It is unusual for my ladies-night-out group to converse about topics much more serious than our hot flashes. We meet about once a month for takeout, wine and laughs. I'm not sure how we got started talking about euthanasia at the end of life. I am sure that my friends were shocked at my vehemence against it; I usually take a liberal stance about such issues. My opinion changed radically after I got to know Edna and Millie (I've changed their names to maintain confidentiality).
Edna was my patient for about a year before her death. I had a contract to provide psychological services in the nursing home where she lived. She was referred to me to help her adjust to the nursing home environment. Edna had become very nervous and angry since her poor health had made it difficult to care for herself. Her daughter had insisted that Edna give up her apartment and move to the nursing home. Edna disliked the regimentation and being told what to do by the staff.
At first, Edna and I met in an empty room, to maintain her privacy. Then, as Edna's physical and mental condition deteriorated, Edna did not want to leave her room even though Millie, her roommate, was always there. It was hard to see Millie's presence as interfering with confidentiality. Millie appeared to be barely conscious and was hooked up to a ventilator and a feeding tube. Although her eyes were open, they maintained a fixed stare. At random intervals, Millie would let out a moan or make babbling noises. Although the staff did its best to keep her clean, there was always a lingering odor of body fluids. When I met with Edna, I drew the curtain around her bed, and I could forget that Millie was there. I often thought to myself what a waste of resources caring for Millie was; she had no quality of life that I could discern.
Often during that year, I wondered whether I was accomplishing anything. Edna talked about how much she missed her independence and her dog, and about her ongoing conflict with her daughter. She complained about her treatment by the staff. Her mood would improve and then plummet after a disagreement with an aide or a quarrel with her daughter. At times, I worried whether I was just serving the function of a friendly visitor. Edna insisted that she knew I was her therapist and not her friend. She gently reminded me that sorting through her feelings didn't mean that her feelings would change.
The staff became concerned about Edna's increasing social isolation. I asked Edna if her mood would improve if she got out of her room more often. Wasn't being stuck with her roommate 24 hours a day depressing? Edna looked at me as if I had just grown another head. Millie, Edna insisted, was her best friend and confidante. Her face glowing, Edna told me about how nice Millie was and about her "sweet nature." About how she would talk to Millie long into the night and they would cry together. "I love her, and she loves me," Edna said.
As Edna became bedridden, she started to become delirious and paranoid at night and then for increasing lengths of time during the day. As time went on, it became more difficult to help Edna distinguish reality from fantasy. Eventually, I was not able to interact with her in any way that could be called psychotherapy, and I discontinued treatment. But I continued to drop in for a few minutes when I was there to see other residents, and I was always surprised that she recognized me. On the last of these visits, I noticed that Millie's bed was empty. When I asked her about it, Edna told me that the staff had "killed Millie" the day before. I held Edna's hand silently while she sobbed.
Edna died a couple of weeks later. I attended the memorial service in the recreation room of the nursing home. Edna's daughter thanked me for helping her mother. She told me how important my sessions had been to Edna. But I knew that Millie had kept Edna alive and provided pleasure and meaning to her life. Without her friend's loving presence, Edna no longer wanted to be a part of this world.
- Lynda I. Gurvitz is a psychologist who lives in Clearwater.
