12.36 Helping Dan Die - The Morphine Effect

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36.  Helping Dan Die – The Morphine Effect

Early evening, Dan's living room – Ali at center of sofa; Dan facing her across low table in rocking chair. Each has done a Morphine injection a minute before.

   “Dear Miss, I cannot thank you enough for the Morphine. How I feel now – a tingle, aglow, alive without worry - on tasting food, on taking a bath, on feeling you sexually in bed; even my dreams have improved. It makes me value my alive time more than before.”
   “My pleasure, Dan boy.  And – Boy – you do it like a - Boy!"

   “I want to say something important.” Dan raises right hand.  "Now I have experienced Morphine, I strongly do not desire to leave this enjoyable life. I want to delay if I can keep control.”
   “What about your rational suicide?”
   "Well! Well! Well!  I am prepared. And now that I have you to help I no longer worry about it. Suicide I can always do. Now my mind has turned to prolonging my life on my terms.”
   “Which are?”.
   Dan settles back in chair. “On my feet, with my wits and in possession of wit.”
   “So how you gonna manage that with your tumor growing every day?”

   “I have been to library, dear girl, and also I spoke again with your Dr Stan.”

   “Boy! Do I dig him. What's he say?"

   “The x-rays show the tumor is one centimeter diameter and they have its location inside my skull. Dr. Stan says I am a best case for a new radiation treatment that uses powerful, very high voltage x-ray focused into a tight beam. It is like a very fine surgical scalpel.”
   “Wow! That's wild, Dan! So when?”

   “Not so quick, my dear. No one in the world except the Radiumhemmet Clinic in Stockholm Sweden is doing it. And with the world at war ...?”
   “Gee, Dan. I want to keep you around. So what's the plan?”

   “Before Morphine, I would give up. Resign myself.  Now I want to live. I am 83 so I cannot expect much. But this excites me. I like the experiment part. If I have to die, let it be as part of an experiment to see how well this x-ray knife works. The idea makes much sense. It removes the trouble and pain and complications of real surgery. An invisible knife that passes through flesh and bone and cuts no tissue."
   "Wow! Wow! Wow!  But how'll you get it? Sweden?"
   "I would have to fly. And from a neutral country.  Mexico is the closest with a flight from Cuba to Iceland to Stockholm and takes two days. Could you be with me?"
   “Yeah, anything. I'm your help.”

They do sex, which Ali likes before eating because Morphine gives better sex before eating than after. Then they eat: Ali goes to kitchen and comes back with spaghetti that has her herb special – the Mitsuba – spread over it in cut pieces and also cut tomato and berries. They use chopsticks. Ali prefers chopsticks because, being smaller picker-uppers than spoon or fork, the chopsticks prolong the pleasure of eating by rewarding one's mouth more frequently with littler bits at a time.

Another day, a little later, evening again in Dan's living room, he and Ali sit facing.
   "With the help of the Swedish Consul and an introduction from Dr. Stan I have an appointment in Stockholm. The treatment will take two weeks and they want me to stay a while for observation."
   "When do we leave?"
   "I'll confirm it. Then tomorrow we go to my bank and I execute a power of attorney on you."
   "What about close family? Anyone who might make trouble?"
   "I have only the nephew who lives in Dallas Texas and has not written me in years. If I die in Stockholm, no one need know for years, especially with war on. And I want you to start practicing my signature because it might be useful."
   Ali likes the idea of taking care of, and be taken care of, by, Dan's money.  Better her than the nephew. And she knows Dan will be happier knowing his money will go to help his loving one and not an undeserving legal heir.
          
