I was asked to visit Roger.  He was in the hospital, again, and this time there was clear evidence that the colon cancer that had been resected the year before was recurrent.

Roger, as always, was calm.  He was a Vietnam Vet and had been exposed to Agent Orange. He was surprised to have survived Vietnam the first time and now saw this new diagnosis as Vietnam finally catching up.

During our initial meeting, we began to get to know each other. Roger’s wife was ill herself and he did not want her to have to take care of him, particularly in the last days of his life.  I assured him that we would do all we could to support him – that we were hoping the chemotherapy would buy us some more time, and that if he preferred to be in a facility (hospital or hospice home) at the end-of-life, that was fine.

It was then that Roger asked “Is that when I will get the shot?”. Puzzled, I asked him to tell me more. He calmly explained that in “Nam”, the wounded were triaged when they were in a battle. Those severely wounded but potentially survivable were lifted out first, then the walking wounded, and finally, those who were dying received “The Shot” and they were transported last.

I asked Roger if he was asking about MAID.  It was often in the news at the time because of court cases and was known then as Physician Aid in Dying.  I patiently explained that this was legal in only a few places and not where we were.  I did commit that we would work to make sure he was safe and as comfortable as we could at the end.  He nodded and said he understood.

Now, nearly a year later, Roger is in the hospital and his time is short.  When I went to see him, he said his pain was well controlled but he was just so weak he could do very little for himself.  I told him that we had ordered medicines both scheduled and as needed for pain, anxiety, and other symptoms.  If he needed something to help him sleep later, that had been ordered, too.

When I came to see him the next morning, he was mad! He had asked for a shot to help him sleep. The nurse gave him the low dose of Ativan and he had dropped off to sleep, but then he woke up! “I thought I was getting ‘the shot’!” he exclaimed. I told him I had always said that this was not a possibility and he said “I thought that was all a wink and nod but you would help me in the end!” He died a few days later as the natural course of his illness.

I am reminded of this case of miscommunications as I read about the now nearly 20-year experience of MAID in Washington and Oregon.  While we don’t have “The Shot”, an increasing number of states have adopted MAID and the number using these medications slowly increases, now accounting for about 1 out of every 300 deaths each year in these two “pioneering” states.

Al Rabadi, Luai, et al. “Trends in medical aid in dying in Oregon and Washington.” JAMA network open 2.8 (2019): e198648-e198648.   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747692

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