Beyond Heaven and Earth

by Steven H. Propp

  “That’s good,” Jobran said. “I’m sure that most people wish they had more certainty to back up their own supposed convictions.” He shook his head, and said, “If there’s anything I’ve learned since my wife died, it’s that nothing on earth is certain. Different people believe different things, but no one can convince the others. That’s why we all end up in our isolated little silos—and we’re afraid to

  come out of them.” “Even at the end of their lives, for some of them—like Mr. Phillips,” Etta said. “Even at the end of their lives,” Jobran agreed. “Some people just choose to die

  the same way that they’ve lived, I guess.” Etta raised her glass to Jobran as if proposing a toast, and said, “Whereas, oth

  ers of us choose to live the same way we would want to die!” “That’s definitely a better path,” Jobran concurred. And they clinked glasses.

  34

  A GOOD DEATH?

  Jobran was making his rounds, going from room to room, seeing if there was anything he could do for the patients: make them more comfortable, get them anything, or just sit and listen to them.

  He knocked at the door to one room. When he heard no response, he assumed the patient was asleep, and was about to go on to the next room, when he heard a peculiar sound: the “squeak” of rubber wheels on a clean floor, and of metal groaning from being stretched. Alarmed, and fearing that the patient might be tossing and turning in his sleep and gotten tangled up in his life-support apparatus, he entered the room quickly. He saw the patient turned over halfway on his side, fully conscious, manipulating the mechanism that his oxygen tubes were attached to.

  “Mr. Kramer, what are you doing?!” Jobran exclaimed in shock, as he rushed forward. As gently as he could, he detached the man’s hands from the apparatus, and he attempted to turn him back over. Jobran’s presence seemed to remove all energy from the man, and he limply allowed Jobran to place him meekly back on the bed.

  “Mr. Kramer, sir, what’s wrong? Are you having trouble breathing? Do you need me to call a doctor?”

  The patient shook his head. “No; in fact, the doctors around here are the whole problem.”

  Jobran finished making Mr. Kramer as comfortable as he could. “You shouldn’t ever touch your apparatus, sir; you might have cut off your supply of oxygen.”

  In a matter-of-fact voice, the patient replied, “That’s exactly what I was trying to do.”

  Horrified, Jobran said, “But why? Are you in pain, or…”

  “Always,” he interrupted.

  “Have you talked with the doctors? Surely they can give you more medication, or something stronger.”

  “I’ve talked with them,” he said, wearily, ending with a coughing spasm. “But I’m a terminal cancer patient; so there’s only so much they can do.” He laughed lightly, causing him to cough again, and added, “But they don’t want to increase my dosage of medication because One: They’re afraid I’ll be so doped up, that I won’t know what’s going on, and Two: They’re afraid of making me a drug addict. Christ, I wish those were my biggest worries!” He coughed again, violently, and Jobran held on to him until the spasm passed. “Goddam cigarettes; got hooked on ’em in while I was serving in ‘Nam, and didn’t quit until I was diagnosed.”

  “Do you need a doctor, Mr. Kramer?”

  “Call me Nick.”

  “Nick.”

  “No, I don’t need a goddamn doctor, unless you can find one that will give me what I want,” he said, bitterly. A glint of remorse showed in his eyes, and he said, “I don’t mean to take my problems out on you, son.”

  “It’s no problem at all,” Jobran replied. “That’s what I’m here for.”

  “So anyway, they won’t increase my dosages, so I lie here on this bed of pain, day in and day out.” He closed his eyes, deep lines of pain and worry etched into his forehead. “I mean, hell: I’ve got terminal cancer—what are they afraid of? Do they think that if I get hooked on my medication, that I’m going to bust out of here, and break into their nice suburban homes in order to support my drug habit?”

  Jobran laughed, involuntarily. After a moment of silence, he said, “But why would you want to take your own life, Nick?”

  “A young person like yourself can’t possibly understand,” he replied. “But you can reach a point to where life is actually an intolerable burden to you, and being relieved of it would be the most welcome thing you can imagine.”

  Jobran thought for a moment, then said softly, “Actually, Nick…I believe that I can understand what you mean.” He took a deep breath before continuing, then said, “My wife passed away nearly two years ago. Since then…well, let’s just say that my life lost most of its meaning.”