Ten days later at Radiumhemmet, Dan is being wheeled on stretcher into a hut-size capsule with 5-cm (c.2 inch) thick lead walls and leaded glass window. Ali sits outside looking in,
   "They certainly don't fool around here," she says under her breath. Just 2 days before, they had arrived in Stockholm.
   Ali had studied up on the place. Radium Home in English and the Swedes refer to it as the Hemmet and it was opened in 1910 a little more than 10 years after Roentgen discovered x-rays and at a time of great enthusiasm that x-ray would cure cancer. The Swedish King gave the Hemmet  a million dollars Swedish kroner - a lot of money then. The x-rays turned out a double-edge sword - they killed cancer cells but also killed surrounding normal tissue. The answer - according to Dr Larssen the director - is the x-ray knife developed at the Hemmet. Its terrifically high voltage, by use of lead shielding, directed a very tight beam of x-ray that needed to be finely moved by the hand of the operator. Nowhere else in the world is there such a machine and no one else but Dr Larssen has the experience and skill to operate it.
   Brain cancers, because they are isolated from other tissues and can be position-pinpointed inside the bony skull, are ideal for the x-ray knife. 
   The day Dan arrives at the Hemmet, the first step is to exactly locate the tumor point by point. To do this, a series of x-rays using geometric formula estimate the tumor's position. A plaster cast is made of Dan's head with a plaster brain inside whose dimensions are based on the x-ray views. And inside it is a replica of the 1-cm diameter tumor. 
   With this model, Dr Larssen did dry runs with the x-ray knife. Actually, the x-ray knife cannot cut out and remove the tumor as in real surgery. What it does is first create a line of radiation-burn incision, cutting off tumor from rest of body, and then with crisscross motions it obliterates the tumor by very exactly focused powerful x-ray point beams. The idea is that only tumor tissue is destroyed but the reality is that inaccuracies of measurement and machine and human error involved outside brain tissue sometimes result in complication like stroke, epilepsy, mental change or even coma from brain swelling. 
   Dr. Larssen says in the first interview "The statistics show a 40% cure or near cure rate."
   "What do you mean by near cure, doctor?" Dan asks.
   "It means recurrence but it has always taken at least a year and the average has been 3 years."
   "For me at 83, even a year is a cure. But what quality of life?"
   "There has been about 10% chance of stroke, 5% epileptic seizures, 1% brain swelling and coma, and 5% mild mental changes."
   "Well, that leaves 79% good quality, doesn't it doctor?"
   "Yes, and in your case, I am optimistic because your tumor is very localized and no sign of spread. You are an ideal case for the x-ray knife."
   "I'll go for it doctor. Also I am volunteering for any experiments in technique you wish to do."
   "Thank you, sir."

After the interview the admitting office takes care of the paper work that includes an ahead-payment $3,000 US cash, a permission, a next-of-kin power-of-attorney and blood tests and admitting examinations.

Now, several days later Ali watches Dan being strapped into position inside the capsule. He must be totally un-moving - even the slightest move will throw off the x-ray knife from its target. So in addition to strapping he is well sedated and almost asleep.
   Dr Larssen comes into the treatment area.
   "Alright, Miss, now you go out. Even with five centimeter lead shield, some radiation gets through and could affect your reproductive organs. A nice young girl like you needs to take very good care."
   Ali thinks she detects a gleam in the doctor's eye from his voice. She guesses he is still in his 50's.
   "OK, Doc.  You know my native language is Japanese and we say at this point, Yoroshiku, o negai shimasu' or Please do your best."
   
Four weeks later Dan and Ali are back in the Apartment 2A, Dan in his brown rocking chair facing Ali on the sofa.
   Ali is recalling the eventful days in Stockholm at the Hemmet. The x-ray knife took two days because it is done in small parts - very, very carefully, under attached electroencephalogram to be sure the knife is not inadvertently off target where it would cause immediate brainwave haywire signs. Happily, all went well. Then Ali sat by Dan's bedside day by day as he recovered. Dr Larssen explained that even with good result the first few days show mental changes and temporary weakness and speech difficulty. By one week Dan seemed back to normal. 
   Then an event occurred. Early afternoon, Ali is talking with Dan who is sitting up in bed. She asks Dan a question and he does not answer and she guesses he is thinking it over. He seems lost in thought. A puzzled look comes over his face and he starts smacking lips and sniffing. "Dan! What is it?" she asks. Then he gets his voice back. "I, --- feel strange, dear, dear whatsyourname. It stinks here. Such a smell." She knows something is wrong and runs to get Dr Larssen.
   After hearing what happened and quizzing Dan he says. "A temporal lobe epileptic seizure; not the classic grand mal with muscle movements and unconsciousness but petit mal, a kind of lapse. It is not a very bad complication. But important that he start taking an anti-epilepsy medicine. I shall order phenobarbital 15 milligram three times a day."
   After the doctor leaves Ali tells Dan, who has regained full control. "In my book, it's win-win. You'd have made a win not having any complication, but - au contraire - you made a win by having the one complication that's not too serious to your quality of life and gives you more of a medicine you very much want and an excuse for getting a bigger supply."

Now back in the Bronx, sitting facing Dan, Ali thinks how lucky it has turned out. Dan has made a good recovery. Today is going to be his first day out on a park bench.
   For next, click 12.37 Ali's Alone Day