“… I investigate not these things, but myself, to know whether I am a monster more complicated and more furious than Typhon or a gentler and simpler creature…” –Socrates
Here in the last slip of rural country near Raleigh, I drive slowly down a gravel road, unsure if I’m going in the right direction. The road gradually becomes dirt: two tire ruts divided by a hump of grass. Sparse rows of pine trees line both sides of the narrow road. I’m a social worker, and I’m making an early morning visit, a new referral to start the day. This one a possible suicide case—I hate suicide cases.
I stop the car near a yellow brick house with a small wooden deck, and an open field on one side. There is no other car so I know the mental health worker, whom I’ve asked to meet me, hasn’t arrived. A sliding glass door above the deck is open.
“Hello. Adrianne Haywood?” I shout into the house. “It’s the social worker.”
“Yes. Come in,” a strong voice responds.
The front room is cluttered with stacks of papers and books. A hospital bed has been pushed to the side; its rails remain up. The wood floor is gritty, and I feel the crunch of hard dirt pebbles and small stones underneath my shoes.
In the next room she is sitting in a La-Z-Boy chair, her socked feet touching the floor only with the toes. She wears a thin nightgown that reaches mid-thigh. A Foley catheter tube winds its way from underneath her garment to the floor. A small puddle of cloudy-colored urine fills the clear plastic bag at the end of the tube.
“Are you Ms. Haywood?” I ask.
“May I sit down?”
She motions for me to grab a chair. At the same time her right foot gingerly pushes the urine bag around the side of the La-Z-Boy. She snags a crumpled white towel from the table beside her and drops it over her lap so that it hangs below her knees.
“I just got out of the hospital.”
“Can you tell me about it?”
“I tried to kill myself,” she says.
Adrianne doesn’t turn her head. In fact she stares right at me: a plump face, lips turned at the corners, Mona Lisa-like, big brown eyes showing through wire-framed glasses.
I stare back. I try to understand the meaning of her stare. Is it simple pride or something else?
“Can you tell me why?”
“I have MS. I can’t walk. I’m tired all of the time. Before I lose the little strength I have in my arms, I wanted to go my way.”
“Do you still feel this way?”
What amazes me is Adrianne’s posture. She doesn’t flinch. She is direct and minimally polite, but I know she regards me as more than an imposition. I am an intrusion. She goes on to tell me that her only embarrassment is that she didn’t use enough Amitriptyline the first time she tried to end her life. She has no family contact; they live out west. Her neighbor friends are her family.
Julie, the mental health worker, comes into the house. Her hard shoes click sharply on the hardwood floor. I give her my chair. “I’ll be outside,” I say.
Out by my car, leaning against the trunk, my legs are shaking. I want to sit down and hide, watch the mental health worker come out of the house, searching for me in the horizon of wind-blown grass. When Julie does come out, only about five minutes later, we decide to drive off Adrianne’s property and stop to talk at the end of the long driveway. Julie gets out of her car and immediately lights a cigarette. “She’s certainly dangerous to herself,” she says. “She’s already proven that. But she’s not mentally ill, if that’s what you’re going to ask. I don’t know what a hospital would do with her?”
“So you don’ t think she can be committed?” I ask.
Julie takes a puff on her cigarette. As we continue to talk, I imagine Adrianne in her house swallowing dozens of pills with as little water as possible. I picture her head lying back in the La-Z-Boy contemplating her end, smug in the knowledge that she was able to win one last battle in her life: dying before we could do anything about it.
Perhaps Julie reads my mind. “But I guess we’ve got to do something,” she says. I’ll call you later.”
From the beginning, I struggle dealing with Adrianne’s case. I empathize with her decision to end her life. I’ve never been diagnosed with a life-threatening illness, but at the age of fifteen, I witnessed my father quickly whittle away from colon cancer. Years before hospice came to our small town in southwestern Michigan, and long before Jack Kevorkian had pervaded our common consciousness, he died in a hospital, a mere wisp of a man: six-foot, three-inches tall, weighing only eighty pounds.
My intervention for Adrianne was to wait. Suicide is a mental health issue. As an adult protective service’s social worker, I have been assigned the case to determine if Adrianne is self-neglecting, a nonsense phrase that conjures up images of self-flagellation or welcome impoverishment. She is receiving four hours a day of in-home services. An aide helps her change her clothes, gives her a sponge bath, prepares her meals, and completes various household tasks; neighbors are bringing meals in the evening. In short, all of Adrianne’s essential needs are being met. Her unflinching desire to die is her only transgression.