  Nick looked closely at Jobran, then nodded. “So maybe you can see where I’m coming from.” With a sharp look, he added, “Maybe in my situation, you’d feel the same way.”

  “Maybe,” Jobran agreed.

  Nick said in a bitter tone, “You know, I never thought I’d be in this position; my wife and I both signed Living Wills, stating that no ‘extraordinary’ means would be taken to keep us alive, and that in the event of us lapsing into an unrecoverable ‘vegetative’ state, being declared ‘brain dead,’ and so on, they could disconnect our feeding tubes, and such.” He gave a small humorless laugh, which set him off coughing again. “Unfortunately, neither of us expected that I’d be in the position of being fully conscious and of sound mind, where my body is just dying slowly, bit by bit, day by day, in a process that requires months.” He shook his head, and said, “Why doctors think it’s OK to withhold treatment that will result in your death, yet in a similarly hopeless situation they just let you drag on and on, prolonging the inevitable, is beyond me; why not just go ahead and end the person’s life now? What’s the point in waiting?”

  “Well, I guess it’s because of the laws,” Jobran said. “Doctors don’t want to get sued, or put in jail for murder.” He looked at Nick, and asked softly, “Does your family know how you feel?”

  “Yes,” he said, bitterly. “But they’re as helpless as I am to do anything about it. And so here I lie, draining all of my family’s economic resources, for what purpose? My wife’s going to have to sell our home for sure, and my kids have already taken out a second mortgage on theirs, just to cover my day-to-costs.” His eyes filled with tears, and he added in a shaky voice, “Oh, they try not to show their worry, but I know it drags on them, constantly. My wife Shari looks like she’s aged ten years since I’ve been in here.” He balled his fists together in frustration, and said, “If only I could convince them to let me take all this money and effort they’re devoting to a hopeless case like mine, and put it into some kind of ‘medical savings account’ for my grandkids, or something, in case they ever really need an expensive treatment.” He gestured toward the wall of sophisticated instruments behind and around him, and said, “All this just to keep me alive against my wishes? Sounds like throwing away ‘good money after bad,’ to me.”

  “It’s a terrible situation you’re in for sure, Nick,” Jobran said, with genuine sympathy. “Is there anything—anything at all—that I can do to help you?”

  For a moment, Nick had a flash of hope in his eyes. “Turn off all these damn machines,” he said, with assurance, “And let me die, finally.”

  Jobran was shocked and jumped up, before replying, “I can’t do that! I’m not a doctor! And I’m certainly not going to do anything that would result in your death—I became a hospice volunteer to try and enhance life, not to take it! I’m here to try and comfort the suffering, not kill them.”

  Nick coughed again, violently. With a note of desperation in his voice, he said, “But none of the doctors here is willing to take the chance of being prosecuted for murder. But you can take that chance—you’re only here part-time, no one would ever suspect you. And the nurse made her rounds just before yo
u came in, so it will be almost two hours before anyone else pays me any attention….” His eyes were pleading, as he whispered, “Please believe me: You would be doing me the greatest act of kindness possible. No more suffering, no more lying pointlessly here on this bed, causing grief and expense to my family. They wouldn’t have to go through watching me die, either; they would just get a phone call from the hospital, and…”

  Jobran jumped up, and backed away to the window, saying, “I can’t do something like that; the whole idea’s ridiculous.” Then he sat down again, forcing his voice to be reasonable and calm, and said, “And anyway, you can’t end your life in a hospital; you’re hooked to all of these technical monitoring systems. If you were to stop breathing, the resuscitation teams would be alerted.”

  “Bringing me back to life, whether I wanted it, or not,” he said, wearily. “They know there’s no cure for me. So the only hope they can only offer me more drugs, to try and dope me up, but none of these damn doctors is willing to do anything at all to end my pain, for good. And all they have to do is give me a damn overdose, and I’d just go to sleep and be at peace, finally….” The effort of speaking caused him to have another violent spasm. Jobran sat by him, holding him up from behind the shoulders, until the attack finally passed. When it was over, Nick collapsed back in his bed, exhausted, and gasping for breath. But with one last superhuman effort, he asked Jobran, “If you were in my situation…wouldn’t you ask the same thing? Wouldn’t you want to be put out of your misery, just as you would put an animal that was suffering to sleep?”

