Feature

When Death Is a Choice

As medically assisted dying becomes a reality, one man picks his final day

Illustration by Karen Shangguan

On a quickly darkening Friday afternoon in February, the mood is light at David Forsee’s house. When the seventy-two-year-old Hamilton man spoke to his doctor earlier, he realized making an appointment to die is akin to buying milk or renewing your driver’s license. “I went from the mystical, complex question of which day is right, to waiting in line,” he says through his oxygen mask.

Forsee has Idiopathic Pulmonary Fibrosis, an ultimately fatal lung disease marked by progressive tissue scarring and shortness of breath, and in late January he’d been approved for medical assistance in dying (MAID). He requested Monday morning, but his doctor already had another MAID appointment—how about Wednesday at seven p.m.? “I don’t want to spend the day sitting around,” Forsee says. “Three hours to go, two hours to go—I couldn’t handle it.”

“I cried and laughed,” Forsee’s friend and housemate Sarah Truman says. “Who wants to die on a Wednesday night at seven?”

The doctor said her next available morning was Saturday the eleventh, eight days away. Like that, Forsee’s death was pencilled in. Though he’s been losing weight steadily (a side effect of one of the IPF drugs), at 6’6” he remains an imposing figure. He’s sitting upright in the middle seat of the living room couch, the oxygen line wending across the hardwood floor to a sixty-litre tank called The Liberator that’s parked near the front door. Truman stands behind the couch with her hands on Forsee’s shoulders, occasionally looking down at his shaved head. She admits her imagination has assumed a nineteenth century ghoulishness: “Will they come kill him and then just leave? ‘Oh, we’re not taking the body, we only do the death part.’ Will a horse-drawn hearse show up?”

She turns for the kitchen to simmer some lentils, and Forsee qualifies her breeziness: “We have periods of being morose, but they’re so wearing.” He spent most of his forties and fifties living at an ashram in British Columbia, and even as the illness is a drain it seems to have fortified his yogic composure. “I’m not afraid,” he says. “I’m just not. It’ll be like getting on a train.”

In a sense, Forsee’s train left the station in 2004, when he came down with a serious lung infection and a bronchoscopy revealed scar tissue unique to IPF. The disease appeared to be dormant, and as Forsee was sturdy and physically active, the doctor in Kelowna told him not to panic. For several years after leaving the ashram, Forsee was a long-haul truck driver, and in 2009, while on a Vancouver to Toronto run, his lung collapsed. He drove through the pain (“strong-willed,” he says), finally getting himself to the hospital in Hamilton, where he’d made his new home. He bounced back from the pneumothorax and his respirologist encouraged Forsee to carry on with his life.

It wasn’t until the summer of 2016 that the fibrosis took a firm hold, and Forsee’s lung capacity started shrinking precipitously. In late fall, though he wasn’t sure he’d submit himself to any high-risk procedures, he got assessed for a lung transplant. The decision was taken out of his hands on Dec. 23 when he was declared ineligible. Age was a factor, as was the fact he’d withered to 145 pounds; his system was already too compromised. He filled out the MAID forms on Christmas Day.

On Jan. 18, Forsee’s case is still in limbo when I visit him in the austere, whitewashed second-floor bedroom where he’s been spending much of his time. (The stairs are becoming a feat of endurance, and even though Truman cranks the oxygen to 15 from 10 to juice him for the trip, Forsee arrives at the couch spent as a marathoner.) He’s sitting up in bed, a white blanket pulled to his waist. On a narrow wall shelf within reach sits a bottle of Gaviscon and an alarm clock.

“I knew there was a possibility this thing could bog down,” he says. “Sure enough it did.”

Among the stipulations of Bill C-14—Canada’s assisted dying legislation that became law last June—two independent doctors must agree that the applicant’s death is “reasonably foreseeable.” One doctor has signed on. Another doctor, who would eventually become Forsee’s second advocate, came by earlier in the week to explain palliative care so that he better understood it as an option—more protocol, and Forsee did his best to be tolerant, though a little sarcasm seeped out. “I told her I didn’t apply for this to extend my life.”

None of the doctors, including Forsee’s respirologist, will hazard a guess as to his life expectancy, but his condition is well-documented and none dispute Forsee’s own feeling that without intervention the trajectory is perhaps two months. “I don’t want to hang around to see if I’m right because the last little while is no prize,” he says.

