Choosing The Clothes To Die For

(The author is associate professor of anthropology at Brandeis University, where she teaches classes on medicine, religion, death and dying, and has emerged as a leading voice on death literacy in the United States. The following narrative is excerpted from the prologue of her just-released nonfiction book, The Day I Die: The Untold Story of Assisted Dying in America, available at major bookstores and online. You can find her at anitahannig.com and on Twitter @AnitaHannig. – Jay Niver, editor)

The morning of Ken’s death, I stood in front of my closet, trying to figure out what to wear. I knew Ken didn’t want his death to be a somber affair. He was ready, giddy even.

The drab librarian dress was definitely out. Jeans, on the other hand, seemed a little too casual. I wanted to look nice and give Ken’s death the gravity it deserved, while also honoring his wish to celebrate. As I thumbed through my hangers, I couldn’t help but feel the dissonance of choosing an outfit for someone’s final hours. Three years into my research on assisted dying, I still found myself in situations like this with no formal playbook. But if I didn’t decide promptly, I was going to be late.

Finally, I opted for a pair of striped summer slacks, a sleeveless, navy blue satin blouse, and leather sandals. Then I grabbed my notebook and ran out the door.

Thirty blocks to the east, at the foot of one of Portland’s iconic city parks, Ken was also getting ready. Though he had spent much of his life flouting propriety, he had decided to dress up for his death. In the quiet light of the morning, he trimmed his white Vandyke beard, slipped into a clean pair of khakis, buttoned his olive-colored dress shirt, and threw on a charcoal vest. He dug out his red bandanna and tied it in a neat triangle knot around his neck. Then he traded his tired plaid house slippers for a pair of elegant, pointy leather brogues.

Ken’s breakfast that day was simple: a single hard-boiled egg and a cup of black coffee laced with Fireball whiskey. Not that it was his habit to drink alcohol with breakfast – it didn’t mix well with his heart medications – but today Ken felt festive. He had waited for this day for months.

At 10:30 a.m., I met Ken’s prescribing physician, Neil Martin, in the foyer of Ken’s retirement facility. Save for his medical bag, which could have passed for a plump briefcase, you wouldn’t have guessed Martin was a doctor – he wore a cornflower-blue dress shirt, black Levi’s, and hiking sneakers. Martin had begun working with terminally ill patients interested in using Oregon’s Death with Dignity law in 2009. After his retirement from family medicine in 2015, he had kept his license so he could continue to volunteer as a physician.

Martin and I signed the facility’s guest log and made our way to Ken’s apartment in the far corner of the building. At the entrance to the dining hall, next to a roster of activity charts announcing bingo night and water aerobics, a cluster of walkers sat parked, waiting for their owners to return. We swung left down a wide hallway lined with rustic watercolor paintings, all depicting stone bridges reaching across gurgling creeks. The pictures conjured a pleasant but generic nostalgia. Ken couldn’t stand them.

When we entered his apartment, everyone else was already there: Ken and his two sons, Tony and Zack; Ken’s granddaughter, who had flown in from California; and Sophie, his beloved caregiver. Standing and chatting among the family was Derianna Mooney, a volunteer for End of Life Choices Oregon – a nonprofit that accompanies patients and families on their path to an assisted death. Derianna was here to ensure that everything went smoothly and that Ken felt supported in his wish to die.

The apartment looked exactly like it had the last time I was there: stuffed with furniture, unwieldy plants, Ken’s hand-drawn paintings, and stacks of loose paper. Two golden, helium balloons – spelling 90 – still clung, bloated, to the ceiling like giant bubbles trapped under a bottle cap. Ken had turned 90 exactly a week ago.

As I greeted his family, Martin, Derianna, and Ken huddled to go over some last-minute logistics. I could tell that something was off. Ken’s voice sounded more hoarse than usual, and a look of panic flared in his eyes.

Martin hadn’t remembered until just now that Ken had a pacemaker. He thought it would be safer to turn it off prior to Ken’s death, to prevent it from jolting him back to life after his heart stopped beating. Turning off a pacemaker falls under the responsibility of a cardiologist, which meant that Ken would have to postpone his death. Martin stepped into the bedroom to make some calls.

Ken chastised himself. He had been so careful to put all the pieces in place. Two days ago, he had called Derianna late at night to ask if he should still take his heart medications on the day of his death. He didn’t need to, she had said. He also wanted to know which foods to avoid, to maximize his body’s absorption of the lethal dose. “Nothing too fatty,” she had advised, so no steak the night before. And now this.

Minutes later, Martin reemerged with the good news: the pacemaker could remain on. Unlike other pacemakers, Ken’s didn’t have a defibrillator, so it wouldn’t interfere with his plan to die. Ken heaved a sigh of relief and lowered his tall frame into his armchair. His dog Fluffy, a white shih tzu, jumped onto his lap. Smiling broadly, Ken folded his veiny hands around her. He locked eyes with Martin, who nodded and stepped closer.

Kneeling in front of Ken so they could be at eye level, Martin held a bottle of Seconal, a powerful barbiturate, between his thumb and index finger. It had Ken’s first and last name written on the label.

“Do you know what this medication will do to you, Ken?” Martin asked. The question was part of a protocol the doctor followed each time to ensure that a patient fully grasped what was about to happen.

Ken lifted his eyebrows and puckered his lips. He was gearing up for a joke. At the last moment, he thought better of it. Ken sat up straight.

“I will never wake up again.”

“Do you still want to proceed?” Martin needed to know.

Ken couldn’t resist.

“Well, I wouldn’t want to chicken out now. The party’s already in full swing and all the guests are here.”

Martin rested his mocha eyes on Ken, waiting patiently, studying his face. There was a tenderness in the doctor’s mannerisms that surprised me every time I saw him interact with a patient. What I had initially mistaken as shy reserve was a deep and abiding empathy for human hardship. I sometimes wondered if he had chosen medicine or if medicine had chosen him. Martin told Ken that it wasn’t too late to change his mind. They could call the whole thing off right now, Martin said evenly.

A sense of alarm flashed across Ken’s face.

“No, I want to go through with it,” Ken said, holding the doctor’s gaze. He sounded more sincere now, more resolute.

Their exchange reminded me of a similar conversation I had with Ken about a month ago. I had asked him if he thought he might change his mind when it came closer to the end. He had stared at me with a firmness I had never seen in him before.

“No! Not me. If we’re gonna rob a bank, we’re gonna rob a bank, OK?”

At the time, I broke into a grin and thought, I would rob a bank with you. I liked Ken. Some people probably found his sense of humor grating, but to me his candor felt refreshing. Even at 90, Ken didn’t let anyone put him over a barrel. But he also knew that not everyone shared his sense of relief that his life would soon be over.

“I have to respect the kids too,” he had said to me. “I don’t want to try to make a happy occasion out of what they think is a sad occasion. But I think they’re realistic about it.”

Ken’s sons knew about their father’s daily physical struggles. How numbness crept up his arms. How fluid retention caused his limbs to inflate. How he had started urinating blood. How every time he exerted himself, he would experience a piercing pain in his chest. How he could barely walk the 50 feet to the parking lot outside his back door – even with the assistance of a walker and Sophie’s help – without feeling like he was having a heart attack.

“I’m getting worse every day,” he had told me, the weary look in his eyes amplified by his droopy eyelids and tinted glasses. “I don’t want to have a stroke and have the boys take care of me and my wife. I’m more afraid of living than I am of dying.”