When the time came to grant his wife’s final wish, Herb Myers took the bottle of pills from his safe and went to his home workshop and set it on the flat surface of the table saw. With shaking hands, he pulled apart the capsules, one by one, and emptied their contents onto a dinner plate.
Not all of the secobarbital came out cleanly, so he used a drill bit to scrape inside the capsules. The pile of powder grew so slowly that for a while he feared there would not be enough, and in a final surge of denial he almost believed she wouldn’t go through with it.
But after 90 minutes and 100 pills, a substantial amount of the drug lay before him, and he poured the bitter substance into a plastic bottle and added a few ounces of a sweet sports drink, a flavor his wife had selected the night before. The pharmacist had offered to mix the solution but Herb, uncertain it would ever be used and fearing that there might be a shorter shelf life once the drug was mixed, said he’d take care of it.
But later, he regretted losing even that hour and a half that he could have spent by his wife’s side.
He took the mixture back into the house and set it on a tray where Kathy, one day shy of her 63rd birthday and in the terminal stage of a devastating respiratory disease, lay in her hospital-style bed in the living room.
In moments, she would undertake — possibly for the first time in Colorado — what the state’s new medical aid-in-dying law now permits: She would end her own life by consuming a doctor-prescribed sleeping medication.
But while the legal mechanism was in full force, and Kathy’s condition met all its criteria, she and Herb learned it took longer and proved more difficult than expected to navigate a new and still controversial process.
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The initiative that became known as Proposition 106 passed in Colorado last November by roughly a 2-1 margin. An emotionally charged campaign weighed a terminally ill individual’s desire to end their own suffering against religious and ethical opposition as well as concerns about protecting the elderly and people with disabilities.
The law, modeled after Oregon’s 22-year-old “Death with Dignity” measure, was designed to safeguard both patients and health care professionals. Two physicians must agree on a patient’s mental competence and that they have less than six months to live, and the patient must self-administer the drug.
Individual physicians and hospital systems can decide whether to participate in the process. If they choose not to, the only requirement is that they transfer a patient’s records to a new physician on request.
When Herb first began to pursue the end-of-life option for his wife, he thought Kathy’s hospice care would be on board with providing a doctor. But that proved not to be the case.
“And then I started making phone calls, getting on the Internet, doing everything I could to find doctors willing to do this,” he says. “And I couldn’t find any.”
Herb, who works as an auto mechanic, methodically sought a solution. He says that even their longtime family doctor balked, explaining — incorrectly — that it would take court orders and years of litigation and Kathy would be gone before the issue was resolved. In all, he reached out to more than two dozen physicians — an exercise that revealed some doctors’ unfamiliarity with the law as well as hesitance by others to participate.
Ultimately, he shared his frustration on air with radio host Tom Martino, who put him in touch with 9News, which became the first media outlet to air stories tracking the couple’s difficulties and their resolution.
The exposure gave viewers an early glimpse of how the law can play out in actual practice. But it did more than just air Kathy and Herb’s problem — it solved it.
A physician who saw the initial TV segment contacted the station, Herb says, and in short order they connected. That doctor made a house call and determined that Kathy met the criteria to proceed. A few days later, he called to say he had found a second physician, whom the couple visited to receive confirmation.
“Both of these doctors had extra heaps of compassion,” Herb says.
If he hadn’t taken the story to the media, he adds, he’d probably still be on the phone or clicking through the online world in search of a solution. Supporters of the aid-in-dying law point out that while Kathy and Herb took an unusual route by making their story public, it’s not unusual that patients, testing a new law, have to advocate aggressively for themselves.
“One of the most difficult things about when a law becomes effective is getting the health care community educated and up to speed on the process,” says Matt Whitaker, multistate implementation manager for the pro-initiative group Compassion and Choices.
His organization offers resources for doctors and patients alike as Coloradans adjust to the aid-in-dying law, but doesn’t connect individuals directly to physicians. In fact, he opposes the idea of having any kind of a clearinghouse to allow patients to find doctors willing to help them through the process.
“We want this to be normalized and integrated into the medical standard of care rather than be some kind of specialty practice,” Whitaker says. “That’s not what was intended to be and not how it has worked in the other states where this has been in practice for combined over 30 years. And it’s not what we think will happen in Colorado.”
