A Guide to the Perfect Assisted Suicide

Business class on British Airways is the only way to fly.

November 12, Thursday, London:

Patti died on Tuesday November 10 in Zurich, Switzerland. It was a warm and sunny day. It happened exactly as she had visualized it would.

I wrote this over several days. Some of it before she died and some after. I wrote it in Denver, in Zurich, and in London. I skip around but I tried my best to piece it together so it makes sense. Try to keep up.

November 9, Sunday, Zurich:

TJ (Joyce) Quinn and I had the honor of going to Zurich with Patti. Patti told me about her ALS (aka Lou Gehrig’s disease) in February, I think, and asked me to go with her to Switzerland in April. I’m not sure when she asked TJ. TJ was Patti’s friend and massage therapist for 23 years. I’ve been Patti’s nephew since I was born.

I had no idea how to take someone to Switzerland to die. Sounds funny but I checked on Amazon and at my library and there weren’t any books.

I went back to Colorado in June to see my folks and to go over a few details with Patti. I met TJ for the first time for lunch. It was nice. The trip was months away and wasn’t very real. I didn’t have to think about it much. That’s how I deal with things.

Our departure date was Nov 7. I was fine all the way through October. Things started to get real in November. I talked to a few people about it. A couple people said I was courageous. I didn’t feel courageous. If someone you loved asked you to make this trip you’d just do it. It’s just what one does.

You would do it.

TJ and I exchanged a few text messages about how we were feeling and what we were doing to get ready. I asked her if I should bring a suit and tie. She laughed at me.

I flew to Denver from Seattle on Nov 6 and stopped at Patti’s house to go over some more details. Patti and her friend, Barbara, were at an appointment to get a catheter put in so they weren’t there when I arrived. She was still able to move with her walker but it was slow going. Ten minutes to get out of the car, another 5–10 minutes to go the 20 feet to her door and then a few more minutes to get aligned properly with her chair and ease herself in. The ALS had attacked her leg muscles to the point where they were barely firing. To stand next to her and hear her say “OK, let’s go, one step” and then watch her legs and not see a movement or to see one foot move an inch is at the heart of the disease. The connection between her brain and whatever makes the muscle fire and move was either dead or dying.

Her legs were nearly done. The disease was moving north. So far, her arms were OK but swallowing was becoming difficult. Later, breathing would be a challenge. I can’t imagine the frustration. A beautiful mind and a body that was shutting down. That is what drove Patti to make her decision. She had lived a great life and wasn’t afraid to die. Well, I’m sure she was afraid. Despite what we all say out loud I think we all fear what we don’t know and what we can’t control. Indeed, Patti was afraid. She was desperately afraid of living in that beautiful mind that was attached to a body that didn’t work.

I left her and Barbara to wrap up a few things. Barbara was going to come back the next day at 10:00. I was going to show up at 11:00. We were going to leave for the airport at noon. Our flight wasn’t until 5:30 but we didn’t want to be late.

November 7, Friday, Denver:

We got to the airport. I dropped Patti and TJ off. They waited for me while I returned the rental car. I got to the departures concourse and the three of us went to the counter. We were going to fly from Denver to Frankfurt, change planes and then on to Zurich. It would be a 19 hour trip.

At the Lufthansa counter, the desk clerk immediately took our passports and asked us to hold for a moment as there was a problem. Uh oh. After a few minutes she returned and told us that there was a workers’ strike in Frankfurt and while we could fly there we wouldn’t be able to make our connection to Zurich. I mumbled something under my breath about the Germans but she quickly said that she would be able to transfer us to a British Airways flight that routed through London and then a transfer to Zurich that would get us there about an hour after we were originally scheduled to arrive. I turned around and asked Patti and TJ if it’d be alright to go to London instead. Patti beamed. She has been to the UK, she told me later, 23 times, often with Barbara, and it’s amongst her favorite places on Earth.

“Yes, that’d be quite alright”, she said. A most auspicious beginning.

We ditched the Germans and went to see the British to square things away.

We had to figure out how to transfer Patti’s business class seat and TJ and my economy seats to a comparable seating class on British Air and to get seats close enough that we could tend to Patti. After a little back and forth I turned to Patti and said “Whatd’ya say we go big and get some upgrades for TJ and me?”

One of Patti’s goals was to spend all her money before she died so that fit nicely into her plans.

I turned back to the agent and said “Yes, please. We’d like those upgrades very much!”

The guy helping us at the British counter was in training. Between the transfer from Lufthansa, the upgrades, and needing wheelchair assistance on both sides we were blowing his mind. We got there four hours early so we weren’t in a hurry and were having fun with it. We were the only ones at the counter and by the time we had it sorted out we had the trainee, a manager, two supervisors, three other agents helping us and a baggage handler putting her walker in a bag for safe transit. Patti was feeling very special and well attended to. There were four other agents at another counter not doing anything and I called over to them to see if they wanted to join in. I think I’m pretty funny and fortunately they and Patti thought I was too. At that point I think TJ thought I was ridiculous. I think all the attention and the laughs helped cut the tension a bit.