Near the end of the day, Julie calls.
“We’re going to commit her,” she says.
“Oh,” I say, surprised.“Yes. We have to try and help her. She may be depressed.”
I try not to laugh but realize Julie is probably being facetious.
“If we had worked with her before maybe we wouldn’t do anything. We need to try at least one time. I’ll complete the commitment papers.”
Ignorance is the energy that motivates our culture’s fear of death. Decades ago life expectancy was much shorter than it is now—people died in their homes. Today, many of us are shuffled off to hospitals, nursing homes, or other places of impersonal care to die.
Death is hidden from social view. It is no longer part of the community-at-large. And so some have come to view death as unnatural, something to be avoided or at least delayed at all cost. It is this very fear of death that imprisons us and compels us to keep the dying alive.
Even after a few minutes with Adrianne, I could tell she believed her time had come: her unwavering stare, the defiant attitude, the swaggering self-respect all conveyed an opinion of self-determination. She was convinced that her life was her own and she had a right to do with it what she pleased.
Those were the memories that came to mind when I thought of my father before he slipped into incoherence. His tall, emaciated frame standing near my grandmother, thin wisps of black hair swooped over his shrunken skull.
“Mother,” he said. “I just wish I could see my children grow up.”
“I know, son,” my grandmother said. “I know.”
A couple of days after Adrianne’s admission, her doctor calls. “She is ready for discharge,” he says. “Or almost ready. A few more days.”We discuss discharge plans. Mental Health is scheduled to see her.
“I will visit her, too,” I say.
“I prescribe another anti-depressant. Prozac is not potential for overdose,” he says.
It is at this time that I notice the doctor has a Middle-Eastern accent. There’s
crispness to his words, a heaviness of the tongue. He seems to think hard before talking, formulating the words in his mind. This time he is careful to include an article in his sentence.
“At least the literature doesn’t suggest a potential for overdose.” He hesitates.
“Yes, you visit. That would be good.”
That night I think of Adrianne in the Dorethea Dix Hospital. I wonder if she’s strapped down in bed? Is she scared? I think of her plump body laying flat on a hard wooden table, several psychiatrists standing over her, while her urine bag, minutely punctured, dripped pale-yellow liquid onto the floor.
Albert Camus famously said, “There is but one truly serious philosophical problem and that is suicide.” He was speaking, in general, about the absurdity of life, and contemplating suicide as a strictly philosophical problem and not a sociological one. Suicide, it seems, is a subject that makes many, if not most, feel uncomfortable. As a society, we grapple with what to do in the face of suffering. When we personalize suffering by making the one suffering ourselves, we often come to the conclusion that if we could decide our own fate, we would not want to prolong our suffering in the face of certain death. But when it comes to someone other than ourselves, we often feel differently. Socrates had no problem with death, going so far as to participate in causing his own demise, but he believed that his soul would be freed from his body, and that in essence his true self would go on living. Death, to Socrates, wasn’t an escape from suffering; it was the step that brought him closer to true wisdom.
In the early summer of 1971, I went with my grandparents to visit my father. At the small community hospital in Watervliet, Michigan, he lay motionless on the bed. I looked at his vacant face, the eyes that looked vacantly at the ceiling. The face didn’t look like my father’s. It was too thin; his cheeks had the shape of the deflated sides of a ball. An IV solution dripped into his right arm, the clear tube taped over with surgical gauze. Yellow and purple bruises covered his forearm where previous IV needles have been. Black whiskers blanketed my father’s face.
“Bob, we’re here. Your son’s here, too,” my grandmother said.
My father didn’t respond. There wasn’t even the slightest nod, a flicker in his pupils.
A nurse came in with another intravenous solution. The clear liquid made a bubble when the nurse hung it onto the pole. She thumped the bag twice with her forefinger. “This will keep him comfortable,” she said.
I looked at the liquid and I have this feeling that if I was tall enough I could see my own reflection in the bag. There was something intoxicating about it, magical, like it possessed the power of renewal or want. It seemed clearer than water but thicker, as if you could float on its surface and never sink. I didn’t know if the IV kept him alive or prolonged my father’s misery by creating a sense of stasis, a prolonged sense of nothingness. Suddenly I felt like ripping the bag off the pole and tearing into its contents, dumping the entire liquid over him, where it would either bring him back or send him on his way. Instead, I stood over the bed and watched the IV drip.
