The Sister Pact

Three women confronting a family history of dementia make an unusual promise to one another. Will they have the nerve to see it through? 

By Lee Woodruff
illustration of sisters
Photograph: Illustration by Brian Cronin

“Could you do it?” I asked them. “Could you really help me go through with it?”

We sized one another up with fresh eyes before nodding in unison.

As the car zips across the George Washington Bridge, my doctor friend gets to the heart of the matter, the information I have asked him to provide. We all lean intently toward the speakerphone. “If I were going to take my life, this is what I would do,” he says, then proceeds to outline an easy way: Combine sleeping pills and alcohol and slip away painlessly. “Lots of pills but no more than two drinks,” he cautions. “You don’t want to induce vomiting.” The simplicity of this plan and our collective mental picture silences us for a few beats as we search one another’s faces. Yes. We can do this.

Nonetheless, this pact of ours is daunting. How do we determine when, exactly, it is time? What tests would we administer to one another? We all three agree that the inability to understand where we are, to feed or toilet ourselves or to be more than a physical shell is a starting point. Butwhat is the tipping point? Perhaps in the face of multiple diminishments and dispiriting setbacks, it will be as simple as the morning I no longer look forward to that first cup of coffee. Even though we’ve talked through all these benchmarks, can we make that decision for our own sisters? Can we make it for ourselves?

Certainly we recognize that nothing is fail-proof. There is no guarantee that we will actually be able to carry out our desires in the end. What if we change our minds? Survival is a basic human instinct. It’s human nature to want to reach for one more day, one more hug or sunset or holiday together around a big table. What if only one of us is left? Who will help her, and how will it feel to know that you have been there for your sisters but neither of them is left to ease your way?

Perhaps, in the end, all our talk and planning will be lost in the sea of good intention. There is a chance we may be separated from one another in later years, on opposite coasts or living with our grown children, plucked out of our sisterly orbit. Maybe we’ll each be blessed enough to die peacefully in our sleep, or perhaps a heart attack or physical disease will fell us first. I cannot now help thinking of those ways to die as luxuries.

But two wonderful gifts have grown out of our sister pact. First, we are having the conversation, talking about the end in ways that are healthy, realistic and achievable. This exchange has been so much easier than I expected. Refreshing even, after all the years of not talking honestly with my father about what was happening to him, in an effort to preserve his dignity. Second, and perhaps more important, my sisters and I are more conscious of time passing, of the need to make the effort to congregate, to laugh and dredge up the old stories that keep us connected and devoted.

“If I’m lucky, I’ve got 20 good years left,” I’ll say routinely. “That means I’m going to really prioritize how I spend them.” This shocks most people, who’ll tsk-tsk over such maudlin talk. It’s not intended to be self-indulgent. It’s a wake-up call, a declaration of how I’m going to spend that time. And while we haven’t been vocal with our children about the pact, we’ve started to broach it with our husbands. They know we are adamant and committed, that how we may choose to die is as important to us as how we want to live.

If in the end I get to dodge the dementia bullet, I will view that blessing as icing on the layer cake of life. I’ve already been preparing for the worst by teaching myself to slow down, to more often say no to things I don’t want to do. I’m better at grabbing that lunch or walk with friends, and I stop at the top of a hike to savor the view and listen to the birdsong. I pay closer attention when my children have something to tell me instead of rushing on to the next thing. The gift of fully understanding that you will die is to come to terms with how you want to live. And if you are lucky enough to have sisters like mine, that only makes the journey sweeter.

Originally published in the February 2013 issue.

What’s your reaction?

Comments

02.15.2013

I nursed my father and mother through Alzheimer's and Lewy-body dementia respectively. If I had someone who could help me bow out gracefully should I not realize that I'd gone past the point where I could recognize the danger, I would be grateful. Sadly, I do not.
If you've not seen this happen to a loved one, you can't begin to know the horror of wondering what your last years will be like.

Laura E. Kelly02.02.2013

I was glad to see this article. The boomers, who so avidly did leg lifts with Jane Fonda, will soon be in this sad situation in droves. We need more open conversation and legal options for dealing with this imminent health crisis, not political debate that gets cut off when someone says the words "death panels."
As for preparing for your own end, I always think of the vivid scene in Lisa Genova's book Still Alice where the ailing Alice writes herself a note designed to test her future cognition, with instructions on what to do if she fails the test. When she eventually fails, she goes to carry out the wishes of her formerly well self, but forgets what she's doing along the way. And ends up lost, as feared, since her family can't/won't help her (despite pacts). A haunting scenario.

Dorothy Walsh01.30.2013

Thank you for this beautiful essay. My sister and I have had this same conversation after our mother was diagnosed with Alzheimer's about 7 years ago. It has been a strange and desparately sad journey as she has lost more of herself every year. My mother, if she had any cognition, would be mortified to know that this was the way she was spending her last years on earth. The one thing she loved more than anything were her kids, grandkids and great grandkids. She will never know the ones who have yet to be born. My mother was a very even tempered woman but being robbed of the chance to be with the kids would have pissed her off. My fear, of course, is that I will get this disease but I also fear that if I did it would rob me of the ability to decide to drink that cocktail.

Katie 01.30.2013

If she were serious about this pact, she wouldn't have written this article. If one of the sisters commits suicide, the other two will be in jail because here's the plan, laid out completely. It's just a ploy to sell more books by being so bold.

rie LeMer01.29.2013

Thank you More for this brave article. I continue to admire Lee for the life she crafts, for her resilience, smarts and boldness. I appreciate this glimpse of the deep abiding love of siblings and their crucial role in all things joyous and difficult.

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