November 11, Wednesday, London:

Some days have passed. Patti died. I’m in London pub right now having a Guinness writing this. I walked here. I sat down and put on some headphones and opened my laptop. I stretched my leg out so that I could be more comfortable. My fingers are making the keys clack as I type. The beer is foamy and cold as it goes down my throat. I breathe in deeply through my nose and the air smells differently here than at home. I live on a little island near Seattle and maybe I’m imagining it, maybe I’m just being dramatic, but back home the air is fresher and briny. Sure, England is an island too, but here the air is more, I don’t know, more British. Back in Colorado, the air that Patti has taken in since 1963 is dry and thin. The point is, Patti was looking at a life where her air was going to be coming from a ventilator.

Maybe they have drops they can add that could make it smell and taste fresh or briny or dry or even British. As far as I know the connection between her olfactory bulb, her taste buds and her brain wasn’t going to be affected by the disease. Maybe through her feeding tube they could pour some Guinness or rather, some Prosecco, which she loved, and her brain could experience that. That’d be cool.

Patti was looking at a life where none of those simple things, the things that most of us take for granted and don’t even think twice about would be possible. Some of them were impossible for her as she left Denver and her family and her friends. Some of them were weeks away. It’s likely that she could continue to breathe on her own for a few months or maybe even longer. What was clear though was that she was not going to get better. At some point she’d be in a bed unable to move. Unable to breathe without the aid of a ventilator. They’d carefully thread a feeding tube down her throat to dispense calories. Alive, at the end of a hospital bed, on top of a pillow would be a beautiful trapped mind. Eye balls moving back and forth at whatever someone put in front of her.

November 7, Wednesday, Denver:

We decided that it would be best to buy a wheelchair and use that rather than the walker to get through and around the airports. I ordered it via Amazon. It was in a box at her house when I got there the day before we left. It was black with red flare and looked pretty sporty. Assembling it was easy and didn’t require any tools which was nice since TSA took way my 8” crescent wrench at security. Apparently tools longer than 7” are prohibited in carry-on luggage. After I put it together I tested it out and rolled around her house a bit by myself. It moved pretty well but after a minute or two I got up and pushed it over to the corner not really wanting to look at it.

Patti and Barbara arrived a few minutes later. Patti was exhausted. They told me that an in-home nurse was supposed to come over earlier that morning to insert the catheter but that got all fouled up. They moved to plan B and Barbara was able to get an appointment at the clinic and they didn’t have to wait too long to see someone. Over the past few days the muscles in her abdomen we’re starting to spasm and misfire. She was spasming as they were trying to put the catheter in and it wouldn’t go where it needed to go. Barbara said Patti was trying to give instructions and take control as she was apt to do.

They got two more experienced RNs to assist and were finally successful. Originally the plan was for her to just use the catheter on the plane but she said that she would use it for the rest of the trip.

While I was there her phone rang about a half dozen times and she got about ten text messages. She let most of them go. I think she was done saying goodbye and she just wanted to move forward and get on with it. She did take one call though. I overheard part of the conversation with her friend Andy, she said, “I think my timing is good. If I had waited another week I don’t think I could have made it. I’m so tired and I’m ready.”

The “event” would occur on Tuesday, November 10, 2015. I don’t know if she referred to it that way because she was uncomfortable calling it something else or because she wanted to be sensitive to the rest of us. I suspect the latter.

Nov 8, Sunday, Zurich:

We asked the hotel desk clerk what tourists did when they came to Zurich. He gave us a few ideas and we decided to visit the Rhine Falls which they said was the largest waterfall in Europe. Any time there’s an opportunity to see the largest of anything I’m typically game. Patti and TJ were up for it too!

They say that moving water, particularly fast moving water like you’ll find at waterfalls produces massive amounts of negative ions. Common sense would suggest that negative ions are bad but actually quite the opposite. They attach themselves to positive ions (which are found in bacteria, mold, pollution, diseases, and other nasty things) and rid the environment of the positive ion’s ill effects. If you believe in this sort of thing it could be the reason why people feel so great near the ocean, streams, and waterfalls. We talked about this when we were there and Patti thought it sounded good and bought in. At one point, because of the power of the waterfall and all the negative ions, she joked that she could feel her legs returning to full strength, that she could walk now, and could we please return to Denver. Her positive outlook was limitless.

We got back to the hotel at about 1:00. Patti was spent and needed a nap. It was an unseasonably warm day in Zurich: 70 degrees and wonderfully sunny. As we left her to sleep we opened the balcony door a crack as it was very hot in the room. TJ and I took a walk along Lake Zurich and returned a few hours later. Patti had been awake for about 20 minutes and it had cooled considerably since we’d left.

