Chorus of voices grows stronger for 'death with dignity'

[okarol]

Chorus of voices grows stronger for 'death with dignity'
Maintaining control of when and how they die is an important desire for those who wish to avoid burdening loved ones at the end of their lives.

By Steve Lopez
December 18, 2012, 5:48 p.m.

The bullet that Larry Robert Broman used to kill himself went clean through his head and into the wall.

No one had expected him to do it. Not his ex-wife, who had remained close to him. And not their two grown daughters.

It happened early on the morning of Oct. 21.

"I heard a noise and ran down the hall," said his oldest daughter, Heather O'Hara, who forced her way into the back bedroom of her Riverside home, where she'd been caring for her terminally ill father. "His hands went limp. The gun was in front of the sofa and he was sideways."

Broman, a 65-year-old born-again Christian and former Air Force flight mechanic, had grown increasingly miserable about the indignities he suffered as lung cancer spread through his body. O'Hara suspects he had hidden the 9-millimeter handgun in the folds of the sofa and waited for his moment. A visiting hospice aide, who had stepped into the next room, said Broman's last words were, "Lord, please forgive me."

I've learned a lot this year about that appointment that awaits us all, some of it from personal experience. In February, my father died, and in August I nearly followed. My mortality wake-up call came in a hospital after knee surgery, when I flat-lined because of a heart arrhythmia and was resuscitated by a nurse.

In response to columns about those events, stories have streamed in from people who are running out of time themselves, or enduring the pain of watching loved ones fade. The deaths they face are as different as the lives they've lived, but a steady refrain runs through their emails and letters.

People want more control in the end. They want to be in charge of one last thing.

These people speak a common language, linked by a desire to have lethal, doctor-prescribed medication as a legal option, as do residents of Oregon and Washington. When they can't feed and bathe themselves, when all privacy is lost, when they become a burden to loved ones, they want an exit. They live in fear not of death, but of languishing interminably without purpose or joy.

I've felt privileged to be let into their lives.

The patch job is still faintly visible on the wall of the bedroom where Broman took his life. A company called A-1 Clean the Scene was called in to eliminate the bloodstains.

The agony hasn't waned for his daughters and ex-wife, who wish they had sensed the full depth of his desperation. There's anger, too, along with the guilt. Why couldn't the hospice staff have done a better job of easing his pain? And why aren't there humane options when the suffering has become too great?

"Why couldn't the doctor here have offered … an option saying, 'When you get sick of this, Larry, all you have to do is mix this up and drink it?'" asks Rebecca Beal, Broman's ex-wife. "Part of the horror of all this is thinking of that moment … knowing this was his only way out … when he actually took the gun and had to pull the trigger."

Amy Brackett, Broman's youngest daughter, said that when a pastor visited the house not long before the shooting, he asked her father what his one prayer would be.

"I want to go to heaven, and I want to be with God," her father said. "But I don't want to have to go through this to get there."

Talking about death with dignity is a charged subject. I've heard criticism from people of faith who say life and death should be left in God's hands. But Larry Broman's daughters and ex-wife, all of them Christians, feel differently. They say they've begun advocating on their Facebook pages and elsewhere for better alternatives to prolonged and painful deaths.

O'Hara points out that those who say death should be left in God's hands often take drastic steps to prolong their lives using ventilators or feeding tubes. "They condemn you for taking your life, but they don't condemn you for being artificially kept alive."

At the funeral, the pastor told mourners that Broman's last act was not a selfish one. He was in a burning building, and he jumped.

"God doesn't judge you on your last act on earth, but on how you lived your life," Beal said.

Beal said that Broman's death was particularly hard on her current husband, Sam, a doctor who had grown close to Broman, and has stage four cancer himself. "I don't know what we're facing. I have no idea," a tearful Beal said. "I'm trying to figure it out, but I've learned a lot. I've learned about what I'm not going to go through, and I'm an advocate for people to have a choice at the end."

A house of sorrow

"Recipe for death."

Those were the words in the subject field of the e-mail from Fran Measley.

