Let Me Go

I regarded my relationship with a patient as a contract between partners. I provided training and experience; the patient was entitled to know what was happening and had a right to help make decisions. Sounds simple, but with implications.

I had just moved to the community on Lake Superior’s North Shore where I still live. I first encountered Josephine in the aisles of Johnson’s Food Market. She struggled to separate one package of laundry soap from its fellows while at the same time juggling a cane, both with her right hand. I realized that her left arm was shriveled, held tight against her side in the manner of one riven by a stroke. When she thanked me for handing the box into her cart, I saw that one eye was locked uselessly to the side. Her speech was intelligible, but with a hitch, a hesitancy.

Josephine consulted me in my new office a few months later. I have forgotten the reason for her visit. She was fifty-something at the time, plump, pleasant and clear mentally. I asked about her neurological problems.

“I was twenty-two,” she said. “It was during labor when I was having my daughter. They told me a blood vessel burst in my head. I’ve been the same ever since.” She looked down for a moment, then straight at me. “Since that has come up, Doctor, I have a request. If I ever have a bad stroke, one like you read about where you are unconscious and aren’t going to get any better—I don’t want to be kept alive with feeding tubes and—that kind of thing. If it happens, and you are my doctor, would you just let me go?”

Let me go.

I heard those same three words many times over the years. My mother-in-law mumbled them to my wife, Barbara, and me during the one lucid moment she had while enduring those degrading last days of her life. And I remember the dear friend dying of lung cancer who, when I awakened her during hospital rounds each morning, blinked at me, then said, “Oh no, I’m still here. Let me go.”

Josephine and I made a pact: No therapeutic heroics, no prolongation of a vegetative condition. No feeding tubes. We did not sign any papers, and no one thought to involve an attorney. Our pact was in words and understanding and belief in each other. That philosophy left over from generations past, that “My handshake is my bond,” sealed our agreement.

Years went their way. I received a call from the hospital one evening. Ambulance arrived. Patient unconscious. Need you.

The patient’s breathing was stertorous, her body flaccid, and she made no response to even painful stimuli. Characteristic neurological signs indicated massive brain damage. Josephine had suffered the “wipe-out” stroke she had dreaded. Now decisions were on my shoulders by way of our pact.

I conferred with a daughter and grandchildren, informed them of our agreement those years before.

“She told us,” they said.

Times change, social pressures alter. Politicians involve themselves and guarantees between two people can be called into question.

I squared my shoulders, figuratively.

“I intend to honor our pact,” I told the family. Her daughter nodded quietly. I said, “I will give her intravenous salt solution and water, because dehydration is hideous for all of us.”

“As you decide,” her daughter said.

I made daily hospital rounds on Josephine. She never stirred; her coma never lightened. And she survived without an ounce of nutrition for twenty-seven days. My resolve was a battered husk by the end of that time. Memory of the pleading in her eye, come down through those intervening years, sustained me, and I am sure that I did what she wanted.

My pact with Josephine was not unique. I know from conversations with colleagues that, “Let me go,” is still quietly honored.