She was freezing, her back hurt, her catheter bag had swelled and she wasn’t able to pull enough covers on herself to stay warm. I felt terrible for not being there to close the door an hour earlier or to help her cover up or to roll or adjust the pillows under her legs. Even though she was still extremely fatigued she wanted to use the bathroom. She commented the day before on how accustomed she’d gotten to her hospital bed at home and being able to adjust and incline it to take the pressure off certain parts of her back and to use the bar to elevate herself. The hotel bed, obviously, wasn’t setup for that. TJ held her arms out in front of her to use as bar while I lifted under her arms. It took TJ and me 15 minutes to get her up and to the bathroom which was 9 feet away from the bed. If I hadn’t realized it yet it was then that it hit me between the eyes why we were here and why Patti was doing what she was doing. Once we got her the bathroom I made myself scarce. Patti was a modest person and she certainly didn’t need her nephew in the bathroom with her. I don’t remember what I did. A few minutes later, TJ, came out and asked if I could help. Patti couldn’t get off the toilet.

I know that Patti considers life to be precious and something to be honored and respected. Life comes in all different shapes and colors and perspectives and it’s up to each of us to consciously decide how we want to live the life that was given to us. She also believed that each of us gets to decide when we don’t want to live.

Fifteen years ago Patti worked in a neo-natal clinic. She held babies born much too soon and made them feel warm and welcomed into a world that they weren’t supposed to see yet. She has two beautiful adopted granddaughters, Lexi and Nina, that she held there when they were born and she’s been with them ever since. Patti saw other babies that were kept alive by medicine and science and technology.

They lived but they had a life that some would say wasn’t worth living. Who’s to say though? In the case of Patti’s life, she was the one to say. She lived her life with honor and verve and with dignity. She wanted to die with dignity. The state of Colorado wouldn’t let her.

November 9, Monday, Switzerland:

We wanted to go to a mountain top today. We drove to Lucerne with the intention of going to the top of Mount Pilatus. TJ and I failed to mention to Patti that this would involve taking a gondola. I hate to use the word hate. It is so negative. Patti hated gondolas. Oops.

For me, it was one the most incredible places I have ever been to. Part of the reason was the sheer beauty and serenity of it all. Take that and add to it Patti’s courage of getting on that gondola and enjoying every second of the 5,600 foot elevation gain and it was an incredible journey.

For whatever its worth, Patti was so pissed at us.
Words fail me. What is 10X better than beautiful? Patti likes gondolas now. What is 20X better than beautiful?

We could have stayed hours but we needed to get back to the hotel so that she could nap before the Doctor came over.

November 11, Wednesday, London:

Assisted suicide is legal in Switzerland but that doesn’t mean it’s easy to do.

I don’t know how much money Patti spent to go to Switzerland. Ballpark? I’d say $50,000. That’s a guess though. I really don’t know. A while ago I was talking to a friend of mine about all of this. He said, “A bullet costs about a quarter.” He had a point. An hour ago I met a woman for the first time. She was a friend of a friend and knew I’d just come from Switzerland and knew what had happened. She told me that ten years ago, and I was the 3rd person she’d told this story to, her father, who had terminal cancer and was in terrible pain, swallowed a bunch of pills. There was no autopsy. Four of us, now, know what really happened, the rest of the world thinks he died peacefully, in his sleep, from the cancer. Patti could have moved to Oregon or Maine and setup residency for a year and leave all her family behind and done it there. The Swiss allowed her to plan and to organize and to prepare. The Swiss allowed her family and everyone who loved her to talk with her about what was happening and what she wanted to do. A bullet? Pills? Family and friends and talking and loving and sharing and visualizing how you wanted your life to end and actualizing it? The Swiss with their red and white flag and their neutrality and pacifism know what they’re doing.

Monday evening, November 9, Zurich:

There’s a company in Switzerland called Dignitas that organizes this sort of thing. Dignitas, is a Latin word, the Romans were involved too. Look it up. I’m not going to translate it for you. It was a good name for the place that was going to help Patti. They required that a doctor meet with Patti to makesure she wasn’t crazy or on drugs and otherwise was of sound mind and body (sic). We had an appointment with the doctor in Patti’s hotel room at 5:30. We arranged ourselves: Patti in her wheel chair, TJ and I on the couch, a chair for the doctor next to Patti.

We left the door ajar. She knocked and let herself in. We all introduced ourselves. I took her jacket but I didn’t take notes so I don’t have the dialogue but basically she wanted to make sure that Patti understood the enormity of what was happening and that she was sure. She was filling in for the doctor that we thought we were going to get so she hadn’t read Patti’s paperwork. She was a substitute.

I was annoyed by this. In the end, it was a part of the Plan. She asked Patti about herself. Patti talked about her work as an ER nurse and as a hospital administrator. She talked about her traveling.

When Patti said she’d been to Provence, in the South of France the doctor’s eyes lit up. She was married to a Frenchman and lived part of the year there. The two of them talked about the countryside and the lavender and the light. Patti told her how she painted it. The doctor liked that. Patti told her about holding babies. How she was the first one to do this at that particular hospital and how it was there that she met her granddaughters and how now there were 75 people holding babies. The doctor liked that too.

TJ and I just sat there as she told her story. She told her of the other places that she’d traveled to and the joy that that brought to her. They talked for an hour.

“Patti, you have truly lived a wonderful life”

“Yes. I have”

“I hope you understand this but I have to ask you this?”

“Yes”

“Are you ready to die tomorrow?”