"Dear Steve, as an 88-year-old caregiver of my husband for many months, I do not want my children going through the same experience with me. Would you send me the name of the concern that sells the recipe for death that you mentioned in your column.... My husband and I agreed that when we are old and infirm, death is a friend."

By the time I responded, Donald Measley, an Air Force pilot who flew supplies into postwar Germany as part of the Berlin airlift, had died. I apologized for not getting back to Fran sooner and also explained that I hadn't actually written about a specific "recipe for death." I'd written about Compassion & Choices (http://www.compassionandchoices.org), a nonprofit offering end-of-life counseling nationwide. The organization encourages terminally ill, suffering patients to discuss their wishes with their doctors, but in some cases offers advice on possible combinations of legally obtained medication that when properly self-administered, can hasten death.

Measley, a retired high school English teacher, clarified something, too. It wasn't her husband she was seeking help for. "I wanted it for me," she said. "I don't want my children going through what I just went through."

Her husband lived a good life but did not die a good death, Measley said, explaining how she fed him, cleaned him, picked him up when he fell, and patiently endured his demented outbursts. The last two years were particularly sad, Fran said, and her husband was miserable. Once, he asked Fran who she was. When she said that she was his wife, he called her a liar.

"Honey," he said one day, "I'm in the bathroom and I don't know how I got here."

Peripheral neuropathy left him shuffling along, leaning against walls and clutching furniture.

"He asked our son to shoot him, then said, 'I can't get any better, and this can't go on.' Our son looked at him and said, 'I won't do it.'"

When I visited Measley in the Santa Barbara home she shared with her husband, she vividly recalled the day she came upon him, alone in the den.

"He had a little pistol about like this," she said, holding her fingers a few inches apart. "He didn't say anything. He looked up at me."

Measley hid the gun, but wished there were a clean way out for her husband. If this were Oregon, I asked, would he have asked his doctor for a prescription?

"Yes. He would have been happy to."

Don Measley died Oct. 15 at a hospice center. He was 90. A month later, Fran's 55-year-old son-in-law died in a motorcycle accident.

"This is a house of sorrow," Measley said.

A good time to go

If Kitti Ford-Scholz, 77, was pretending not to fear death, it was an Oscar-winning performance. We sat on the patio of her red, wood-frame home looking over Oahu's Kaneohe Bay, and she told me about the funeral she'd thrown for herself in late October.

"It was a celebration of life," she said. "It was a bunch of people sitting around talking, and it was lot of laughter. Just a happy time. The lady who may be buying my house came in from Washington. A friend of mine who has a titanium spine, and is 85, flew in from Illinois. I got to see all of these people who have been so much a part of my life."

The slender and elegant Ford-Scholz was nonchalant about how terribly sick she was.

"I just found out Oct. 5 that everything was shutting down, that I have cancer everywhere. My biggest problem is that the bones are just riddled.... It's wrapped around my spine, I've got it in thousands of little nerve endings. My lungs. My ribs. My heart. My brain. And here I am. I'm not supposed to be enjoying life, but I am."

It's been a rich life, she said, with three children and an entrepreneurial spirit that led her to start her own skin lotion company. Why end it strapped to a bed or tangled up in wires and tubes?

In that spirit, she rose gingerly but bravely, and we walked to a car that was waiting to take her to a pharmacy for a prescription written by Dr. Robert Nathanson. Nathanson and an advisory council of physicians have been pushing for Hawaii — where polling suggests people strongly support death with dignity — to offer more end-of-life choices. They argue that doctors can legally prescribe potentially lethal dosages of morphine in the service of pain relief, so they're prepared to test whether there is enough wiggle-room in the law to allow them to legally offer more direct aid in dying to terminally ill patients who request it.

We parked the car and Ford-Scholz walked into the store and up to the pharmacy window alone. It seemed cruel that, in such a moment, she couldn't have a friend or family member with her for support. But she wanted to avoid any chance that someone would be prosecuted for participating in her death.

Driving back home, I saw the first hint of hesitation on Ford-Scholz's part as she held the little white bag with sleeping pills inside.

