Right to Die

by Hazel McHaffie

  Still no word of Lydia. Must be serious. But I haven’t tried again to infiltrate the health professional mafia to find out exactly what’s going on.

  Today a judge passed down a life sentence on a father who battered his eighteen-month-old toddler to death. The pathologist reckoned the injuries were equivalent to those sustained in a road accident.

  What kind of a father does that sort of thing?

  Life, the reporter first off the blocks at the close of the court proceedings said, is mandatory for murder, but then immediately he started talking about what the judge will deem the appropriate time before this guy is eligible for parole.

  *(For Ideas Folder: life sentences. Incl. mine.)

  22 JULY—I’m starting to wonder if Naomi’s seeing me differently now that I’ve begun to show unmistakable signs of my illness.

  ‘D’you think you’d be okay if I wasn’t back till late on Wednesday?’ she suddenly asked me, a bit breathlessly, as she changed the sheets on our bed.

  ‘Sure thing. Why?’

  ‘I’ve got appointments. I can ask your mum to come over, if you like.’

  ‘No, please, no!’ I said, wringing my hands in exaggerated pleading, and whimpering.

  She shook her head at me.

  ‘As long as Dr Devlin gives you the go-ahead then.’

  ‘I’ll bribe him!’

  ‘Seriously, idiot. You sure?’

  ‘Yeah, sure thing. I’m tons better. And I’m steaming ahead with my novel right now, so you’ll be back before I notice you’ve gone. I promise I won’t do anything silly.’

  ‘Fat chance!’

  ‘You know what I mean. I’ll be as careful as Aunt Matilda’s granny.’

  ‘There’s plenty of hotpot left. Just reheat that in the microwave. You won’t limp around carrying hot dishes, will you?’

  ‘I’ll be good, Nanny. Honest.’

  ‘I mean it. I don’t want to come home and find you burnt as well as crippled.’ As soon as she’d said it she realised. ‘I’m sorry. You know what I mean.’

  ‘Course I do. One smash-up is enough to be going on with. I’ll be careful. Promise.’ I crossed my heart with a pious look. ‘Where will you be?’

  ‘Oh, just in Edinburgh.’

  ‘One of your cases?’

  ‘A mixture of things. I’ll ring you to check.’

  ‘Okay. But don’t worry. I’m tons better. And I’ll just have seen the Devil.’

  ‘Adam!’

  I rather like the idea of testing my own independence. If Naomi’s here she automatically assumes certain roles. I lead a pretty pampered life, thanks to her efficiency. My female writer-colleagues bemoan the lack of a good wife; I know what they mean. I shouldn’t have allowed this state of affairs to emerge in our household, but somehow I have.

  Dr Tweedy Curtis called in this evening. He flexed a few joints and asked a few personal questions but I seemed to pass his mini-test, because he made some flip comment about not keeping a good man down.

  He’d brought back a book I’d lent him, a brilliant medical thriller about a serial murderer who developed aplastic anaemia. I’d been impressed by the twist in the tale, and thought Curtis might appreciate its medical cleverness. The killer went on to have a bone marrow transplant from his sister. Result: when he was a suspect years later the forensic people said he couldn’t be the killer because his DNA didn’t match the samples from the crime scene. Naturally, the hotshot detective got hold of some distant relative and winkled out the story of the transplant and hey ho, the villain’s clapped up in jail and they’ve thrown away the key.

  Curtis had a fascinating take on some of the medical aspects and I reckon when I’ve written the first draft of my own bestseller, I could do worse than ask him to cast his eye over it.

  If I was going to be around long enough, I’d suggest we put our heads together to devise a cunning plot for a new novel, but that’s not going to happen now.

  ‘D’you remember telling me I should talk to Naomi about the end bit?’ I said.

  He startled and looked at me oddly so I realised that my train of thought wasn’t obvious to him.

  ‘Sorry,’ I grinned, ‘The thoughts were connected in my head.’

  ‘I do remember, yes,’ he said carefully.