“Yes. I am”

The doctor got up and said that she would be back tomorrow morning at 07:30. She held Patti’s hand and wished her a good night.

November 9, Monday, later that night, Zurich:

The doctor had left. We wanted to have a special dinner. Our “Last Supper”. I don’t know if it is sacrilegious or otherwise inappropriate to refer to it as such, but we did anyway. The hotel was offering a special Swiss Fondue dinner. The last time I had fondue I was 12 years old and my parents told me we were moving from Kansas City to Denver. Ever since then I have hated fondue. Fondue in Zurich with

Patti and JK sounded perfect. It was time to get over it.

We had been at the hotel for a few days and had gotten to know some of the staff there. We asked for their help and goofed around with them. We were all having a good time. Patti was going to die tomorrow. It felt weird but good.

We sat outside on the sidewalk. It was chilly but the seats had fuzzy blankets on them, they gave us hot water bottles to keep us warm, and they turned on a propane heater. Marek was our waiter, he was from Slovakia. He explained all the options to us and Patti just had to have the Mountain Cheese and the “moite moite” — half of something and half of something else. We didn’t really care too much. It was so much fun. Patti ordered Prosecco.

November 10, Tuesday am, in our hotel room, Zurich

Our appointment at Dignitas was at 11:00. We had an appointment with the doctor at 07:30. She would come to Patti’s room. My job for the morning was to knock on TJ and Patti’s door at 06:30 as a wakeup call. Turns out I wasn’t needed. I got a text message from TJ at 6:25 saying that they were up.

TJ told me that she was in a deep sleep when she heard Patti, “TJ.. TJ.. it’s 05:30.. I think it’s time to start the day.”

I came to their room at 7:15 to wait for the doctor. TJ had gotten Patti to her wheel chair but they hadn’t been able to put her pants on yet. She had a white bath towel draped over her legs. As a massage therapist, TJ is very strong and capable of moving people around and despite Patti usually being the strongest in the morning, they needed my help to get her dressed. We went through the routine of flipping up the wheel chair foot rests, lowering her feet to the ground, positioning ourselves on either side each of her with one arm levered under her arm pit. Bend the legs so as to not hurt our backs. One, two. Patti would start laughing which would sap all of her strength and that would get us laughing and we’d have to stop and start over. One, two, three..

Patti: “oh.. we can do this.. come on legs.. we can do this.. there it is.. oh.. ok.. hold there…got it!”.

Standing but not steady and not sure.

The whole trip her legs never did give out from her once she was up but I was never confident that they wouldn’t. Months ago, TJ discovered that if she put her hand on Patti’s shoulder blade and applied slight pressure it would gave her legs strength. She taught me this trick. Despite TJ’s knowledge of the human body from her massage therapy training she didn’t know why this worked. I’m positive that she wished she knew the science behind it but sometimes things just are. It would be fun to know why but it wouldn’t change anything. During the trip, every time I helped lift Patti I tried to remember to put my fingers on the pressure point. In my mind it helped give her legs strength. I don’t know if it ever did.

The doctor arrived a few minutes late: 07:38, I think. It didn’t matter and I wasn’t really that annoyed but I do remember thinking to myself that if I was going to be the one to prescribe a lethal dose of Sodium Pentothal to someone I’d be on time. The Swiss are known for their punctuality and precision.

The doctor was from Germany.

Unlike the night before, the doctor was somewhat brief and focused. She was a large boned woman. Blond. 60 years old with large white teeth that showed as she talked and smiled with Patti.

“Did you have a nice night, Patti?”

“Oh yes. We had our ‘Last Supper.’ Cheese fondue outside on the sidewalk. They gave us blankets and hot water bottles to keep us warm. I had a tablespoon of Prosecco and it was wonderful.”

Smiling, “Oh, that’s fantastic, Patti”

I noticed that the doctor used Patti’s name frequently. Maybe this was just her habit? More likely, she thoroughly understood her role in this process and wanted to know her in the short time she’d be with her.

Just a tablespoon?”

“Yes, I loved it but the effect of the alcohol is amplified on account of the drugs that I’m taking. It tasted delicious and I could feel a slight buzz. It was enough”

We tried to take a picture of the doctor talking with Patti. She put up her hand and asked that we please not take any pictures. She explained that despite assisted suicide being legal in Switzerland she had a German medical license and the Germans didn’t approve of the process and she could get in trouble. She said that they were trying to get the laws changed there but in the meantime, no pictures, bitte.

“You haven’t changed your mind, have you, Patti? I have to ask.”

“No. I’m more and more resolved. I had a good night. I’ve written all my cards and I’m ready.”

“OK, Patti.”

It seemed to me that older Swiss/German women when they speak English have a very high, alto pitch. I can’t describe what the tempo is. It’s not sing-songy like the Scandinavians. Whatever it is, it’s nice. I liked it and I liked her.

“Ok, Patti. I wish that I had known you. Next time you come to Switzerland you must do it in the spring.

It’s even more beautiful than it is now.”

“Yes. Next time. That would be nice”

The Doctor made Patti drink a small glass of water. She had to make sure that she could swallow on her own. Satisfied, she left before 08:00. We needed to leave the hotel by 10:15 to make our 11:00 appointment at Dignitas.

