She chose it all on the day she died (Euthanasia)

The Oregonian ^ | 9/30/07 | Dan Colburn

[wagglebee]

Lovelle Svart woke up Friday knowing it was the day she would die.

There was much to do. Her family and closest friends would be gathering at 11 a.m. in her mother's apartment in the Southwest Portland assisted-living center where they both lived.

She directed trips to the grocery store and even called AAA to jump-start the dead battery of her 2006 Scion. She double-checked delivery of food platters from Fred Meyer: turkey sandwiches, strawberries and grapes, pretzels, almonds and sparkling water. There would be pink roses on the dining table and a boombox in the corner to play music, including the polka tunes she loved.

Lovelle made one last trip to "the bridge," a wooden footbridge in a nearby park where she had found quiet sanctuary the past few weeks as painful cancerous tumors spread from her lungs through her chest and her throat.

The consummate planner, she had choreographed the day. She wanted to leave time -- five or so hours -- for storytelling, polka dancing and private goodbyes. And at 4 p.m., she intended to drink a fatal dose of medication, allowed by Oregon law, that would end her life.

A smoker since age 19, Lovelle found out five years ago that she had inoperable lung cancer. Radiation and chemotherapy slowed the cancer's spread but could not stop it.

In June, Lovelle's doctor warned her that she was likely to die within six months, making her eligible for Oregon's unique, 10-year-old Death With Dignity Act.

What some call doctor-assisted suicide and others call physician aid-in-dying or hastened death is one of the most passionately argued issues in U.S. medicine and politics. Proponents frame the question in terms of personal choice, death with dignity and freedom from pain. Opponents say assisted suicide violates the Hippocratic tradition of "First, do no harm" and undermines the doctor-patient relationship by turning physicians from healers into accomplices of death.

Far more people ask for a lethal prescription than actually use the drug. Either their symptoms overwhelm them before they make a final decision, or they find other ways to control those symptoms, including pain.

Lovelle was determined to keep control, if possible, of when and how she died.

On July 1, she filled out and signed a one-page form titled, "REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER." By signing, she agreed that she knew the expected result -- death -- and was aware of alternatives, such as hospice care.

By law, she also had to make two oral requests at least 15 days apart. Her doctor wrote the prescription for a lethal dose of barbiturate in late July, and she had it filled Aug. 7. She kept the orange bottle of clear liquid in a plastic grocery bag on a stack of towels in her bedroom closet -- "hidden in plain sight," as she put it.

She was still unsure whether she would take the drug, but said she took comfort in knowing it was there.

Once she knew she had less than six months to live, Lovelle also decided to try to start a more open public discussion of dying. During the past three months, mostly through a series of online video diaries for The Oregonian, she shared publicly the experience of facing death.

Lovelle, 62, has "touched a chord" by chronicling her "deeply intimate struggle with mortality," said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University.

"People are following closely," Tolle said Friday. "They want to know what happens to her.

"Lovelle has become their friend."

Friday morning, Lovelle stuck a yellow note on the door of her mother's apartment: "Please Do NOT Disturb. Unless Urgent. Thank you."

She wore a blue sweat suit over a "Cancer Fighter" T-shirt.

Lovelle delighted in Friday's blustery weather and a forecast that included possible thunder and lightning about the time she planned to die. "Oh, the woo-woo crowd will have a blast with that," she said.

After AAA jump-started her car, she left the engine running to recharge the battery, returned to her apartment and set the kitchen timer for 10 minutes to remind her.

When a friend later expressed shock that Lovelle had spent part of the last morning of her life dealing with a dead car battery, Lovelle explained:

"The car goes to my sister. I didn't want it to be dead."

In the living room, her family and friends sat and told stories and jokes, sometimes with political references. Sometimes they laughed a bit too loudly, out of nervousness at the occasion. Twice, Lovelle came out of the bedroom where she was having private meetings to say, "No politics!"

A bit later, Lovelle and George Eighmey, head of Compassion & Choices of Oregon, an advocacy group that works with most of the Oregonians who end their lives under the Death With Dignity Act, danced a brief but rousing polka.

By midafternoon, the studiously punctual Lovelle was falling behind her schedule. No one complained.

