By Pat Carl

I still don’t know why she wants me present at her passing. I’m not a particular friend nor even a steady acquaintance.

When I asked her, “why me?” Lorraine — Lani to those who know her best — says, “You’ve always been honest with me.”

So, honest at her end, I can say:

She’s angry.
She’s difficult.
She’s needy.
She rages.

She’s insistent.
She’s determined.
She’s intelligent.
She’s driven.

Her life’s been difficult from the beginning and, at her end of days, even more so.

The kindnesses of caregivers can’t help. The absence of close family doesn’t matter to her.

No home care, no hospice care, no drugs, can alleviate it.

Only the pain, the terrible, terrible pain.

Her brain injury affects all the primitive areas of her brain.

She suffers from:

Insistent fatigue.
Unbearable headaches.
Visual challenges.
Personality flux and confusion.
Lack of coordination.

She can’t:

Concentrate.
Remember.
Sleep consistently or well.
Process information.
Control impulsivity.

She has difficulty with:

Loud noises.
Controlling her emotions.

But the worst of the pain comes from her inoperable spinal stenosis that is progressively damaging her nerves.

Affected are her:

Gait.
Balance.
Dexterity.
Grip.
Bladder and bowel functions.

She believes her earliest doctors were not thorough enough with their investigations into her symptoms, but she feels cared for and comforted by her later ones.

***

Today, a rainy, windy, stormy December 13, she is dying with the help of those doctors and with the support of a few witnesses.

One of those witnesses, my partner, Megan, has truly befriended Lani in her darkest hours. She has run errands to the grocery store and the pharmacy and she has sat patiently with Lani and absorbed her angry outbursts for hours at a time.

She and I arrive at Lani’s home at 1 o’clock. We are greeted at the door by her sister, Pat, who flew into Comox a few days ago and has helped Lani get her house in order. They’ve talked with her lawyer, and her banker, retrieved her will from a safety deposit box, gone to the post office and filled out a change of address card.

When I hear this, I smile a bit, wondering what forwarding address they used for Lani.

Lani is sitting in her recliner eating Poppycock, a Christmas sweet made with nuts and popcorn all covered in caramel.

“Why not?” she says. “I don’t have to worry about diabetes anymore. I should have a treat before I die.”

Gallows humour, so typical of Lani.

Next to arrive is Lani’s primary physician, Dr. Usmani. He brings with him a silver case, the size of a small piece of luggage.

Ah, the instruments of death, I speculate.

I know Dr. Usmani has completed whatever course work is required to be certified to assist a patient who wants to die, but this is the first time he’s actually completing the procedure himself.

That’s why Dr. Reggler, the next person to come through the front door, is with us. He’ll make sure that everything goes as it should this day, that no steps are inadvertently forgotten.

A sort of certification process, that thought jumps to my mind, as the doorbell rings again and an intern, whose name I never did catch, walks into the living room. He immediately goes to Lani and shakes her hand.

“Thanks for letting me observe.”

Seems uncomfortable, I observe, but what else is there to say?

The final person to arrive is Wendy. At first, I think she’s a friend of Lani’s and I’m a little relieved that Lani has more people in her life than just doctors.

But no. Wendy’s the nurse who’ll assist Dr. Usmani.

What has happened to Lani’s friends? Where is the rest of her family? I’m disconsolate, but understand more fully why I am here, a mere acquaintance.

Her pain has hollowed out her life, has reduced it to the bare essentials, to the doctors who can alleviate her pain.

We’re all here now. Dr. Usmani asks Lani to sign some documents.

“I’ve practiced my signature,” she says.

Spinal stenosis affects fine motor function, I recall.

With that done, Lani gets up from her recliner, not without trouble, and says, “Let’s get on with it, then.” She reaches for her crutches, her crucking futches according to Lani, and moves slowly, but independently, down the hall to her bedroom.

Once there, she climbs into her hospital bed, a relatively new purchase. It can be raised and lowered at the head and knees.

I note the impressions in the carpet that mark the foot of her original bed, and ponder, A memory not quite disappeared.

As Lani lies back on a stack of pillows and raises the head of the bed a bit, her sister climbs into the bed with her, sits next to her, and holds her hand.

We are finally all settled and Dr. Usmani explains the procedure. “There will be four injections,” he says. “The first one will put Lani to sleep; the second will eliminate any pain that the other injections may cause; the third will deepen Lani’s sleep; the final one will paralyze her muscles.”

Stop her heart muscle, I think.

Lani doesn’t seem disturbed by this list at all. She’s heard it many times by now.

Dr. Usmani asks for her verbal consent to proceed. He does this three times. Each time she responds in the affirmative.

The last time she says, “Yes,” and turns to her sister and says, “I’m scared.”

This is the first crack I’ve seen in Lani’s resolve.

“Of course, you are,” her sister says. “But this is what you want.”

“Yes, it is, “Lani visibly swallows, her teeth grit, her face settles determinately. “It’s way past time for this.”

Dr. Usmani begins the series of injections. Megan walks to the foot of Lani’s bed and holds onto Lani’s legs, supporting Lani one last time as she leaves us. Lani falls asleep.

Fifteen minutes later, after listening to her heart through his stethoscope, Dr. Usmani says, “She’s gone.”

Pat, a religious person, tells us how she justified witnessing Lani’s death. “God would want us to help her come home to Him.”

I think how this comforts Pat, though it’s a perspective I’m sure Lani doesn’t share.

For me, the years-ago Catholic, I silently repeat the beginning of Psalm 23:

Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me, thy rod and thy staff they comfort me.

Later, Dr. Reggler straightens out Lani’s legs, Wendy lifts Lani’s head and removes the pillows propped behind her. They both straighten the comforter covering Lani.

The doctors and nurse leave soon after. “Stay with me,” Pat asks, “until the funeral home comes?”

We agree. We reminisce about Lani.

I remember what Lani said, “I am not choosing to die…I am dying anyway. What I’m choosing is how and when and where to die.”

The funeral attendants arrive bringing a stretcher with them. I’m startled: They’re both women. Why do I think that unusual?

Moments later, they wheel Lani out of the bedroom and down the outside ramp Lani had built when she could no longer manage the porch steps.

Lani’s favourite plaid blanket drapes her body.

Salut to you, you most uncompromising woman. You have not gone gentle into that good night.

Pat Carl is a writer and a participant in the Comox Valley Civic Journalism Project. She may be reached at pat.carl0808@gmail.com

 

 

 

 

 

 

ABOUT MAiD

Patients and their families have many decisions to make when faced with end-of-life care or intolerable suffering.

Legislation governing Medical Assistance in Dying (MAiD) was passed by the Federal Parliament on June 17, 2016. This means medical assistance in dying is now legal in Canada when provided within the purview of the legislation. 

Under the new law, doctors may provide medical assistance in dying to capable, consenting adults who have a grievous and irremediable medical condition that causes enduring, intolerable suffering and who are at a point where natural death is reasonably foreseeable.

British Columbians seeking medical assistance in dying should speak with their physician or other primary care provider or their local health authority.

For more information, click here