Helping with Dad’s Last Wishes

By Richard Merris

Dad died by his own wish, will and act on July 23, 1991. It was close to midnight. It was nine days after his 77th birthday. I think that he was happy. It would be wrong to say that he was glad to die, but I believe he was happy when he died. He was at home, and, as he said shortly before he died, he was in his favorite place, in his favorite chair and with his favorite people – Mother, his daughter and son-in-law, Dilys and Peter, and myself.

The death certificate stated that the

causes of death were respiratory failure, bronchopneumonia and metastic colon carcinoma. The doctors had arranged it so that he could come home four days prior to his death. The colon cancer was not curable, and his condition was too weak for it to be advisable to operate further in an effort to

extend his life; he had been operated on in March 1991 for a cancerous tumor, and, at that time, there were numerous microscopic tumors, which could not have been removed. Another operation would have accomplished nothing except probably weaken him further and hasten or even cause his death. The chemotherapy that he underwent between April and July may have held the cancer at bay, but at least some of the microscopic tumors started growing rather quickly, and the chemotherapy caused him to vomit regularly, and there was a steady deterioration in his condition.

I flew from my home in California to Boston, rented a car and immediately drove to Cape Cod Hospital in Hyannis. When I arrived at the hospital on July 17, he was very weak and jaundiced, due to a blockage of the bile duct from his liver to the upper colon. He looked terrible, but I was forewarned by Mother and Dilys, and I was not shocked. I was sad and concerned that he be comfortable and that we

be able to communicate. I soon found that, although he was very weak and his speech was rather soft and slurred due to some of the pain-killing drugs that he was on, he was present, both intellectually and emotionally. It took some patience and careful listening, but we were able to communicate. In many ways, time was suspended. Dad would often drift off to sleep, or, perhaps, he was just resting his eyes.

I learned that, for him, the effort to talk or move was extreme, and he tired very easily. His body weight was down to about 120 pounds from a normal weight of about 165 pounds. I think that the cancer, the chemotherapy and lack of real food intake had taken so much out of him that any physical exertion was much more difficult than I could imagine.

On the first day, I showed him some pictures that his granddaughter, Barbara, had made, and I read him some “get-well” cards. He spent some time dictating his obituary to me. I said that I would edit it, have mother type it and would read it back to him so that he could approve it and make any changes or additions he thought were needed. It took him some time to do this, and he sometimes drifted into irrelevancies (irrelevant only as far as the actual obituary was concerned); for example, at one point, he stated that his happiest years were those when he was teaching at Greenwich Country Day School. I attribute this only to his physical weakness and to the fact that he was sometimes on the border between waking and dreaming; his train of thought was usually quite lucid. I know that he was calm and happy to have me there. He was also, at times, somewhat impatient with the nurses. He was also anxious to get home from the hospital. Mother, Dilys, Peter and I were all concerned to get him home, and, I later learned that the doctors were equally concerned that this happen. They knew that this was his wish and our wish, but it wasn’t easy to accomplish that. We finally got Dad home late Friday afternoon, July 19th. In order to do that one of the doctors had to rub a tube down his esophagus, through his stomach and through the bile duct in order to clear it so that he wouldn’t have to vomit so much and could perhaps take some food. This also worked to dispel the jaundice, and the yellow pallor had disappeared by the time

he returned home. The same doctor opened a hole just below his sternum and inserted a tube into his stomach so that bile and/or any food that he ingested could go back out the tube and into a bag that we could then empty. This was because his lower intestine was blocked by the cancer, and it also would preclude vomiting. By Friday afternoon, when I realized he

could come home, I also realized the extent of compassion and thoughfulness of the doctors who were caring for him. They really did everything they could do in Dad’s and our interest. They said that he had pneumonia, and that there could be a benefit in that in it would be less painful to die of pneumonia that from the cancer from which Dad was suffering.

The four days between Friday night when Dad came home and Tuesday night when he died were certainly the most difficult, emotionally, that I have ever faced, and I’m sure that they were the most rewarding. It was either Friday night or Saturday morning that Dad asked if I would help him to die – to take his own life. He reminded me that he had considered this an option a year or so previously – at a time when he was in good health, before the cancer had appeared. He had struggled with, and with

the help of radiation therapy, had overcome prostate cancer about five years previously. When he mentioned the option of suicide in

the face of terminal illness and extreme and unrelenting pain, he was in good health, so I was prepared to some extent, but I had forgotten that conversation. While I did not want to maintain any moral or philosophical opposition to the idea, it was very difficult emotionally, especially since my own mother had committed suicide, under very different circumstances, in 1949, when she was only thirty and I was six and my sister, Dilys, was two years old. When Dad had talked about the possibility of taking his own life under these or similar circumstances, I had responded that I wasn’t necessarily opposed to it. I felt that it was a choice for him to make, and I certainly did not want him to do it suddenly and without any participation in the decision from those close to him. He had agreed to that.

