An Oregon Man Suffering From an Untreatable Cancer Lives in the Only State Where He Can Legally Take His Own Life. He Makes the Decision.
Los Angeles Times Magazine, Copyright
Howard l. Wildfang makes it a point to stay busy while he waits to die. He has been a man of determination for all his 85 years, and when his sickness finally closes its circle, he will quit life on his own terms.
He sits in his Salem, Ore., retirement-home apartment in a straight-back chair pulled close to the table. His papery skin is mottled. His body is shrunken. His words are reedy and pushed out with great effort, but his mind is alert as he organizes the tabletop. Strewn on it are newspapers and magazines he would like to read. Clamped to the table at the end of a metal arm is a round magnifying glass, big as a saucer. Drawing it close to his eye is the only way he can read because he has a degenerative eye disease. It's a mean thing for a man who loves ideas. He grasps the glass with hands misshapen by rheumatoid arthritis and a deterioration of the tendons in his thumbs. They are locked at mid-joint at a 90-degree angle backward. One finger is only a stub, most of it lost to a sawmill blade years before. For someone who made his way in life with the strength of his arms--farmer, laborer, carpenter--it must be a hopeless thing to look down on crippled hands.
During the past dozen years, Wildfang has had three minor strokes and three operations for bladder cancer, which was not life-threatening but added to his health burdens. Last Aug. 29, Dr. Paul Munson called in his patient and friend of 30 years with unhappy news. An X-ray showed that the pain Wildfang had complained about was a 7-centimeter mass in a lung. There was little chance it wasn't cancerous. Both knew the old man couldn't long fight off such an attack.
What Munson didn't know was how defiant Wildfang already was at the prospect of a lingering death.
In the month after seeing Munson, Wildfang had a ct scan, which confirmed the tumor, then a CT-guided needle biopsy, which identified it as "squamous cell carcinoma," a nasty and ambitious cancer. He also met with Salem oncologist Charles Petrunin and radiation oncologist Nancy Boutin. Petrunin determined that chemotherapy wouldn't help Wildfang, and might kill him. Boutin was more optimistic and began radiation therapy at the beginning of October. It lasted all month, interrupted by a brief bout of pneumonia.
Boutin says she is pleased that the tumor has stopped growing and hopes that the radiation treatment will give Wildfang several more months. But it is clear the cancer is not going away. "The tumor is high up in the lung, up against the chest wall, causing him pain," she says. "Mr. Wildfang's cancer is one that doesn't spread to other parts of the body as quickly as other types. The radiation is not likely to cure him, but I'm hopeful it'll buy him some quality time. I suspect, when he dies, he will still have this cancer, whether he dies of it or of one of the many other things that 85-year-old men die of."
Wildfang says he submitted to radiation only to please his family, and he's resigned to his death, sooner or later. Sooner can be a few weeks, later can be several months.
"Sometimes now I just can't seem to get my thoughts together, and I feel like an idiot," he says. "Sometimes my words come out funny. It's been that way since my last stroke. But that's not the me I want remembered."
This is not a complaint. His doctors say he never complains. Wildfang is the product of a German-Scandinavian heritage in which grit is valued above style, and strength is best expressed as silent and unflinching. Like most of his generation, the Great Depression scarred his psyche. He learned that hard work and guarding dimes as if they're diamonds are the only means of pushing back poverty.
As the days stretch through November, he endures the cancer with painkillers, but he has no appetite, and his low weight leaves him vulnerable to infection. He grows increasingly apprehensive about what is to come. He thinks often of his first wife, Vivian, who died in 1975 of heart disease after months of pain-filled lingering that wore on her and the family. He thinks of his second wife, Georgia, who lost a son to cancer only a year ago, and of his four middle-aged children who also can't forget Vivian's death. What is he about to put them through? He does not want his passing to be a burden lifted.
"I know everyone in the family will say they'll take care of me, and all that, but why should I take advantage of the love they have for me?" he asks. "Psychologists say, 'Well, you grow closer together.' But the way I see it, it's their generosity and my selfishness. They may be willing to suffer through with me, but why should I let them? Watching me deteriorate would take a lot out of them that I don't want to see them give up."
Wildfang makes the loneliest and most personal decision of his 85 years. He will take his own life.
He has been thinking about it since Munson told him of the chest tumor. That he can even contemplate such an act is the result of an Oregon initiative that took effect in October 1997. The Death With Dignity law says that, with stipulated safeguards, any person with a disease diagnosed as terminal within a probable six months has the right to hasten death.
Wildfang also is driven by another impulse. He comes out of the rural Great Plains tradition that fostered much of the social and economic progressivism of American history. Through his death, he sees another way he can serve in that same populist spirit by showing others that they can control their lives right up to the end. That's why he has agreed that I can spend these days at his side or on the telephone with him. He wants to show others that there is a way to negotiate an honorable peace with death.