Sisyphus was the mythological Greek king of Corinth who was condemned to push a heavy stone up a steep hill only to have it roll down again as it neared the top. Camus’ surmised that Sisyphus found value in the absurd task, and that it was far better to live life in struggle than not at all. Camus concludes his book-length essay The Myth of Sisyphus with these sentences: “The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.” Absurdity, according to Camus, didn’t exist “outside the human mind.” Socrates, an Athenian, reasoned death wasn’t the end of life, but perhaps a step closer to acquiring truth. Perhaps Sisyphus and Socrates came closest when Socrates, addressing his accusers and to those that condemned him to death, said, “I say again that daily to discourse about virtue, and of those other things about which you hear me examining myself and others, is the greatest good of man, and that the unexamined life is not worth living.”
At its heart medicine, and the practice of medicine, is a form of creating, bringing into existence, whether through literally helping in the birth of a newborn baby, or fashioning the improved health of an otherwise unhealthy person. Dying voluntarily, on the other hand, is an admission that life isn’t worth living.
“Creation is the greatest mime,” exclaimed Camus. He was speaking with respect to creative endeavors and not physical life. However, science is increasingly moving toward ultimately creating an inorganic human being. And what is this act, if nothing else, other than a godlike desire to create oneself. The ultimate artistic creation, therefore, is life. But inevitably will not such a being, like Frankenstein’s “creature” ask, “Who was I? What was I? Whence did I come?” These are questions “organic” humans are still debating. In fact, in terms of Shelley’s monster, which was created by a devil-may-care alchemist, using the parts of dead bodies, it could be said the relationship between life and creation is only a matter of timing. That is to say, Frankenstein gathered his parts admittedly “with profane fingers” from graves of the deceased; yet, today, parts from the immediately deceased, such as hearts, lungs, eyes, kidneys, etc. are routinely harvested to be used in the bodies of others. Granted the aim is to save a life rather than, as Frankenstein surely produced, “a new species” of inhuman proportions.
I don’t know what Frankenstein’s ultimate goal was, if he had one. Was it to create a race of giant human beings? As he begins to put his creation together, he has doubts, but he proceeds anyway, tempting hubris. The monster, in the case of Frankenstein, isn’t simply an eight-foot being, of course, but perhaps a warning to human beings that to stop time and to determine a way to live forever, is, particularly in the case of creating another species, forever fraught with peril. Yet, when I think of Adrianne, and her own individual life, if science could have offered her a reprieve, a cure even, a hope, though no guarantee, wouldn’t she have taken it? Wouldn’t I as I stood over my dying father, all those years ago now, have accepted a doctor’s offer of a transformative elixir, something that would have born him again, perhaps even in to some kind of altered state? I think I would have.
After Adrianne is sent home, I think about calling before I visit her. In the end, I decide to just show up.
I walk through the front room and see her sitting in the La-Z-Boy.
“Come in,” she says. She points to a chair.
“How are you?” I ask.
“Better,” she says. “I wasn’t doing very well during your last visit. I’m better now.”
“Oh. If I might ask, in what way?”
“I was depressed.”
Adrianne might as well have told me directly, “I will tell you what you want to hear. I will not tell you what I feel.” I feel sad that she can’t open up to me. That out of fear she can’t tell me that she still wanted to die.
“So you don’t plan to kill yourself?”
“No,” she says. “I don’t.” She snickers. “Where’s Jack Kevorkian when you need him?”
I look at her and smile. She smiles back.
“Tell me,” she asks, “what’s the secret to everything?”
“I don’t know that I know the secret to anything?”
Adrianne grins. “Good answer,” she says.
“Let me tell you a story,” she says. “When I was a girl, a very young girl, my father used to take me to get ice cream every Wednesday night. It was just the two of us. My mother didn’t go. There was a little ice cream shop at the top of the street from where I grew up. In the summer, my father and I would walk to the shop. It was those walks that I remember the most. Not the ice cream. My father would usually tell me something about his day at work. What I remember, mostly, was the way he talked to me. He let me into his world. He didn’t talk down to me. I felt special during those moments, like he was sharing something with me that was only for my ears.”
