Signed Up for MAID

MAID is one of those super easy to remember acronyms. It stands for Medical Assistance in Dying. When I first heard about it I was incensed at the bureaucratic roadblocks in place before I could have access to this service. Specifically I was pissed at the idea that I would have to give ten days advanced notice before a doctor could be summoned to put me in park and turn off my ignition. It’s not that I’m against planning. But the thought of setting a date ten days in the future and having to wait through the ten days did not appeal to me. I’m an impulsive person. I want to make up my mind when it’s time to leave the party and just go.

And of course I’m perfectly capable of going out sideways (as my dear father was fond of calling it) without anybody’s help. A tank of nitrogen from the welding supply place and a plastic bag would do the trick nicely. But that still left the possibility of failure. Nothing would embarrass me more than failing to kill myself.

I once talked to a paramedic who arrived on the scene mere seconds after a man put both barrels of a double barrel shotgun under his chin and pulled both triggers. Ten days later he walked out of the hospital, minus his face. They saved his life. The shotgun pellets were deflected by the shape of his skull during the process of sweeping off his jaw, lips, and nose. Now, to me that sounds like a very serious suicide attempt, and the cruelty of saving his life is truly monstrous.

I read about a man who shot himself in the head with a pistol, and then walked around for a while, visiting a variety of locations, thoroughly confusing the police investigators, before succumbing to his injury. That also sounds like a serious attempt, followed by a whole lot of no fun.

So medical assistance is a very attractive option, if they will just cut the red tape and let me do things my own way. And now it turned out they will.

When I mentioned my concerns to my wonderful palliative care team, they told me that the ten day waiting period begins with putting in an application. Once that happens, and ten days elapses, a request for help finding the exit can be made at any time, and can proceed immediately. Well, that’s more like it. I made an appointment with our family doctor to get the process started.

I was told that a face to face appointment was required, and that took well over a month to achieve in these times of Covid19. I went in expecting my doctor to print out some forms and ask me some questions and then the clock would start on the ten days. But when I arrived at my doctor’s office, it turned out that the system had been adjusted and he wasn’t hip to the changes. There are now only two doctors in Nanaimo who do assessment. I was given the name of one of them, Dr. F______, and a phone number. I called. She asked me to go online to download the application form, fill it in, get it signed by two witnesses and myself all at the same time, and get it back to her. That happened in a day. Two of our best friends signed the form for me, I scanned it, and emailed it off. The next day Dr. F________ called to set up a time for a video interview. That happened last night. Now the form she has filled out goes to another doctor who will also get in touch with me to set up a video interview. But the ten days clock is now ticking.

I really enjoyed my conversation with Dr. F_________. It turned out the main point of the interview was to determine whether I qualified for MAID, i.e. do I have a terminal illness and do I not have a mental disorder and do I seem to be making rational decisions. As near as I can tell I passed this qualifying lap with flying colours. I told Dr. F_______ that I really appreciate her willingness to do this kind of service, and that I feel a distinct affinity for her as a person. I told her that if hers is the last face I’m ever going to see, I’m okay with that. She smiled, and seemed to take that as a compliment. I asked her if she would be willing to arrive dressed as death and carrying a scythe. She seemed to think that could be possible. She has attended some wild end of life parties at funeral homes in the past. I have the scythe hanging on my shed wall in the back yard. I might make a cardboard blade for it, just to make sure nobody get hurt.

Death AKA the Grim Reaper image

Years ago when Doctor Kevorkian was trying to goad the government into charging him with murder so he could present the case for medical assistance in dying, I watched him terminate the live of a man with ALS. That was a disturbing video. It was all so quick and clinical. The man was asked whether he wanted to die, replied that he did, and Kevorkian injected him with drugs that would accomplish that result. There was no emotion on display by anybody. It wasn’t an attractive ad for medical assistance in dying, but it did get Kevorkian arrested, tried for murder, and jailed. So it served it’s purpose.

Now Canada has made medical assistance in dying legal, if certain rules are followed. The catch is that I will have to be able to give conscious and enthusiastic consent right up to the last minute. I can’t be unconscious, or unable to communicate. I won’t be able to write out instructions for my wife in the event that I have a stroke, or lose the ability to speak. This means I will have to set a date and be ready to go when that date arrives. I’m getting used to that idea.