November 12, Thursday, London:

I’m still in London but it’s the next day. It’s cloudy and cool and crisp outside. It’s not raining. There are a bunch of Brits around me. I’m in a cafe sitting in a corner with a coffee. A guy, about 25 years old with a 35mm camera and a large lens just sat down next to me. He asked me about my laptop.

“Where you from?”

“Seattle.”

“Ah, the windy city.”

“No, that’s Chicago.”

“Oh, right, the rainy city.”

“Yeah. That’s the one.”

“What are you doing here? You on holiday?”

That’s the 3rd time someone asked me that. The prior times I just made something up. This morning I didn’t feel like lying and it was too much effort to make up a story so I just told him why I was in Switzerland.

“Bollocks! You don’t hear that everyday”

I don’t know if my story opened him up or if he was just naturally chatty but he told me how he’d been in Iraq and got blown up by an IED. Got sent back home with rods and pins in his legs and an aversion to fireworks. Last year he was driving his motorcycle and his leg wasn’t strong enough to apply the brakes. Instead he slammed into the back of a truck. Three weeks later he woke up from a coma and was paralyzed, had a dozen or so broken bones and no teeth. They couldn’t do an MRI or CAT scan to find out why he was paralyzed on account of all the titanium that was holding him together. One day he could just feel again and walked. Sitting next to me he said that while he was lying in that bed paralyzed thinking about the rest of his life he was so angry that he couldn’t pull a trigger. I asked him if he could hear people talking to him when he was in the coma.

“No. I couldn’t but I’m a heavy sleeper. Others have told me that they could though. I wish I could have. It would have been nice.”

He’s still sitting next to me. I’m not making this up. I asked him to read this section to see if I got it right. He read the first sentence and handed my computer back to me.

“I’d rather not. I have self-image problems. Just write the truth.”

For me, one of the things I’ve learned in the past few incredible days is to be more real and to talk to people. When TJ talks to people she faces you, leans in and listens and hears. And not just with her ears. It was unnerving at first and then I got used to it.

At home, I get busy. I’ve got my job and routine and sometimes it’s simply exhausting to talk and to listen and to engage about anything beyond the mundane. It’s easier that way. I need to decide what I’m going to do going forward. Whether I’m going to listen to and hear.

Tuesday November 10th, Tuesday still, Zurich:

Patti was getting a sore throat. The day before TJ and I went to an “apothecary” and got some cough drops. We got the Swiss brand Ricola. I’d seen the advertisements for these on the TV back home. I don’t remember it very well but in my mind there is someone hiking through the Swiss mountains, maybe even with some Swiss cows and their cowbells clanging, and a guy blowing that 12 foot long Swiss mountain horn. We thought it was fun to buy real Swiss cough drops in Switzerland. Patti thought it was fun too. She said that she thought she was catching a cold.

“My cold isn’t too bad today. I think it’ll be here in about 2 days.”

She giggled at herself. The “event” was going to occur in a few hours. She was going to beat the cold.

Before we got to Zurich I asked TJ how she was doing with all of this. I really wanted to know but selfishly I was looking for advice for myself. I should have gotten some counseling before I left but I didn’t. I was confident that I could do my “job” and get Patti where she wanted to go. However, I didn’t think I knew how to support Patti emotionally or how to take care of myself or TJ. Or how to ask TJ to help take care of me. TJ said that she was compartmentalizing to get through it. Do the job. Deal with the rest later was her strategy. Patti had been her mentor, her guide, and her supporter for so long that she didn’t want Patti to have to take care of her on this trip. She wanted to stay strong and grieve later.

November 10, Tuesday but later in the am, Zurich:

After the doctor left I was sitting on the couch with Patti in front of me. TJ was to my left, a little behind Patti. She was hurting. Badly. She was quiet with a faraway look and tears on her cheeks trying not to shake. I started to lose it too. I was a mess. We both got up and went to the other side of the room and hugged each other while we cried quietly. Patti let us be. She knew that we didn’t want her involved at that moment. Her wisdom was astounding.

We started to get ready to go downstairs to the hotel restaurant for breakfast. Patti wanted her black sweater but we couldn’t find it. She thought maybe we’d left it last night when we were having fondue.

She wore her red jacket instead. She brought her purse and denim bag that has a few other items in it.

We left her suitcase, the rest of her clothes and her toiletries in the room. She wouldn’t be needing them. She wouldn’t be coming back.

Breakfast was nice. They had a full buffet: eggs, bacon, various breads, and four types of Swiss jam, salami, prosciutto, muesli, lox, fruit, and cheeses of all sorts.

We pushed two, two-person tables together and took away one of the chairs to make room for her wheelchair. She was facing the window so she could see people going to work and the Swiss trollies winding down the road. TJ asked her what she wanted. “A little bit of everything but no more cheese. After that fondue I think I’ve had quite enough for a while.” Maybe you had to be there, but we thought that was funny.

I went to the front desk to see if they’d found her black sweater. They had. Patti was glad to have it along with her red jacket. It was another beautiful day. A bit chilly but not cold. Full sunshine. I think she just liked having both her jacket and her sweater and wanted to bring them with both with her.

