"But I do when I go out," Mark said.
When Teresa and Amy returned with the anti-nausea medication, they found that Mark had changed to a long-sleeved dark gray print sportshirt, gray sweatpants and socks.
A tear was trickling down Mark's cheek. Teresa handed him the pills and asked again if he wanted to change his mind. She assured him he could do so even after taking this first medication.
He would not be changing his mind, Mark said. It was 4:25. He parked the pills on his stomach and took them one by one with water.
The aroma of coffeecake baking in the oven filled the house. The family asked if Mark could eat a little. Teresa wasn't inclined to deprive him. He hadn't wanted to eat for two days, but that morning he'd asked for breakfast. Joan thought he was testing himself, making sure he could get it down. Now he took three bites of the coffeecake.
Margaret felt glad she wasn't there as a professional. She hadn't wavered in the least when Mark asked her to come. I'm taking the afternoon off, she'd told Mt. Hood Director Lindy Blaesing. This seemed so strange to her though, so upsetting. She kept thinking, what's the one thing I can say to change Mark's mind? She wanted him to hear of the value he'd been to his children. She wanted to say things that would make him wait.
She turned to Joan: "I'm searching for something to say."
Joan looked at her. "Margaret, don't you think if there was something to say, I'd have said it?"
Mark now wanted to be alone with his family. Teresa and Amy left the room, went into the kitchen and began preparing the lethal dose.
It's a real narrow line to walk, Teresa thought, between feeling like an intruder and a helper.
Using a knife, she and Amy cut open the 90 Seconal capsules for the better part of an hour. The powder inside each, which includes lactose and other fillers, was compact, so they had to start picking it out with a toothpick from Teresa's Swiss Army knife. The family finally found them a box of wooden toothpicks.
When they finished, they had 18 grams of powder in a bowl--less than three tablespoons. Half of that was the secobarbital sodium. Nine grams make for quite a lethal dose. Contrary to general impression, morphine and other opioid analgesics are not a good way to end life; they induce tolerance. For oral ingestion, short-acting barbiturates are the medication of choice. Once swallowed, they're rapidly absorbed in the stomach and small intestine.
Secobarbital is odorless, easily soluble in water or alcohol, and bitter. To mask the taste, Compassion in Dying recommends mixing it with pudding, applesauce, pureed fruit or liquid flavoring syrups such as cocoa and raspberry. If necessary, sweetener may be added. Taste buds can also be anesthetized by mint flavors or a weak solution of lidocaine.
On her lunch hour the day before, Teresa had stopped by the Compassion in Dying office to pick up a basket with flavorings, sweeteners, lidocaine and the anti-nausea drugs. Of all her tasks, this one seemed the oddest to her. She felt chagrined. Everything else related to her nursing career. Picking up that basket put matters on a different plane.
The basket proved necessary, though. After Teresa and Amy mixed the powder with Joan's homemade applesauce, they tasted the result and winced. This, Teresa thought, was about the most bitter thing she'd ever tasted. They added several tablespoons of NutraSweet. It still tasted bitter. Man, Teresa said, that stuff is bad.
By now, Teresa's detached personality was wearing on Amy. It seemed to her that Teresa was unable to whisper. She kept trying to quiet her companion. She thought Teresa's levity--little jokes about the flavoring, for instance--inappropriate. She wished they could be doing things differently.
Margaret, too, found Teresa's manner disturbing. In fact, both of the Compassion in Dying caseworkers bothered her. These women just didn't know the Kobayashis. Margaret had been there for the long haul, and they hadn't. Yet here they were in the Kobayashi home on this day, acting so flip and casual. They're not hospice workers, Margaret fumed. They're here simply to help Mark die.
It's a strange thing, she thought, to be attached to a death while missing all the life that went on before. It's strange to show up just for the death. Yet the Compassion in Dying nurses filled a role. She knew that. They filled a need, since right now assisted suicide was treated as if it were illegal.
It shouldn't be treated that way, Margaret believed.
Or should it? The more she thought, the more Margaret wished things could be as they'd always been: doctors and patients handling end-of-life issues privately, doctors writing prescriptions for medicines that got stockpiled. Better than this public law. The old way didn't ask so many others to be involved.