When I conveyed to Dad how difficult this was for me, I could see that he was agitated that I wasn’t taking it calmly, that it caused me some difficulty emotionally and that I needed some time to think about it. I assured him that I appreciated his openness and need to involve us in the process and that I wouldn’t try to prevent or impede his intention to take his own life, but I needed some time to reconcile myself to it so that I could feel O.K. about helping him. In hindsight, this was not as difficult as I had at first thought. I had almost no difficulty in recognizing that this was totally different from my Mother’s suicide (she was unhappy for reasons that no one has been able to explain, and she communicated with no one about it – it was a different time and a different universe), and soon realized that there could be no reconciliation of the feeling of wanting Dad to stay alive and of not wanting him to suffer through a slow, steady and painful deterioration of his physical condition. I knew that there could be no reconciliation of these two differing emotions.

What was more difficult to deal with was the associated guilt feeling that this was “too easy” for everyone and that it meant that we didn’t value life and the will to live highly enough. This enters murky areas of philosophical and moral arguments that are largely unproductive; however, due to a definite distaste for “guilt trips”, I have to formulate an answer to this apparent dilemma. I think that the best way to

love someone in these circumstances is to wish them the best in whatever existence may come after death and be willing to let them go. In addition, assuming a “right to die”, an individual should have a right to determine when and where the quality of life is a greater value than life per se. In retrospect, the emotional quality of the whole experience verifies that such arguments and thoughts are “right”. As I have said, even though it was probably one of the more difficult things I have ever done, it was also uplifting, and the strong emotional connection that we all felt at the time is something that has definitely enriched my life and has made me a stronger, more balanced person.

Between Friday night and Tuesday night, when Dad consciously and actively departed from this life, it seems that experience was enlarged and intensified, not intellectually or physically, but emotionally and not in an agitated or upsetting manner. While there was certainly sadness at knowing that Dad would be leaving and certainly nervousness about the logistics and details involved in helping him, I think that there was also a large well of emotional and spiritual calmness derived from a knowledge that this was “right” for him. This came largely from Dad; he had given a lot of thought to this, and I think he died calmly and happily, in the knowledge that we were with him and that he was not dying “alone”. This was very important and is the primary reason that I felt calm in supporting him.

Another thing that I have realized is that there was considerable bravery on Dad’s part in the face of uncertainty about how we would react and in the details of how to take his life, but more particularly in the face of the unknown. He had said that he had relatively little fear of death due to a number of mystical experiences from which he knew of a “peace that passes all understanding”. Much of this came from his experience in Quaker worship. Even so, from this side of it, there is no question about the finality of death. I know from this experience that it is both tangible and overwhelming. There must always be some fear or at least uncertainty in the face of death, and I credit Dad with bravery in the face of a very large unknown.

If an angel of death visited that night, I have only a minimal awareness of it. I noticed nothing fearsome or threatening, as in the Adventures of Baron von Munchausen; if there was an angel present, it was very quiet, sweet and accepting, as was Dad.

We did not talk much. It was hard to know what to say, but I didn’t want Dad to die thinking that everything was just wonderful, and I did have

to fault him for his tendency to not recognize other people’s feelings and for not recognizing that this was especially hard for the rest of us. I didn’t want him to feel guilty and didn’t feel right about expending much time or energy talking about his “negatives”. I did not pursue this line of conversation, particularly as I saw that it caused some confusion in him. What did seem particularly appropriate and of benefit to all of us was listening to some of his favorite Mozart and Beethoven pieces. I also know that what was most important was that we were all really “present” and very much caring about Dad and helping him to die in the best possible way. The “quality of death” may be as important as the “quality of life”.

I come to the details last because they seem secondary to all that I have just said – the emotional and spiritual support are of primary importance for all those involved; and the details are certainly of interest and may be of some help to others.

Sometime previously, Dad had received a supply of Nembutal capsules from a friend whose spouse had taken her own life after considerable physical deterioration due to emphysema and in the face of extreme and prolonged physical pain. She had taken the suggested dosage of thirty capsules after a light meal. It was also suggested that a shot of hard liquor could be taken. This caused us some concern because Dad had not been eating, and we thought that the liquor would be more likely to hinder than benefit the process. Upon receiving this information from his friend, Dad decided that he should practice eating, so that he could have something approximating a “light meal” before taking the pills, and we decided to dispense with the “shot of whisky”.

I had to feed the pills to Dad in a teaspoon – three or four at a time, because he was too weak to take them himself. Peter then helped him

to drink some water or apple juice. This was difficult in that there was still conflict between not wanting to do this at all, not wanting him to die and wanting to have it over and done with. Remembering that this was his “show” and that we were there to help him to die as he wished helped us to stay focused, but it was hard. It is hard not to be self-centered.

Another difficulty we faced, we did not know how long it would take his vital functions to cease. We thought that it might take forty-five minutes to an hour, but this was not so. He took the pills at around 8:30 p.m., and he died at around 11:30 p.m. We became concerned about whether it was working and what to do if the pills did not work and so we were somewhat agitated and were not able to stay by his bedside the whole time. It would have helped if we had known better what to expect regarding the time that it would take him to die.