  ‘Well, I know you’re right, but I must admit I haven’t got round to it yet. I don’t know, we just seem to have lurched from one crisis to another these past few weeks. She’s had a lot on her plate lately. Some pretty difficult cases on just now. And what with my accident and the cat and everything…’

  ‘The cat?’

  ‘Ahhh. Yes. Cassandra. A stray we adopted years ago. She managed to acquire something or other incurable and had to be put down about three weeks ago now.’

  ‘I’m sorry. Not easy. Even with a pet.’

  ‘Indeed.’

  ‘Sounds like you’ve both had a bit of a plateful one way and another.’

  ‘Exactly. I don’t want to add to her stress.’

  ‘Sensible. Best to leave it till she’s more herself,’ he offered vaguely.

  ‘Will do.’

  ‘How are you coping with all these things – on top of your MND?’ He was looking at me directly now, something watchful about his concentration.

  Naomi drew in her breath sharply. Had Dr Curtis given the game away? Adam was obviously picking something up from him.

  It made me pause and think before replying.

  ‘Okay, I think, thanks. A bit rough once or twice but getting there.’

  ‘Are you still finding the physio helpful?’

  ‘Indeed I am. Knowing how to do ordinary things as well as what exercises to do helps. I’m able to keep going for longer and my muscles don’t ache as much. They also give me permission to rest – and I’m afraid I need permission! Even now.’

  ‘I know what you mean,’ he grinned understandingly.

  ‘But I have to admit I miss Lydia. She’s a one-off. No disrespect to Véronique but Lydia is in a league of her own. Any chance she’ll be back soon?’

  ‘She’s due back on Monday, actually.’

  ‘Ahhh. Brilliant. It’ll be good to see her again.’

  ‘You know about her, yes?’

  ‘Know what?’

  ‘Why she’s been off for a couple of months?’

  ‘No. They wouldn’t say. Nothing serious, I hope.’ I didn’t like his tone.

  ‘Her husband died suddenly. A heart attack. Only in his forties.’

  ‘Oh no! How appalling. Poor Lydia.’

  We sat in complete silence for a long moment.

  ‘Should I… would it be acceptable to send a message?… break the ice before I see her… professionally, I mean?’

  ‘I think she’d appreciate that.’

  Long after he’d gone I sat there immobile, thinking about Lydia and the impact of her loss. I wish I’d known. It seems so heartless to have said nothing, done nothing. And if Curtis hadn’t told me, I’d have gone in there all cylinders firing and trampled all over her pain.

  Naomi let out her own breath slowly. Lydia to the rescue again. Unwittingly. Or was this Dr Curtis deliberately deflecting attention away from her?

  23 JULY—I left loads of time to get to the clinic this time. For some inexplicable reason I didn’t want Devlin to see me staggering about. Why I should crave good marks from this bloke who surrounds himself with all shades of ungainliness is beyond me, but there it is. I just do.

  He was jaunty in red and navy today. But he seemed to be feeling the heat; a thin film of perspiration stood on his forehead and twice he fiddled with the fan on his desk, angling it towards his face. It didn’t so much as stir the immaculately combed hair on his head, but he had to weigh down his papers with the stapler.

  And his hand was shaking.

  He wanted to know all about the accident, which bits I’d hurt most and so on. He listened to my unvarnished account of the increasing weakness, but declared himself impressed by what I could still do in sp
ite of my recent collision with a BMW.

  ‘Are we doing everything we can to help?’ he asked.

  ‘More than I ever expected,’ I told him, praising Lydia and Véronique and Curtis in particular. ‘And I appreciate your seeing me ahead of schedule too.’

  ‘Let us know if you think you could do with anything else. Our aim is to keep you as mobile and independent as we can for as long as possible.’

  ‘Well, there is one thing…’

  ‘Yes?’

  ‘Can I ask you a couple of questions – about later… you know… the end?’

  ‘Certainly.’ He sat back, steepling his fingertips with his usual precision.