  Jobran was silent for a long time, as he pondered the question. Finally, he answered in a soft voice, “Yes, I think I would feel the same as you, and that I would ask to be put out of my misery.”

  A note of hope in his voice, Nick pleaded, “So, can’t you do this for me, then?” A crafty edge to his tone, he added, “Think of it as being a ‘practical’ application of the Golden Rule: You’d be doing for someone else what you would want them to do for you.”

  Jobran rose, and headed to the door, then turned back and said, “Look, there’s no way I can do anything like that; I wouldn’t even know what to disconnect or what to turn off, even if I was willing to.” Then, from the doorway, he called back, “But maybe I’ll see if I can speak to your doctor…” and he turned and hurried away.

  He went into the restroom, glad to see that it was unoccupied. He splashed cold water on his face, and dried it with a paper towel. After he finished, he stood staring at his reflection in the mirror, with Nick’s question burning into his brain,

  “If you were in my situation…wouldn’t you ask the same thing?” and Jobran

  knew with absolute certainty that the answer was “Yes.”

  Jobran exited the restroom, and headed to the Nurse’s Station.

  The nurse coming on duty smiled as she recognized him, and said, “Hi, Jobe; how’s it going?”

  “Hi, Sandra,” Jobran said, as he shrugged his shoulders. “For me, fine.”

  “Your shift over?”

  “Yes,” he replied, but added, “Say, who is the doctor in charge of Mr. Kramer?”

  Sandra looked concerned, and said, “Mr. Kramer? Is something wrong? Or is he having a bad day?”

  “He’s having a terrible day.”

  “Poor thing; I’ll have a nurse check on him,” she said, shaking her head with concern, as she looked something up her computer screen. “You feel so helpless; there’s just nothing you can do for cases like his.” Finding what she was looking for, she clicked her computer keyboard, and said, “His doctor is Dr. Secrist.”

  Jobran nodded his head with recognition. “What time does he come on duty?” Jobran asked.

  “Actually, he’s already here, until 2:00; he’s just making the rounds right now; if you wander around in the halls, you’re bound to see him sometime.”

  “Thanks! I’ll see you later, Sandra…,” and he left to begin searching.

  After about fifteen minutes, he noticed Dr. Secrist coming out of a patient’s room at the end of the hall. Jobran hurried toward him, as he stood while he was making notes on a clipboard, before he had a chance to enter another patient’s room.

  “Excuse me…Dr. Secrist?” Jobran asked, somewhat out of breath.

  The doctor looked up, and recognized Jobran as one of the hospice volunteers. “Ah, yes…Mr. Winter, isn’t it?” Jobran nodded, and the doctor added, “And what can I do for you this fine afternoon?”

  “Actually, there’s nothing I need,” Jobran said, “But I think Mr. Kramer needs something.”

  Dr. Secrist nodded at the name, and said, “I haven’t gotten around to him yet, today. And how is he? Something urgent?”

  “To him, yes,” Jobran replied. “Not medically, I mean. He’s in a lot of pain, and…”

  The doctor interrupted, and said, “I thought that might be the case. I’ll probably increase his level of medication again after I see him, and he should be all right then.”

  “I don’t think it’s just his level of pain that’s the problem,” Jobran said. “When I entered the room, he was trying to shut off his own oxygen, to kill himself.”

  Dr. Secrist looked startled. Then he said quickly, “Of course you realize that a bedridden patient can’t reach the controls of his life-support mechanism, so he couldn’t have actually…”

  “I know,” Jobran interrupted. “But the fact that he seriously wants to take his own life is…well, isn’t that significant to us? Maybe he needs to be allowed to go home, or…”

  Dr. Secrist shook his head, decisively. “Unfortunately, in his case, it would be impossible to continue the treatment he needs at home. He’s one of the cases that must remain at the hospital, where we can continue his treatment.” He thought a moment, then added, “If he was at the very end, when treatment wouldn’t prolong his life at all, we could let him go home to die, basically; but he should live for several months, even with the worst prognosis.”

