Sunday I went on a bike ride with three of my good riding buddies. It was a familiar loop, I know every dip and crest of it, and when I wasn’t chatting with one of them I had time alone on the road for thinking. When I think of riding alone, the term clears the mind occurs, but it’s not quite accurate. For me, riding clears away the junk in the mind so I am free to focus intently and yet in a dreamy subconscious sort of way on what I really want to think about. Sunday, what I wanted to think about was what happened on Friday at work.
Sometimes I come home from my job and I’m talking on the phone with a friend and they ask how was your day? And I have to pause before I start telling them how my day was. Because truthfully, my day can sometimes only be described as crazily surreal and weird. And if I just launch into it, it might be alarming to folk who go to work and then come home and never encounter people in their last days or hours of life with the peculiar symptoms and the madly poignant painful sweet heartrending moments and conversations.
Last Friday, a patient of mine availed of the End of Life Options Act. In other words, she took medications to legally end her life. This was not a suicide. It was calmly and thoughtfully planned, and it was executed in accordance with California law.
Throughout the week I kept thinking: Friday, I’ll go see my two morning patients, and then go be with her while she ingests the meds. So I’ll drive to her house and I’ll be with her while she dies. I’ll watch her die. I walked through it over and over with myself, trying to anticipate what it would be like, how I would feel, how I could best support her and not let my own emotions get in the way. I’ll be there in her bedroom by the bed, I thought. I’ll talk with her a bit like we have talked on all my visits in these past few weeks, and then she will take the meds, and then she will slip into a deep coma and death. And that will be her last hour, and that will be her partner’s last few minutes with her, and that will be my Friday afternoon at work.
So as I rode by Nicasio Reservoir’s lush plenty on Sunday, reveling in how full it was after our bountiful rain, and exulting in the rush of being on the bike on the open road in the brisk headwind, I thought about how Friday afternoon went down. I cannot share any details, due to privacy laws, but I can tell you how it was for me.
The visit lasted three hours. My patient took the meds and they worked. It all felt simultaneously matter-of-fact and hugely surreal. After she died, I made the few calls I needed to make. I sent the emails I needed to send. I documented her death and discharged her from hospice, meaning she was deleted from the entire system, cancelling all future visits and notifying everyone involved in her care that she had died. Nobody was notified that she had taken the medications. Aid-in-dying medication ingestion is a private matter that is not shared with anyone other than those the patient wants to share it with. Her death certificate would have her hospice diagnosis on it as the cause of death. What went down in that room stays in that room.
When I left her house, I stood in the street outside for a few minutes with the social worker on the team, who had also been present. It was a brilliantly cold and bright February afternoon. Neither of us could come to a decision about what to do next. Our options were: 1) drive down to our hospice office and debrief on the visit; 2) go home; 3) have coffee somewhere and debrief between the two of us.
We stared at each other for a while, and at the surrounding houses and gardens on the very ordinary street. We laughed at our own indecision, and quickly sobered as we realized how strangely paralyzed we felt by what we had just experienced. Finally, we agreed on the third option. It just didn’t feel possible to either of us to go into the office and be around people who might be having a fairly ordinary day. And neither of us wanted to go home quite yet and be with our families, for the same reason. As a hospice worker, sometimes it’s best not to lay your day on your loved ones.
After we had coffee together, I felt I could go home. It was the Friday afternoon of a long weekend. I knew I would spend some of it with my daughter, take a bike ride with my riding buddies, and have time with my new love. I had support. I thought I’d need to grieve a lot for my patient, but I found that as the afternoon wore on, I felt lighter and lighter. I had cried at her bedside, holding her hand. I had shed tears after I knew she was dead. But she was free at last: it was what she had yearned for and was ready for.
As for me, I had met a woman of extraordinary courage and strength. I had got to know her in a very intimate way, and she had asked me to be present at her death. Hers was an ordinary sort of bravery: not the stuff of medals or awards, but the kind of grace and beauty of spirit that I feel is the best of being human. And if there was any appropriate way to celebrate her life and her death, I felt that I could do it by riding the windswept open roads of West Marin on a sunny late Winter Sunday with the hawks and the new roadside waterfalls and the very beginnings of wildflowers that herald the Spring.
lovely
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