The call came one morning in February from Susan in Montana. I asked if there were guns in the house.
"Yes, several, and I don't know if I can stop him!"
Her voice filled with tears, Susan went on to tell me her husband Jake had lung cancer, now spread to the bone. He was 58 years old. They had four children still at home. They had been married for 29 years.
The first priority was to get Jake comfortable. Susan told me hospice was due to visit the next day. I could hear Jake hollering in the background -- "Tell her how bad it is, that I can't get my breath, I can't sleep!" Jake panicked when he felt he was suffocating, and he seemed to be hallucinating at times.
I told her to call the doctor and hospice back, tell them what she had told me, and ask them to come out immediately. If they couldn't, then I suggested she take Jake to the Emergency Room.
"He doesn't want to go to the hospital," she told me. "I promised him we would keep him at home."
Susan said she and Jake had talked about assisted dying when he was first diagnosed -- only 4 months ago.
"It's been so quick," she said. "Jake said he didn't want to waste away and die in pain in front of his children. And now he is. What's happening is exactly what he didn't want."
Susan called me later that day. Hospice had come and started Jake on IV pain medication and something for his agitation and breathlessness. Jake was feeling a little better, but he was still in pain. He talked about using a gun again, and Susan asked me what else was possible.
Susan and Jake asked about moving to Oregon to use the Death with Dignity Act. I explained the law, how difficult it would be for him to move in his present condition, establish residency, and find a physician.
We talked about obtaining medication from Jake's current physician. I mentioned terminal sedation because of his agitation and the difficulty of managing bone pain. Jake and Susan were both interested. I offered Compassion in Dying's booklet "A Gentle Death" and some articles on terminal sedation. I also offered to have one of our physicians contact Jake's physician.
The next morning Susan's voice sounded less strained. The pain medication was working -- Jake wasn't hallucinating any more. We talked about getting support for her and the children. I encouraged her to lean on hospice -- to take advantage of all their services, especially help for the two older teens.
Later that day, Susan called to report Jake had talked to his doctor and was very angry. The doctor told Jake he would not prescribe anything Jake might use to end his life, and he also rejected terminal sedation.
"'That's too much like killing,' he told us. Jake is really mad -- he thought he could count on this guy. Jake was so up after your call -- he felt like he had some choices. Now he feels betrayed. I just don't understand why the doctor is acting like this. All Jake wants, all any of us want, is for him to die peacefully on his own terms. I wish we lived in Oregon!"
Then I abruptly lost contact with Susan and Jake. I called and left messages, but received no answer. I finally heard from Susan about two weeks later.
Jake had died "on his own" after 6 horrible days of increasing agitation, hallucinations, and uncontrollable pain. At the end, Jake was in the hospital, where he died several hours after admission.
"The kids and I were there -- he died in my arms."
Susan went on to describe the death Jake most feared.
"It was really rough those last days. I wanted to keep him at home, but we just couldn't cope. He went downhill so fast -- no one expected it. He kept pulling out his IV, and falling out of bed. He was screaming in the middle of the night -- it was terrible! I wish he had the option to take something to end it all when things got bad.
"I'll never forgive the doctor for turning his back on Jake. Hospice was wonderful, but in the end they wouldn't really do anything. They were too afraid and refused to sedate him to unconsciousness. I want to do anything I can to bring choice to my state. In Jake's memory and for our kids. Let me know how I can help."