Beyond the Call of Duty

A daughter reflects on the meaning of her mother's suicide.

Vivian Rothstein

On national pro-choice day my mother put a gun to her head.

I'm headed out the door to a demonstration dressed in suffragist white when I get the call. I quickly phone my sister and rush over to my mother's place at Holiday Villa where police and paramedics are crowding her single room. A small trickle of blood runs from her left temple to her ear, but her vital signs are strong and she tells the cops what she's done. I am panicked that she's talking; the paramedics are excited she's alive. I can barely stand as she's taken out on a stretcher.

At UCLA's emergency room the police bring in an envelope my mother left on her dresser. In it are a good-bye note, paid bills, and a postcard to her dentist that reads, "Please cancel my teeth cleaning appointment for 11/20. I'll be out of town."

When the emergency room doctor stops by to explain the treatment plan, I ask him why they're doing a CAT scan and preparing for neurosurgery. Don't we have choices to make? He glares at me: "My job is to save lives." No discussion.

This was not the first attempt, we explain: a huge dose of sleeping pills the previous January landed her in the hospital. Despite ingesting the fatal dosage she'd read about in a newspaper article, she survived. Six months later I took away a handgun she bought and then decided she didn't have the nerve to use. More recently a fantasy about drowning herself off the coast of Santa Barbara caused me to put such discussions off-limits between us.

In the hospital waiting room my sister and I beg them to leave her in peace. Her note, our appeals, and multiple copies of her living will designating me her legal spokesperson make no difference.

The week that follows is sheer hell. After surgery my mother looks frog-like, her eyes bulging, black-and-blue globes. Her shaved head is covered in white gauze. The bullet went crosswise through her brain, severing one optic nerve and damaging the other eye. In intensive care she's hooked to a respirator, her lungs pumping furiously. She can't speak with the pipe in her throat but follows simple directions and squeezes my hand as I stand crying over her bed promising I will do all I can to get the hospital to leave her alone.

I demand to know who's in charge. Where's a doctor we can talk to? Don't they know she wants to die? Doesn't anyone care what she wants? We leave and return with the sheaf of papers she has signed over the years asking not to be kept alive by extraordinary means, "No tubes! No tubes!" written all over the margins. I give the signed papers to the nurse who clips them to the chart at the foot of the hospital bed.

A young neurosurgeon stops by and explains confidently that "many people go through this and come out of it and are happy to be alive. We've taken out portions of the front temporal lobe before on people, and it's made no difference. Lots of people are blind and find meaning in life. This may turn out just fine. Don't worry about it. Let's see how it goes." He will not consider the possibility that at 81 my mother has finished living and wants to leave this world on her own timeline.

I tell my mother's story to everyone at the hospital who will listen. I tell them she's signed papers. At least let's get a "Do Not Resuscitate" order on her chart. And what about the respirator? It looks like she's in pain. Can't we have it removed?

The afternoon of the second day the nurse says she's called the hospital "ethicist" to talk to us. It looks like the papers may have had an effect after all. Meanwhile my mother looks so awful I can barely look at her, and she's stopped responding to the attendant's commands.

The ethicist, who's both a lawyer and a psychiatrist, agrees that "It's an unusual case," but adds that "the State of California is against suicide. People have to live. The ER doctors could not have been persuaded. It doesn't matter what papers you have. My job is to prevent a war between the family and the doctor." "I'm too exhausted for a war," I say. "How about just a DNR order on her chart?" "I'll work on it," he promises. "We'll meet again."

The morning of the third day I go to see her. There's no order on her chart yet. I tell her I know what she wants; I'm working hard for her. Pretty soon she'll be able to let go and they won't interfere. I hold her hand and kiss it, tears streaming down my face.

The next day I return to the hospital with my sister to meet the ethicist and the general surgeon. They've discovered she's an HMO patient, and have lost interest in her--she'll be transferred to a community hospital as soon as she can be moved. The institutional pressure is gone and she's off the respirator. I tell her the hospital will leave her alone now. My sister shouts, "We love you Mom."

That evening I talk on the phone with my mother's friends. One, a nurse practioner, tells me how to end her life--take away antibiotics, water or food. It seems simple.

I talk to my mother's personal physician and tell him about her condition. It sounds horrible, he says. He'll take over when she's transferred to the local hospital.

My partner comes over and makes a wonderful dinner: salmon steaks, wine, baked potatoes, squash. Towards the end of the meal I talk about depriving my mother of some life-giving support. Marc grimaces. He doesn't say a word, but I feel his discomfort and displeasure. I see myself on his face and wonder if that's the person I want to be. I shut up, afraid he'll think I'm a monster.

Late that night I talk to my rabbi about life and death, duty and integrity, quality of life, and who judges the worth of living. I'm backing away from my single-minded campaign to help, or to let, my mother die. It's clear there is a difference between the two. I ask my rabbi if he will go with me to see her. If she would tell me what she wanted, then I could do it. But without a sign it's further than I can go.