During breakfast Patti remembered her Mom leaving her little pink house in Fergus Falls waving goodbye for the last time. Patti remembered leaving her house back in Colorado for the last time.

Barbara was there. She said it felt fine.

It was about 10:00. TJ and I left to go get the van which was parked a few blocks away. In my mind I’m good with directions and navigation but really I’m not. The streets of Zurich confused me. Not many of them ran straight for more than a few 100 feet and they were narrow and all had German names with at least 22 letters forming a long word that made no sense to me and that I couldn’t remember. TJ grew up on a farm in Eastern Colorado near the Nebraska border. When she was young her father would take her out to the fields and spin her around and ask her which way was North. There were no landmarks except for the crops and the horizon. She always passed his test.

I drove while TJ navigated. Google maps helped a bit but the whole time TJ made sure we never got lost.

In front of the hotel they had a red carpet at the entrance way. TJ thought it would be fun to wheel Patti down the red carpet. As soon as she said it I could hear Patti giggling.

It was hard pushing her up the ramp into the van. It was steep and Patti wasn’t light. The ramp had good grips on it and I got her up inside safely at which point I told Patti that I had a vision of slipping, and her rolling backwards over me and into traffic where she got hit by a trolley. She laughed at my gallows humor as I knew she would and said that she’d be so pissed at me if we’d gotten this far only to not make it with an hour to go.

TJ and I strapped her wheelchair down, folded up the ramp, and left at 10:15. Google maps said it would take us 37 minutes to get there.

The drive was quiet. Not like all the other driving we’d done the previous three days. I could see Patti in the rearview mirror and I would look back at her every few minutes. Her lips were pursed. I could see her Mom, Esther, in her face. She was glancing left and then right.

To me, Switzerland was different than a lot of countries I’ve visited. It’s a small country. The entire country is 16,000 square miles and they have a population of 8.1 million. To put it in perspective, Colorado has 104,000 square miles and 5.3 million people. About 1/3 more Swiss people in an area 7 times smaller. Lots of hills and mountains. Not a lot of room to grow or build things. They have to maximize the space. As we drove down the highway towards Dignitas we’d pass factories which were next to houses, next to apartment buildings, next to green fields of alfalfa or vegetables and other fields with cows grazing. The cows were fenced in with short, portable fences that were at most 2 feet tall. TJ was convinced that even those fences weren’t needed to keep the cows in. They wouldn’t run away because they were so happy and it was so beautiful there. I liked the way she thought.

I looked back at Patti again. She was still scanning. She looked left and she saw things. She looked right and she saw some more. Every time I glanced she was repeating the pattern. We were all quiet. She’d blink. I don’t know what she was thinking but I imagine that she was taking pictures with her eyes. To keep it. To take it with her.

TJ navigated. I drove. We arrived at Dignitas at exactly 11:00. We were glad we were on time. We wanted to do well. TJ and I were a great team.

Dignitas was a two story blue building set behind some hedges. Across the street was a fallow field.

Behind it was some sort of manufacturing facility with forklifts. I didn’t see them but I’m sure there were Swiss cows nearby.

Our pattern was that we’d park the car, TJ and I would get out and meet at the back of the van. We’d each take one side of the ramp and lower it to the ground. I’d climb up the ramp into the back and she’d go around to the side. I’d release the back two straps and she’d release the front two.

“Right brake,” and Patti would release the right brake on the wheelchair.

“Left brake.”

I’d wheel her backwards down the ramp while TJ held on to the front. Meanwhile Patti prayed that we wouldn’t let her roll into traffic.

We rolled around the hedge to the front door where Ericka and Horst greeted us. Ericka had been a nurse for 35 years. She said that she’d seen a lot. Patti told her that she’d been a nurse too. Ericka said that she knew that. She’d read about her. She’d been working at Dignitas since May 17, 1998. Fifty two years helping people in different ways. She had strong white hair pulled back tight and the same voice as the doctor. High toned and intentional. I liked her immediately.

Horst was old too. He had similar white hair swept back and a beard but no moustache. He smelled of pipe tobacco. I liked him too. He had a green turquoise earing about the size of a ladybug in his right ear. Later I noticed that Ericka had a matching one. I asked her about it. She said that she was with her first husband for 40 years. He died when she was 60. When she met Horst and decided to marry him she didn’t want another ring on her finger so they decided to share the same earring. I never really thought about it but an earring is as good as a finger-ring when you share it with someone you love.

We went inside. Our room was large enough: 15’ X 30’. Wood floors, a window looking out into a garden where there was a fountain. A small table with 4 chairs, a couch, two tables with candles, and a bed against the back wall. There were boxes of tissue on every flat surface.

Ericka led us to the table. I removed one of the chairs so that TJ could wheel Patti to it. We sat down. Horst stood quietly behind us.

Ericka smiled and said how glad she was that Patti was there.

“Now Patti”, she said, with her accent that I loved, “I have to ask you some very blunt questions.”

“I understand.”

“Are you sure that you want to die today?”