"I'm not sure how strong I am, but I think I'm strong enough to take it," she said.

We opened the bag and inside were 90 capsules.

"I'm supposed to pull 60 of them apart and dump the capsules into applesauce or chocolate pudding or something," she said. "I don't know if I can eat four ounces of something. That bothers me. There are still a lot of ifs."

In Oregon and Washington, many people who have met the requirements for aid in dying don't end up using the medication. But they say they're comforted knowing they have the option, and Ford-Scholz said the same.

Earlier in the day, she told me she was tired of hearing from people promoting one remedy or another for her health problems.

"I keep trying to tell people....I don't want it, leave me alone. I don't want it, and besides, the economy in this country is so bad, and in other countries, too, I'm kind of glad I'm leaving. I think this is a good time to go. I think you guys have your hands full."

On Dec. 6, Ford-Scholz died at home, peacefully, with two daughters at her side.

She was too incapacitated in the end to use the prescription.

The most humane option

In September, a Northern California man named E. T. Rulison wrote a letter that was passed on to me by a friend of his.

"Dear Californians planning to live out your life in this state:

"I am a physician. Since the 1940s I have been deeply dedicated to quality of life for my patients and loved ones. I am now 97, and can feel life ebbing away steadily… The majority of people I have cared for at the end of their lives desperately have wanted the dignity of ending their lives as they lived their lives, with some influence over their conditions…

"I have … friends who saw no better choice for themselves in their … suffering but to end their lives ungraciously, by suicide. The loved ones left behind were devastated by the consequences… I am encouraging you to begin conversations about the end of life choices such as are available for the dignity of citizens in other states."

Rulison lives with his wife in Cameron Park, on the eastern flank of Sacramento. Jean is 87.

"I robbed the cradle," said Rulison, whose mind is still sharp even as his body gives out.

"I don't think he's forgotten anything he ever knew," his wife confirmed.

And there's a lot to remember.

Rulison worked as an anesthesiologist with the Army Medical Corps in World War II, treating wounded soldiers in the 51st Evacuation Hospital in Europe. He went on to a long career as a general surgeon, then retired and began traveling the world with Jean as a scuba diver and underwater photographer. Together, we watched an old "American Sportsman" episode in which Rulison and "Jaws" author Peter Benchley dive in the Sea of Cortez to study the schooling patterns of hammerhead sharks, and in one scene, Rulison rides a manta ray with an 18-foot wingspan.

These days, the big adventures are history, and Rulison gets around the house with a walker and cane. He has survived a triple bypass, and about 20 years ago, oral cancer spread to his neck. Part of his face was removed, chewing became impossible, and he has existed on pureed foods for two decades.

But he enjoys reading, loves his wife's company, and he has a new cause. Death with dignity. Legislative and ballot proposals have failed previously in the state, but Rulison hopes Californians can be educated to view the option not as suicide, but as an acceptable personal choice.

"I don't want to sit around a nursing home and not know what day it is, or have people come and see me and I don't recognize them," Rulison said. "To me, that's not living."

When he decides he's ready, he will open a safe that contains a vial of methadone, a syringe and a needle. He's been holding on to that drug since he shut down his medical practice in 1976. He will squeeze one shot into each hip, he said, find a comfortable place to lie down, and that will be it. If he is too feeble to manage that on his own, he has arranged for someone to help.

I asked why he would do it that way rather than starving himself. Not eating or drinking will certainly do the job, Rulison said. But why shouldn't we all have the most humane option available to us?

"It's quicker and neater, I think, to do it my way. I'm just eliminating two weeks of starvation. It gets messy toward the end. You get so weak you can't take care of yourself."

There is no trace of fear in his voice.

"I have a rather pragmatic view of life," Rulison said. "To me, we're born, we live, we die and we're recycled into new life."

In his letter to California, Rulison ended with this:

"Perhaps these last encouragements before I myself die with dignity will fall on listening ears."

steve.lopez@latimes.com

http://www.latimes.com/news/local/la-me-lopez-dignity-20121219,0,2923995,full.column