Funny thing, Death. Those of us who work on its fringes come to know how it is mostly unexpected: the guest nobody wants. We become inured to headlines, Six Teens die in Horror Smash, 2000 Die in Bangladesh Floods, but that’s other people. But one day that little twinge in the side, or the indigestion which has just got worse, could be diagnosed as something serious. Something life-limiting. Healthy eighty year olds, even those over ninety, are not ready. ‘This is ME. I can’t die.’
True, there are Death Cafes, but have a look at the people sipping coffee and chatting about dying in Lovecrumbs Death Café in Edinburgh.
They are all young. Maybe in fifty years time they will be well prepared to die, but there is also the hope that in the short term they will have more skill in coping with the deaths of friends and family.
So there is a good chance the prospect of one’s demise will take time to come to terms with, and once the idea of life ending is accepted to some extent, the details have to be dealt with. How much treatment to have, how to avoid a prolonged and painful death? Do I see it through to the bitter end, or should I opt out while I am able? Lately there is more discussion about this in the media. Some say good palliative care eliminates the need for assisted dying, others say we should have the right to choose to end our lives if they no longer have any value or meaning for us due to suffering and debility.
Steven Amsterdam, a palliative care nurse based in Australia, has attempted to show how individual situations might play out if legislation was brought in to legalise assisted dying. In The Easy Way Out he shows different cases as encountered by a nurse whose job it is to assist patients to self administer the prescribed drug, and to companion them and their families during the dying process.
Evan is a nurse who lives in a time, a little in the future, when Measure 961 has been passed and we meet him as he is about to assist in the death of Teddy. The procedure will also be recorded by monitors and be visible on multiple screens. Evan constantly monitors his own behaviour and thoughts; we learn he is thrown by the presence of Teddy’s kids in the room, which he wasn’t expecting. There are scenes where the family cling to the dying man, unable to let him go. He remains resolute, but the high levels of emotion are interfering with the process.
At some point during the process during the to-ing and fro-ing, my cup-holding hand has tilted, dripping an oblong stain of poison wetness onto the bed.
His cup runneth over. It’s half-empty. Half-full. Depending on your perspective, but that’s not mine… With a whiplike response, I overcorrect, and jerk-jerk being the operative word-a seemingly equal amount of the Nembutal onto my shirt and pants.
My stunned, ‘Shit’, seems insubstantial.
Somehow he achieves a successful outcome.
Evan soon has another client, a very rich man, dying alone (his Guru refused to be with him) The man is ready to go but Evan is perhaps a little impatient in his assistance. Those monitors show him assisting his client a little more than is allowable. There is a question about how ethical his behaviour is.
We see him working outside the system; a quick visit to be with the client and picking up an envelope stuffed with money is all it takes. This is uncomfortable stuff and when Evan’s mother, the Bohemian and outrageous Viv, begins to lose her health and strength he is deeply conflicted as to the course he should take.
Amsterdam looks at assisted dying as the province of the state, how it might play out when done by an underground organisation, or done privately by a family member. There is one ‘beautiful’ death of a woman who has her female partner and her daughters present. She goes out on a wave of love, champagne, and chanting. Evan thinks:
My death will look nothing like the pageant of tenderness behind this door…there is a slim chance of assembling, much less siring, such faithful handmaids for my last instant…No, none of them would be there. They are all, like me, only passing through.
Most of the situations have drawbacks, some are weirdly creepy, and Evan, who lost his father to a one-car accident, does not meet the ‘no suicide in personal history’ rule for death assistants. He constantly thinks of his father and his childhood. The work takes its toll.
Amsterdam shows the various ways in which life might become intolerable, but he also shows the complicated emotions we all experience about death. From the palliative care practitioner, to the dying assistant, from the devoted son, to the confused and irascible parent he shows human living and dying in some of its many forms. He does not hold back from the messy details nor does he fail to show the humour in the most grotesque situations.It seems there is no easy way out.
An excellent and thought-provoking read.