Today is World AIDS Day and, in honor of my mother, one of the victims of AIDS, I want to write on a hopeful topic. Yes, death is or can be a hopeful topic.
Death is a part of life, just a part of the cycle all living things progress through. I remember my grandfather’s death in an accident. That was particularly traumatic because my cousins tortured 3 year old me by telling me it was my fault. He died in a construction accident at work. But children, especially confused children in pain, can be AWFUL. Feeling guilty, it was a while before I told my mother that my cousins had told me I wasn’t allowed to go to the funeral because his death was my fault. She comforted and explained and then took me to his grave and encouraged me to talk to him. I’ve been talking to the dead ever since.
Interestingly, despite what my mother did for me, she was not the least bit comfortable with death and dying. I found that out in my teens when my second eldest cat died in his sleep, curled in a ball, in his favorite spot. She had no idea what to do with him, living in the City as we were, and it wasn’t like today with virtually all the same services available for pets as for humans. I found her standing in the kitchen, frozen, ashen, trying to call the veterinarian for advice. He was one great vet and human being. I made the call and then took Feisty to him. I wrapped him in a towel just like for any visit to the vet and my mother was still ashen, now slumped in a chair in the kitchen with a cup of coffee I’d made. I cried the entire way to the vet’s office. The vet met me half an hour before clinic hours and we arranged to bury Feisty in his private cemetery. We didn’t even know he had one before that. And it was nice to be able to visit him when we took others in for exams.
There is something about seeing a parent shaken. My mother was an incredibly strong person. She’d earned a Ph.D. when that wasn’t close to the norm for women. She generally took everything in stride and I had never, ever, seen her shaken like she was that morning. I was near my mid-twenties when my eldest cat clearly needed to euthanized. I hadn’t realized my mother had been carrying guilt all those years about how things went with Feisty until she started a repetition of saying she’d take care of Panther when the time came. Well, the time came and she kept procrastinating and I could see her pain and distress. She went away for a conference and I took Panther to the vet sure but not entirely sure. That same wonderful vet said it was time, oh yes, maybe a bit past time. He was 20 years old, underweight, dehydrating rapidly. He was kind enough to walk me through the signs and gently show me what I was seeing in my beloved cat. I left him to be euthanized. My only regret is having left him for the process. It may have been the common practice then but I’m sure I would have been allowed to stay if I’d asked.
I was 26 when the third cat needed euthanized. My mother was dying of AIDS and this was my third childhood cat who had adopted my mother early on. Purr was HER cat whether she wanted him or not. Purr was a purple eating Siamese and his full name was Purple Eater, having been changed from Frisky when he was diagnosed as a wool eater. He was 18, arthritic, overweight (common in wool eaters) and had been on steroids for a year as he camped at the foot of my mother’s death bed like a dog, which he thought he was. I’d swear he was intent on hanging in until she died but he just couldn’t quite make it. The last 2 steroid treatments hadn’t worked and he was failing fast. The vet asked if I’d like to stay and, although surprised, I said yes. He was euthanized in my lap. I got to see him relax, pain free, purr contentedly as he drifted off, never to awaken.
I can’t describe my pain, how much I miss those cats even now. But that is my pain and it is a selfish pain. To have prolonged their suffering, their deaths for my benefit, to defer that pain, was/would have been wrong. I waited too long with Panther and I would never do that again. We all want the beautiful death that seems apparent when one dies peacefully in their sleep but the reality is that is rarely the case for animals of humans.
In retrospect, I was inordinately lucky with these 2 euthanasias. It would be advisable for any pet owner to become familiar with the process long before they are confronted with the choice. Here’s a good place to start. Look into it now as this choice often has to be made without the leisure of elder death and the time it permits for decision making and research.
My mother was diagnosed with AIDS in 1986 when it was a death sentence. Still, we had the time to make peace, make amends, and make decisions. She executed a healthcare directive and appointed me, all of 24 years old, her proxy and her only child. Unlike with the pets, she’d never had a problem dealing with human death. She’d grown up in a time when families often cared for and tended their own dead; when pets were not what they’d become by my youth, quasi-family members. We had a year of conversations on “what to do if…” It is impossible for a written health care directive to cover all the possibilities and that’s exactly why one appoints a proxy, someone who should know the person well enough to choose what they would choose if they could. Being my mother’s proxy was, bar none, the hardest job I’ve ever had. She did not make the same decisions I would have made/have made since then. She did not make the decision a child would make for parent in those desperate moments when it’s truly real, when the choice means saying goodbye forever to a parent and the child in you screams NO. Unlike pet euthanasia, human death is often a series of decisions.
