Laine Berman

I wrote these words during my tenure as projects coordinator for the Australian Red Cross in Aceh following the tsunami in 2004. I was concerned that none of the interventions managed by most aid organizations had an exit plan, something I thought would be devastating to the already devastated communities we were supporting. You cannot simply turn your back and walk away from people you have lived and worked with for a few years. One of my tasks in Aceh, then, was to assist each division of the Red Cross intervention to create their gradual and fully controlled end of project strategies.

Years later, after having watched both my grandmother and my mom deteriorate into the deep dark abyss of Alzheimers, my own chances of contracting that hideous disease too seems frighteningly probable. Because of this likely reality, I am prepared with my own exit strategy. I have given my husband clear instructions on what I will do if and when that time comes, or what he should do if I am too far gone in the disease to carry it out.  This, to me, seems absolutely sensible and sane. It may never be needed, but just like my post-disaster social work, a carefully planned “cessation” must be part of the conversation.

Since my home is literally 12 time zones away from my parents, my twice yearly visits ‘home’ to Hollywood Florida were not simply long weekends. Nor would I waste my time during those month-long visits to my folks in the old-age home, or Finishing School, as I learned to call it, where they had moved after my mom’s condition became too difficult for my dad to manage on his own. I listened very carefully to the other residents as they eagerly told me their life stories, their geriatric love affairs after the death of a spouse, and how they planned their own deaths. It was a given that many assisted their friends to pass when the pain, the lack of dignity, or just boredom overwhelmed and they longed for death. Death with dignity is extremely important to these ninety-somethings. Death was never described as a horror or frightening; rather it was a dear friend they longed to embrace. It was life, lived too long, or life in dependency on machines, drugs and doctors, that was the horror.

I became an ‘expert’ on this other kind of exit strategy through their guidance when my mom, suffering horribly through her arthritis-ridden body and her Alzheimer’s cloud, begged me to help her die. She could hardly speak anymore and would never say this when anyone else was present. But to me alone, it was slowly and clearly uttered, “Don’t leave me like this. Help me die”. It took several years of effort, but I eventually did, cradling her in my arms to prevent the nurses from intervening.

Four years later, I was back in Florida where I had quickly returned to somberly await the passing of my father. My first night back, following the usual 38 hour – three flights from Indonesia to Florida, I had gone to dinner with two close friends and neighbors. Over our Mexican repast, our conversation moved toward death and how appalled I was over standard medical interventions despite both my parents having living wills and Do Not Resuscitate directives. My mom had been kept alive against her will and all our better judgements for years. Dad had been resuscitated when he should have simply passed in his sleep – had I been there to ensure it. Instead, as his health surrogate, I was back home on the other side of the planet, when he was brought to an emergency room. Following CPR and whatever else they did (which cracked his ribs), he suffered through two weeks of pain, confusion, and fear.

“He was 93 for goodness sake. He had all his directives. The home staff knew this, yet they still said nothing to the ambulance staff,” I raged to my dinner companions.

I was angry at the world for torturing my aged father and frightened for him. His very vocal fear made my own bedside vigil that much harder. When I finally arrived back in Florida, the first thing I did was demand a stop to all interventions and have him removed to hospice. At least there he would have some peace and comfort as he neared his inevitable demise.

Over Margaritas and burritos, my friends and I each shared our own exit strategies, since we all agreed that the idea of suffering at the end was entirely unacceptable. All three of us had clearly thought about our own exits and under what circumstances they would need to be enacted. John, on my left, would simply shoot himself in the head.

“Easy, quick. Messy, but who cares at that point!”

“Well, I’ve saved all my folk’s oxy and carefully store them in the fridge. When the time comes, I figure mash up a dozen or so and down ‘em in apple sauce or the like”, I explained.

“Oh, you realize, I hope, that you’ll puke them up and not die?” said John.

“Dang, no. Shit. What do I do to keep them down?”

“You will need an anti-nausea drug to counter the opiate effect. Pepto Bismol or the like will work.”

“Sweet. Thanks!!” I replied, truly glad for this necessary information.

“Ah, you guys. I have the best plan yet!” exclaimed George full of pride.

“I would kayak out to my favorite reef off Dania Beach, put on my diving gear, making sure my oxygen tank was empty. The carbon monoxide in the tank will put me to sleep. My weight belt will pull me down to the reef. Painless death by asphyxiation and I become fish food. No need for funerals. Easy. No mess, no fuss”, he explained happily.

“Wow! What a great plan! Doing what you love best, and no messy clean ups!”

I was jealous of George’s no funeral, body recycled plan. I hated the idea of burial and while I had organ donor on my US driver license, what I would do if I died in Indonesia was another issue altogether. 

It is easy to assume these conversations, well remembered from an enjoyable evening with good friends at a difficult time, were marked in my memory because of the honesty and trust we three shared in discussing what is normally a taboo topic. A few days later my dad died. He had not woken from the coma he had slipped into the night before.

More than a year after my dad died, I was back in Florida at the condo I inherited from him and that fateful conversation came back full force. I was phoned by my neighbor Willy to say George’s sister just received a brief email from him. It read “I’m throwing in the towel” and left a few meagre instructions on how to dispose of his things. This is where my disaster training came into play. “Willy, call the police and I will meet you at the apartment. Have the police meet us there”, I said firmly. “Hang up the phone and do it. I am on my way home now.”

I knew immediately that George had carried out his exit plan. On one level I was happy for him for having accomplished his well-thought-out goal. Fortunately, my knowledge of this plan could assist the police and coast guard in the search for his body. More importantly, it was clear, at least to me, that this was indeed a planned, deliberate action and not simply a kayaking accident; nor were his actions spontaneous or rash or impetuous. Yet, what George neglected to include in his perfect plan became all too apparent. George never told anyone why he did what he did. So, in effect, he turned his back and walked away from those who knew him – exactly what I had said was unacceptable to my staff in Aceh. Not only was the shock of his suicide unbearably stressful, the frantic search for his reasons, which we all accept must have been sound, plagued most of our discussions. Further, the lack of a corpse meant no death certificate would be issued leaving pretty much everything he left behind in a limbo that was exceedingly difficult for his family to manage.

That night when we happily and proudly shared our exit strategies, those we would leave behind were not part of our plans. My experiences in post disaster work, evidenced by my own exit strategy definition above plus my personal exit strategy shared with my husband, should have shown me that any decent exit plan must include those we were to leave behind. As the only one of George’s friends and family that had knowledge of the exit strategy, I felt horribly responsible for not refining our plans that night to ensure they would be carried out correctly.

The last time I saw George alive was two days before he left us. We were at a local beerhouse where he was in a great mood (because he had already decided to leave us?), as usual railing against the environmental destruction of our planet and singing Bob Dylan songs. I told his family this. I added that I have an image of him in my mind: kayaking out to his favorite reef, thrilled to be returning to his spot, smiling and singing Dylan songs, utterly content with the execution of his great exit plan. We can bombard ourselves and others with all the questions we who knew him need answered – but none will ever come. Instead, I hold tightly to my image of his great reasons for needing to do this – whatever they may be – and his happiness in having and enacting his perfect exit. That’s my story and I am sticking with it, in spite of my knowing only too well how flawed it truly was. As I had explained to my Red Cross staff, a good exit strategy must be designed in full collaboration with those we leave behind.