Kristine Rusch: Reflections on Life and Death

— She’s not that bad, is she?

The doctor shrugged.— I’ve been secondary approving physician on cases less advanced than hers. Once it reaches this stage, the future is certain. Death.

—The future is certain now, Sarah said. You’ll die. I’ll die.

The doctor shook his head. That’s not certain. There is research in Sweden that shows degeneration can be prevented.

—Then why can’t we use that treatment on Mother?

The doctor’s look was withering.

—Because she can’t afford it? Sarah asked.

The doctor took a step back, as if Sarah’s tone startled him.— Because it’s experimental. And even if it weren’t, she’s not a candidate. Degeneration is advanced in her. The Swedish treatments begin before the internal organs show advanced signs of wear. For some, that’s age twenty. For others, that’s forty-five. For no one is it seventy. No one at all.

—So you’re saying kill her, Sarah said.

The doctor didn’t meet her gaze. What’s more humane? Letting her die now, with all her faculties in place, or waiting until she shuts down, part by part?

— Isn’t that what death is? Sarah asked.

— Death, the doctor had said as if he were quoting a textbook, is the cessation of life.

“Mom?” Sarah said. She sat beside the bed, and put the papers in her lap. “Mom, wake up. It’s me.”

Her mother’s eyes opened. They were yellowish, bloodshot, exhausted. “Sarah?” she whispered.

Sarah nodded. “I brought papers here from the extended care center.”

“Papers?” Her mother’s voice was stronger now. She dug her hands into the mattress and pushed herself up. “What kind of papers?”

“Entrance agreements. They have the regular agreements there on computer. I told them you weren’t linked here.”

Her mother frowned. “Have you read them?”

“Yes,” she said. “They seem fine. All they ask is that you agree to the rules of the center.”

“And what are those rules?” her mother asked.

“They’re listed in the regular document,” Sarah said.

Her mother crossed her arms over her sunken chest. “I won’t sign,” she said.

“If you don’t sign, you can’t go,” Sarah said. “The hospital has the legal right to put you on the street.”

“I’ll go home,” her mother said.

“Mom.” Sarah had been dreading this moment. “They rented your apartment. I had to put your stuff in storage.”

“I pay my bills,” her mother said.

“No, Mom,” Sarah said. “Your weekly allowance has been coming here, for the deductible.”

“You didn’t pay my rent?”

“I can’t afford my rent.”

“But you can afford storage.”

“It’s cheaper than rent,” Sarah said.

Her mother’s lower lip trembled. “They’ll kill me in that center.”

“People die there, yes, Mom, but the officials don’t kill anyone.”

“Read the forms,” her mother said.

“Mom, they have to have ways of dealing with the critically ill.”

“I’m not critically ill,” her mother said.

“Your doctor says you’re dying,” Sarah said.

“My doctor’s wrong.” Sarah’s mother raised her chin, a slight gesture of defiance.

“That’s denial, Mom.”

“No, Sarah,” her mother said. “I’m alive, and I like breathing. And I’m not afraid of what the future holds. I want to see each phase through, the way God intended.”

Sarah shook her head. Her mother didn’t understand. She couldn’t. If she did, she wouldn’t want to die, bit by bit, piece by piece. “Gram—”

“Your grandmother was a coward,” her mother said.

“Gram was thinking of us,” Sarah said.

Her mother’s eyes narrowed. “Was she? Was she really?”

2003: Gram’s house. An EMS truck was parked in the driveway. Sarah’s mother stood in front of the door, arms crossed. Her hair was falling out of its ponytail and her right cheek was streaked with blood.

Sarah parked her car across the street, and ran to her mother. Her mother held out one blood-stained hand.

“You can’t go in,” her mother said.

“But you called—”

“I did,” her mother said. “Before I knew. Gram’s in the truck.”

“Then she’s all right?” Sarah started for it, but her mother grabbed her arm.

“No,” her mother said, her voice oddly calm.

“I want to see her.”

“No,” her mother said.

“What happened?” Sarah asked, panic eating at the edges of her stomach. “She used your grandfather’s handgun. She always said she would. Dramatic to the end.” Her mother shook her head slightly, as if she couldn’t quite believe it. “She called to say good-bye, and not to worry. That’s when I called you. That’s when I came here. The neighbors heard the shots. They’d already called 911.”

“But she’s all right,” Sarah said.

Her mother’s eyes met Sarah’s. “She’s gone.”

Sarah frowned. “But I told her I’d take care of her. Yesterday. I told her I’d be here, and we’d get through it.”

Her mother blinked hard and wiped at her nose. “Your grandmother said to tell you that she didn’t want you to waste your life.”

“But I wanted to help,” Sarah said.

“I know.” Her mother put her arm around Sarah, not noticing as the blood on her hand stained Sarah’s white sleeve. “But you can’t any more. And now we have to get through this. Together.”

Sarah sat at her desk and scanned the documents the social worker had e-mailed her from MLECF. Her hand was shaking as she scrolled, her brain overloading from the legalese.

She would have found nothing if the social worker hadn’t highlighted two sections for her.

1. Patient grants MLECF power of attorney in all matters pertaining to health.

and

50. Patient agrees to allow doctors and social workers to determine, in tandem, when resources allotted exceed gains returned.

She printed up both and handed them to her cubicle mate, Lars. He scanned them. “So?” he asked.

“What do they mean to you?” she asked.

“They mean the facility has the. right to put a patient to sleep if they can no longer afford treatment.”

“That’s legal?”

“Sure,” he said. “Has been for as long as I can remember.”

“And it doesn’t shock you?” she asked.

“Why should it?” he said. “These places have been doing it for years.”

“I didn’t realize,” Sarah said.

“Not many people do,” Lars said. “It’s just an efficient way of dealing with a burden on society.” He handed the hard copy back to her. “Why’d you ask?”

“For my mother,” she said.

“Oh,” Lars answered, and had the grace to flush.

1990: Spring thaw, Lake Wingra. First meeting of the Wingra Seniors’ Polar Bear Club. Sarah wore her down jacket, unzipped, and a pair of fleece-lined boots. Her mittens dangled from strings, and the sweater her mother had made her wear that morning was too hot. But her face was cold. An icy mist was falling, making it feel as if the air were spitting.

Near the water’s edge, four old men wearing rubber boots stomped away the last of the ice. A doctor stood beside the men, shaking his head as he watched.

Gram was beside Sarah. She wore a heavy car coat over her sweats. In her arms, she clutched a fluffy towel, still warm from the dryer.

“You’re nuts, Gram,” Sarah said.

“I’m living, baby doll,” Gram said. She handed Sarah the towel, then peeled off her car coat, and her sweatshirt, revealing a one-piece suit underneath.

“That water’s cold, Gram. What if you get a heart attack? What if you get sick?” Sarah lowered her voice. “What if you die?”