End of Life Options

Earlier this year, a new person moved into my apartment building who demonstrated some behavior that I have judgments about: she told an outright lie in order to gain occupancy, which I think I mentioned here. I gave her a little lecture in my mind, and then quite a few more. I came to think of her as a bad person. She proved to be a major door slammer, and every time I heard her door slam—about eight times a day—my lack of charity grew. Months passed without my laying eyes on her, though her front door is close to mine. When the day finally came that I encountered her, I walked past her as if we were two strangers in the corridor of a downtown office building. It didn’t feel good, and I resolved that the next time I saw her, I would make eye contact and say hello.

More recently, I was entering the front door of our building, my bicycle panniers loaded with groceries. My neighbor came up behind me and said, in a very sweet voice, “I can hold the door for you.” She held the door, and I barely looked over my shoulder—I didn’t even see her face—and mumbled, “Thank you.”

Moments later, I felt heartsick. I had taken one fact about a person—she told a lie—and used it to make her into a non-person who could be treated accordingly. Thanks to studying the precepts for school, I was unable to stand the results of my own actions for more than 15 minutes, and went to knock on her door. She didn’t answer, so I sent her the email below. I reflected that while she took an action I deplore, I don’t know why she did that, and I still don’t know much else about her. It was a powerful reminder to be aware of what information I am taking in and what conclusions I am drawing, which may be entirely wrong, and also a reminder not to tell and retell myself judgmental stories about someone else. 

Dear [Neighbor],

Thank you for helping me with the door today.

I have not been friendly to you the time or two we have encountered each other—in fact, I have been rude, and I’m sorry. Please forgive me. You may rely on my being a better neighbor henceforth.

(I knocked on your door a couple of times today, as I would rather have spoken in person, but found you not home.)

As long as I’m writing, I would be appreciative if it would be possible for you to close your door a bit more gently when you go in and out. :-) Please let me know if there’s anything I’m doing that’s bugging you.

Best,
Bugwalk

I got a really nice note back from her, in which she said she would try to do better with the door. For a few days, it actually did seem a little quieter, but soon she was back to her normal ways. It bothered me less, though, because I had at least said something.

At work, I made a second visit to a patient who is very sad and discouraged, not sure if he wants to be here. I’m trying to develop ways of allowing lots of silence without it seeming really odd. One question that has perplexed me: where do I rest my gaze during these moments? Staring into the patient’s eyes is obviously not good, and looking just past his or head seems nearly as bad. I can imagine the patient asking in the first case, “Why are you staring at me?” and in the latter, “What on earth are you looking at?”

With this patient, I chose a spot on the floor fairly close to the edge of his bed and pretended it was a TV that we were watching together. I took five leisurely breaths; out of the corner of my eye, I could see the patient look at me once or twice, probably wondering what was going on. After five breaths, I looked at him and half-smiled, letting him know I was still with him, and then I looked back at my spot and took five more breaths. During this time, I was conscious of my own discomfort and strong wish to break the silence by, if necessary, veering off into a social conversation. However, I made it to the end of the second five breaths without saying anything, and then the patient suddenly said something about a big decision he is trying to make, the first I’d heard of it.

This patient has the means of taking his own life available at home, which he mentioned several times during our first visit. Every time he said it, he looked at me with a fearful, semi-daring expression that I couldn’t quite interpret. Does he think suicide is terrible? Did he assume I think suicide is terrible? Did he think he was saying something extremely shocking? Was he afraid I would yell at him? 

He mentioned it again in our second visit. I mentally weighed my dislike of giving a lecture—really, imparting any information whatsoever that hasn’t been asked for—with the possible helpfulness of what I might say about this, and decided to offer my views, which are based in tenets of palliative care. I said, “I think that can be a reasonable choice in some situations. I think we want to make sure first that symptoms such as pain, anxiety or depression are being well addressed. It’s also important for people to know that they will be supported and cared for as time passes.” This seemed to make the patient relax a bit; he let out sort of a sigh. Many times, when a patient wishes to exercise his rights under the End of Life Options Act, it is because he has symptoms that are not being properly managed, or he fears that his needs will overwhelm others and he will end up being abandoned or not cared for. Most particularly, depression is correlated with patients wanting to end their own lives.