Making end-of-life choice a brave act

My old friend Anita did something extraordinarily brave: she chose the time for her own life to end.
Her death was not by suicide.  Neither was it the result of her earlier, well-thought-out directive to physicians that, if she were incapacitated, she would not want any extreme, life-prolonging interventions. It was simply an acknowledgement that her earthly time was drawing to a close; she merely requested nothing more than palliative care for herself.
I’ve known Anita since our childhoods, when our families were neighbors and friends; we were even further united when one of her cousins married one of my aunts. But as we grew older, distance pulled us apart. We met again many years later, here in Dallas.
I’ve learned to recognize some coincidences as times when God has chosen to remain anonymous. I moved here in 1980, and soon had a welcoming call from a neighborhood bridge club. It was Anita on the phone. I didn’t recognize her voice at first, but its distinctive Pittsburgh “accent” was enough for me to pose the questions that led to our joyous reunion.
Then, a decade or so later, she and her family moved away. But this time we did not lose touch.  So it was during a visit to her Florida home, about 10 years ago, that I saw for myself the first sign of something very wrong: Her hands were shaking. Parkinson’s, perhaps? No. The diagnosis was hydrocephalus — more commonly known as “water on the brain.”  With it come other difficulties, including physical weaknesses and mental lapses, always accompanied by fear.
Treatment begins with insertion of a shunt in the skull to drain off the offending liquid.  However, this is not a cure. Anita went on with her life, but it would not ever be the same. And after another long decade filled with doctoring and cautious watching and waiting, the disease worsened, with all symptoms augmented. So a second shunt was placed …
The phone call from Anita’s husband came not long after Yom Kippur. She had decided, following that second operation, that enough was enough. Throughout the High Holidays, while welcoming the New Year, asking forgivenesses and praying earnestly to be renewed in the Book of Life, my friend accepted that her future was at best faintly penciled in, not written boldly with ink. She was weary of illness and the treatments that would never provide full cure. So she called the halt herself. No more shots, pills, or therapeutic regimens. She told her husband she was dying, and she knew it, and asked to be placed in hospice care.
“I fought with her at first,” he told me during our post-death conversation. “But before long, I knew I had to acknowledge she was right.” She could never again experience anything but painful existence, full of unsuccessful treatments to keep only her breath, rather than her whole self, alive.  So he agreed. After that, Anita personally invoked her own new directive to physicians. She passed away, peacefully, a mere three days later.
The whole family rallied around — her siblings and her husband’s, their three children, their five grandchildren — the oldest of whom will be married late this month.  Anita had hoped to attend the wedding, but when she realized that, even if she would live that long, she would not be able to celebrate it in person. She decided it was time to let go.
Hydrocephalus is not a common ailment. Surprisingly, I have a second friend also suffering from it, with all its mental and physical affects. Don has memory problems and bouts of depressive paranoia; his loving wife could be a proper poster person for caregiver frustration and fatigue.  His choice, however, is not Anita’s; he soldiers on with the shunts, the shots, the pills and the therapies.
Is Don right?  Was Anita right?  How can I know? But I can acknowledge the bravery inherent in both their choices.

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