My Dad’s 75K pacemaker did not perform the miracle he was hoping for. It was the placebo effect talking when he said, “Let’s go to Walmart!”
Cruising the aisles of Walmart was his “big day out”. He would go up and down every aisle, stopping and looking at random items, cat food, saurkraut, votive candles, pickled pig’s feet, and all the meat… his favorite display. Any meat marked down went into his cart. He would bring it home, take it out of the grocery bag and call out through the apartment door, “Peggy, come here!” He would show her the meat like a proud hunter, she would dutifully admire it, “Wow, that’s a great find, Jess!” Then it would go into the dark cavern of the 27 cubic foot chest freezer in the garage.
His imaginary new energy lasted less than half the trip. He attempted to walk the grocery aisles instead of riding the handicap buggy. We barely made it out of produce into the dairy aisle when he leaned against the apple display counter and out of breath said, “Dammit. You better go get me an old-fart-cart.” His cardiologist had told him he set the heart-rate as high as he could but with only 25% heart function it would not help with most of the congestive heart issues.
After a few months his legs started swelling again.
His cardiologist admitted him to the hospital where they drained about twenty pounds of water from his body. He was scared. One of us or his grand daughter stayed with him in his room around the clock in case he died. When he released him, his cardiologist said, “Man, he just keeps beating the odds.”
Then COVID hit. During that year I spent four weeks in the hospital due to two cancer surgeries and a complication. There were no visitors or family allowed and eventually no rooms available. The prospect of being found forty-five minutes after dying when a nurse finally gets around to checking on your last gasp push of your emergency call button is a gut challenge to your bravado faith regarding “fear of death” and dying alone with only God and your angels surrounding you.
It was no surprise that he declined again sooner than later. He couldn’t breathe. He dipped into his stash of the last of his doses of steroids he had squirreled away for his lungs in case he couldn’t get a new prescription. They didn’t help. His legs started swelling again. He self-adjusted his Lasix and blood pressure medications. It didn’t help. I knew he was getting bad when he asked for the walker.
“Call my cardiologist”, he said one morning, “there’s gotta be something he can give me… maybe he can adjust the pacemaker again… maybe he can get me into the hospital…”
I cringed. I feared if I called his doctor that’s exactly what would happen: he would do “SOMETHING” that would offer another short lived placebo hope but no real cure. Of course he would: doctors are first, interventionists. This is “their lane”. They were trained to be healers, not metaphysical philosophers, theologians of death, existential crisis psychologists, economists about their decision’s impact on the aggregate distribution of limited healthcare resources, nor judges of “quality of life”. If they do their job then their default is to do what their Hippocratic Oath requires until someone gives them permission to stop. As long as dad asked for treatments they would keep pushing drugs, procedures and machines at him regardless of the potential expense, consequences or inevitable outcome.
I called my sister. She had worked in cardiology and had cared for people dying of congestive heart failure in the hospital. She was in on the doctors’ visits on my phone with us for the past couple years. She knew what the doctors really said and what their euphemisms and med-speak really meant regarding efficacy of the procedures, potential expectancies of life and risks.
“He’s going, and realistically, there’s nothing more that can be done. Congestive heart failure isn’t a pretty way to die, you’re basically slowly drowning in your own fluids. It could be a week or a month, but if he goes into the hospital he’ll probably die there this time. Dr. James needs to be honest with him. He really needs to go on Hospice.”
“I tried to talk to him about Hospice. He didn’t want to call them.”
“Yeah, he’s still in denial. We can’t tell him that, he has to hear it from his doctor. Even then… I dunno. ”
I called his cardiologist and told him what was going on. “My Dad is going to call you. He wants a new prescription or for you to admit him to the hospital again.” He groaned and sighed. “He’s grasping at straws. His heart is just done. I’ve kept it going for 30 years. There’s just nothing new or different I can do for him. I’ve juggled everything I can for as long as I can. I could hospitalize him… ”
“If you put him in the hospital, you need to be aware that he’s got advance directives for DNR, no intubation, invasive procedures or feeding tubes. I want you to be sure you read his paperwork and follow through.”
“That’s about all that’s going to keep him alive if he ends up the hospital. Then he’s basically done. Hospice is probably the best thing at this point.”
“Then you need to tell him that. Straight up. Tell him to get his house in order. We’re prepared for this, he’s not. He’s going to call you this afternoon. I know you hate to give up, but you need to do this. I don’t want him dying alone on a gurney in the hall of the ER.”
“OK. You’re right. I’ll talk to him. I’ll tell him… Thanks for the heads up and for the support.”
