get him one—not on his birthday, not for Christmas, now. We’ve had so many beautiful Christmases with them, my daughter, my son-in-law, my grandson, my Leonard. Beautiful Christmases filled with wonderful people and snow and love for years and years. The best Christmases you could want.

All the alien plastic things I’m tethered to here in the hospital remind me of those space-age playthings my grandson craves except that mine come wrapped in clear plastic, not gift paper. He doesn’t care about the gift paper anyway. And it would be a joke if these things came to me in pretty wrapping. Each one is a new torture device.

I’m not sure what all the people working here want me to think. Each new item they bring in promises to make me better in some way. But I can’t shake the feeling that they’re just toys too. What can they possibly do to help? I’m 90. My heart is failing. A week ago they told me my kidneys are failing too, or something like that. I had a feeding tube that went wrong, so then there was an infection in my lungs. I feel trapped inside my body and like I am slowly suffocating on sickness—even though, thanks to this breathing tube down my throat, that won’t happen any time soon.

I remember the sound of my grandson’s shrieks of delight at his toys’ flashing lights and noises. Here, my new toys also keep coming with their impressive flashes and growls and alerts. Alert people to what? That I’m dying? That’s not news. Obviously, I’m dying. We need an alarm for that? I can’t sleep.

I have this disquieting feeling that we’re just rearranging deck chairs on the Titanic, as my dear Leonard would say. I miss him, even after all this time. He didn’t pull any punches, Leonard. He’d give things to you straight and true. At least Dr DeWahl is like that. He makes eye contact with me. The people bringing in the new toys are nice, but there’s something off about it I can’t quite place. Maybe deep down they feel the same way as I do too, that we’re all just busying ourselves for no real reason, but they don’t want to say so, because then there’d be no point in setting up all the new toys and making sure they blink and beep.

My mother passed away quietly at home, years ago. No fancy toys for her in the end. She went peacefully in her sleep, while coffee perked down the hall in the kitchen. I sort of assumed that’s how I’d go too … at home, with the smell of fresh coffee in the air, enjoying a nice nap that simply didn’t end. I guess I assumed it would be morning, I told Dr DeWahl, with the coffee perking and everything. I never thought I’d be pinned down like this with tubes and the rest of it. I told him I’d like to just go now, with or without the perking coffee. He thought that was funny, I think.

A couple weeks ago, Dr DeWahl told me that even though he wasn’t allowed to give me a pill to end this quickly, there were other simple ways as well. I could starve myself. Actually, he didn’t say “starve.” He said something medical-ish, like “voluntary refusal of food and fluids.” The physician said, “Marjorie, if you don’t wish to keep going on like this, you don’t have to. There are other options. If you decline nourishment, your body will quite peacefully fade away, with very little suffering. It might take a week, but we’ll be with you all the way and keep you very comfortable.” I remember my mind blanking for a good few minutes. Starve myself? He gazed calmly back. But even as my gut instinct recoiled from the idea, the prospect of a quick and quiet ending intrigued me. And these days I barely remember what having an appetite felt like anyway. Leonard would have laughed at that. He would have teased that I was the pickiest of eaters to the last.

My younger friends would say that this sounds awful, even crazy, and not at all like something a real doctor would say. My sister Anne in particular would have a fit if she heard that. Not my Leonard, though, I don’t think. He would have said, “Honey, this isn’t you anyway. However you choose to go, I know there’s a better world waiting for us, and I’ll patiently wait for you there with the Big Man and take you dancing when all this is over.”

Speaking of the Big Man, I don’t think the Good Lord intended for me to go starving myself. This is not the discussion you are prepared to have with yourself, figuring out how offended your creator might be if you interfered with his business. How mad would God be if I just stopped eating?

Then more things went wrong. Going wrong is all my body can do anymore these days, it seems. Apparently, I had a couple of strokes, and now I can’t control my peeing. What fresh hell is this? I’d imagined a lot of things like dying in a plane crash, but I never imagined that the end of my life would be sleep-deprived misery filled with bedwetting, like I’m a not-yet-housebroken puppy or a young child. No matter how fast they come to change the bedsheets and clean me up, it’s humiliating. And the answer is more humiliating. They can put yet another tube in me so I don’t wet myself. But I can’t do it. It’s just too much. It’s just one floppy tube too much.

Perhaps refusing food was my best bet after all. It still sounded a lot like suicide, but that discomforting idea paled in comparison to the rest of it. As I sat there thinking about my eternal enslavement to machines and moist sheets and the smell of food I couldn’t eat even if I wanted to, I found myself letting out a chuckle. All those patients out there dreading the horrors of dying—they don’t imagine the various horrors of not dying.

Well, I’m dying to die right now, I told Dr DeWahl when he came around next, and even though I feel like I’m one of the sickest people in the whole hospital, I just can’t seem to get it done. What a joke. Dr DeWahl sat patiently and listened to me for a long time. I told him about my grandson, about my Leonard, about how frightened I am that I will be awake forever in the middle of beeping noises and moist sheets and that will be my existence.

Dr DeWahl thought about this with his nice face and said, “Marjorie, there is another possibility. We can put the tube in to catch your urine. That’ll make you more comfortable and help you sleep better. Then you could decline to have the tube changed.” I looked at him, not quite sure where he was going with this.

He went on, “If you decline to have the tube changed, you will very likely get an infection in your body. After that, you could choose to decline antibiotics. Without antibiotics, the infection will result in a painless death within a few days. As always, we’ll be by your side.”

The no-eating-and-drinking idea had been hard for me to accept, but this seems different. Maybe because eating and drinking are familiar to me and this other thing is not. I mean, what happens? I get the hose, it gets dirty, I get an infection, and I fall asleep. It sounds swift and easy, and I’d like to think I wouldn’t be killing myself. I’d just be letting nature take its course. People have often died from infections for most of human history, haven’t they?

Yes, this sounds good. I feel a sense of calm already, just knowing that I don’t have to stare down endless tomorrows of more of the same, senseless, pointless agony for no reason other than there is no other thing to do. Imagine being a hostage to a rogue body full of pain, shameful sounds, and fluids and leaks, and a hostage to a room of plastic tubes and bright blinking lights that are measuring your agony and despair and shame for a record that means nothing because it is the end anyway. There is no reason to keep a record other than to keep the record, and I’m past wanting this kind of life to be recorded or witnessed anymore. Now there is only an interminable holding pattern for an unforeseeable eternity, for less than no reason, with nothing to gain and only more to lose.

When I think about being able to do this another way, I start to feel less far from my dear mother and the way she went, quietly and peacefully with the smell of perking coffee. I start to feel closer to my Leonard, waiting “upstairs.” I feel like a good departure might not be so far-fetched after all.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

How to Cite this Article

Bair H. My exit. Perm J 2019;23:18.283. DOI: https://doi.org/10.7812/TPP/18.283

Author Affiliations

1 School of Medicine, Stanford University, CA

Corresponding Author

Henry Bair (hbair@stanford.edu)

Keywords: death, end-of-life, geriatrics, hospice, palliative care

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