Goodbye, My Brother… A Death with Dignity

My brother, Marshall, wandered happily for 17 years, free camping and spending most of his time sitting outside and enjoying nature. He loved our property for its woods and wildlife. This was one of his favorite locations. His chair is now vacant.

I was with Marsh when he died on June 2, gently holding his shoulder. His hospice nurse, C, was holding his hand and quietly taking him through a beautiful meditation. She included the deer herd that had come down off the hill and stood around the RV. Coincidence? Probably. We normally have three or four that live on our property. But this time there were nine or ten. The extras had shown up when Marsh had come in from wintering in Arizona. Last summer he house-sat for us while Peggy and I were backpacking on the PCT. He was very generous with apples, a fact the local deer had shared with their country cousins.

When I went out to tell Peggy that Marsh had passed, the deer herd had disappeared. Only Floppy, named for her ears, was still there. She was Marsh’s favorite and had always been able to talk him out of an apple. She waited until the hearse arrived and took Marsh’s body away. She watched as it drove up the hill and then walked over and sniffed his chair. A final farewell, perhaps. She then hurried off to our canyon where she had hidden her fawn. I had hoped she would bring the baby by while Marsh was still alive, but a cougar hunting in our area made her more wary than usual. Our next-door neighbor had called three weeks earlier to tell us that the cougar was sleeping in her yard. We were all more cautious.

Floppy, hanging out near Marshall’s chair.
A couple of weeks after Marsh died, Floppy brought her fawn down for a visit.
Marsh would have loved this little fellow with its curiosity about everything and its tendency to cavort.

I found Peggy busy watering the honeysuckle Marsh had urged that we plant in our yard. It was her way of honoring him. He and I had grown up in Diamond Springs, California in the 40s and 50s with a large trellis of it outside our bedroom window. It was packed with flowers in the spring. At night when we went to bed, its delightful fragrance would come drifting in our open windows. Peggy had planted ours in April and it was in full bloom in May. Each time my brother walked by it, even when he could barely walk, he would stop and admire it, a fitting, living memorial.

The honeysuckle provides a backdrop for our two ceramic Steller jays, which was appropriate because Marsh was aways amused by the antics and personality of the jays that live around our house.
One challenge that the jays faced and overcame was how to get birdseed out of a feeder that was made for smaller birds. By perching on the pole and reaching out as far as their neck could stretch, the birds could just reach the feed.

Utilizing Oregon’s Death with Dignity law, Marsh had chosen the time and place of his death. When he had called in March, he had told me that his tongue and throat cancer were back. He had fought a valiant battle in Florida five years earlier. It had allowed him to continue doing what he loved to do— wander. He had spent two more years migrating between North Carolina and Florida as he had for 13 years and then moved West to travel between Oregon and Arizona. At 78, he had decided to let the disease run its course. There would be no ambulances, no emergency rooms, no ICU’s, and no tubes keeping him alive into insensibility. He requested that I be empowered to make decisions through an advanced care directive and a dual power of attorney to make sure his wishes were followed if he were incapacitated. I drafted a will for him based on his desires and we signed him up for hospice care. It was his intention to die in our back yard.

Marshall’s preference was to simply go to sleep and not wake up, peaceably drifting off to nothingness or wherever else death might take him. While neither of us is religious, we both believe the universe is a wondrous place, full of the unknown. He had gone through the process of signing up for Oregon’s Death with Dignity as an option. It was a detailed process. Two physicians had to agree that Marshall had less than six months to live and that he was mentally capable of making the decision to end his life. He had to state his desires both orally and in writing some 15 days apart. And, in the end, he had to be able to sit up and drink the medication on his own without help. Two End of Life volunteers, Tall M and Short M, had met with us to discuss what the procedure would entail if he chose to use it. Everyone, including doctors, end of life volunteers and hospice workers had emphasized that he could change his mind at any time, right up until he drank the medication. It was his decision— and only his decision to make.

As the weeks passed, Marshall failed rapidly. His tongue and throat cancer made it difficult to eat, drink and talk. Eating or drinking anything caused him to cough. Never big, his weight had dropped from 120 to 85 pounds from February until June. His skin draped over his bones. During his last week, his food had consisted of two 8-ounce bottles of Ensure. Earlier, he had desperately wanted to eat something else. He tried scrambled eggs and could only eat a couple of bites. “But those bites tasted so good!” he had exclaimed. I made him a fruit smoothie as recommended by his hospice team that he drank with delight. I cooked him one of his favorite veggies, acorn squash, to the consistency of baby food and he ate a whole bowl. But those were exceptions, and he didn’t want more. 

When it became obvious that he had only a week or two left and he would be confined to bed, he decided to it was time to end his life. Being fiercely independent, he couldn’t imagine lying in bed while someone attended to his every need. He set Monday, June 3, four days away. Marsh decided to spend Thursday outside enjoying nature, which is what he had been happily doing for 17 years, except when driven in by the weather to his tent, van or RV. He had me cut up a bowl of apples for his deer visitors and insisted that I cover the apples with water so they would be fresh. Peggy and I sat with him. That evening, I joined him in the RV to keep him company. He asked for help walking to his bed and collapsed in my arms. I had to carry him. I worried that he had waited too long, that he would end up helpless, unable to meet the requirements of Death with Dignity.

