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Death Channels

I ended up spending a month living in Larry's apartment, deciding what to do with his personal effects. I searched the place for a will (which I never found), but in the process learned the truth about my uncle.

Where to begin? First of all: He was a criminal. I never knew this, but I had always wondered what his "job" was. Turns out he "made a living" by forging checks, stealing people's identities, embezzling, you name it. I found this out because he wasn't a very good criminal: he had gotten caught numerous times, and been sentenced to several jail terms over his lifetime, the longest being three years in state prison. Next: having HIV apparently didn't put a damper on his sex life. From the evidence strewn about his apartment and his computer, he was quite "active" until the day before he fell unconscious.

But the last thing I learned about Uncle Larry was the most significant: He had long been diagnosed as having "bipolar disorder," what they used to call "manic depression." Which, in retrospect, explained a lot. Sometimes when he visited my family as I was growing up, Larry was giddy with excitement, spinning me around, taking everybody out to expensive dinners, telling wild stories, buying everyone presents. That's the Larry I like to remember. But there was another side of Larry I only saw from the shadows: desperate calls in the middle of the night, inconsolable depression, suicide attempts, a near-catatonic passivity in the face of endless financial and legal problems. That was the Larry which had driven my father to distraction, and the reason the rest of the family had cut him off.

And I became convinced that it was this "down" Larry who had signed the "Advance Health Care Directive" quoted above. As I riffled through his disorganized paperwork files, I found that his 1996 HIV diagnosis was followed by a long period of severe depression, including half-hearted suicide attempts, a stay in a psychiatric facility for "observation," notebooks filled with mostly illegible self-obsessed morose ramblings. It was in the middle of this period that his doctor advised him it was wise to make some crucial "end-of-life care" decisions, and a depressed self-destructive Larry signed the form stating "I do not desire any form of life-sustaining procedures."

Turns out he had gone on an "end-of-life care" binge, as I found several similar documents he had also signed, some with doctors, some on his own, including:

Durable Power of Attorney for Health Care Decisions

Medical Treatment Desires and Limitations

I do NOT want efforts made to prolong my life and I do NOT want life-sustaining treatment to be provided or continued: (1) if I am in an irreversible coma or persistent vegetative state; or (2) if I am terminally ill and the use of life-sustaining procedures would serve only to artificially delay the moment of my death; or (3) under any other circumstances where the burdens of the treatment outweigh the expected benefits...


Physician Orders for Life-Sustaining Treatment (POLST)

A. Cardiopulmonary Resuscitation (CPR):

Do Not Attempt Resuscitation/DNR (Allow Natural Death)

B. Medical Interventions:

Comfort Measures Only

Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Antibiotics only to promote comfort.

C. Artificially Administered Nutrition:

No artificial nutrition by tube.

In the midst of his depression, Larry saw a way out: suicide by withheld treatment.

But when his HIV infection did not progress to AIDS, and he remained healthy, Larry's mental state improved. And improved. Within two years of the original diagnosis, he was back on a high, jetting off to resorts in South America and Asia, getting involved in ever-more grandiose shady financial schemes -- punctuated by the occasional arrest and conviction, or getting prescriptions for anti-psychotics and mood stabilizers, or entanglement in this or that disastrous love triangle. He lurched from crisis to crisis, from ecstatic highs to miserable lows.

In recent months, however, he seemed to be on a high. The overdue bills which would have been hair-raising for the average person were of little concern to Larry; his bills were always overdue (as far as I could figure), so it was par for the course. The sudden onset of AIDS and the collapse of his immune system seem to have blindsided him.

And now here he was, unconscious in a hospice care facility, an "Advance Health Care Directive" clipped to his chart instructing everyone to let him die.

On my daily visits over that month, I began to wonder: Had Uncle Larry changed his mind? Did he still want a "Do Not Resuscitate" order to prevent anyone from saving his life? From what I could tell, he had signed all the "end-of-life instructions" while in a state of passing depression, and then had likely forgotten all about them once his mood had lifted.

I've studiously avoided the word "coma" to describe my uncle's condition, because in fact he was not in a coma. He often slept for days at a time, but he would on occasion wake up -- or at least open his eyes. Even so, he never really was able to speak. He'd look around, and now and then weakly move his lips, but no sound came out. I once put a pencil in his fingers and rested it on a pad, to see if he could at least write something, but his hand remained limp.