  ‘If I were to ask for help to die, would you respect that?’ I blurted it out before I could lose my nerve.

  ‘Well, we would certainly respect the wish.’ He didn’t so much as startle.

  ‘But you might not do what I ask?’

  ‘Well, we must and do, I think, respect deeply-held sincere views but we have our own medical standards and professional conscience, and that too must play a part. Patients certainly have the right to state their preferences but they cannot be allowed to dictate the moral values of medicine.’

  ‘In my book, a miserable, protracted life is far worse than dying.’

  ‘I can understand that. But some of the biggest advances of recent years have been in the field of palliative medicine.’ He paused for effect and, almost furtively, wiped his upper lip with his finger. ‘Patients are often surprised themselves at just how much better things are than they anticipated.’

  ‘So would you ever give them something to help them on their way?’

  ‘Some doctors are more comfortable with this idea than others. It would depend.’

  ‘And that’s part of the patient’s dilemma, if I may say so. I mean, take my case: I’d give this life more of a whirl if I knew that when I said, “That’s enough,” you – or somebody who has the know-how – would be ready to help me go.’

  He was nodding slowly. ‘I quite understand where you’re coming from.’

  ‘So why doesn’t modern medicine respond to that?’

  ‘Well, we do respond, but perhaps just not in the way you’re meaning. And that’s for a number of reasons, I think. One: we’re trained to cure and to care, not to kill. And two: it’s actually very hard to be sure a patient really, really means it when he says he’d rather be dead. And, of course, there’s no going back to alter that course of management. And three: well, most of us doctors aren’t wildly enthusiastic about spending years going through nasty court proceedings.’

  He smiled rather apologetically.

  ‘I can understand why you might not want this enshrined in law,’ I said, ‘but surely doctors should have a degree of discretion.’

  ‘Many doctors would agree with you. But maybe it’s something best done quietly and unobtrusively.’

  Was he offering me hope? Who could tell?

  ‘Actually, when I was in hospital after the accident, it occurred to me – the doctors might have looked at my notes, and thought, no point in pulling out the stops for this one, best let him go now.’

  ‘Well, I doubt any doctor would make that call in your case at this moment in time.’ He gave a rueful smile and somehow one of his eyes stayed in one place long enough to convey a sort of twinkling warmth with the statement.

  ‘But say something like that were to happen when I’m further down the line. They might think, It’s futile to treat this one, best let him go.’

  ‘Well, it’s possible. But for what it’s worth, if, on the basis of his technical and medical expertise and experience, a doctor judges treatment to be futile, it’s a medical decision. The patient’s views and preferences are irrelevant.’

  ‘Really? But the doctor might be allowing his own value judgments to influence that decision.’

  ‘Indeed.’

  ‘And the family’s values might be different from his.’

  ‘Indeed they might, and that’s partly why most of us prefer to work with patients and their relatives and weigh up the pros and cons together.’

  ‘Hmmmmm.’

  ‘But to go back a step, if I may, saying that a doctor doesn’t have an obligation to treat implies it may be permissible for him to do so, or not. That’s not the same as saying he has a duty not to treat. Then it’s not permissible.’

  ‘Fair comment.’

  He shrugged but offered nothing further. I saw one of his eyes glance at the clock and took the hint.

  He gave me the usual invitation – four months, but contact us if you need to see us sooner. It appears on the surface to be bowing to the dictates of consumer-centred care but I suspect it’s actually a cloak for ‘if you deteriorate more quickly…’

  All the way home I was mulling over this business of assisted death. Maybe he’s right. Maybe it’s best left to the discretion of the medical team rather than lawyers. Maybe attempting to regulate things would just drive the practice underground – or maybe just mean different things being covered up.

  Maybe you can be too transparent. It’s a bit like protecting precious artefacts, shielding them from the full glare of natural light. Shine a dim, artificial substitute on them and their contours, their detail, may be softened but they’re preserved intact.

