My mother has forgotten she wants to die. For as long as I can remember she has been, not exactly planning it, but asserting her right to control her manner of death. When our family gathered for an Easter lunch during my freshman year of college, I announced that I had received a full scholarship to study abroad. She announced that she was going to kill herself at 80.
She would have been 48 then. She is 78 now. In the interim, packages have arrived in the mail every now and then from ‘living will’ companies. Advance directives have been stashed in locked filing cabinets. Powers of Attorney have been signed and placed in safe-deposit boxes to which she alone has access (folks, do not do this).
Also in the interim, a long-fought battle for Medical Assistance in Dying triumphed in our jurisdiction and just this month the government announced new legislation to allow advance requests in cases like Alzheimer’s. You no longer have to play roulette with timing—just make the request compos mentis and trust that it will happen once you’ve lost the plot.
It’s a recognition that what someone would want for themselves if they were in sound mind should be, if not automatically deferred to—particularly in something like death—seriously considered.
***
Two weeks ago, an acquaintance (we’ll call him Bob) starts messaging me in the throes of psychosis. “You are the first person to understand that I gave everyone the code to the theory of everything at my first TED talk…every gift I gave you is an answer…I have been planning this my whole life…there’s a problem that every time you see my theory you forget…you need to start recording yourself…record, listen, read, repeat…Use the physical world to construct your inner world.”
I ping Bob’s husband (we’ll call him Sandeep) to check that his family is aware and on top of things.
“He don’t listen to me. I need help. If I say anything he get aggressive vocally. He won’t listen about the hospital. He won’t allow me to text and ask for help. Super confused. He changed in just 3 day…I don’t have any power left. I am trying my best.”
It turns out they are in Kathmandu. I offer to call the American Embassy (“yeah please if you can do it”). A private hospital would be a safer option than emergency services there when it comes to a mental health crisis. Emergency services are stretched thin anyway since the catastrophic flooding in Nepal three weeks prior.
The embassy asks for Bob’s number. They plan to call him directly and ask if he needs consular assistance. If he says no, they’re not going to do anything. I explain that, actually, I just had a Facebook video call with Bob in which he ranted about numerology for 20 minutes. I explain that psychotic states often feel euphoric and liberating but that Bob is a danger to himself and others right now.
They call him, he sends them away. Today, Sandeep’s Facebook account is deactivated. Bob continues to post his “equations”. “0’ = 0 + H. H is the history of every transformation… 0’ isn’t the original zero. It’s zero with a history.”
It seems to count for nothing that most of us, if we later found that others had gently saved us from ourselves during a psychotic episode, would retroactively be grateful for the intervention.
Meanwhile, my mother is still in the early stages of dementia, but one of the first symptoms in her disease variety is anosognosia, the inability to perceive one’s own impairment. It’s a result of damage to the part of the brain that handles self-awareness and insight. She suspects our talk of her cognitive problems is some kind of conspiracy. She will no longer cooperate on matters of her care. She doesn’t want to book her brain scans. Nobody may drive this bus but her, but she is physiologically incapable of seeing the approaching intersection.
My mother will likely never accept that she has the condition that will kill her slowly. As a result, she will lose her lifelong dream of a controlled death. I don’t pretend we should act on her non-specific wishes of the past, but it’s a rather extreme example of the best laid plans being laughed at by the universe. For now, the mind that can no longer ask for help still has the final say.
Image: Wikimedia Commons