Co-incidentally, my son Casey phone me the night of the call from Dr. F______. Casey is a paramedic. He has seen what happens if people miss the opportunity to die when they want to, and he doesn’t want to see it happen to his father. So he is totally on board with the MAID program. We talked about my interest in having a green burial, and Casey suggested that I could be buried in a green way on his beautiful property up in Salmo. He also said he would be honoured to be a witness to my death. That all prompted the following letter:

Subject: my current thinking about my inevitable demise.

Dear Casey:

Thanks for that phone call last night, and for your invitation to have a green burial on your property.  I had my first interview with Dr. Marcia F______, one of the two doctors in Nanaimo who are doing assessments and taking registrations for the MAID program.  That brought up a whole bunch of issues and things for me to think about, so now it’s four in the morning, I can’t sleep, and I wanted to write a some of this stuff down.
First I want to say that you can’t say fuck off to the authorities and just bury me on your property.  They would make you disinter me and replant me in a certified cemetery and, even with a long and expensive court battle, they would succeed in making that happen.  I love the idea of you establishing a family plot on your property.  Rather than taking up your time, I’ll do the research and find out what it will take to get you certified as a small cemetery.
My thoughts on my death have evolved a lot since my diagnosis.  I used to think that I didn’t want to see death coming, that I wanted to be walking in the park without my tinfoil hat and garbage can lid and get hit by a meteor and instantly gone.  But as I get into the conversations with you and with friends, I realize that I wouldn’t miss this time and experience for anything.  Already I’ve had the magical trip to Scotland with Rod and Ruth and Rod’s daughter, Kipling.  Who knows what other delights await me. Ruth wants us to plan our endings, and I’m all for that.
I also used to think that I didn’t want to make any kind of a fuss.  I thought I wanted to make a “French exit” from the party, one where you slip quietly away without anybody noticing that you are leaving until they realize that you are gone.  I’m now changing my mind on that too, and now thinking that saying goodbye to everybody could be a nice thing to do. So here’s the sequence of events as I fantasize it happening:
When I feel that the time is right, I want to set a date for a celebration of my life party.  I’d like it to happen here in Nanaimo, with invitations sent to everybody I have ever known, possibly in the Wellington Hall a block from our house if it looks like there will be more people coming than would fit comfortably in our house and yard. I would like a banner in evidence someplace stating: “This is not about you.” I’d like it to be a wild and joyful party, with plenty of booze and smokables and food, though I’d like to discourage people from actually getting drunk or stoned.  Just enough to lower inhibitions and set a party mood. (I may change my mind about this and make it a dry party.  The last thing I want to have to deal with is a bunch of emotional drunks.) I’d like mostly live music and an open mic for people to take a turn saying whatever they want to say to me, good or bad.  I’d like to MC the event myself. I’d like the party to start early, say about four in the afternoon, and go until eleven in the evening.
At some point, probably around eight o’clock, Dr. F________ will arrive.  She thinks she’d be okay with coming in costume dressed as Death and carrying her medical equipment and a scythe (which I can provide).  I’d like her to be welcomed warmly by everybody there, and given maybe half an hour or so to meet people and enjoy the party.  Then she and I, along with Ruth and you and a select group of family and friends, will slip away and go to our home.  There I would like time to have a shower and a shave and lie down on our bed with everybody gathered around me as Dr. F_______ puts the IV’s into my arms.  I think she said that the process takes about ten minutes and is much like going under anesthetics for an operation.  That being the case, I’d like to relax and listen to Philip Dyson play Scott Joplin’s “Solace” as I slip from consciousness. At the moment I think I’d like to have all of this video taped, but that may change after discussions with Ruth and others.  Maybe it would be better to keep it private and intimate.
Once I’m dead, I would like my body to be transported to Salmo to your property for a green burial.  I’m going to investigate the permissions required for this to happen.  And from this point everything is out of my hands and control.  So whatever happens will be up to you, Ruth, Laara, and possibly other relatives who want to be involved.
You need to make sure that your family is okay with all of this.  That’s a lot for your kids to deal with, and from Kiri’s reaction to the mere mention of palliative care I’d guess there will be some emotions to process.
So that’s it for tonight.  Once again I want to make it clear that I’m hoping for at least one more hunting season with my friend Rod, and as many going into the future as my health allows. So this is all long range planning.