I feel an urge to get up and touch Adrianne, to physically acknowledge her words, but I don’t know if this is something she would like.
“Thank you for sharing,” I say.
“He died you know.”
“My father. When I was a teenager. I don’t think I’ve ever gotten over it.”
Years after my father died, my grandmother told me she was there when his last breath was drawn. “I saw his chest rise and fall back,” she said. “And that was it. I knew he was dead, hoped, in fact, he was. I wanted his suffering to end.” She reached up and pulled my face close to hers. “It’s a painful thing to watch one of your children take there last breath in this world. I hope you never have to see that, Bobby.”
I was fifteen. At that point in my life I couldn’t imagine having children of my own.
“I held your father’s hand,” she continued. “A hand so thin and pale and so bruised up. I waited until I didn’t see his chest rise again, until I knew it would never rise. Only then did I go for the doctor.”
A few weeks after my last visit with Adrianne, Sarah, the new mental health worker now assigned to Adrianne’s case, calls me.
“Did you hear?” she asks.
“I’m not surprised,” I say. “Drug overdose?”
“No. She suffocated herself with a plastic bag.”
For a couple of seconds I don’t respond. I feel my breath leave me.
“Hello?” Sarah asks.
“Was anyone with her?” I ask
“I don’t think so. I didn’t even have a chance to get out and see her.”
Adrianne has been dead for thirty years now. I don’t dwell on her death, but it’s hard not to think about it. Death remains a constant reminder. Uncles, aunts, distant cousins die; coworkers, their families, celebrities are mentioned by newspersons on the television. I can be sitting in a café, sipping a cup of coffee and overhear a scrap of conversation. “Did you hear so and so died?” And suddenly I’m transported back to the yellow brick house with the giant silver dish looming in the background.
I think what I’m mostly saddened by is that Adrianne died alone. She didn’t have her friends around her like Socrates. I assume she didn’t want to involve her neighbors and that she felt to include them would perhaps implicate them in some way. She needed to push the rock uphill one more time, by herself.
And so I’m saddened that Adrianne felt her only way to go was by suffocation, but I marvel at her tenacity and ingenuity. When I choose to think of her death, I choose this: she decides to go the way she came into the world, uncluttered from any artificial tubes, so she removes her Foley catheter. She has kept a small amount of brandy on the table beside her chair. The top has been purposely kept loose. She drinks and feels the heat of the brandy. Before the aide left her she requested Vivaldi’s The Four Seasons be put on the tape deck. A chorus of violins showers the room. Her only wish is that it is louder. Before she gets too relaxed, she takes the piece of plastic, which she has kept between the chair and the cushion. It is somewhat crinkled, but she thinks she can find a large enough section to fit squarely over her mouth. There! she thinks. Her lips are tightly closed, and then she slowly, ever so slowly, opens her mouth. She stops for a second, feeling that the plastic is about to slip off. She knows this is her only chance. She will not have the strength to try again. The plastic stays in place, and she opens her mouth some more until it is nearly wide open. Then she gradually lets out all the air in her lungs. The plastic swells a bit, and she can feel a tiny bit of air seep in near the corner of her mouth. But the plastic holds, and when her lungs have fully released their air, like a piece of Saran Wrap over a cup, the plastic seals around her extended lips. When she attempts to take in oxygen, the plastic sucks into her mouth and tightens further around her lips from the moisture and warm air. There’s a brief whoosh—so soft that if anyone else were in the room they couldn’t hear it—when the plastic collapses into her mouth. When she breathes out the plastic doesn’t move. It clings to the inside, lies like a blanket upon her tongue. She closes her eyes, thinks of her father, and the story—which Dostoyevsky once wrote, “If a man has one good memory to go by, that may be enough to save him”— comes to her, the story that has sustained her all these years. She breathes in the story. She breathes in the music. She breathes in the story. She—
ROBERT WALLACE has published over fifty personal essays, many of them in the Raleigh News & Observer. He has two essays forthcoming in Cagibi. He is also the author of over 35 fiction stories in journals such as The North Carolina Literary Review, The Bryant Literary Review, The Long Story, The International Journal of Comparative Literature and Translation Studies, and others. He is the author of the novel A Hold on Time. He has critiqued fiction and nonfiction manuscripts for the NC Writers’ Network since 2000. Wallace has received a Writer’s Fellowship from the NC Arts Council.