But a little before 4 p.m., she decided it was time to make her final preparations. First, she had to take the two pre-medication pills -- to calm her stomach and control vomiting. They were hard to swallow, given the tumors in her neck, but she got them down with water.

"It" would be in about an hour, she told her family. Time now to sit alone with her mom, Vi Svart, in her bedroom for the last time. The rest of the group sat in the living room, debating whether they wanted -- and whether Lovelle wanted them -- to be in the room with her at the end.

Lovelle's three siblings and her mother, despite deep misgivings about her decision to end her life, supported Lovelle in her choice.

"I feel so at peace," she said. "I've had such a good time. . . . And today has been so wonderful.

"I'm really ready to go. I'm ready."

About 4:30, Lovelle announced she wanted "a hugging line" -- one last hug for everybody. "You'll be first and last," she said, turning to her mom.

Lovelle stood in the center of the living room and embraced them one by one -- long hugs with tears and laughter.

Then one last cigarette break on her favorite sitting stone next to the parking lot. Afterward, Lovelle took the elevator up to the third-floor apartment and hung up her coat and hat.

"OK," she said to no one in particular. "I'm going to get into bed now."

In many ways, Lovelle fits the pattern of Oregonians who choose to end their lives under the Death With Dignity Act.

Like most, she had cancer. She was in her 60s. Well educated and insured. Not formally religious. White. Enrolled in hospice care.

And fiercely independent.

"I could be very gregarious -- and very private," she said. "Very much the partygoer -- and very much want to stay home and read."

She was chosen Miss Cafeteria at Crater Lake Lodge in the summer of 1963, and she has the lemon-yellow rayon dress to prove it. She left it hanging in a plastic dry-cleaning bag on her bathroom door.

She loved surfboarding and polka-dancing and both her first and last names, "because they are different, and I like things that are different."

And she liked, as she was the first to admit, being in control.

Lovelle decided it was more important to die by taking the lethal drug while she had a degree of control over her body than to wait for nature to take its course. But how to decide when?

Her symptoms -- shortness of breath, stomach distress, weakness and pain -- were intensifying. If she waited too long, she would be unable to drink and swallow the lethal drug on her cupboard shelf.

Lovelle sought a shifty window between life-worth-living and incapacity, "this tiny bit of freedom" when, for her last act, she could swallow a fatal potion in the company of family and friends. "That's when I want to go."

Last Sunday, after a painful, restless night, Lovelle decided it was almost time.

Swallowing was more painful than ever, like choking on broken glass or razor blades, she said. She had barely eaten in two weeks. She started taking morphine to dull her pain.

She told family and friends to come Friday.

Lovelle sat on the foot of the bed, while 10 others gathered around. A photograph of Lovelle as a curly-haired 5-year-old stood on one bedside table; on the other were a glass tumbler containing the liquid medication, which looked like water, along with a container of morphine and Lovelle's ever-present mug of Gatorade. On the wall above the head of the bed were five more family photographs.

With some help, Lovelle yanked off her shoes and socks and slipped partway under the covers.

Eighmey stood by her bedside. He has attended more than three dozen deaths of this kind.

"Is this what you really want?"

"Actually, I'd like to go on partying," Lovelle replied, laughing before turning serious. "But yes."

"If you do take it, you will die."

"Yes."

Ever the detail person, she reminded him that she wanted her glasses and watch removed, "after I fall asleep."

Eighmey warned her that the clear liquid would taste bitter. She needn't gulp it. She would have about a minute and a half to get it down.

Lovelle dipped her right pinky into the glass and tasted.

"Yuck," she said. "That's why I need the Gatorade."

Holding the glass, Eighmey asked her again to affirm that this was her wish.

Yes, she replied.

Someone asked, "Can we have another hugging line?"

One by one, they came to head of the bed for hugs and teary whispers.

"Sweet dreams."

"It's all right."

"I know."

"Thank you for being my big sister."

"All the church is praying for you."

Lovelle was sitting up in bed, three pillows propping her up.

She held the glass tumbler in her right hand, raised it to her lips and drank. It was 8 minutes after 5.

"Most godawful stuff I ever tasted in my life," she said, making a face before taking a sip of Gatorade and plain water.

She laid back and scrunched down under the covers, glasses still on to see her loved ones.