From a hospital perspective, the biggest problem with the End of Life Options Act was that there was very little “ramp-up” time between passage and implementation, says Colorado Hospital Association spokeswoman Cara Welch. The association provided resources to members including model policies and information to help them decide whether to participate, “but it was difficult because it all happened so quickly.”
“Hospitals are in a state of process with some of this,” Welch says. “Even though they may have policies in place, many are still looking at it, and are open to reconsidering at a future date.”
Physicians are still coming to terms with the law and its evolving rules for implementation, says Dr. Lynn Parry, chair of the Colorado Medical Society’s council on ethical and judicial affairs.
“Once the law was passed, everybody assumed that you could just turn on a switch and it would all happen,” she says. “That’s certainly not the case. There are a lot of physicians that are uncomfortable with it.”
The learning curve, she says, applies to both doctors and the public. “These are very difficult times for everybody, and we need to find more comprehensive and compassionate ways of dealing with the angst people are going through,” Parry says.
Whitaker stresses that patients are best served if they continue to receive care from their regular physician who’s familiar with their symptoms and has built trust — although some doctors find themselves ill-equipped to navigate this unfamiliar area.
“Anecdotally, what we often hear from physicians is they don’t know how to respond to a patient till they’re sitting in the exam room having a conversation,” Whitaker says. “There’s a lot of difference between medical aid in dying as a theoretical practice and as an actual practice.”
Whitaker says he’s aware of about a dozen individuals who have obtained the secobarbital, and “more than one” who have used it. The Colorado Department of Public Health and Environment will report at year’s end how many prescriptions were written and filled for the drug, but the state won’t track data on how many patients actually use it.
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Kathy and Herb Myers had talked about their end-of-life preferences for years, he says, but never in this context — having a law in place to actually support them — until several months ago.
Their attitude about a patient’s choice in ending his life was shaped in part by an experience in the mid-1990s, when Herb’s 34-year-old brother Logan was dying of AIDS. Herb, who held his brother’s medical power-of-attorney, told doctors during one particularly difficult hospital stay that Logan wanted his treatment stopped. But it was days before the hospital granted the request.
“For those few days he was in pain, he was restrained, he couldn’t even scratch his nose,” Herb says. “I thought to myself at that time: ‘This is no way for people to die.’ ”
As animal lovers who fostered many dogs in their home over the years, and witnessed some that had to be put down, Herb and Kathy only half joked that they’d prefer the same treatment if they faced terminal illness. “If I get sick, take me to the vet,” they’d say. “Don’t take me to the doctor.”
Then last year, Herb, an avid cyclist despite multiple heart surgeries, had just completed Ride the Rockies when he saw a group of people soliciting signatures on a petition in support of what became Proposition 106. He signed it. In the weeks afterward, he and Kathy talked a lot about the proposed law and their own preferences.
Both of them voted for Prop 106. In fact, Kathy told Herb after the November election that she wanted to act on it on Jan. 1, assuming that would be the day the law went into effect.
Actually, the measure was signed into law on Dec. 16, and three days later Herb launched his quest for the requisite doctor approval and to obtain the prescription. Kathy’s condition had deteriorated markedly in the last few years, as she required oxygen for the last four years and she went under hospice care for the last several months of her life.
Through 38 years of marriage, Herb had come to accept Kathy’s smoking, in part because he understood the hold it had over her. Once, she lost a child during pregnancy and the doctor pointed to her smoking as the underlying cause.
“So if anything would’ve made her quit smoking it would’ve been that,” Herb says. “But she was never able to quit. And she tried everything.”
Twice she went to a hypnotist with a friend, only to have the friend quit smoking while Kathy resumed her habit. She tried vitamin injections to her face. Then acupuncture. The patch. The pill. The gum. Nothing was off the table.
“We were in Vegas one time and there was a place that shot lasers in your ear, which sounded pretty hokey to me, but we figured we’d give it a shot,” Herb recalls. “She was smoking on our way back to Denver.”
She was diagnosed about 10 years ago with COPD — chronic obstructive pulmonary disease — and the doctor told her that if she didn’t stop smoking, she would be gone in three years. She outlived that prediction, but still she couldn’t quit, though she continued to try.