I had just arranged my father’s voluntary passive euthanasia… IF he followed his own end of life directives.
I knew he was hoping to out live my Mom. He was a micro-manager. He didn’t trust us and her caregivers to take care of her properly without his supervision and direction. I didn’t know if he would demand medical interventions to keep his body alive just so he could “be here” even if it was unconscious in a hospital bed where he couldn’t do anything. I didn’t know if he was capable of trusting us enough to give up.
He called Dr. James. Through the door I heard one side of the conversation.
“I didn’t think there was much you could do. Thank you for everything you’ve done.” He hung up. I gave him some time before I went in to the apartment. He was sitting at the dining table, his bowl of breakfast cereal soggy and half-eaten, pushed away, the phone faced down in front of him.
“What did James say?”
“He said there wasn’t anything he could do with the pacemaker. I guess this is it… maybe I should call 911 and go to the hospital…”
“Dad… if you know this is it, we can call 911 and they’ll take you. But if you do, you know that you’re probably going to die in the hospital this time. And you’ll die alone because if you can even get a room, no one can have visitors now.”
“Not even if you’re dying?”
“No. They’re totally locked down. No one can be in your room with you.”
“That’s bullshit.”
“Or we can call Hospice and we can set you up here and you can die in your own bed next to mom with all of us and your grandkids with you. You tell me what you want to do.”
The fear of dying alone was worse than the fear of dying.
We called Hospice.
Within a few hours we were sitting at the dining room table doing the intake interview and paperwork. Dad sat in his customary chair at the end of the table, his oxygen canula in his nose. He nodded off while I answered most of the questions and listened to the instructions for comfort meds and when and who to call when he passed.
“So you guys will be taking care of both of your parents now… That’s a lot on your plate. If you need anything or respite be sure to call us,” the nurse said.
Dad’s head lifted. “Your mother isn’t going anywhere anytime soon,” Dad said with a wry “hmph”.
“Yeah, I don’t think so either. But, I want you to know that Peggy and I will take good care of Mom when you’re gone. We won’t stick her in a home. She will die here in the house with us just like you. ”
“I was wondering about that”, he said. I could feel my body sink.
I had said it because I knew he didn’t trust us in spite of everything we had done. But I wasn’t prepared for that. If he had said, “I know” or “thank you”, anything but “I was wondering” it would have lifted a lot of the past. But he didn’t. It piled on another burden I’d have to shed one day.
The nurse reassured him they would continue to care for mom when he was gone and that they have been impressed by the care she was getting in our home, that he had nothing to worry about.
He signed the final paperwork, laid the pen down, then put his hands on the table, pushed himself up and said, “I’m going to bed”. He slowly shuffled toward his bedroom, a hand on a chair, a hand on the kitchen counter, a hand on the wall, a hand on the door frame along the way. He sat on the edge of the bed, bent over, breathing deliberately. He looked up at my mom asleep in the hospital bed next to him, his wife of 68 years who did not know who he was anymore, slid his house slippers off, laid back in his bed and pulled the covers over himself.
It was as if a light switch in his soul had been flicked off.
I went in to check on him and mom a couple hours later.
“I need some help,” dad whispered. “I think I shit my pants.”
I helped him out of bed and to the bathroom. I got his clothes off while he leaned on the bathroom counter and cleaned him up a little. I got the shower chair we had used for my mom for a couple years, helped him down into it and gave him a shower. I dried him off while he stood shaking, holding on to the countertop. He was gasping for air even with his oxygen.
“I better put some Depends on you instead of your skivvies, in case you have another accident.”
“Fuck this shit. Call Hospice and ask them if they can give me something to speed this up. I want to get this over with…”.
I wanted to stand up and punch him in the face.
I wanted to yell at him. “Fuck THIS shit?! What the fuck do you think you put mom through for the past three years?! THIS shit?! One fucking day and you can’t handle THIS shit?! Fuck YOU. I’m not letting you out of this…”
We had plenty of stuff in the refrigerator to end it for him, bottles of morphine, atropine and hydromorphone we had accumulated for my mom over two years. I could have mixed up a cocktail and handed it to him as he stood there then put him to bed to die peacefully, painlessly. With his shaky hands there was no way he could mix his own even if he could make it to the refrigerator. No one would know what happened. It would have been “heart failure” on the Hospice death certificate.
But I didn’t. Not because of hard convictions about suicide, nor of assisted suicide. I think I could have done it for him if he hadn’t wondered, if things were different between us. But they weren’t. And I didn’t.