  And Devlin’s definitely right on one thing: doctors aren’t vending machines, churning out what patients request. He’s watched hundreds of patients with MND die. I’ve only watched one, part-way. So his clinical judgment and ethical wisdom count, as well as his technical expertise. I suspect I’ve been too defensive and too shackled by my own preconceived ideas to be receptive to all his cues up till now.

  Naomi read this entry a second time. Slowly. And again. It was amazing how clearly and objectively he could think through something so emotionally laden. Was it this that had sustained him for so long? Or was it a form of emotional denial that had also rendered him impervious to her private agony? It seemed incredible that he had not suspected, not pressed her more for an explanation.

  25 JULY—Another idea’s been squashed at birth. Seems even the fully functioning bits of my anatomy are no use for transplant purposes. I ceremonially shredded my donor card yesterday. Damn. Another door closed.

  Curiously enough it was pesky Harry who prompted me to investigate that question. I was proposing a feature on our local liver transplant unit – based around the anniversary of the first transplant ever carried out – and Harry dropped in a suggestion that we give it a donor angle. A quick tramp to see the transplant co-ordinator, and there I am joining the ranks of the outright rejected. Beryl, one of our copy editors, was turned down by the blood transfusion people after fifteen years of valiant service on the grounds of heart arrhythmia and they counselled her to death to bolster her self esteem. But then, nobody knew I was taking this journalistic strike personally.

  Hey ho. There are no perks-for-heroes in my little battle.

  Anyway, organ donation’s out. So it’s just a question of, do I want the whole wreck that currently houses my mind, body and soul to be excavated in the line of medical research? The brain and spinal cord would apparently be of particular interest – not because I’m the donor and happen to have a reasonable endowment in the upper storey, but just because they’re looking for cause and effect.

  I must admit Naomi’s feelings on this are a big stumbling block. She’s the one who’d have to live with the knowledge. I don’t want her to suffer unnecessarily.

  I desperately want to talk to her about the whole business of how much she can tolerate but I can’t seem to find a way in that feels safe. There’s something intangible around her at the moment that tells me she’s vulnerable; close to tears but gritting her teeth. And now we seem to be steering back into calmer waters, she and I, I don’t want to risk rocking the boat. I’ve tried being direct but she says she’s fine; just tired. And if I’m brutally honest, I daren’t probe too deeply. I don’t want to hear that she’s already near t
he end of her tether with me.

  Ahhhhh. So that was why.

  A quick exit from life before I need extra care seemed like a good solution on first inspection but I worry that she’ll feel eternally guilty. Or worse, think I didn’t value life with her. I guess I could write an explanation for her posthumous comfort. But my mother’s hang-ups show me just how the stench can linger.

  On the other hand, I hate the idea of Naomi having to deal with the physical side of things, of our home being tainted for her, pervaded by the aura of death and decay.

  I could, I suppose, elect to go into a hospital, or a hospice. But my big worry there is that with all those experts on tap doing all manner of aggressive things, I’d linger till long after my sell-by date and Naomi’s ordeal would just be protracted. Okay, I know they’ve got it down to a fine art, this balancing of the emotional, physical and spiritual, but I don’t want to be so successfully cared for that the dying is strung out way past the point of common sense. And I’m not convinced I’d have the strength to fight the whole bang shoot of them with all the logical right they’ve got on their side.

  I forgot to record, the other day, one point of fact. Curtis says I’m most unlikely to choke or drown to death. That’s the fate everybody fears with this particular form of dying (as he confirmed), me included. So it helps, knowing. Best not to hang your entire strategy around an inexactitude.

  The ideal? Slipping away peacefully in my sleep. How do I contrive the equivalent?

  Naomi read this extract four times. Carefully. No, there was still no hint of suspicion.

  But the memories uppermost in her own mind contributed to a particularly virulent variation of her nightmare. Mavis’s hands around her neck were relentless, her face distorted with the sheer force of her effort as she hissed, ‘Those who live by the sword shall die by the sword. A life for a life. You murder my flesh and blood, I’ll murder you.’