His hospice nurse came in on Friday morning. I am convinced that these women and men who devote their lives to helping people ease their way out of life are as close to angels as we come on this earth. I say this not only for the expertise, peace and comfort they brought to Marshall, but for the knowledge and comfort they brought to Peggy and me. The End of Life volunteers that functioned as a support team under Oregon’s Death with Dignity law were equally caring and supportive. C talked to Marsh about his rapidly ebbing life. And Marsh, out of caution, moved his date from Monday to Sunday morning at 10:30. He also sat up and drank an Ensure in under ten minutes to prove that he could swallow the medication in the time required. Time is important because the medication contains a potent medicine that puts you to sleep in a few minutes. You need to drink all of the medicine before then. 

While Marsh was meeting with C, I drove into Medford and picked up his medicine. Only two pharmacies in Medford carry it. Again, there are stringent safety rules. I produced both my driver’s license and my dual power of attorney. The doctor’s prescription had the wrong date for Marshall’s birth. Fortunately, the POA showed the correct date. I waited while the mistake was cleared up with the doctor. The whole experience felt strange and almost surreal. I was collecting the medicine that would lead to my brother’s death.

On Saturday Morning, I joined Marsh in his RV at 9:00. As I walked in he gave me a big smile and a thumbs-up. He had managed to get dressed, was sitting at his breakfast table, had drunk another Ensure, and had written up a to-do list for me. Among other things, he wanted to make sure that his beer found a good home. He’d bought a couple of cases of Miller Ice at Walmart to see him through his last weeks and then couldn’t drink it. (I gave it to Ed, my barber. Ed greets Pacific Crest Trail hikers as they cross the Oregon border into California with food and drink. Having hiked over 700 miles of the trail myself last summer, I knew how much the beer would be appreciated.) 

I sat with Marsh all day while we listened to music from his 40s, 50s and 60s collection, sad songs and love songs from an almost forgotten era. He could barely talk. We communicated when necessary by writing notes. Mainly we sat in quiet, supportive silence as the music took us back in time to when we were young. He checked his watch often as the seconds, minutes and hours wound down.

I was out early on Sunday morning. I knew Marsh would want to be up and I needed some time on my own to prepare for the day. At eight I went out with a cut up apple and left it where I keep a deer block to supplement the does’ diets when they are nursing. I thought of the apple as an offering. Decades earlier, when I had been a Peace Corps Volunteer in West Africa, I often found food left at the base of towering cottonwoods as I hiked down jungle trails. It had been left for the spirits that resided in the trees. I’d been fascinated by the ritual. As I placed the apple on the deer block, I asked the forest spirits, or whatever gods that were listening— if any— to make Marshall’s passing easy and give him peace. 

Marsh was in his bedroom. “I am so glad you came early,” he whispered. “I tried to call you on the walkie-talkie but couldn’t make it work.” Technology wasn’t his thing, to put it mildly. He was still in bed, unable to dress. I helped him pull on his pants and socks. He had me pick out a handsome, long-sleeved pullover. He wanted to look good. Marsh asked for my hand in standing up but insisted on walking out to his couch, carefully holding onto things as he went. It was to be his last walk; he wanted to do it on his own. He sat up straight, fighting sleep. Peggy came in, sat down beside him, and held his hand. She and I shared stories and even laughter, helping Marshall pass the time and letting what we feel for each other include him. He started coughing so I offered to place some liquid morphine under his tongue. C had told us it would relax him and help reduce the coughing. Marshall agreed since coughing might interfere with taking the medicine. Although the hospice team had brought the morphine on its first visit, he had refused to use it. He was proud of the fact that he had reached 78 without prescribed medications and had been feeling only minimal pain.

C drove down our road at 9:30 and joined us. While hospice nurses are not allowed to mix or provide direct help in consuming the medicine, they are allowed to give comfort. Their presence is totally volunteer. Marsh had wanted C to be there and she had readily said yes. I brought out the anti-nausea medicine he was supposed to take. Throwing up was not an option. I told Carrie some of my favorite Marshall stories while we waited for the End of Life volunteers, again helping him pass the time. He grinned when I told his favorite tales.

Tall M and Short M arrived at 10:00. Peggy and I went into our house to give the three time to meet with Marsh. Their job was to assure that he still wanted to take the medication and to determine whether he would be able to sit up and drink it. Short M told us later that he had dozed off while talking with them. He had awakened with a start. “Am I dead?” he had asked. All four, including Marsh, had shared a laugh. After a very long 15 minutes, the EOL volunteers came in and told us that he still wanted to take the medication and that they felt he could manage it. 

While Peggy stayed with the volunteers to assure they had what the needed to prepare the medicine, I went out to share my last minutes with my brother.

Tall M came in with the medicine in a glass and handed it to Marshall. She also brought apple juice. The medicine is said to be extremely bitter. The apple juice would help counter the taste. There was absolute silence as Marsh took his first sip: silence out of concern and out of respect. The concern was real, intense. Could Marsh finish the drink before he fell asleep? Would drinking the medicine cause a coughing fit? Would his passage be easy? While people drinking the medicine go to sleep immediately, it normally takes 30 minutes or so to die. It can take up to 20 hours.

The seconds passed, becoming minutes. Marsh moved slowly. Stopping to look at the glass or to sip apple juice. I quietly spoke encouraging words to him. We all did. Then he was finished. He motioned for the apple juice, raising it toward his lips as C began her quiet meditation. It never made it. A tear formed in the corner of his eye. I gave his shoulder a squeeze and whispered “We love you.” And he died. A quiet, dignified death. 

Peggy went out later to tell him goodbye. The EOL volunteers had laid him out. “He looked so peaceful,” Peggy told me. “His eyes were closed and his lips were parted like he was sleeping.” Or maybe he was smiling.

Marshall, who described himself as ‘An Itinerant Idler,’ happily spent 15 years migrating between the mountains of North Carolina and the swamps of Southern Florida. Rest in peace, Brother. May you continue to wander.