She reached for her mother, who leaned closer, then laid down next to Lovelle, stroking her hand.

"Are you OK, honey?"

"I'm fine, Mom."

"You're not sick?"

"No. I'm peaceful. It stopped raining, the sun's out. And I've had a wonderful day.

Her eyes closed.

"It's starting to hit me now."

For a while, no one moved or spoke, as Lovelle drifted into a coma. Then Lovelle's mom asked for a prayer. Others spoke up with prayers and memories, which prompted other stories. Lovelle's brother Larry read part of William Wordsworth's "Intimations of Immortality."

Lovelle lay motionless but for the gentle rise and fall of her chest. Her heart slowed but didn't stop.

About an hour into the vigil, Lovelle's mom lit three white candles in cut-glass candlesticks in the living room. "She's still with us," she said.

Hours passed. Given what Lovelle's body had been through -- not only lung cancer but also open-heart surgery in 2004, Eighmey was surprised how long she was lingering. But not her family.

"I hate to say this," one said with a smile, "but this is just like her."

"A little spitfire," agreed another.

"Above average -- that's Lovelle."

"One last reminder that she's the one in control."

Jane O'Dell, a volunteer for Compassion & Choices, sat at Lovelle's bedside all evening, holding her right hand, monitoring her breathing and regularly checking the pulse in her wrist and neck.

About 10:30 p.m., more than five hours after she had taken the drug, O'Dell signaled that Lovelle's breathing had become shallower and more labored. Her pulse dropped, her skin turned pallid and her fingernails bluish. It was more than a minute between breaths.

Family and friends resumed their bedside vigil, and silence again fell over the dark room. Lovelle's chest stopped moving.

Eighmey leaned over at 10:42 p.m. and put his ear to her chest to listen for a heartbeat. He stepped back, shaking his head and spoke in a quiet voice.

"She's gone."

[mamelukesabre]

I don’t understand these people that keep saying they want to be “in control”. I can understand being afraid of the pain and misery. But the control thing leaves me confused. Do they really think they are in control? God is in control. We control nothing. It seems to me only a fool would be convinced he/she has control.

[LaineyDee]

I guess it depends on the State... and the Dr’s.

[Old Professer]

No one has the right to commit suicide, they just await opportunity.

[longtermmemmory]

This is about “duty to die” creeping in.

Eventually the government will say, society says you must die because you are a burden.

[Alouette]

control freak

Exactly my thoughts as I read this creepy obituary.

[LaineyDee]

Do you have any first hand experience with someone dying who’s body has been ravaged with tumors? This is not a tv or movie death where they simply close their eyes and are gone.

Watching your mother suffer must have been terribly hurtful to you. May I ask if she had any hospice care toward the end?

[MarkeyD]

I wasn’t talking about the “uncomfortable spectacle”. She was the most religious person I have ever met, but I knew her feelings and she would have taken the option had it been available to her.

[Old Professer]

The writer paints with a fine line, each brush lays its layer on a slowly built canvas; careful not to lose sight of his horizon, he draws his strokes toward the point where all lines lead, but in his haste to display his finished work, he loads his brush and leaves a smudge.

[MarkeyD]

No hospice, just a visiting nurse and my brother, sister, and I.

[Dianna]

Don’t say what you will do, or not do, until you get there.

Bless you, my FRiend. I hope you store up a lifetime of memories in the time you have left.

You never do really know how you will react in any given situation. As many FReepers know, I lost my 14 year old son not quite a year ago. If someone had asked me, prior to Derrick's death, how I would react, I'd have said, "Find me a padded room and a straight-jacket."

Well, I have found strength I never knew I had. Angels have walked by my side. Sure, I'd prefer to have my kid and the belief in myself as a weak person back in a second! But I didn't get a choice and I guess I have to take whatever "good" I can get.

I wish you strength, as much as you need, to do whatever you need to do.

[kcvl]

GEORGE EIGHMEY
Democrat

George Eighmey helps people kill themselves, from showing them how to fill out the paperwork required by Oregon’s assisted suicide law to handing them a final glass full of lethal “medication.” He has, by his own count, watched two dozen people kill themselves.