"Sometimes, late at night, I wake up and think about dying, and how it's going to happen. I know they can keep me doped up and all that, but I don't want to get to the point of being of no use to myself or anybody else. Life always reaches the point where it's time to pass on. Nowadays, we're often forced to live so much longer than nature intended; we stay beyond our time. I know from being around [elderly neighbors] that they worry about losing control near the end. It's bad enough to have to face death, but it's worse if we have to imagine ourselves just wasting away to where we don't amount to much more than something to pity. And suicide's not the answer. Why should I have to take a gun and commit violence as my last act on earth? Death With Dignity gives me the right to control my life right up to the end. And if I can do something that'll help other people realize that they can . . . well, maybe die a little better, then that's the memory that I'd rather leave with my family."
Dying is a far more wrenching thing than simply setting an example for others. Wildfang has his haunting moments. Those who say an 85-year-old should be ready to die are not 85. He blanches as he tells me that his rheumatologist and eye specialist both canceled further appointments with him. Their point: Why bother? He knows that's true, but it's still a slash to his psyche. When I ask if he just wants to get it over with, his eyes flash. "No. I want to live as long as possible." But a moment later, his head sinks: "Possible" is beyond wishful thinking.
If Wildfang lived anywhere else in the U.S., his legal death would have to be in nature's own time and way. Oregon is the only state that allows assisted death for the terminally ill. Some would say Oregon is the only state where it could happen because of its history of liberal social legislation. In California an assisted death initiative failed 12 years ago by a 54% to 46% vote, and in recent years voters in Washington state, Michigan and Maine have rejected the idea.
Social forces, however, are changing in a way that could propel the issue to the fore in many states. According to Portland attorney Eli Stutsman, president of Death With Dignity, several factors will guarantee that it becomes an eventual issue: the baby boomer population is aging and becoming more educated and less traditionally religious. These are the people who tend to most support the law. In Oregon, 171 residents over age 18 have used the law.
Death With Dignity supporters have no staff in California, and no plans to try to legalize the program in the state. Nationwide, the group is biding its time. And a lot of biding seems required. Even in Vermont, which had a liberal physician, Howard Dean, as its governor, a recent legalization attempt has encountered tough going. The organization, however, remains optimistic about approval there soon, and is also trying for legalization in Hawaii.
Organized opposition to the movement in Oregon and elsewhere comes almost exclusively from religious groups, at least their hierarchies, according to Scott B. Swenson, executive director of the Death With Dignity National Center in Washington, D.C. Although many religious people with a liberal orientation, such as Episcopalians, tend to favor or are neutral about assisted death, most Christian and Jewish denominations are opposed: Baptists, Mormons, Christian Science followers and Orthodox Jews are unequivocal in rejecting assisted death. By far, the most adamant and weighty opponent is the Catholic Church.
In May, Oregon prevailed in a court challenge that Atty. Gen. John Ashcroft filed in 2001. The government had alleged that the law violated the federal Controlled Substances Act of 1970.
Nonsense, the state said. Substance-abuse law fights drug trafficking, not the relief of suffering. The state argued that Ashcroft's suit was a federal intrusion into states' rights and was an attempt to interfere with the practice of medicine by Oregon physicians. The federal 9th Circuit Court of Appeals rejected the government's complaint, saying, in part, that the attorney general overstepped his authority. The court also noted, "Should patients attempt suicide without the assistance of their doctors and pharmacists, they may fail or leave loved ones with the trauma of dealing with the aftermath of certain forms of suicide too unpleasant to describe in this opinion." The government has not yet decided whether to appeal.
In mid-November, Wildfang approaches Petrunin to help with his assisted death. The doctor hesitates. Like many Oregon physicians, Petrunin does not oppose assisted death, but neither is he comfortable being part of it. He refers Wildfang to his partner and fellow oncologist, Peter Rasmussen, a strong advocate of the law.
When Wildfang sits down with Rasmussen on Nov. 21, he wants to know how the disease will work its will on him. The physician tells him that his cancer can go in several directions. For smokers, as Howard had been for 70 years, pulmonary problems are common because the lungs have been weakened. The usual result for those patients is pneumonia, from which someone Wildfang's age usually doesn't recover. Also, the cancer can metastasize to bones, causing severe pain, or the brain, which can lead to nausea, behavioral changes and disorientation. Finally, the cancer can spread to a metabolic organ such as the liver or kidneys, a process that tends to be gradual and relatively gentle. The doctor tells Wildfang that, as the end nears, he can be kept sedated and on painkillers; in effect, kept in a coma and allowed to starve to death.