The oxygen flows unceasingly and sounds like one long exhalation. His mask has four central holes, and with an index finger Forsee reaches through one of the bottom holes to worry a fleck of skin from his lip. While his respirologist says Forsee is certainly at risk of another lung collapse, Forsee himself is more fearful of having a stroke and losing the ability to consent, which is what happened to a friend of a friend who had the same illness. (She had compared the struggle to breath to having an elephant sitting on her chest.) He’s also fearful that institutional tip-toeing will confound his desire to die at home. Forsee is registered with the McMaster Family Clinic, and although they helped move his file forward, the clinic’s in-house decree is that patients requesting MAID must be hospitalized. To acknowledge his application but deny a home death strikes Forsee as “cruel and self-serving.”

“The law came into effect before the medical establishment was prepared for it,” he says. Forsee’s anxiety is no match for his equanimity: he knows his team is on board, but they’re navigating unknown territory. He arranges a couple feet of oxygen line so that it runs parallel to the bed sheet at his waist. “Lots of obstacles,” he says. “Understandable obstacles.” He lifts the hemmed edge of sheet and alternates covering and uncovering the length of thin hose.

Although some of his friendships have endured thorny moments during his illness, Forsee says receiving so many well-wishers is the best part of dying. “I’m amazed at the depth of feeling people have,” he says. “Somehow I missed it when I was upright and in the running.”

Among the traits his friends admire is Forsee’s lack of guile, but suddenly that forthrightness pertains to his death. He’s not merely being taken from their company, he’s deciding to go, and he’s defending the choice with his familiar fierce intellect. For a couple years in the early 1970s, Forsee was a producer and host for CBC radio in the Arctic. Later, at the ashram, he was obliged to become a jack-of-all-trades: bookkeeper, carpenter, cook. Setting aside the bodily withering and the ever-present oxygen mask, to his friends he remains the David, or “Swami,” they’ve always known: the questioner, the listener, the helper. For some, the fact he hasn’t changed makes it harder to accept his resolve.

More than one friend has asked Forsee if he’s certain that every avenue of treatment has been explored, while another echoed the doctor’s palliative care spiel: It’s great you’ve got MAID in your back pocket, but have you thought about hospice? “The conversation slid into her feelings about how this is not something she wants to happen in the near future,” Forsee says. “The near future is the whole purpose of this thing.”

And there’s a case of basic denial. A friend had begun dropping by less often, and Forsee, sensing the big topic was being avoided, approached it head-on: “You don’t seem to understand I don’t have a lot of time.” The friend felt reproached and left angrily. They did reconcile, though the relationship in its last phase still requires Forsee to pretend he’s not dying: “We talk about if the stove works, or why the windows don’t fit.”

Even those who wholly support Forsee’s choice find his unsentimental pragmatism a little jarring. “In a similar situation I think I’d be clawing at life,” says his friend Joe Ollmann, who has tried to entice Forsee with outings. “Let’s drive up to Port Dover!” Ollmann suggested once. It wasn’t merely boyish optimism: Forsee had grown up in that Lake Erie town; perhaps he’d like to see his old stomping grounds.

“Jesus Christ, Joe,” Forsee said. “I’ve been to Port Dover. I don’t need to go to Port Dover.”

Forsee says he’s trying to be “conscious of being curmudgeonly,” but he can’t deny that dying, and the IPF in particular, has made him impatient with small talk. In his prime, he rarely hurried a thought, and in his illness he can’t afford to. “It’s not always necessary to fill the air with empty words,” he once scolded Ollmann during a drop-in.

Ollmann wasn’t thrown. “If the man is pissed off, let him be pissed off,” he says. He lives a block away and walks over a few times a week with a foil-covered plate of something classic and hearty like shepherd’s pie. For Ollmann, the sharp moments reflect a relationship that’s become intensely honest, and occasionally ribald: “You got any Playboys in the garage you need me to bury?” (He didn’t.)

As January unwinds, both Ollmann and Forsee realize that the nice meals and the nice openness aren’t prolonging the end, but rather heralding it. “I have affection for many people, but affection and connections aren’t enough,” Forsee says. “All of this delays the inevitable.”

On Jan. 24, when I next visit Forsee in his bedroom, he’s stuck in another waiting period but it’s a more serene one. His application has been approved, and his wish to die at home will be honoured. The attending doctor is out of the country until early February, so Forsee has time to ponder what day might be best. “We grow up thinking we’ll never know when,” he says.

