Don Ringe died on October 11. This final blog was submitted by Don's wife, Jeanne.
When the California Death With Dignity law took effect June 9, Don was one of the first patients in the Kaiser system to ask for the end of life pills. On April 19, he had been diagnosed with Glioblastoma Stage IV, and in mid-June, he was in the middle of six weeks of radiation and chemo, the standard treatment for this deadly primary brain cancer. Don knew his chances of beating this were slim no matter what we tried, and he wanted some semblance of control at the end of his life.
The law requires a patient to have two appointments with a doctor at least 14 days apart in which the patient brings up the subject without prompting. Don had the first required meeting with his primary physician in July, alone, but by the time of his second appointment in August, his short term memory failed him; between the waiting room and the exam room he'd forgotten why he was there.
Don's long-term memory was less affected, and he was cognizant enough to understand that this law wasn't written for people in his situation, or for patients with Alzheimer's or other cognitive deficits. Beyond the doctor visits, it requires a patient to open the bottle, count the pills, and make sure they're all taken on time. As an issue advocacy media consultant, Don was ready to advocate for a change in the law, but time was not on his side.
Inasmuch as he had convinced me, his 18-year-old daughter, and the rest of his family (and we were all on board with his decision) when he couldn't get the pills from Kaiser, he found another dignified way to die.
On September 17, we visited his friend in Bel Air. He wasn't using a walker, but required a lot of help getting into the house and getting around. We went to see "Snowden" that night and a fellow moviegoer helped him make it out of his seat and back to the car. Though his MRI from 9/14 had shown only very minimal tumor regrowth, his condition was worsening. He had one infusion of Avastin on 9/19, the Hail Mary of GBM treatments, and it did nothing for him.
We signed up with home hospice on 09/30.
End of life decisions and definitions of dignity vary widely. For Don, cognition and continence were paramount. In the end, he had neither. Yet by my definition of dignity, he prevailed.
He refused any food or liquids after 10/4 and by 10/11 he was done. With morphine, he never had a moment of pain or apparent discomfort. He was at home with candlelight, soft music, prayers and chants and rituals from many traditions, phone calls from old friends (though he had lost his ability to speak by October) and I was by his bed when he took his last breath.
For Californians at the end of their lives who want to die with dignity and can't get the pills, not eating or drinking is a natural way to take control. And it may be easier on the family since the timing is on nature's clock, not pharma's.
As a political ad guy, Don was known for creating spots that were breakthrough and unexpected. And he had a powerful sense of humor and satire.
I know he would have appreciated the irony of having our peaceful home hospice environment disrupted by the blaring smoke alarm set off by the shaman when he lit the sage, or when the cat jumped up on his chest just as he took his final breath.
He would have tried to figure out how to use these scenes in a campaign commercial.