“I am very sure. I do.”

TJ and I locked eyes for strength.

“Patti, have you had any alcohol or drugs today?”

“No. Not today. Last night I drank a teaspoon of Prosecco and it was wonderful”

Ericka smiled and said that she was glad.

Ericka asked if she wanted anything in her coffin with her. We were confused by this since she was going to be cremated.

“Anything to go with you?”

“Oh. No. Nothing.” She slipped off her favorite silver earrings and her trademark blue turquoise ring and gave them to TJ to keep.

“Patti, you can stay here for 24 hours. You can go out to the garden and sit in the sun. It’s a beautiful day. You can take a walk if you’d like.”

Patti smiled and said, “No, I’d really like to get on with it. I’ve been visualizing this day for months. The last few days have been exactly as I wanted them to be. This room is exactly as I saw it in my mind. I’m ready.”

I think Ericka was surprised. She didn’t say this but the look on her face told me that most people took more time.

Patti wanted to change into her pajamas. Back at the hotel, she and TJ picked out her favorite bright blue one.

Ericka offered me a cup of coffee so I excused myself while TJ helped her change. I’m sure it wasn’t easy. There was a box of tissue on the kitchen table where I took my coffee. I used it.

Horst took a small bottle out of a drawer and went into another room. I saw him drip 30 drops of clear fluid into a small glass. I stared and counted them. He was very intentional. I thought it was the Sodium Pentothal. The drawer where he got it was close to me. I wanted to open the drawer to see if there was anymore. I wanted to look at it up close and touch it. Touch Death. I could have done it without him seeing me but I didn’t.

TJ came out and said that Patti was ready. She had gotten her pajamas on her and put her into the bed by herself which must have been very difficult. We pulled the bed away from the wall a few feet so I could be on one side and TJ could be on the other.

Ericka and Horst came in and said that they wanted her to drink something to help her stomach. Turns out that is what he was dripping into the cup. Ericka said that it tasted fine and that she needed it in her system for about 20 minutes. Patti drank it and said that indeed it tasted fine.

Ericka said that they’d be back into a little while.

I sat in a chair on Patti’s left side while TJ rubbed Patti’s legs. Patti loved it when TJ did this!

TJ asked Patti if she’d ever been visited by a spirit. Patti said that she had. I don’t remember his name but he was a part of her gang from the 5th grade. He died when he was in his 50s and came to her in a dream. She didn’t remember much of the conversation other than that he was visiting his friends from Fergus Falls. He apologized for it taking so long but there were a lot people to visit. She giggled when she said that. She said that he was reassuring, peaceful and kind.

TJ shifted to the other leg.

Patti told us that she’d been taking an anti-seizure medication but stopped taking it the night before.

The doctors said that if she didn’t keep taking it she could have terrible and painful seizures. She said that she wanted to take charge once again and that she was going to stop taking it and “get out of Dodge while the gettin’ was good.” That last part is a direct quote. Cracks me up. Can you believe she said that?

She said some other things that I didn’t write down but they were funny and all three of us were smiling.

“I’m glad that I could entertain you,” Patti laughed

“For years,” TJ said.

Ericka knocked quietly on the door and came in. Horst was behind her with another small cup. I looked at it. I didn’t like that cup. Three ounces at the most.

TJ sat in a chair on the right side of her bed. I sat on the left. Ericka folded herself onto the bed near Patti’s legs.

“The medicine tastes very bitter, Patti. It will be difficult to swallow. I’ve made this syrup that I want you to drink afterwards. Will you taste it now to see if it’s alright?”

It was in a clear glass and was yellow and looked like it had honey in it.

“Yes. That tastes nice.”

“Patti, you have to drink all of this within 20 seconds otherwise you will go to sleep but death will not come.” The accent was there as was the kindness but she was intentional and serious.

She gave the cup to Patti who raised it to her lips and then she started to giggle. I didn’t move. I don’t know what TJ was doing. Ericka put her hands on Patti’s hands and they both cradled the cup. Patti tried again and laughed again and lowered the cup. A 3rd time. The same.

We have all experienced Patti’s laugh and its joy. This was different. To say that Patti was afraid at this point would seem to disrespect her. The motto at Dignitas is “To live with dignity — to die with dignity.”

She was going to but, Jesus, Patti loved life.

“Alright Patti, serious.” Ericka said.

Patti looked up at her and said, “Yes. Serious. How long will it take?”

Ericka had crooked teeth but smiled a beautiful smile. “We all take our time to come. We all take our time to go.”

She drank it by herself and it was terribly bitter. Ericka placed a towel under her chin. I thought she was going to gag. She didn’t.

“Oh, that stuff tastes like crap!” I remembered Patti’s mom, my grandma, Esther, saying something like that.

She drank some of the syrup and it helped get the taste out of her mouth. Patti put her hands by her side. Ericka gave the glass to Horst.

TJ told me later that it took all of her strength to not knock the glass out of Patti’s hand. She didn’t want her to die. None of us did. Patti had taught TJ so much about herself and how to live life with honor, intention and dignity over the years and shared so much of her own life with her. They were family. She wanted more. We all did. I’m guessing now but I suspect it was the single hardest, most selfless thing that TJ has ever not done. To want something so badly for yourself and to let it go takes the type of courage that is rarely seen.