Any questions?
Much love
Dad

Since writing this letter I have investigated getting permission for a green burial on Casey’s property. It turns out to be something that I can’t do, and he doesn’t have time to do. So that part of the plan is up int he air. I also realized that by the time I’m ready for a visit from Dr. F________, I will probably be too sick to MC a party, and probably too sick to want to experience a party. So who knows how much of this fantasy will come to pass in the end. But it is an interesting fantasy, eh.

I’m sure there will be more to say about all of this later. If you have any feelings or opinions about what I have written, in this or any other post, please take a few minutes and add a comment. I get the feeling I’m screaming into the void here, but I do know that some people stumble on my blog and read it. It this is you, please leave a comment.

All comments gratefully received.

Contingency Plans

I’m still dealing with the fact that I am terminal. This condition comes with all kinds of thoughts and considerations, but mostly questions. I can tell that I’m in decline. That’s obvious. But how long do I have? And how will I know when my time is really running out? Exactly how terminal am I? After all, we are all terminal, eh.

The doctors are unbearably optimistic. It feels like they are in denial, or like they don’t want me to get upset and do something premature, like offing myself. But it seems obvious to me that a time will come when I will want to head for the exit door. When the party is over, I will to want to leave quietly, skipping the indignities and pain of a long and lingering circling of the drain.

I chose this image for circling the drain from a Google image search. Most of the images available showed the screen of the drain blocking larger chunks from going down. But this one conveys the real horror of the expression: There’s nothing to catch me when the inevitable happens and I’m sucked down into that black hole of oblivion.

I was quite annoyed when I read that, according to the rules of MAID (Medical Assistance in Dying), ten days notice is required before I could have a doctor’s help in doing myself in. You mean, I would have to pick a date ten days in advance of a visit from Dr. Kevorkian? Then I would have to lie around waiting for his arrival? This would be hard to take. I don’t want some bureaucrats dictating how and when I exit this planet. I just want them to get the fuck out of my way. So please, just give me the pills or the syringe and walk away.

And then, once the ten day cooling off period had passed, I would be required to sign my name to a consent form? What if I can’t do that? What if, during the ten days, I have slipped into an intermittent coma? What if I become a brain locked in an unresponsive body, unable to speak or move or hold a pen?

Yesterday I learned that my understanding was flawed. I was discussing my situation with the palliative care treatment doctor, Doctor Katherine King, a kindly maternal woman who checks in on me once a month and never gives me any argument about renewing my opioid prescription. I was explaining that my fear is of being blind sided by a sudden loss of capacity or cognitive ability which would prevent me from giving consent. I know that my situation can change overnight. A stroke. A fall. A further loss of function. And suddenly it’s obvious that my life is not worth living. At that point I want to just go. I don’t want to have to make an application and wait ten days, hoping that when the ten days are up I will still be able to give consent.

Dr. King, or maybe it was the angel who was on the conference call, Angela J. Lorenz RN BSN CHPCN(C)Palliative Care Coordinator, Island Health ((Angela, Such an appropriate name.) informed me that this isn’t the way it works. The ten days notice is from the point when I make an application to be on the program. Ten days after that there is no waiting period. I will be able to just call the doctor and exit, assuming the doctor will make a house call.

So it’s more like buying a gun with the intention of shooting myself and having to go through a waiting period before I can take possession. Once the waiting period is over and I have the gun, I can put it to my head and pull the trigger whenever I’m ready.

That’s a comfort. Now if I can just talk them into giving me the medication and leaving it with me, to use when and if… But this isn’t going to happen.

Of course, what I really want is to give my sister or my wife written instructions to send me off as soon as I’m unable to communicate. Then I could stop worrying about losing control. But this is not allowed under the present rules.

Hopefully this will change as the public becomes more accepting of our right to terminate and the damned Catholics stop raising objections. For now, ability to confirm consent is required up to the point just before the medication is given that will put this amazing body into park and turn off the ignition.

It’s another beautiful Fall day. The squirrel is back at the bird feeder that I hung on the clothes line. For now there’s still a lot to enjoy about being alive. I’m just making contingency plans, eh.