In 2014, my 91-year-old father, Robert McConnell, a retired physician, attempted to end his life in the face of end-stage heart disease. He had had heart surgery 20 years prior, he was maximized on medications and knew there was nothing more that could be done to improve his heart function. With his quality of life severely diminished, he saw no benefit to hanging on. My father did not see any redeeming value in unnecessary suffering.
Dad had four children who adored him. He was very kind, had a great sense of humor and was incredibly frank – if you asked him a question, you were going to get an honest answer. As a physician, my father was caring and dedicated. He once cancelled a family vacation so that he could take care of an actively dying patient. Although his disease was not related to my father’s specialty, my father said, “He thinks of me as his doctor and I can’t leave now.”
My father still had his house call bag, from when he was a practicing physician, which contained a few medical instruments and medications, including morphine. With no one else in the home, he took an overdose of morphine, went to the garage, turned on the car and sat waiting to die from the combination of the overdose and carbon monoxide poisoning.
The next day, my brother went to our father’s home and found a suicide note stating where his body could be located. He found that our father had fallen out of the car and had spent the night on the cement floor of the garage, but he was still alive. My father had retired at 70 so the morphine was old and not very potent and his garage was old and leaky so much of the carbon monoxide had escaped.
Dad was much more frail as a result of his suicide attempt, and his doctor enrolled him in hospice upon seeing him. The hospice medical director, however, was furious that a suicide attempt had been admitted. He threatened my father with an involuntary psychiatric admission, had my father strapped to a stretcher and taken to a psychiatrist. Fortunately, the psychiatrist recognized that my father was mentally competent and not depressed – he just knew what he wanted. He returned to hospice and immediately ceased eating and drinking and refused medications that were not palliative in nature in an effort to control his dying process.
The idea of being dead didn’t bother my father, but the process of dying frightened him. It's hard to imagine him walking out to the garage by himself. That must have been so lonely. It's also hard to think of the suffering he experienced in the aftermath of his suicide attempt. Once in hospice, he deserved the option to state when enough was enough and not be made to linger in pain.
It took eight days for my father to die. He often drifted in and out of consciousness and the last day he became very agitated, he was grimacing and pounding his hand on the bed. He was obviously in a lot of pain but the nurse refused to give him more pain medication. Moments later we were lucky that the nurse practitioner came in, took one look at him and returned with more morphine. He suffered a heart attack and died a few hours later. It was a long and draining experience.
It would have just been so much better had he had the option of saying, “I’m done. Anyone who wants to say goodbye, I’m out of here Wednesday morning.” His prolonged death was difficult for him and it was difficult for us to watch him suffering. Because dad’s dying took eight days, not all of us were able to be present at the end. We wish we could have all been there to be with him in those last moments, to comfort him. It wasn’t an easy death. He deserved a peaceful ending.
Now, as a hospice volunteer I am regularly reminded of the need for compassionate end-of-life options that allow a dying individual some control. As a volunteer of a program called No Veteran Dies Alone, I sit with actively dying veterans and I am painfully aware that not every death can be made peaceful. People who faced death in their youth as soldiers are now facing a terrifying death in their final years. Hospice, no matter how hard they try, cannot give everyone a peaceful death. Dying individuals need options.