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Comment: This article shows how realistic reassurance is better than euthanasia-for EVERYONE in the family.

Keeping a Promise When a Life Is Near Its End


“If something should happen to me, and I couldn’t help myself, would you be willing to help me?”

It is the question so many of us dread hearing.

My mother asked it of me around her 75th birthday.

Of course I didn’t need to ask what she meant by “something” or “help.” She was a card-carrying member of the Hemlock Society. On her bookshelves were titles like “Final Exit” and “The Peaceful Pill Handbook.”

“Can I think about that?” I said, hoping she might forget to follow up. It was a ridiculous hope: she took as gospel my every medical comment, and she never forgot a single one.

My mother had been ready to die for years. Not that she was suicidal, but she had always been one of those people who found the cloud in every silver lining. For my mother, life’s positives outweighed its negatives, but just barely.

When she lost all but her peripheral vision to macular degeneration and could no longer read, drive or teach, the scales tipped in the opposite direction. Whenever an acquaintance died or received a diagnosis of something swift and painless, her reaction (often to the dismay of those around her) was “Oh, that lucky fellow.”

Her greatest fear was of a stroke or some other catastrophe that would force her to live on for unwanted years, unable to care for herself. Her own mother, after a stroke, had spent the end of her life in a nursing-home wheelchair.

In a phone call two weeks to the day after her initial question, my mother did follow up: “Did you get a chance to think about what I asked?” Of course I had. I had spent large chunks of time obsessing about it. So I gave the only answer I could stand to give, the only kind answer I could think of.

“Yes,” I said. “If you ever need my help, of course I will help you.”

Then I changed the subject, but not before hearing the immense relief and gratitude in her voice. Even though I was quite sure my definition of “help” did not match hers, to answer otherwise would have been cruel. What did it matter, I thought; she couldn’t possibly hold me to it, and with a little luck it will never come up. And in fact, the subject did not come up again for more than a decade.

A couple of months short of her 87th birthday, my mother began to complain repeatedly of being unable to work the remote for her large-screen television. Each time she said this, someone would painstakingly walk her through the steps. But a few days later something would go wrong and she would need help again. A few weeks later, when her shower faucet went on the blink, it finally dawned on me that the fault might lie not in the remote or the faucet but in their user. I persuaded her to see her internist, and I called to let him know my concerns.

The internist called me right after her appointment to tell me she was being admitted to the hospital. She was wheezing, and a chest X-ray showed pneumonia. In addition, the brain M.R.I. showed several lesions — strongly suggestive of a tumor.

Multiple scans and doses of antibiotics later, the pneumonia was reclassified as a lung tumor and the brain lesions as metastases. My mother was put on steroids, and after considering and rejecting brain irradiation, she left her home near Boston and moved into a hospice five minutes from my house in Philadelphia.

She lived three more weeks — three weeks during which the only help she ever asked of me was to bring her chocolate milkshakes (which I did, often several times a day).

The night she died, I sat with her. She was unconscious by then, seemingly comfortable but breathing more and more rapidly, her skin growing more and more mottled. As I held her hand and mopped the bubbles from the corners of her mouth, I remembered a conversation we had had in the hospital in Boston right after her doctor had given me the results of her chest scan. I had told him that I would give the news to my mother.

My mother knew there were “masses” in her brain (she herself was calling them tumors), so I expected the news not to be a great surprise and, more than likely, welcome.

When I finished speaking, she looked concerned and frightened, making me wonder whether all her talk of wishing to die had been just that — talk.

“What if I don’t go quickly?” she asked. “What if this takes forever?”

“It won’t, Ma,” I answered, relieved at such an easy question. “Everything’s going to be O.K.”

“Are you sure?”

“Yes,” I replied, with the certainty I knew she craved and trusted. “All the tests confirm that it won’t be long now.”

Tears filled her eyes. “Do you remember, years ago, you promised you would help me if I ever needed it?”

I nodded.

“Well,” she said, “you just did.”

Ellen D. Feld, M.D., is an internist who teaches at Drexel University in Philadelphia.
November 11, 2008