Though she had worked off and on at the post office and for a company that offers human resources management, she hadn’t worked since her diagnosis, except to take care of animals, particularly as a volunteer with Colorado Pug Rescue.
The house’s carpet was eventually pulled up in favor of tile to more easily accommodate their foster dogs. Since she was home all the time, she often looked after the sick ones that required constant care.
When her COPD worsened, she took in kittens, but eventually even that became too much.
“That was her nurturing side,” recalls Herb. “It broke her heart she couldn’t do that stuff anymore.”
In the early stages of her disease, Kathy suffered from shortness of breath. But soon the symptoms became worse — gasping and panic that she likened to someone rising from the bottom of a swimming pool, desperate to break the water’s surface.
The couple considered moving to a lower elevation to ease her breathing, but the trade-off of being farther away from their youngest child ultimately persuaded them to abandon that plan. Over the last two years, Herb figures, Kathy left their Aurora house perhaps twice.
“So she was on oxygen, and her world became 50 feet from that corner,” Herb says, pointing to the spot in the living room where he positioned her hospital bed. “That’s how far her hose would go. She’d always loved her gardens here, and she couldn’t do that anymore. She spent all day pretty much in the bed, watching news.”
Once Herb connected with a doctor willing to help with the aid-in-dying process, that physician found a pharmacy that would fill the prescription for secobarbital. The bill came to nearly $4,000. Herb’s online research had warned him that the drug would be pricey, but he felt lucky he had an empty credit card to absorb the expense.
He tried to keep the cost a secret from Kathy, whose frugal nature led her to seek a deal on her own cremation by offering to donate her body to science. Herb didn’t want her to feel that the expense somehow obligated her to actually use the drug.
Once the secobarbital had been procured, Kathy seemed to relax. She even put on a little weight to a frame that had withered away to 78 pounds.
“It was a load off her mind,” Herb says. “So once she got it, it was like, ‘OK, if things get bad, I can take it.’ So it did give her a lot of comfort knowing it was here.”
Kathy first said she was ready to take the lethal dose one evening in early March, but it was late, and she was full of morphine, and Herb thought it best to revisit the idea later. They spoke only sporadically about following through over the next week or so. Then Kathy broached the idea again.
The following day, March 12, Herb purposely kept her off her morphine, so she would be clear-headed about any final decision. In midafternoon, Kathy phoned her hospice nurse, who wanted to be present if she ever acted on the aid-in-dying proposition. Kathy said she would be taking the secobarbital later that evening.
Herb gave her a bed bath and Kathy changed into the new pajamas that were a birthday gift from her daughter. She read all her cards that had arrived, then made another phone call to gather her daughter and son-in-law so they could be there at the end.
Kathy had chosen a day removed from milestones such as their wedding anniversary and family birthdays in January and February. When she indicated it was time, Kathy gripped the bottle containing the mixture Herb had prepared and chugged it, came up for air and then took the last few swallows.
Herb held her hand as Kathy laid back on her pillow, and he and their daughter, Amanda, spoke to her but heard no reply. After a couple of minutes, Herb could feel Kathy’s grip loosen and he looked up at her face. He never saw her take another breath, and the hospice nurse soon afterward checked her vital signs and found nothing.
In time, the warmth left her body and Herb’s instinct was to pull up her covers so she wouldn’t be cold. He felt relieved that everything had gone so quickly, that Kathy had shown no signs of distress.
Now, the nights are the toughest times for Herb, who feels his sense of loss closing in on him as the world grows dark. He also feels it in those moments at the auto repair shop when he solves an unusual problem — such as the other day, when he diagnosed that a mouse had chewed through a wire — and realizes that he can no longer share the simple joys of everyday life with her.
“I’m working away, and it hits me she’s not there to tell,” he says. “We shared pretty much everything, and after 38 years together, you get used to that person always being there. It’s just a really strange feeling in the evenings to come home and it’s me and the dogs.”
But the difficulty of pursuing his wife’s wish for a peaceful end on her own terms persuaded him to continue to be a public face of a law whose implementation remains a work in progress.
“I know how hard we struggled to get this,” Herb says. “People are still going to be running into the same thing. I don’t want people to have to struggle the way we did.”