“There will be no pain, Patti,” Ericka whispered.

“Just go to sleep,” she said as I gripped her left hand and TJ the right.

“Tell Barbara Jean that I love her.”

“Just go to sleep.”

“I love you Patti,” I said.

“Just go to sleep.”

“I love you Patti,” TJ said.

“Just go to sleep.”

Her last words were, “I love you all.”

Patti went to sleep and was snoring in less than five minutes. I think she’d be mortified to know that I’m writing that she was snoring but for me it was comforting. It let me know that indeed she was sleeping.

Ericka said that Patti couldn’t talk to us anymore, she’d be in a coma soon but she could hear us.

I didn’t want to let go of her hand so I couldn’t take notes. I don’t remember what TJ and I talked about but I remember feeling Patti grip my fingers. I remember not being sad as Patti snored. I actually felt light and good. We stayed that way for about an hour. TJ was sure that she could hear everything we were saying. I wasn’t sure. She talked directly to Patti and told her how much she loved her. I said I was glad she hadn’t rolled out of the van onto the freeway on the way there. We laughed. Ericka brought us tea. Horst sat on the couch behind us quietly. It was sunny outside.

The day before I was talking with Patti. I don’t know where TJ was.

Patti said to me, “Michael, when I was a nurse I saw a lot of people die. Death isn’t pretty. When the body shuts down and the organs fail it can be messy. Sometimes the bowels release..”

“Yes. I know.”

Ericka offered us more tea. We hadn’t finished our first cups. She laid out 4 different flavors for us to try if we wanted more.

A bit later Ericka came over and said she’d spoken with the clinic and they said that we should turn her on to her right side. It’s possible that the medicine had gotten stuck and hadn’t made it yet through her system. Horst and I were on the right side. Ericka and TJ were on the left. Ericka didn’t weigh much more than 100 pounds but she was very strong. She had done this many times before over the past 50 years. We got her stable on her side. I brought my chair over and sat next to TJ for a few minutes as we

looked at her and talked quietly.

TJ got up to go talk with Ericka. She came back a few minutes later and asked me to come over to the other side of the room. She said that Ericka said it could take 9–10 hours. She didn’t really know how long. We were welcome to stay as long as we wanted, she said. Often times, though, it takes longer for the person to let go when there are family members around. They don’t want the family to see what happens after death.

Patti wrote me a card on her last night after our fondue dinner. I read it after she died. Among other things she said, “your respect for my personal privacy was very much appreciated.” Except for when I had to help her get off the toilet that one time, TJ handled all the “private” details.

Patti’s message to me the day before about what happened to the body after death was to prepare me, but I think it was a also a hint that she didn’t want me to see that part of her death.

TJ went out to the garden. I don’t remember what I did but I passed the time for a while. Later, I went out to the garden and sat next to TJ on a bench next to a little pool of water. I didn’t know what to say or do. The job wasn’t done. TJ and I didn’t want to leave her without her family being there.

I don’t remember who said it first but we both knew it was time to leave. We’d done everything perfectly as had Patti. I was proud of us. I was proud of Patti. God! It was hard but it was time to let her die with dignity.

TJ and I sat on the bench crying for a few minutes then got up to tell Ericka.

Things started to move quickly. Ericka asked us about the wheelchair. We asked if Dignitas could use it. They could. I asked Ericka if she would take Patti’s red coat. She turned her back to me and I helped her put it on out in the sunshine. It was big on her but looked beautiful. She said she was going to wear it to dinner that night.

Ericka said that she would call us with updates except she didn’t know how to dial our US phone numbers. We Googled it to figure out how to do it. Ericka called TJ’s phone from 6 feet away. They said hello to each other via satellites and cell towers and laughed.

TJ and I left at 2:15. Google took us home a different way than we’d come. Through a few small Swiss hamlets and along Lake Zurich instead of via the freeway. It was pretty. I drove. TJ navigated.

TJ’s phone rang.

I pulled over into a parking lot.

Ericka told TJ that Patti stopped breathing at 2:35, 20 minutes after we left.

I could hear her sweet Swiss voice over the phone.

Her heart stopped beating at 2:40.

“I love you all,” was the last thing she said.

I’m not making that up.

TJ and I were there to hear it. It was meant for the two of us who helped her travel to Zurich but I know that she was saying it to all of us, all of you who are reading this and all the people that she knew and who knew her that this note won’t reach: the people that she lived life with for the past 70 years.

Life isn’t easy. Patti struggled. She struggled with her self-image, with her weight, with depression. I think most everyone knew that. As for me, when I think of her, I think of a thousand things. Most of them good, inspiring, and wonderful. Mostly, though, it’s her wisdom and her laughing and giggling and her smile that made her eyes disappear.

My friend, Bill Tyree, who I love, wrote her a card for her to read in Zurich. He said, “You lived your life on your terms and showed us what true courage is.”

I loved Patti.

It was sunny outside. And warm. In Switzerland.

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