Forsee’s parents died in a car accident when he was 23. (His father was CBC personality and “car safety guy” Reid Forsee, and in a sad irony the car that hit them had a broken tie rod and had never been serviced.) At the time, Forsee was working on an English degree at Laurier, and he took a hiatus, but he admits he’s unsure how the trauma informed the rest of his life or his notions of death. “It’s a taboo subject,” he says. “We don’t embrace it willingly, but everyone has to eventually.”

Death is an intricate crossing, Forsee writes in the journal he’s been keeping of his illness. Crossing to what? I can’t say.

His hands are palm-down on each side of him. He looks both calmly fixed in place and braced for sudden movement. “Nothing has prepared me for this,” he says.

On the day Forsee makes his appointment, his Russian piano teacher, Vitali, comes by. Vitali has wavy silver hair and sharp blue eyes, and he pulls a chair up next to the couch where Forsee sits statuesque.

“You are writing?” Vitali asks. His voice is nearly a whisper.

“I don’t want to start anything I won’t be able to finish up properly,” Forsee says.

“You can finish,” Vitali says. “Work will give you energy.”

Forsee scratches his nose through one of the upper holes in his mask. “It’s close,” he says. “There’s no guarantee I won’t be in trouble in two or three weeks.”

Vitali leans closer to the student he’s been working with for four years. He tells a story about going to Moscow to see his cancer-stricken mother. He remembers her dancing despite her illness. “Three weeks later she is gone,” he says. “When she stopped fighting—” Vitali raises his hands, palms out.

Forsee lets the anecdote settle. He’s not going to rebut his teacher and friend, even though he’s always disliked the battle metaphor. (“I never understood who the enemy was.”) Eventually, Forsee says, “It’s like when you get to the end of a piece of music. You think, boy, is that it? Maybe I’ll just play the last ten bars over and over.”

They both laugh. “I come see you next week, yes?” Vitali asks.

Forsee nods. He hasn’t sorted out how to accommodate the many who will seek closure with him, even if all they care for is a simple goodbye, and he’s not yet willing to turn anyone away. Teary-eyed, Vitali heads for the door. The oxygen raspily hums.

Two hours later, Forsee remains centred on the couch. He takes a digestive cookie from a wooden bowl at his side and breaks off a nibble. Forsee’s cat Lonesome, three years gone, stares at him with psychotically wide eyes from a black and white portrait leaning against the living room wall. “Exacting vengeance even in the afterlife,” he says. “She could be affectionate, and then she’d lose it.” Forsee has a few destinations in mind for his ashes, including Long Point on Lake Erie, where his ancestors were from, but a “sprinkling” will be saved for the garden where Lonesome is buried.

Truman again appears at Forsee’s back. “It’s strange, rooting for someone to be able to die,” she says. “He could be with us, cognizant, for a couple more months, but it’s not up to us.”

Through the sliding doors behind them, the back porch glows burgundy. A brittle leaf skitters across the boards. “Whenever I get sad he says, ‘Light. See me in the light.’ And I picture him dispersing.” She looks down at the top of his head. “We have to let you go.”

Forsee holds his gaze on Lonesome. “Absolutely,” he says.

On the morning of February 11, Forsee has a crumpet topped with maple syrup. He also enjoys a cup of coffee, even though it will mean trekking to the bathroom for a final pee. Ollmann and a couple other friends have been invited over, and the group hovers nervously in and around the bedroom. Forsee finds the energy a little feverish and asks if they might wait downstairs and visit him one at a time.

Truman is last, and after she helps Forsee get comfortable on the bed, the doctor asks him again to confirm his choice. “Yes,” he says. “I’ve maid, M-A-I-D, my consent.” The pun elicits a groan from both the doctor and Truman. Forsee takes his mala (prayer beads) in one hand and Guan Yin (idol carving) in the other, and the doctor surveys her kit and its sequence of vials (sedative, coma-inducer, lethal dose).

After the sedative is administered and Forsee is asleep, Truman calls the others back. They assemble around the bed, setting their hands on Forsee’s long limbs and chest as the doctor stops his heart peacefully. Truman brings bourbon and glasses for a toast.

A short time later, Ollmann finds a chance to be alone with Forsee. A cartoonist by trade, Ollmann stays a while, drawing a picture of his friend. The white bedroom is uncluttered as ever, and intensely quiet. “Except for the clock,” Ollmann says. “You could hear the stupid clock ticking.”

Dave Cameron earned a gold National Magazine Award for his 2012 Walrus feature, “Fade to Light.”

Karen Shangguan is an illustrator from Vancouver, BC.

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