The Easy Way Out
By Steven Amsterdam
If you could help someone in pain, would you?
Evan is a nurse, a suicide assistant. His job is legal . . . just. He's the one at the hospital who hands out the last drink to those who ask for it.
Evan's friends don't know what he does during the day. His mother, Viv, doesn't know what he's up to at night. And his supervisor suspects there may be trouble ahead.
As he helps one patient after another die, Evan pushes against legality, his own morality and the best intentions of those closest to him, discovering that his own path will be neither quick nor painless.
He knows what he has to do.
For anyone looking for an easy read this is not it, but it is a good read if you want to read about assisted dying.
Evan is a nurse and a suicide assistant; he hands out the last drink to patients who ask for it. Under the rules of article 61 there are very specific rules dictating who is eligible for this controversial legal procedure.
Evan’s mother, Viv, is the only one who knows his job title, he hasn’t disclosed it to his friends/lovers as he is aware of the strong reaction it can provoke in people. Even his supervisor, Nettie, doesn’t know the full story but she suspects she may need to keep a watchful eye on him.
As Evan gets deeper involved in the job, and his life becomes increasingly complicated, he begins to question his beliefs on love, life and death.
As someone who works in healthcare I have seen the effects on patients and family of a long and painful illness and it has made me question my own views on assisted dying and how a law on it would work. It has also made me wonder how it would feel to be the healthcare professional that was in charge of helping someone to die. These questions were one reason why I chose to request this book for review from Netgalley.
The opening lines of the book throw the reader straight into the middle of an emotive scene: “The trio of daughters at the bedside shift their stares between the cup and their emaciated dad. Horrified. Unfortunately, this is what we’re gathered here for today.”
The cup mentioned here is filled with a substance called Nembutal which is administered to those who wish today. In order to get to this point they have be referred by a number of healthcare professionals and their family members have to agree to it. It also has to be only discussed when all other options are exhausted.
At times the descriptions of the patients choosing to die were a harrowing read: “The cancer ran through him like a drain cleaner. First the disease, then the treatment, until he was reduced to the usual constellation of bony prominences, forehead and cheekbones around ashy eyes, all floating on a long and increasingly unresponsive body that’s starting to go chalky at the edges. His right side is nearly paralysed.”
Ethan describes how, “Quality family time has been reduced to personal care. Increasing pain and decreasing consciousness are all that’s on the horizon.”
As a way of ensuring no coercion occurs Ethan’s actions when assisting with a suicide are recorded to be reviewed at a later date. When the book begins Ethan is participating in his first assisted suicide and his knowledge of the camera makes him aware of every action.
On my second reading of this it struck me that there was a sharp contrast between Teddy’s treatment by the hospital and Sanford’s treatment. Teddy wanted to die on the ward he had recently spent time on with nurses he knew but “management would rather confine our dirty business to the specialist wing.”
Ethan points out, “Anywhere else on the planet, Teddy would have withered from his disease months ago, no paper work required. But his doctor was optimistic and pumped him up with six rounds of chemo. Since that didn’t do the trick, here I am.”
We learn that Ethan’s mother, Viv, has Parkinson’s and his father committed suicide when he was younger. Nettie is only aware of the first of these facts but likes to keep an eye on his mother’s condition so she can monitor any potential conflict which may arise.
Throughout the book I was aware that the author probably had some sort of experience working as a healthcare professional because he handled the final goodbye scenes with the families in a vivid but sensitive way. For example, Teddy’s own goodbye scene:
“The daughters cocoon around him, desperate for the last traces that he’ll be leaving. They’re not even trying not to cry…Teddy comforts them, switching between their faces every few seconds as greedily as he can. ‘I’m going to miss you girls so much.’ After all the interviews and fuck-ups, this is what finally gets me.”
He makes an interesting point after this scene when talking about one of the daughter’s Hannah and her possible thoughts on her father’s death, which would probably depend on how well her family explain the situation to her after. “I escape the hospital at 5PM through the sliding doors, wondering what soon-to-be-five-year-old Hannah’s formulation of this afternoon will be. Death is something that happens when a stranger makes you drink from a plastic cup. How will she cope the first time a dental assistant offers her mouthwash and tells her to rinse?”
Evan’s father died when his car missed a turn and span down a Cliffside before bursting into fire. He had a broken neck, burns and asphyxiation.
“After an auspicious young adulthood that included top-of-the-class honours and a national scholarship to design a vaccination program for impoverished populations in the same do-good outpost where he met my mother, my father, in his twenties, peaked. Then was the wedding followed by the idealistic relocations that kept not working out. The locals weren’t equipped, weren’t engaged, weren’t appreciative. White guilt, an embarrassed move back to the mainland and a short resume of ineffective attempts to improve the lots of others. So they had a kid. All this, and seven-plus years without real work, in the context of his undertreated depression, managed only with daily use of marijuana, sourced straight from a lab. He refused to try a different approach: say to see a therapist.