Dad soon went to sleep and was breathing.

We kept a vigil at his bedside for perhaps an hour and a half, but, becoming restless and uncertain about what to do, we did not all stay there the whole time. We never panicked, but not knowing what to expect was unsettling. I think we called and talked with Dad’s friend who had given him the pills, but he was not able to remember how long it had taken for his wife to die or if body weight and metabolism might make some difference. We even discussed putting a plastic bag over his head. I’m glad that we had the patience to wait and good sense prevailed. We never had the feeling of desperation, and horrible imaginings did not get the better of us. Greater knowledge of procedures and what to expect in these circumstances is both important and necessary.

When we knew that Dad was dead, we called the Nurses Aid people. They had been coming in once or twice a day for his medical care. We called them because it had to be a doctor or a registered nurse to pronounce him dead and to provide information for the death certificate. It took some time for the nurse to arrive because they were not able to locate the nurse who was on call. She had been at home, but was asleep and did not hear the telephone. Another nurse came – one we had not met before. This turned out to be just fine because she offered some “comic relief” as well as some comfort. She seemed to be what I would call a “professional hugger” – a large matronly woman, warm, friendly and sincerely sympathetic. She gave warm, uninhibited hugs to all of us as though she were part of the family. I found her amusing in that she offered a notable contrast to our traditional New England reserve, and I appreciated her warmth and eagerness to comfort all of us. It seemed natural and not at all offensive.

In addition, I think we were relieved that it was not the nurse who had been caring for Dadwho came because she might have suspected the real cause of death. While Dad was very weak and did have pneumonia, his vital signs had been good and he might not have been expected to die this soon. On the other hand, I’m sure that in many cases this is not a difficulty in that most health care people who are familiar with prolonged, agonizingly slow deaths would not have difficulty in their hearts and consciences accepting suicide under these circumstances. It is probably more common than we know. The only problem is in the legal ramifications in their support of or knowledge of such suicide, so we felt that it would be best if medical people not know about it. It would only be appropriate that medical people know about it if they wanted to make a test case regarding the proper function of the medical profession when a terminally ill patient wishes to die by suicide in peace and dignity.

In closing, there are some thoughts and ideas that I think are of particular importance.

Firstly, it is important, if a person wishes to have some determination regarding the manner in which he or she dies, to think about it and make a statement, preferably in writing, about how one would wish to die. While the above description is personal to my family and me and I have no desire to impose any particular way of thinking on anyone else, it is important to know that there are choices that are available and feasible. Supreme Court cases (especially Cruzan) have recently given credence to the idea that there is a “right to die”. I think that there is great value in dying in peace and dignity, and it should be generally known that the choice that Dad made is available, acceptable and conscionable.

Secondly, I think that one reason why people have difficulty with this idea is that, in spite of the omnipresence of violence, destruction and death in our culture, especially as it is shown in the news and entertainment media, the personal reality of death is often very far away from us. Children in our society do not die from disease or injury at anywhere near the rate that they did seventy to one hundred years ago. It is not often that we see a dead person. We seem to have insulated ourselves from that experience. My father was only the second person I had ever seen in death. This reality is usually far away from us, and mortuaries and funeral homes have participated in this insulation in various ways to “protect” surviving family members from really experiencing and knowing of the death

of a close friend or family member, by being so “quiet and considerate” of those who are grieving.

In my father’s case and I’m sure that in many cases it is not only appropriate to grieve the loss of someone close, it is also appropriate a long and fruitful life. I don’t know why I should not celebrate and grieve at the same time. I

will not “complete” a mourning period, because I will always feel the loss. I wish to always appreciate and celebrate Dad’s life, both for what he gave to me and for what he gave to many, many others – friends, students and other family members. Perhaps I see this dichotomy, this disconnection in our view of death more clearly than most because I have such a vastly different experience in the death of my father from the death of my mother, even though each took his (her) own life. The two experiences are as different as night and day. Undoubtedly it would not seem so clear if I had been an adult when my mother died. But I was a child and everything, including the fact that she was dead was kept from me, and I’m sure that I was hurt by that fact as much as I was hurt by the fact that she had left with no word as to how, why or what.

I hope to be as calm, dignified and brave in the face of death as my father was.

A little bit about the author, Richard E. Merriss

Richard E. Merriss, scion of (somewhat) blueblood/Celtic ancestry, born and raised in Connecticut and Cape Cod, has been a Birdwatcher/Birder from the age of 9. He has been a jack-of-all-careers, including Teamster-truck driver, grade school teacher, Entry Gate salesperson, mediator, landscaper contractor, Contracts manager, Program Manager, dishwasher, field researcher, retiree and political animal. and somewhat gregarious introvert. He is the father of four children, who all seems to be doing very well in their adult, independent lives and careers. Richard has lived in Cotati for 20 years and in Sonoma county for 50 years. There are a few stories there.