My mother’s final illness was pneumonia and I was with her in the hospital the last few days as her lungs filled with fluid and she began to gurgle when breathing. She had begun to call me “mommy”, sometimes the “other mommy”. No one and nothing prepares a child for that although it isn’t uncommon. Mommies take care of us and she had 2, her mother and me. The techs would sit her up and pound her back to clear the fluid every few hours. It was clearly painful despite the morphine. In accord with my mother’s directive, I demanded morphine a bit before these treatments. It was inconvenient for the staff to schedule around her morphine doses. I didn’t care. The fluid was accumulating faster and faster and they had another option. Shove a huge needle between her ribs, the ribs of this frail, 90 pound, dying woman, and drain the fluid and, when it came back, do it again. Maybe they’d do this 2 or 3 or 4 times in the remaining hours. It might buy her an extra day, not likely more. It would be in painful and they couldn’t increase the morphine any more.
This was proposed despite my mother’s filed directive and their agreement not to propose anything in violation of it. This would have been a clear violation. I said NO. I later found out that they’d contacted every living relative they could behind my back because, under that state’s laws, a single relative could give consent and override her directive and me as proxy. Fortunately, every family member had the good sense to defer to my decision as her proxy.
My mother’s wishes for this type of situation were very clear. If bedridden, incoherent or silent, the end is coming and nothing can stop it, provide pain drugs and lots of them. She did not want pain. If the pain medications hastened death, all the better. Ah, but we’re aren’t supposed to feel that way; we certainly aren’t supposed to say it. Doctors don’t euthanize.
Oh, yes, they do; regularly. And, when they don’t, death can be a very slow painful process. You may not know but most who die from long chronic or terminal illness die starving and dehydrating, slowly and painfully, without the energy to express that pain but it is there nonetheless.
There’s been quite a bit of media attention to “Death Panels” of late. What is really being proposed is the opportunity to discuss one’s final wishes with those knowledgeable in the process of death so one can make one’s own decisions, make a well drafted directive, have one’s wishes honored without question. In the last few hours of my mother’s life, I had to insist, demand, cajole to get her morphine. I knew when I demanded the last dose that it would be the last dose. I can not put into words how hard that was to struggle against the hospital staff and doctors to get her what she’d been so clear in wanting while the little girl inside was screaming for me to shut up and sit in the corner with her and eke out as many minutes or hours as nature would allow, no matter the pain to her. We are all selfish but being an agent, a proxy, means doing what is best for, what another would want; not being selfish, not doing what one wants. Technically, to my mind, this was euthanasia and I had lots of “help” from doctors and nurses. Legally, it was just a side effect of pain relief.
My mother was 52 when she died. I was 26. It was 1988. Being her proxy was the hardest job of my life and it aged me in so many ways. Yet I learned a great deal in the process about death and dying. I do not fear death but I DO fear dying. I want my wishes, my choices honored and I’ve made them clear to those who will have to speak for me when the time comes.
We will all die and we cannot predict how or when but it may well end with someone else having to second guess our wishes. I urge all of you to think about the process and what you would want. Discuss it with your doctors and do not let them weasel, they are often uncomfortable with the subject even these days. Put your wishes in writing to the extent possible. TELL your family what you’ve decided and that they are not to second guess. We all fear the unknown but much can be known and the fear reduced through this process. It is not a “death panel” to urge you to terminate your life early, it is to honor your final wishes. (BTW, I’m not a big fan of the proposed health care changes but this little part I can get behind whether any of the rest is or isn’t passed into law.)
And MAKE A WILL and do it NOW. There may be a bus around the corner with your name on its bumper. If you can’t afford a lawyer, make a will from a kit. You can order them on-line (I like Nolo Press) or pick them up in bookstores. If you have pets, consider including them in your will. A few dollars to accompany them might just be the difference between life and death for them.
Me, I want the beautiful death only veterinarians are permitted to provide. I want to relax into purring sleep when the time comes. I would prefer to be taken to a veterinarian than to a hospital but, alas, we do not condone that… yet. Perhaps, if we all become more informed and can make discussing the death process less taboo, we can all choose the death we consider most beautiful; whether that is euthanasia or fighting tooth and nail to the end. Unlike our pets, we can and should speak for ourselves and I hope we will.