Picture my mother’s increasingly withering patience. The completion of his failure came the day before he died. Viv suggested he moved in with his parents for a while.”
Viv’s approach to parenting certainly seems unique. For example, the abrupt way she informed him of his father’s death, “There’s no sugar-coating this one,’ she says, instantly ruining whole species of donut for me forever. ‘Dad is dead. It happened last night. He drove off the road and died.’
“When I first asked if dad had committed suicide, my suspicion was confirmed and then shushed. He was sick. But you and I are ok. That’s been the bargain all along: we ignore.” It seems that Viv takes this approach to all difficult topics in both her life and also Evan’s.
At the start of the book Viv is living in Willow Wood care home after her Parkinson’s takes a turn for the worse and she knocked herself out after a fall. This marker of a worsening in her condition prompted Evan to take the four hour drive and move into his mother’s former flat so he could help her when needed. Viv comes across as someone who very much knows her own mind and is determined to fight the nature of the degenerative disease all the way. Viv’s consultant tells her that, “hope is the most addictive narcotic that modern medicine offers.” Ethan argues with her over her determination to carry on as normal, “The truth? I don’t feel like it. Your mind is where it used to be, which is wonderful, but your body isn’t there yet, so part of me doubts your judgement.”
Ethan takes quite a practical approach to looking after his mum despite it clearly being a situation and role that neither of them is used to or particularly comfortable with. “Cut to, her son the suicide assistant, living in her apartment with her dried-up oils and broken easel, supplementing her bills with his nest egg. Turns out this is the future I’ve been looking for.”
Viv comes across as a very strong character, but also a bit flighty. She lived on a commune with Ethan for a time and still calls him by his chosen name from his time there, “Everly.” Viv has not had a steady relationship or a long-term home since the death of Ethan’s father.
Ethan is very much a product of his mother’s parenting. He finds it difficult to get close to or to open up to anyone. This is reflected in the number of times he has changed jobs even just as a nurse and also in his personal life. His relationship with his friends is sporadic at best and his choice of relationship appears to be more out of avoidance of intimacy than anything else.
Around the time Article 961 was passed he saw an advertisement for what was clearly a job as a suicide assistant, “The job involved a psychiatric assessment , patient advocacy, writing skills and an ability to liaise with other hospital departments, including Ethics and all medical wards.”
The prompt for him to take the job came after a bad death he had witnessed. “I had recently witnessed one spectacularly bad death on the psych ward where I had been working. A woman in her forties with that burnt-out kind of schizophrenia that imparts few delusions anymore but limits daily function to drinking coffee, smoking cigarettes and taking every drug accept the ones prescribed. The lung cancer was an occupational hazard for her and it had gone to her bones before it was caught. Poorly managed schizophrenia led to poorly-controlled pain – because no one wants to give an addict too many opiates, even if it is her last month alive. In the end, they put her in a room away from the meal area, so her screaming wouldn’t distress the other patients. My memories of the sound of her pain, along with the lingering questions of my father’s consciousness as his car burned him, let me to apply. Who doesn’t like the idea of a comfortable death?”
One of the patients he assists made him think of his own mortality and also what kind of deathbed scene he and Viv would share. “Viv and I won’t make a scene like this. We don’t do feelings this naked. Her parting message won’t be a roar. No, she’ll be saying. Isn’t this interesting? As she steps off the cliff, as the lion’s teeth close around her neck. Any other response would require an acknowledgement of the facts. Viv likes to stay upbeat.”
I think Mryna puts forward one of the best arguments for assisted suicide VS a natural death. “This is the way death ought to be. Not the torture my husband went through. He had a heart attack. Next thing we’re in the hospital. They couldn’t save him, but they worked on him for half an hour. Beating on his chest, trying to drag him back to the world. Revived him twice. I knew he was dying, that he wanted them to stop. They finally listened to me. He should have been allowed to go peacefully, but the reflex of the world is greed, always trying to get some more, this what you did today convinces me. Leo got to say Enough. And that means everything.”
However, some of the drawbacks are pointed out quite clearly as well, “Our patients have to do it alone and if they’re too sick to give all the consent they gave last week, or if their brother-in-law is feeling a bit too Jesus this afternoon to sign off on it, well, then we have to abort.”
I enjoyed reading this poignant book and thought the characters were very well developed. It made me laugh, cry and frequently gave me food for thought.
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