I didn’t because I wasn’t going to give him the pleasure of an easy death. I wanted him to live in my mom’s pain. I wanted him to experience the humiliation of dependency, the indignities of helplessness, the ruin of his abilities, and the insult to his independence and self-sufficiency. All the things I had compassion for for my mom I now could inflict on my father. I was now his god. I would teach him a lesson. For his salvation. But, not really. It was for my unrighteous indignation, vengeance on behalf of my innocent mother. Whether she wanted my vengeance or not. I wasn’t even going to ask her for her demented permission. I was now in control. I became my dad…only worse.
But I said nothing. In silence I knelt down on the cold, wet tile, lifted his legs into the Depends and pulled them up then helped him into his pajamas. I held his arm while he shuffled the dozen steps to his bed in his walker. I put my arms around him and lowered him onto the edge of his bed. I let him catch his breath, then I bent down and swung his legs up into the bed where he stayed, us feeding him, changing his diapers and medicating him until he died a few days later.
We called my sister and his grandkids while he was still able to talk. He wept when we hung up. “I’ve had a good life,” he said. “Yes, you have. You’re a good man, Dad. You did good,” I said. He was, and he did. The next day he began going in and out of consciousness.
It was not pretty. In the last couple days, he was gurgling, drowning as his lungs filled with fluids. He could not speak. As I sat beside his bed watching him struggle for air, partially conscious, I recalled a scene from The Longest Day. (I was ten when I saw it with my father, so it might not be exactly as I recall). It haunted me then and still does to this day. During the ground invasion a soldier gets wrapped up in barbed wire. He is on fire from a flame thrower. His buddy is watching helplessly. The soldier is screaming in pain, “SHOOT ME! SHOOT ME!” His friend hesitates, machine guns him to death then walks away to finish the war. My father had screamed “SHOOT ME!” and I did not.
There were moments as I kept vigil by his bedside that it seemed a godly mercy and not an “unforgivable sin” if I fulfilled his wish to help him stop his suffering. But I still didn’t let him off the hook. I gave him his comfort meds, but I don’t know how comfortable they could make a drowning person. Eventually he slipped permanently into unconsciousness. The hospice nurse said to drip the meds under and along side his tongue into his cheeks in case he could still feel any pain. I could have dripped the whole bottle of morphine in. But I didn’t. I think now I regret that more than I regret my anger. He did not die by suicide. At least he died without that “sin”, with or without the “sin” of my assistance. In the back of my mind was the “theological hard line” that all of his other sins could be forgiven on his deathbed, but not his last damning one if I had helped him willfully kill himself before “God’s ordained time”.
What I’ve always been told is, at least I didn’t help send my dad to hell and I avoided hell personally by not assisting him. After watching people die over the years I’ve never been fully convinced of that.
__________________________
I always wondered where this “hard line” came from. How has it gotten softer, it seems, in recent decades?
The predominant Christian view of suicide as an unforgivable sin was essentially first theologically explicated by Augustine in the 4th century. Prior to that it was generally condemned but there was no “systematic theology” of suicide in Christian writings. It is interesting that suicide was also generally condemned by the pagan philosophers for various reasons, but with caveats and nuances regarding what might be regarded as an “honorable, noble suicide” vs. a “selfish or cowardly” one (ie., Socrates as a prime example). Augustine theologized on the commandment “Thou shalt not kill” to include one’s self. It was reinforced and further explicated by Aquinas in the 12th century and his teaching is predominantly the “Christian position” today: suicide is ultimately a sin against the sovereignty and providence of God over the order of the world and over our life and death no matter what our circumstances therefore it was “…the most fatal of sins because it cannot be repented of" (Summa Theologica 2-2, q. 64,5). Suicides, because of the impossibility of repentance, in their teachings, were not permitted a Church funeral or burial (which is still “policy” in some churches today).
However, Augustine recognized that his teaching was contrary to the practiced piety of the Church which canonized as saints people who had committed suicide for pious reasons. One example of many is from Eusebius (Ecclesiastical History, Book 8, Ch. 12), who tells of St. Domnina and her two daughters (commemorated Oct. 4) who were captured by soldiers and knew they were going to be raped. Instead of submitting to the rape they threw themselves into a nearby river and drowned. Others are “voluntary martyrs” like St. Aggias, the 40th martyr of Sebaste who revealed himself as a Christian and took the place of the one who recanted his faith (March 3), or Lucius, a bystander who volunteered to die with Ptolemy (October 19).