We meet at the hospital in the morning and enter her room. She looks bad. The nurse says we seem to have lost her overnight. I ask for a sign--squeeze my hand if you hear me--nothing. Jeff says a prayer in Hebrew and English. In the high tech world of monitors and tubes, the old words sound like an ancient call for help.

Then we go to the hospital cafeteria to talk. "How can I be an obedient daughter and carry out her wishes? Why did she choose me to represent her interests? Is it because I can fight institutions to allow her to die? Or because I'm thoughtful and will protect her when there is still a chance for her to live? What is quality of life anyway? Could she regain it after such an injury? Would a damaged brain bring her the peace of mind which so long eluded her? Who am I to decide? And what are my beliefs? Can my mother ask me to go against my own principles? Does she trust that I will or I won't?"

But then she couldn't have been more clear about her desires. My sister wants to pull the plug if we can. But she shies away from dealing with the hospital, doesn't visit for two days, and seems too eager for mom to die. Finally, my sister says we'll do whatever I want.

The problem is, I want a mother who is living--not one who is dead.

That evening I get a call from my mother's physician who tells us she's been transferred to the local hospital. We meet there and are told her reflexes and rapid breathing indicate damage to the brain and brain stem. She also has fever from a possible infection, and the only way to find the cause is through invasive procedures. Why hurt her anymore?

"There's a great difference between community medicine and a teaching hospital," the doctor says. "Here we care about a person's quality of life and the family's wishes." The doctor has no problem allowing mom to die. Take her off antibiotics. Keep her fever down to minimize discomfort. Put a Do Not Resuscitate order on her chart. See how she's doing in the morning.

We go in to see for ourselves. She's burning hot. The heat of her hand sears into my palm like the fevers of my children when they were little.

Mom's hands with her neatly polished nails are starting to curl up. This is finally it. She looks so much worse. Was it the move, the fever, the swelling from the surgery and injury? Or did she simply decide to let go once I told her it was OK?

The evening of the sixth night I take my son and daughter to say goodby to their "oma." My sister thinks it's a bad idea to take the children, but at the last minute she and her husband decide to go along. As we enter mom's room my kids are scared and sniffle a little and hold on to me for dear life.

I ask the children if they want to say goodbye, and I say a few parting words myself. Then a nurse comes by to ask how this has happened. I try to explain and start to cry and my kids join in. One last time I stroke my mom's leg--sort of stiff now--and tell her I love her. The nurse says they'll rub her back and turn her over to keep her comfortable.

On the way home we pick up a video comedy, and I laugh a little too loud at the punch lines as the kids and I snuggle on the couch watching, then go to bed.

At one in the morning the doctor calls. She just died; her heart stopped. I debate a minute and then call my sister with the news. We talk for two hours about mom and how much we tried to make her happy and how we really were good daughters to her despite how everything turned out.

Free at last! My mother finally accomplished her mission. We're both free: me from the responsibility for her life and her death, she from a life she no longer wanted. Whether for good reasons or bad, right or wrong, she didn't want to be alive any longer.

A month later a package arrives from the local hospital. In it are my mother's hospital charts and her beautiful white, wavy hair, shaved in preparation for the neurosurgery she didn't want. I'm shocked by the brutality of the hospital's gesture and throw the packet in a suitcase with her old letters.

My mother has been dead now for seven years. She raised two childen on her own through the 1950s, establishing her life in a new country after fleeing the Nazis; in her sixties she became a political activist and a role model to members of her local Older Women's Liberation chapter. Few of her friends were aware of the depression with which she struggled. Anti-depressant medication, so helpful to many others, gave her no relief.

I still don't know how to think and feel about my mother's suicide. Was it the act of a self-determining woman who decided that she had the right to control her destiny, in death as in life? (The date she picked surely was no accident. When I leafed through her appointment calendar, guiltily wanting to prove to myself I had been spending enough time with her, I saw a small "x" on that Sunday and the one before it. For her own reasons, she held off her act to coincide with the pro-choice march, for which she had no doubt received numerous mailings.) Or was her suicide the result of an illness that robbed her of life's joys and meaning? As a feminist I respect her courage; as the daughter of a suicide I feel abandoned and resentful.

My mother was one of five women at Holiday Villa who exchanged Hemlock Society literature. Four are no longer living. The details of their individual deaths are unknown to me but I know at least one, a 95-year old biochemist, had the technical expertise to die at her own hand. The one remaining member of the Holiday Villa Hemlock Society now lives in a nursing home. She has debilitating osteoporosis, and is nearly blind. Yet she is an avid listener of news and talk radio and has a Clinton-Gore poster on her door. Nurses and attendants spend hours in her room sharing their life dilemmas and getting her sage advice. The time may yet come when she is ready to die, but right now life is still offering enough excitement to keep her interested.