Wildfang rejects that alternative because, as he says later, "I guess I wouldn't feel anything, but my family would have to stand around the bed day after day and watch me shrink away. Why? What's the point in that?" He ends his meeting with Rasmussen determined as ever to, as he keeps repeating, "keep control."
Rasmussen is a quiet, kindly man of 58. He says Wildfang understands what is to come, but seems strong in the face of it. The doctor is struck that Wildfang wants his death to show others that life can be controlled to the end. "Howard is unique in that he's still interested in the big picture. He still cares what happens in Iraq," Rasmussen says. "As most patients get closer to death, their world cracks. Their interests contract down to, 'Who do I want to have around me today?' "
The physician outlines the steps the assisted death law requires: The patient must make verbal and written requests, and must wait at least 15 days before obtaining a prescription for the fatal dose: 10 grams of pentobarbital in a drinkable solution, about triple the amount necessary to kill an average adult. A psychiatric examination is not required unless one of the two physicians who must sign off as a final safeguard deem it necessary. The key to the process, which separates it from Dr. Jack Kevorkian-style assisted dying, is that the patient must self-administer the drug. The glass must be taken in hand and swallowed by the patient without assistance, although Rasmussen says that whether a family member can guide or steady the hand seems to be an untested gray area.
Of the patients who inquire about assisted death, about 10% carry it out, he says. Some decide later to allow nature to take its own time, and for many others, death gets there first.
Now, barely into December, Wildfang waits, and thinks. He worries that his wife will have to struggle financially. He welcomes the chance to talk about what his life has meant, what he has done with it and what he has left undone. He is concerned that he has not influenced the world in the way he wanted, and he knows the chance to do so is fading. The centerpiece of his mission is a self-published book titled, "The Perfect Triangle: A Common Man's Philosophy," written during the course of a decade in his later years. It outlines his belief that society is gravely threatened by the excesses of corporate greed, corruption and lack of Christian social compassion. The book is homespun and not academic, but cogently reasoned and clearly written. It is not angry, only sad. His arguments are similar to those heard often in the Grange and farm-union halls of rural America 50 to 100 years ago, but they still hold currency today.
Wildfang had 500 of his books printed several years ago and has given them away to spread his beliefs. He has about 200 books remaining, and it's vital that as many as possible be given away before he dies. His wife Georgia tells of going shopping one day, and when she returned, the old man had pushed heavy boxes of the books out of their basement, onto the elevator and into their apartment, where he eventually autographed every one.
He says he worried that his lack of a college education would make his writing less significant, but then he decided, "Education doesn't help you understand right and wrong, only a good heart does."
Is he an evangelical? He chuckles. "No, no, no. Anything but. I understand that to mean fundamentalism, and, boy, I'm just the opposite. Everyone has their own God, but those folks [fundamentalists] want to make sure that theirs is mine. To me, God is your conscience. I read [the Gospel of] Matthew, and I got a sense of Jesus the social worker. That's what I'm looking for. But with all respect to Jesus, there are a lot of good religions, and a lot of good people who follow them.
"We all want to be better than we are, but in our society, it doesn't allow it. We're in a society that's dog-eat-dog. For example, if I'm going to sell you a used car, I should show you the bad parts, point out the bad transmission and the worn-down brakes. But if I do that, I get fired by the sales manager, and then my children don't eat. Right off, in society, I've got a morals mountain I can't climb.
"You can't survive in this corporate society and treat other people like you want to be treated. And I will go to my grave wishing I could have done more to change that."
Does he believe in an afterlife? "I don't know, but I guess not. I'm still trying to figure out this life," he says, then smiles. "Better hurry, huh?"
He does not want to die; he is afraid of dying. He is sad at the idea of not being. The question in his eyes is: "How can your lives be empty of me?"
The first week in December, the Wildfangs sign him up for hospice care. The hospice will deliver a portable hospital bed to their apartment when his time draws near, and offer counseling and other support. This represents the crossing of a bridge, because hospices only work with those who have less than six months to live.
Wildfang is unwavering in his determination to control his end, but he wants to square it with his children. So on a rainy night, he and Georgia drive to the house of his eldest son, Richard, where the children and their spouses await. They know about his disease and sense what he is thinking, but still. . . . They know what he has always wanted his life to represent, and although they all protest that they wouldn't mind taking care of him, there is no argument when he repeats several times that he wants to spare them an ordeal, and to also set an example of personal independence for others. Tears are blinked away because these are children trained in his own stoic culture, and they know he intends this to be his final social statement. "If that's what you want, Dad," they say over and over.
It is only when he speaks of their mother, Vivian, who had died so slowly decades earlier, that emotion breaks into tears, including his own wet eyes. "I really loved that gal," he says, speaking slowly, giving the words weight.
