Friday, August 1, 2014
I didn’t lose more weight, maybe I’d even gained a pound or two. Never imagined I’d be happy about that one day. It didn’t mean my odds were any better, but it meant more normalcy, more strength, and more me. At least for a little while.
I was sporting a new look these days. A lot less cancer patient, and a lot more pale and pixie cut. My spiky, short hair gave me an edgy look that was every bit as badass as I felt when I managed to keep breakfast down.
“Need a coat?” Kyle entered the foyer, watching me slip on my shoes.
“Probably should,” I replied, since I’m still always cold, despite the extra pounds. He wrapped the jacket around my shoulders and slid my arms inside. “Thanks.”
There was a stiffness to him. The way he was looking down, moving with restraint. He was holding something back, though it was no secret what. He wanted to stop me—my plans dashing his hopes for a miracle. But, he said nothing.
He opened the front door and ushered me to the car. A few minutes later, we pulled up in front of the hospital and headed up to Dr. Morales office. A nurse pointed us in his direction and we found the doctor seated at his desk, flipping through my file when we walked in.
“Mrs. Falls, great to see you again,” he said with a friendly smile. He stood and shook my hand, then Kyle’s. We greeted him, then took a seat on the opposite side of his desk. He lifted a file and flipped through a few pages inside. “So, I got the report from Dr. James.”
I leaned forward. “What did she say?”
He cut right to the chase. “She believes you know the options available to you, and have come to your decision of your own free will with a full understanding of the ramifications.”
I clasped my hands together. “Does that mean I’m approved?”
He shook his head. “No. Dr. James provides a recommendation I will use to make the final determination.” Dr. Morales folded his arms on the desk top, focusing his gaze on me in earnest. “Mrs. Falls, in the two weeks since we last spoke or you met with Dr. James, it would be completely natural to have had second thoughts or to change your mind.”
“I haven’t,” I reply quickly, cutting him off. “Not even a little.”
Dr. Morales slowly nodded his head, leaning back in his chair. “Let’s get started, then. There are quite a few legal steps we’ll need to satisfy.”
I let out a long exhale, releasing the tension I’d been holding. It was finally happening. After everything I’d done to get here, the relief at knowing it had all been worth it was freeing.
“I’ll need a second verbal and written request.” Dr. Morales handed me a piece of paper and a pen before standing. “I’m going to ask my colleague to witness. In the meantime, please write down your request.”
He left the room, and I immediately began writing.
Dr. Morales To Whom It May Concern:
It’s about goddamn time I, Tessa Elizabeth Falls, have fucking cancer a grade four glioblastoma with a terminal diagnosis. I have chosen to use dope ass pain killers palliative care and hospice measures during this time, and want to be prescribed an end-of-life medication. I’m smart as hell fully informed and capable of making this decision of my own free will. This is my second request after the insanely long fifteen-day waiting period.
Signed,
Tessa Elizabeth Falls, 8/1/14
“Tessa?” Kyle squeezed my knee as I placed the pen down, finally coming up with a good letter despite no direction and crossing out half of it. “Are you sure about this?”
“I’m sure.” I nodded. “I’ve been working toward this for months.”
“I know, but you can change your mind… even after you have the meds. No one would fault you.” He laced his fingers through mine. “We could wait?”
“If I wait, I could miss my chance entirely.”
Kyle looked so defeated that my heart twisted in my chest. I brought his hand to my face, laying my cheek against his palm. “Can you do this?”
His eyes found mine, shimmering green as tears welled on his lower lashes. He shook his head. “I’m not leaving.” He slid his palm down to my chest, my heart beating beneath his touch. “I want to feel this forever.”
My pulse quickened at the low tenor of his words. I was sure he could feel the throbbing ache of my heart against his palm. “Kyle,” I started. “I—”
“Dr. Paul, you remember the Falls.” Dr. Morales walked in.
Kyle’s hand dropped to my lap, where I squeezed it tightly in one of mine. We exchanged greetings and introductions before I handed him the written request.
Dr. Morales took a seat behind his desk while his colleague leaned against the wall, his hands in his white coat pockets. “Everything looks to be in order. Before the verbal request, let’s discuss the decision you’re making on record—for legal protections.” He held up a tape recorder.
I could probably recite the speech he was going to give at this point, but I didn’t mind rehashing it. The law was difficult. It needed to be that way, and, truthfully, I appreciated that.
He clicked play on the recorder and set it between us, giving a verbal introduction of who he was and then asking me to state my name and current legal state of residence. Dr. Paul also introduced himself, along with Kyle, before Dr. Morales started his spiel. He reiterated my diagnosis, life expectancy, and confirmed that I understood the limitations to the medical prognosis. We discussed the second, third, and fourth opinions—all of which resulted in the same accounts—as well as Dr. James’s evaluation.
He then launched into treatment options, how further radiation and chemotherapy could possibly extend my life by a few months. I shuddered at the thought of going through those again. The pain had been intolerable, and there was no doubt I couldn’t handle a second round. Dr. Paul mentioned clinical trials and experimental medications and procedures I could try. I gave them both a resounding no to each. Feeling certain I understood the choices, Dr. Morales discussed the palliative care I’d be receiving to make my transition into hospice as painless as possible.
