My Sister Ra Died a Hero

Not long ago, my sister Laura died peacefully, just shy of her 81st birthday, and I held her hand as she passed away with a trace of a smile on her face. Laura (we called her Ra) was always my favorite of my four older sisters growing up in Ann Arbor, home of the famed University of Michigan. With her winning smile and lively sense of humor, she made friends easily, and we conspired to find fun and laughs together in that quintessential college town. Sadly, tragedy struck in 1952, when Ra was serving as a nurse's aide at the University Hospital during the annual summertime polio epidemic. When she developed a fever and aching muscles, our family pediatrician quickly rendered the dreaded diagnosis—poliomyelitis! Soon she was a patient in the hospital where she had no doubt contracted the disease, and she remained there for the next 8 months undergoing a series of difficult treatments. These ranged from a brief stint in the iron lung to months of daily painful Sister Kenny muscle-stretching exercises in a heated pool to orthopedic surgeries on her hands and feet, finally coming back home the following spring to continue rehabilitation overseen by our mother. Through her courage, determination, and unquenchable good cheer, Ra managed to complete her college education (on Canadian crutches), marry her high school sweetheart, bear and raise their four children, and support her ambitious husband's career until he died suddenly of a heart attack at 50. As a widow, she struggled for over 30 years to remain independent as she experienced progressive disability from postpolio syndrome, ultimately needing to use a power wheelchair the year before her death. When she had a recurrence of her breast cancer in Stage 4, she persuaded her doctor to support her enrollment in hospice care so she could remain in her apartment and, most important of all, avoid having to surrender her treasured independence. It had long been her steadfast determination that she would not lose the independence to which she had clung so fiercely since her polio was first diagnosed. Her choice of Oregon for her last home was deliberate, for her final exit was to be on her own terms, according to the terms of that state's pioneering Death with Dignity Act. Nearly a decade before she died, she committed her own plan of explicit directives to her family in a “pink book” that she kept close by throughout her final years and even prepaid for her cremation and the burial of her ashes. According to the terms of the Death with Dignity law, individuals are required to self-administer the chosen drug (secobarbital). With Ra's waning strength, loss of appetite, aching and swelling in her arm from lymph channels blocked by her tumor, and struggles with insomnia and exhaustion, she feared that she might be unable to give the drug to herself unless she moved quickly to the end of the road, and she called the local chapter of Compassion and Choices for help in negotiating her final exit. This proved to be far from easy. When her doctor's office finally called to report that her medications were available at a local pharmacy, she motor-scootered nearly 4 miles on a two-lane highway (with no sidewalk), only to learn that her prescription was not really ready (her doctor's nurse had made an error), and she turned around and went back home the way she came. What fortitude, what strength, what grit, what determination! That was Ra to the core. After some further delays (her physician was out sick) and obstructions (one of the pharmacists refused to dispense the drug to her because it was against his religion), secobarbital was finally made available (ground-up tablets packed into old-fashioned capsules), and Ra was now just about ready to proceed. She quickly arranged for all of her valued belongings to be distributed or sold. Finally, and most tellingly, when the adoption of her twin Abyssinian cats had been arranged—she was ready for her final exit. Ra called to ask me to be with her at the end, and I felt honored by her request. When I arrived at her home the next day, we chatted and patted each other and shared the hopes and dreams of our many years as best friends and siblings for an hour or so. Then the wonderful volunteers from Compassion and Choices arrived. They provided a couple of medications to “settle her stomach.” We sat at the table while they emptied all of the secobarbital capsules and mixed the powder with some applesauce in a small bowl. They explained to her that once she had consumed the mixture, she would pass into a coma in about 5 minutes, and her death would occur about half an hour later. So we all moved to Ra's room, and she climbed into her bed for the last time. Through this, Ra and I continued to hold hands and smile at each other. She carefully spooned the mixture into her mouth, cleaning out the last trace before falling asleep quietly, still with a bit of a smile on her face. After a few minutes, her heart stopped beating, and there was no more movement or evidence of life. A hospice nurse arrived shortly thereafter and pronounced her death, and soon the funeral director and his assistant came to remove her body—and I was left to spend the night there alone with my thoughts. Ra had died as she had lived—a hero, a pillar of strength, and a source of love and inspiration. I shall miss her forever. Conflict of Interest: None. Author Contributions: Dr. Hazzard was the sole author of this manuscript. Sponsor's Role: None.

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