“That’s chilling,” says Dr. Kenneth Stevens, a cancer doctor for 38 years, who doesn’t share Mr. Eighmey’s enthusiasm for suicide. “I went into medicine to take care of patients, not to harm them,” Dr. Stevens told Catholic San Francisco. “Assisted suicide is the ultimate abandonment of the patient.”

Mr. Eighmey, a former state legislator, is executive director of Compassion in Dying of Oregon. His organization “handles roughly 80 to 85 percent” of the people who kill themselves under the terms of Oregon’s “Death With Dignity” law, he says. The law, an initiative known as Measure 16, took effect in late 1997.

Dr. Stevens, chair of radiation oncology at the Oregon Health and Sciences University, is president of Physicians for Compassionate Care, a group whose mission is to preserve the doctor’s traditional role as healer and to “speak out for the inherent value of human life.”

[Old Professer]

“the Red Shouldered Hawks will soon be hunting the hay fields”

I think you just wrote your tagline; such a powerful, certain, image-laden phrase.

[Old Professer]

My comment wasn’t personal - it was directed toward the notion that what one can’t control should present itself as an object of shame.

[figgers3036]

I watched my grandfather waste away due to lung cancer. But if anyone ever suggested he take something to stop the pain and commit suicide, he would have been appalled and immediately whip out his Bible and try to rationalize that person away from that line of thought.

It was tough. He was on oxygen and had hospice care. I remember the giant hospital bed taking up the entire family room. But he didn’t want to miss out on anything happening in his family. My grandmother has said that he loved watching all of us grandkids go through school, and was fighting so that he could see us all go through. He didn’t make it, but he still wouldn’t ever have thought of taking his own life. To him, it would have been selfish.

[JamesA]

We lost my beautiful daughter, Jennifer, Octover 22, 2004. She had been forced to drink Liquid drano by 2 men who raped her, beat her and tried their best to kill her. She had lost her stomac, her esophogus and all her teeth due to malnutrician. She was fed through a feeding tube and was with us eight hard, yet wonderful years after the incident. She hurt and suffered for sure, even shed a few tears but absolutely refused to give up, she loved the Lord and witnessed to many by telling her story. How proud her mother and I are of her, and how humbling an experiance it was to watch her share her experiance with others in similar circumstances. Today thinking back I remember asking God why he didn’t just take her home, remove her suffering. Jennifer taught us that Life has a purpose, we may not like it or even understand it but Gods will, be done in his time not ours. Is it right for someone to terminate their existance?, I just don’t know, I will leave that up to God and know he will be right every time. Our Jennifer was 32yrs old with two beautiful daughters and husband when the Lord called her home, she simply went to sleep one morning with no more pain, no more suffering and only glorious days ahead in a new body.

[LaineyDee]

I think she would have benefitted greatly with hospice care. It is such a blessing to patients such as your Mom. There are pallative measures such as pain and anxiety meds that relieve most of the suffering....giving the family and patient a better quality of life together .... even though the patient is actively dying.

I had a misconception of hospice because of what I read about Terri Schaivo... but since working with it the past few months....I have to say I've never been associated with such caring staff, Dr's and nurses. They do everything humanly possible to make the loved one's death a non-traumatic event.

I've sat in meetings to discuss care strategies for dying patients... and it is amazing to hear the compassion and concern coming from these professionals. It's been a real eye-opener for me.

[wagglebee]

Thank you so very much for telling us Jennifer’s story.

God Bless you and your family.

[stentorian conservative]

I think this is definite slippery-slope territory.

So a healthy twenty-year-old is involved in an accident and is now a quadriplegic. No pain and no dignity. Are the same options available to him? And who decides what is or is not “suicide worthy?”

I’m not judging anyone here. I was taught not to judge in Sunday School. I was also taught where suicide would get me.

[Nachoman]

Dang, this woman did more on her dying day than I do on my best days. I hope I don’t have a burst of energy like this when I kick the bucket.

[LaineyDee]

Jennifer taught us that Life has a purpose

And if that was her "purpose"......she fulfilled it graciously.

The Lord gave me a poem years ago...(now published) during a traumatic time in my life. I too asked why He just didn't take me and get it over with. He revealed to me "His Purpose". It's not just about us... what we want .....or who we think we should be.