Death On-Demand
Sometimes doctors are called upon to hang up their stethoscopes, check their white coats at the entrance, and just show up. Be a friend. A shoulder to be cried upon.
Lizette was waiting.
She must have rehearsed what to say, but her mouth was sealed as she sprung to her feet to hug me. It felt like I was hugging a rumbling volcano. Worry lines on her face shifted as her expressions changed rapidly. Words tumbled out even before I sat down. The whispers must have signaled great urgency — even the waiters stayed away.
Later, Lizette would tell me why she had chosen a restaurant to share “the most difficult of conversations of my entire life.” She said she wanted to have that dreaded, private discussion in a public venue to contain her emotions.
“I’m going to tell you something today that no mother would ever think to say about their own child,” she said.
I’ve never seen Lizette cry or display much emotion before, although we who knew her well knew she worked hard to hem her feelings in and tuck them away. The whole time she had stayed in an abusive domestic relationship, she was stoic, always ready to appear happy. After finally escaping that relationship, she remained uncomplaining. After all, she had a purpose, a daughter who needed her complete attention. Osha.
Her voice was trembling now.
“Osha?” I asked.
“Osha, yes,” she said. “I’ve no one to turn to.”
I let her know I’d be there for her. Unconditionally.
“Don’t judge me,” she said, after telling me what Osha had asked her, and what she had already agreed to.
I reminded her that I had no expertise on the subject.
“You are not here in the capacity of a doctor,” she reminded me.
“Oh yes, I’m here as a friend,” I confirmed.
Lizette’s rush of words was punctuated by searching pauses. The silences amid the restaurant’s din spoke louder than words. I remember her blowing air to resettle the curls of hair teasing her face while her body remained motionless, arms crossed and braced across her chest, tamping down her breaths.
*
California has wrestled with The End of Life Option Act for years. It was first admitted and passed in the legislature as a bill in 2015, but reversed in 2018. The bill is likely to come up again: a survey conducted by UC Berkeley found that 76 percent of voters supported allowing terminally ill patients to take their lives.
Unlike in the case of human births, where the religious right and the medical community disagree at every turn, end-of-life issues bring them scarily closer. If not for the same reasons, then towards the same end. The American Medical Association finds the idea a slippery slope which could eventually result in state-sponsored killing. The medical world and the religious right share their fear of hastening end of life. Even with terminal, painful imminent deaths, the medical association waffles, forcing physicians to make their own calls and risk prosecution.
However, what is very clear now is how both the detractors and adherents would go weak in the knees if end-of-life options were exercised for non-terminal, quality-of-life illnesses such as depression, vicissitude, congenital disorders, and chronic intractable pain.
Can a severely depressed person request it? How about someone who has deemed that the quality of their life is so dismal — enter Osha — that flying away is their only option?
If death could be offered on-demand, might not every person with suicidal ideation be tempted on a particularly bad day? Does every birth come with a warranty to die with dignity? Is it considered abetting to walk in tandem with a person wishing to claim such a privilege?
*
Our small circle of friends know and love Osha.
She’s in her mid-twenties now, but her medical history dates back to when she was 6 and diagnosed with a brain tumor. Removing it required multiple cranial surgeries that left her with intractable pain, memory issues, and a major seizure disorder.
Between regular prolonged hospital stays, Osha nevertheless (and miraculously) grew into a productive, energetic, and love-filled human, although she could never finish high school. Some years ago, at a college recruitment fair, Osha walked around toting a very unique-looking violin tucked under her armpit. When recruiters asked her about it, she explained how she made the instrument herself, rattling off mathematical ratios and conjecturing high concepts in physics. She left with a direct admission offer into MIT.
Her creativity included the creation of culinary delights which once made a Michelin-starred restaurateur swoon. She played her harp at old-folks’ homes, accompanied handicapped children to the boardwalk, and ran marathons because running helped her cope with the pain.
When Osha was about seven she moved into a garden shed behind their mountain home to escape her abusive father. Lizette continued living with the man for several more years before finally escaping his clutches. By that time Osha was living in her own trailer, and she was able to offer her mother a room of her own as their lives intertwined again.
“A peaceful, humane end is all I ask for,” Osha told Lizette five years after they relinked. In the interim, Lizette had taken her daughter to countless medical centers, tried alternative treatments, and visited faith healers. Lizette measured her happiness in units of Osha’s.
Most medical centers had nothing concrete to offer. Osha’s supernumerary seizures had started to dictate the quality of every moment of her life. Every vacation planned turned from a ride to the airport into an ambulance ride to the ER. Holidays and special events were not spared either. Each episode left Osha mentally fogged, vacillating between anger and frustration. Lizette was a daily witness to her beautiful daughter functioning at a very diminished level. When Osha’s drivers license was taken away, she returned to her mountain home and retrieved an unused a motorbike tucked in the garage. When she could no longer ride the bike, she found a used bicycle until that too was lost. Even a walk to the local park ran the peril of finding herself unconscious under a bush.
Osha ran away countless times. Lizette collected an anthology of goodbye notes. Whenever Osha went missing, we, Lizette’s friends, wrung our hands as we tried persuading her that life was still worth getting out of bed for.
Osha always returned, offering only the sketchiest outlines of her “escapades” “near lakes and inside forests, under bridges.” Her dimples made her seem like she was smiling even though we knew better.
By this point, Osha was not able to eat. Chewing triggered a flood of pain.
“I get satiated just watching you eat,” Osha said as she spoon-fed her mother, “and my pain doesn’t have to get aggravated. See, it’s win-win.” Her dimples flashed again.
Osha was wasting away.
“I just die every time you leave,” Lizette said.
“I would have died too, mother,” Osha said without irony, “if I didn’t think I’d botch the job. There are really no manuals, ya know.”
*
The Oregon Death with Dignity Act went into effect in 1997. Washington state followed suit nearly a decade later. Despite its Roman Catholic background, Belgium has one of the world’s most liberal policies toward euthanasia. Every termination is evaluated by the Euthanasia Control and Evaluation Commission. Even a chronic, incurable psychiatric patient can be helped to die with dignity. Such possibilities have given rise to the idea of Suicide Tourism.
Osha’s pleas for help to end her life escalated as her suffering intensified: “Nothing anyone can do for me now,” she repeated.
“If I cannot live with dignity, surely, I should be allowed to exit with dignity,” Osha said.
This is when Lizette called me.
“Osha can be such a passionate giver of life,” I said, trying to mask my own sadness. “She is a beaming sun whenever the clouds do clear.”
“That’s your perspective, not hers,” Lizette said. “You don’t understand, Osha has made her decision. She is not asking for counsel. Only proper directions.”
I think about how amazing a mother’s love must be to find such clarity amid such interminable suffering. I wonder, too, what will make Lizette carry on — the notion that she had extended this one last act of compassion to her daughter or the knowledge that she did nothing about it.
In the near term, I see no winners here. But I do see Osha’s suffering end. So, what does a civilian friend do? Start making contacts? Fly to Belgium? Become a suicide tourist?
What would you do?
Thaila Ramanujam is a physician in private practice in California. Raised in a literary family as the daughter of a prominent Tamil author, she developed a passion for Immunology early on and moved to the University of Washington to pursue research. She writes both fiction and non-fiction, and her work have been published/ or won awards in Nimrod, Asian Cha, Glimmer Train, and Readers. Her translations have appeared in International Literary Magazines. She is a columnist for a Tamil literary magazine, Kalachuvadu with international readership and has an MFA from The Writing Seminars at Bennington College, Vermont.