  “So he has to stay here, even though you know there’s no chance of him recovering?” Jobran asked, pointedly.

  “There is always a chance of recovery,” Dr. Secrist said, firmly. “Cases of spontaneous remission in cancer patients abound—even in some cases almost as advanced as his.”

  “But what is the purpose of keeping him alive when he doesn’t want to live?” Jobran asked, plaintively.

  Dr. Secrist looked carefully at Jobran, then said quietly, “We keep him alive because of how unique and valuable each individual human life is. We keep him alive in the hope that one day he will understand what a precious gift it is that he has, and he shouldn’t squander it, by taking his own life.”

  Jobran shook his head, and said, “Unfortunately, I think he’s beyond that point now. He seems to have lost his will to live.”

  Dr. Secrist nodded, and said, “That may be true right now; but who knows what can happen in the future?” Then, in a more sympathetic tone, he said to Jobran, “Look, I know what Mr. Kramer wants: I’ve read his Living Will, and it was very clear that he wants no life-sustaining measures to be taken in the event of brain death, or his entering a persistent vegetative state—but that’s not his case. Although he thinks that his oxygen tubes, and intravenous tubes are ‘keeping him alive,’ that’s not true; the pure oxygen just helps him to breathe more comfortably and reduces his coughing, and it would take him weeks or months to die if we removed his feeding tube.” He removed his glasses, massaging the bridge of his nose, then replaced them. “Look, Mr. Winter, like almost all other doctors, I have no problem with terminating or withholding life-sustaining treatment for terminal patients who, after due consideration, do not desire it—I’m talking about cases where the life support mechanisms are merely delaying the inevitable death, and recovery is not realistically possible. I would even be willing to cease such treatment for a patient in a vegetative co
ndition, if the next of kin requested it properly. Activists sometimes call such actions ‘passive euthanasia,’ but that term is really a misnomer: All we’re doing in such a case is allowing nature to take its course; that is, ‘Nature’ as it was before modern medical science invented so many new sophisticated techniques to sustain and preserve life.” He gestured toward Mr. Kramer’s room, and said, “But that’s not what Mr. Kramer wants,” Dr. Secrist said, passion in his voice. “He wants what they call ‘active euthanasia,’ meaning that he wants us to take some ‘positive’ steps toward deliberately ending his life. In my case, specifically, he wants me to give him an overdose of drugs.”

  “And you can’t do that?” Jobran asked. “Even if not openly?”

  Indignantly, the doctor said, “It happens to be illegal—even in California—for a doctor to knowingly give or prescribe a lethal dose of medication; that’s the kind of activity for which a doctor can lose his license to practice medicine, not to mention be brought up on charges of murder!”

  “Suppose that not only Mr. Kramer agreed to take the lethal dose, but his family agreed as well; then could you do it?” Jobran queried.

  Dr. Secrist shook his head, looking at Jobran almost as if he were some unenlightened savage. “Mr. Winter, it’s no more legal to be killed by a family member—or with their consent—than for a doctor to do so. The family’s wishes are of course often determinative where the person is comatose, or not competent to act in his own behalf, but they don’t overrule the law.”

  “Even though it would be completely voluntary on Mr. Kramer’s part?” Jobran asked, incredulously. “I mean, suicide isn’t ‘illegal’ any more, is it?”

  “No, but assisted suicide is,” the doctor replied, curtly. “Suicide isn’t a ‘crime’ any more—we don’t put people in prison because they try to take their own lives—but as a society we do actively try to prevent people from taking their own lives, because we know from long experience that 95% of suicide attempts are made by persons with a diagnosable psychiatric illness, and the vast majority of suicides are experiencing temporary depression, and are ultimately very glad that they were prevented from taking their own lives.” Grimly, he said, “That’s the problem with suicide, ‘assisted’ or otherwise: once you take that action, you can’t take it back, or change your mind. That’s why we physicians are so opposed to people like Jack Kevorkian—nicknamed ‘Dr. Death’ by the media—who run around ‘assisting’ people with taking their own lives, when they hardly even know the person, much less can accurately diagnose their psychiatric condition. Sometimes, you have the feeling that these people are ‘rushing’ to take action, fearing that they won’t have the same opportunity later.”