An old movie is playing on TV, and Georgia is out shopping on this wet and chilly afternoon in Salem. Wildfang feels talkative. He wanders among the years of his life, reliving the missions he undertook. He seems most proud of the years he spent pounding nails to build homes for the poor as a Habitat for Humanity volunteer. He also devoted decades fighting for small farmers in the National Farmers Union. And because he has a stepson and a great-granddaughter who are gay, he is active in Parents, Families and Friends of Lesbians and Gays.
"I've lived for almost a century, and I've still got the same big question I had when I was a boy: Most people want to do good, so why is it we can't make this earth work better? Why is poverty a price we're willing to pay for greed? In a short while I'm not going to be here anymore, and it won't be a long time after that all traces of me will disappear forever. Like I never existed. So what's it mean? I don't know, but then, fellows a lot smarter than me didn't know either." He pauses in counterpoint. "Looking back, I'm disappointed I couldn't make a bigger difference, but I guess I shouldn't overreach. I loved two good women, and raised four children who are a credit to me. On my last day, I'll have the thought that that's pretty good."
He says he doesn't put much stock in memorial services. "Too much about what people wish the life was about, not what it really was. I'd prefer that someone just read the list of things I've been involved with." He hands me a photocopy of a list written in a shaky hand. "This list is pretty much me."
Wildfang is enjoying a burst of strength, and the family takes advantage by observing an early Christmas on the 13th. About 30 relatives and four generations celebrate solemnly. Even the small children sense the gravity. The evening is loving, though a bit awkward. However, the timing is excellent because just the next day a new bout of pneumonia sets in.
The infection quickly drives Wildfang into a sickroom maintained by the retirement residence. In reality, it's a death-watch room, and he's aware of that. Wildfang says that he has three remaining tasks before he drinks the poison: He wants to distribute family memorabilia to his children, he wants to finish a letter-to-the-editor to the local newspaper on his political views, and he wants to wait until his final Social Security check has been mailed on Dec. 31 so that Georgia will have it, because they don't give money to dead men.
It's almost the end of the year now. Since Christmas, he has drifted in and out of grieving, as Rasmussen had predicted, and his spirits are being ground down. Finally, he tells Georgia he's ready to "do it." He leads her through a final discussion on the financial adjustments she'll have to make after he's gone. At one point, Wildfang's lifelong frugality surfaces in a way that gives Georgia a painful chuckle. He asks what will happen to the life-ending prescription if he ends up not drinking it, which Rasmussen told him is always a possibility. "I'll throw it away," she answers. Then, after saying that, and looking at his concerned expression, she realizes that his "waste-not" credo has instinctively kicked in, even on this.
On the 30th of December, in the middle of a snowstorm, it is decided. Tuesday, Jan. 6 will be the day, because Rasmussen is out of town until Jan. 5. The law doesn't require a physician's attendance, but Rasmussen wants to be at Wildfang's side. Georgia will pick up the prescription on Friday, Jan. 2, and have it filled the next day. Three days later, the family will gather at his and Georgia's home at an appointed hour. He will be wheeled from the infirmary to the elevator and up to their eighth-floor apartment. There, with the family gathered around, Rasmussen will mix the chemical into a drinkable solution and hand it to Wildfang. After saying his farewells, Wildfang will take his drink. He will have a few more moments with them, but with each minute he will grow more drowsy. After about five minutes, he will fall asleep. After about an hour, he will stop breathing.
While final plans are being made, his physical discomfort grows. It is Dec. 31, and his feet have developed a painful fungus, his tailbone is acutely sore, his breathing is more labored, and a yeast infection on his tongue resembles a huge strawberry because antibiotics have destroyed the "good" bacteria in his mouth. His body is breaking up. Even so, Wildfang is observing his final New Year's Eve knowing that his resolve has not failed him: The letter to the editor giving his antiwar views and a final swipe at corporate greed was published on the 28th, the Social Security check has been mailed today, and the plans to end his life are in place. Now he can rest and wait.
As on every day of this final ordeal, Georgia's morning begins and her evening ends at his side. Now, knowing that those days are being counted off one at a time, she is even more often with him.
On the very first morning of 2004, a nurse summons her. Georgia enters the room, approaches the bed and softly says "Howard?" She says it again. A little louder, a little sharper. "Howard?" She doesn't say it again. Wildfang's illness has taken him. A final kiss.
Here is Howard l. Wildfang's list: National Farmers Union (69 years); PTA, local offices and state board of managers; Mid-Valley Community Action Program; Oregon Citizens Alliance; Interact; Habitat for Humanity; Polk County Historical Society; Neighbors Helping Neighbors; Heifer Project International; Christ's Church; Polk County and the City of Independence, Ore. (various offices); Oregon Farm Ministry; Parents, Families and Friends of Lesbians and Gays.