She was one of the first patients with whom I entered into a long-term relationship. No, not that type of relationship, just a young, slightly over-dedicated doctor and an elderly lady patient. I emphasize the “young” and “dedicated” because I had at that period not yet discovered how to be a caring physician without getting too involved personally. She was born in 1910, into a family with seven children. When she was eight she was struck by polio, and as a result lost the function of her left leg completely and her right leg partially. She could, with the use of braces and two crutches, stand up and walk a few steps. When she was ten, her mother abandoned all her children and fled to a lover in France, never to return. Her father distributed his children to several orphanages. She ended up in Amsterdam, where Catholic nuns took her in.
In almost all of the more sizable institutes where children were looked after before the war, you find regimes of incredible cruelty. She often suffered from cold in the winter, and a kind aunt had knitted her a woolen cardigan so she would be more comfortable during the night. It was against the rules to wear your own clothes, and she was caught. They locked her up for the rest of the night in an unheated room, taking away her crutches so she couldn’t move around in order to get warmer. The nuns (described by her as The Bitches of Mercy) rightly guessed that crawling around on all fours, or three in her case, wouldn’t generate much heat.
Her next brush with religion was some years later, when during confession she told a priest that she had had sex with a man and didn’t feel she ought to confess it because, well, because it was such a pleasant experience. His response was: “Ah, and when can I have a go?”
When I first met her in the nursing home, she was seventy-five and bound to her wheelchair. There was often something of a party atmosphere in her room. She always had visitors, mostly nieces and nephews who had traced her and brought her back into the family circle. I usually dropped in at the end of a working day, when the bottle of gin was on the table and we all eagerly smoked our cigarettes and listened to her stories, some funny, some gruesome. One nephew was a nascent writer and theologian, so we had endless talks about the fatal flaw in each other’s character. She loved our jousting and joined in on whichever side she preferred that day. He was tottering on the edge of what would turn into quite a serious drinking problem, warding off all possible comments by a quote from his favorite author: “People complain about my drinking, but what do they know about my thirst?”
She fell in love with her neighbor two doors down from her room. He was eighty-five. One day, as I entered her room, they were embracing in an awkward kiss, as each was bound to a wheelchair. When they noticed me they flew apart like two naughty children on the approach of the headmaster.
“Shame on you both, will you two never grow up?”
“I’ll drink to that” was her reply.
With the help of a sliding-board and a rope from the ceiling, she still managed to get from her bed into the wheelchair without help. And in that way she could use the toilet too, without having to be “hoisted across like a sack of potatoes.” But when she turned eighty, she lost this last straw of independence and wanted her life to end. People who walk around, who wash and brush themselves when they feel like it, board a train or a plane without giving it a thought, even pee and poo without having to ask anyone to place them on the seat, and who moreover wipe their behind in their own fashion—such people do not realize what a terrible thing it is when you desperately need other people all of the time to help you perform these tasks.
She couldn’t take it. After a lifetime of strife to secure her modest measure of independence, she couldn’t bear this continuous need for help. She wanted to die. I was her doctor and immediately refused her request, even though it was probably feasible within the Dutch euthanasia law. The law is based on empathy and autonomy. She was losing her autonomy, and she asked us to sympathize with her loss and save her by helping her end her life.
A colleague stepped in and went through all the motions you have to go through on your way to a legally permitted euthanasia. I had known her quite intimately for several years now, and I was secretly horrified by her decision. I thought: “What is wrong with our love for you? Why can’t you stay? If only for a year, maybe?” I did not dare to share my misgivings with her. I felt that it would only aggravate her misery, which was bad enough without a weepy friend clinging on, turning her farewell into an unkind act. And that because he was only thinking of himself.
On the day of her death I was with her. Sitting bolt upright in her wheelchair, she gave me a goodbye kiss and drank the potion without a trace of hesitation. Long after she had stopped breathing, I still sat there looking at her, silently staring through my tears. I thought it was a horrible occasion.
Some months later I visited her grave and there I ran into the writing nephew. After getting over the mutual surprise, we reminisced a bit, and I finally confessed to someone who knew her that I was very uncomfortable—no, unhappy—about the way she left us. He immediately agreed: “I thought you were fine with the whole enterprise. To me it was like being slapped in the face, almost. It really hurt. In fact, it still hurts.”
Bert Keizer is a geriatrician and writer in Amsterdam. He has a weekly column in a national newspaper and works for the Euthanasia Expertise Center.
