One of my friends died 2 weeks ago. It was a scheduled, doctor-assisted death, with family present. He wanted to die on the Wednesday of that week, but the doctor was not available on that day. My friend laughingly told his family that the doctor asked, “Would Thursday be okay with you?”
An essentially healthy and very active man, 10 years ago he developed recurrent abdominal cramps. His doctor found a lump the size of an orange in the lower left quadrant of his abdomen. Chemotherapy led to shrinkage of the tumor, which was then removed. At surgery some spread into other organs was already evident, but with medicinal therapy my friend’s condition was kept in abeyance over several years and he was able to maintain much of his active lifestyle. Unfortunately, in the last year the spread of the disorder involved kidney functions, necessitating surgical interventions. Related complications caused a great deal of discomfort to him and a degree of disability that disrupted his many activities. A consultation note from three of his doctors indicated that neither surgical nor medical treatment would offer him a prognosis of more than 3 months.
My friend was a plucky English man. I have known him for over 20 years, and in the last year I couldn’t but admire his energy to travel, maintain a large circle of friends here and in the UK, and participate in one of his favorite activities—old car rallies. He made his ending-of-life choice with a clear and bright mind. He brought his family into a close circle around him, arranged his affairs with his customary neatness, and openly discussed his choice with his friends.
In commemorating my friend’s death I was about to write, “Goodbye, dear friend!” But as I started, tears in my eyes obscured the computer screen. The tears were there, of course, because of my sadness over losing a friend and because I thought of all the suffering that made him want to depart from Earth. But my tears were there also because, in a very sad/happy way, I appreciated the great dignity, care, and love that accompanied his departure.
As my tears kept coming I thought of my much-loved wife, who is in her depth of dementia, being cared for with great love and dignity, chained as she is, without a choice, to the uncompromising progress of her disorder. In a grim sense she is already “not here.” Her condition does not permit her to decide to stay or leave. I can only hope that she might sense the dignity and love that will surround her when her time comes, like it surrounded my friend at his chosen moment.
—George Szasz, CM, MD
This posting has not been peer reviewed by the BCMJ Editorial Board.