Augustine could not wholesale condemn the piety of the Church, so he said that, in general, pious suicide (to avoid rape or persecution, or as a pious escape from the “world”) was committing an act that is certainly a sin to avoid something that is uncertain and has not in reality actually happened. However, because of the Church’s canonization of saints who rushed to martyrdom or actually killed themselves to avoid violation of their personal sanctity, Augustine and Aquinas both acknowledged that certain “suicides” of the saints may have been “prompted by divine wisdom unknown to others” in the same way as Samson who died by suicide at the direct command of God for a higher purpose. Augustine therefore said he would not be presumptuous to attempt to discern whether God had personally and mysteriously directed “pious suicides” or not and refrain from judgment of the saints and the Church for canonizing them. (As a side note here: Augustine was also the first theologian to say that a forcible rape was not a matter of guilt, shame nor a sin to the woman, and a woman retained her purity of body, mind and spirit before God because she did not desire it, therefore the suicide was a sin, however the rape would not have been for the woman. So Augustine’s view would be, to commit suicide because of a rape or potential rape would be a sin as a reaction to something that was not a sin, therefore unforgivable.)
So we now have to determine what might be a “licit” or “illicit” suicide even in the eyes of the Church which becomes more and more nuanced in the past eight centuries since Aquinas.
The term “suicide” itself is laden with baggage but we don’t have other terms for “self-killing” that indicate nuances. This is a very short “syllogistic” definition of suicide as we use the term:
Bob does “A” which he believes will cause him to die.
Bob does “A” because he intends to die.
“A” causes Bob’s death.
Therefore, Bob committed suicide.
Simple, straightforward. But if this is the definition of a “damning, sinful suicide/killing of one’s self” then what about the Captain who goes down with his ship, the self-less who stayed aboard the Titanic giving up their places on the life rafts, the soldier who jumps on the hand grenade, the spy who takes poison in order to not give up secrets under torture, the soldier who goes into a hopeless battle, the Japanese traditions of suicide in war or for honor, or the political protester who dies for her just cause? These are all examples of intentional acts of self-destruction but are universally considered courageous, rational, sacrificial, honorable, or beneficial to others in some way. These nuances were not lost on the “pagan philosophers” of Augustine’s day, nor are they lost on us intuitively even without a philosophical education.
The troublesome category of suicide is the “avoidance of suffering” which is almost universally perceived as “escapism, selfish, weak, or cowardly” and is virtually universally condemned in all religions and philosophies as a reason for committing suicide. But is the avoidance of suffering “damning” in all cases? An image that is imprinted on our recent collective consciousness is the person in mid-air who jumped out of the burning Twin Tower rather than burn to death. There are stories of involuntary martyrs who requested they either be strangled or killed quickly by their executioners before being burned at the stake, or be burned with green wood so they would succumb to smoke before dying painfully from flames.
It would be inhuman and against all spiritual intuition to lump all of these sacrificial and avoidance of pain self-killings into one category: “damning selfish, faithless, cowardly despondency” and assign such suicides to hell for their choices. So, the definition of what constitutes a “condemnable/sinful suicide” is not black and white even for Christians. It seems that intuitively and even “hard core theologically” something else, some nuances must be added to the definition of “suicide” and how we regard its consequences eternally: Intention and circumstance.
NEXT: The modern history of suicide, the gift of life, the sovereignty of God, the blessed curse, and the free will of man.
This is wonderful. I lost my dad to cancer 5 years ago. He died in his home (in-home hospice) and was cared for by his wife. It took him 9 months. His wife refused to double up on the morphine even though nurses were telling her he needed it. She refused. He told me that he wished that he could have the “suicide pill”. He was in a lot of pain. He said that that way everyone could plan to be there as he died. My stepmother was very upset that he’d say that, they were evangelical church of God, and she thought she could pray away the pain instead of giving him more pain meds because she was afraid he’d be a junkie (the man was 78 and could no longer even sit up. He had never been any kind of addict.) She also said in her heavy southern accent, “I don’t want him being no *zombie*!” At the end of his life, I began to pray that God would take him so he’d be out of his misery. He was questioning why God wouldn’t just take him already. And honestly at that time I could see his point. But I haven’t walked that path yet myself, I don’t know what I’ll think if I die from a long illness. My dad said he’d gotten the idea from me about the suicide pill and dying with dignity. I’d apparently told him that it was similar to when I was close to delivering my son and I was induced. I was already going to have the baby anyway, we just had to bring the baby a little earlier. So his theory was “I’m already going to die, I would just be picking out the day”. I have no recollection of having that conversation with my dad but he swore I told him that.
You did a very noble thing taking care of your parents. And thank you for sharing this story and for your beautiful writing.
Wow. And….wow. Your writings are wisdom, and it means so much that you are willing to go where others fear to tread. Thank you so much for your indescribable gift.