Finally, after what felt like hours, he broached the topic of end-of-life medications. “If approved, you’ll be taking two medications. Let me make very clear, Tessa, that you are the only one who handles them.”
“Will the nurse be there?” I asked.
He nodded, leaning against his elbows on his desk. “She will, and she’ll assist in case of emergencies and to assess time of death. Medication administration is entirely your responsibility. No one can hand them to you, help you take them. Nothing. This has to be entirely decided by you and acted out by you, with no influence from anyone else. Any third-party assistance, no matter how small, can result in legal action—even criminal prosecution.”
“Criminal?” Kyle looked as surprised as I felt. “But it’s legal.”
“The Patient Choice at End of Life statute last year made it legal for the patient to self-administer the medication. Any other involvement isn’t protected under that law,” he explained. “It’s a stretch, but it’s safer not to risk it.”
“That’s fine. I can do it alone.” I squeezed Kyle’s hand to assure him.
Truthfully, I didn’t want anyone to help anyway. My family was already struggling with the very idea of me dying, and I certainly didn’t want to add to their pain by involving them further. This was a decision I had to make and be fully responsible for—fully in control of.
Dr. Morales glanced at his colleague who nodded discreetly. “Good. You’ll take them simultaneously, but they’ll take effect at different times. The first will make you lose consciousness. You’ll feel nothing after that point. The second will stop your heart. Your organs will shut down, and you’ll be pronounced dead by the nurse soon after.”
“How long will that take?” I asked.
“You’ll feel the effects of the first medication in a matter of minutes, losing consciousness pretty quickly. There have been rare exceptions of twenty or thirty minutes, but the average is five minutes,” he told me.
“And the second pill? The one that stops her heart?” Kyle asked this time, a slight tremble moved through him. I held him hand tighter.
“That is harder to estimate. It varies based on the individual’s body, but can be as soon as thirty minutes, to as long as ten hours.”
I gasped, my stomach sinking with a sickening thud. “Ten hours?”
My main reason for taking the medication was to avoid pain and prolonged death.
Dr. Morales continued, “Correct. However, you’d be unconscious during that time. Your family, on the other hand, would be aware of the situation. It’s something you need to consider, if that’s a possibility you and your family are ready for.”
Kyle’s face paled beside me.
“You are able to change your decision at any time. Whether now, or after you receive the medication. If it’s after, you’ll need to turn the medication over to us to be properly disposed of. Dr. Paul, is there anything I’ve left out?” he asked the young doctor still leaning against the wall.
“I don’t believe so,” Dr. Paul confirmed.
Dr. Morales returned his focus to me. “Mrs. Falls, if you’re ready, we can hear the second verbal request.”
I’d been ready for weeks. “I’ve thoroughly considered my options, followed the legal steps, and I’d still like to be prescribed the self-administered medications I need to end my life.”
Kyle exhaled sharply, turning his head to face away from me.
“Works for me.” Dr. Morales looked at his colleague. “Dr. Paul?”
The second doctor stared at me then nodded. “I’m satisfied.”
“Mrs. Falls, there are quite a few documents you’ll need to sign,” Dr. Morales began, pushing my papers into one large file.
I jumped in. “And then I’ll get the prescription?”
“I’ll send the prescription directly to our hospital pharmacy to fill it. It can be difficult to find pharmacies to fill it, but the hospital will.” Dr. Morales put my file in a cabinet drawer, then turned back to me. “However, I can’t give it to you today. You’ll need to return Wednesday.”
“Why can’t she have it now?” Kyle asked what I was thinking. These trips were exhausting, both physically and emotionally. I wasn’t looking forward to a repeat performance.
“Legally, a forty-eight-hour waiting period after the second verbal request is mandatory before I can write the prescription.” He offered me an apologetic smile. “During Wednesday’s meeting, you’ll have another chance to change your mind, if you so decide. If not, I’ll write the prescription and send it to the pharmacy.”
Kyle sighed. “Jesus Christ.”
I swallowed my irritation—or tried. “Okay, but by the end of Wednesday…I’ll have the medication?”
“If you don’t change your mind beforehand, yes,” he confirmed.
“Damn.” Kyle dropped my hand and rubbed the scruff on his jaw. “I didn’t know we’d have to wait again.”
“We can come back Wednesday.” I was annoyed, too, but in the grand scheme of what we’d gone through to get here, I could wait a few more days. Unless a miracle cure for cancer was discovered in the next week, my decision was made.
His brows furrowed. “We’re leaving Sunday for a week.” Kyle gave me a sheepish smile. “Surprise, we’re going on vacation.”
My mouth fell open. “A trip?”
“Even better,” Dr. Morales said. “More time to consider. We’ll schedule for Monday, August eleventh.”
Kyle leaned closer to me. “You don’t mind waiting longer?”
I shook my head. “Where are we going?”
He winked. “It’s a surprise.”