Philip Ames

Pat, in order to sleep, started to drink one 8-ounce whiskey and water with four Tylenol and two 5 mg Valium tablets.

I knew Pat when she was young and pretty. We all married the same year, had children of the same age. We partied together. Her husband Bill and I were both writers. Even did a couple of books together. He was also a cop. The story that follows is Bill’s, written with blunt pencil on a yellow legal pad. My contributions are in italics.

When I mentioned that Pat had Korsakoff, my doctor at that time told me the foremost authority on Korsakoffs was Dr. Swenson at the UCSD Hospital on Front St.

Statement by William Douglas

My wife Pat was diagnosed with osteoarthritis as far back as 1964 but managed to work through the pain until 1973, when she applied for and received (after satisfying two government psychiatrists that she was in pain) a Disability Social Security pension.

Pat asked me to contact the Hemlock Society, based in Eugene, Oregon, to find some drugs that I could buy in Tijuana.

I took her to just about every arthritis and/or pain specialist in San Diego from 1973 onward, but even though the doctors knew she had arthritis — that it was irreversible — and that she was in terrible pain, the strongest medication they would give her was Darvon, which even the hidebound U.S. Navy has finally conceded is, in most cases, less effective than a placebo. However, because she had taken literally thousands of aspirins over the years, she had become allergic to aspirin, and since Darvon is aspirin-based, she could not take that either.

I just knew I didn’t have any time left and that I’d better go and do it before I died from heart attack or stroke and wouldn’t be able to do it.

“Pat,” I said, "you must've just had bad luck with doctors. When they botched the operation on my spine and left me in constant pain, nobody ever suggested I was malingering. They just told me where to sign and gave me my pension.”

"Bad luck, hell!" Pat said. "Haven't you noticed yet that there's one basic difference between you and me!”

"What's that’”

“I’m a woman.”

"But what’s—?”

"Only men have real pain," my wife contributed. "Women are just neurotic.”

"How about women doctors?”

"Evenly divided," Pat said. "One third are bull dykes. Another third have been psyched out by all the chauvinist pigs who run the medical schools.”

"That's only two thirds.”

"The rest are just scared of losing their license if they prescribe too many pills. How many women do you see on the review board?”

The specialists’ final remedy was Tylenol, and as one doctor told her, “You’ll just have to use your mind to ignore the pain," adding that no doctor would give her narcotics because she was too young to become addicted.

He further prescribed Valium to help her ignore the pains. Pat achieved about a 70 percent success with the mind-control thing but still broke down at least once a week and cried from the pain and the injustice of it all.

In 1981 after my open-heart surgery, Pat, in order to sleep, started to drink one 8-ounce whiskey and water with four Tylenol and two 5 mg Valium tablets. Over the months and years, this increased to three or four 16-ounce whiskeys and water, four Tylenol, and from a minimum of 6 10mg Valium to a maximum of 10 to 14. All just to kill the pain and allow her to sleep.

I had an artificial aorta implant in 1983. Shortly afterward, Pat was hospitalized with a strangulated bowel. During hospitalization she suffered withdrawal from both the booze and the Valium. Also, while in hospital, they gave her pain killers for her arthritis and other pains. So when she was released from hospital, not only did she not have her Valium to help with the pain, but she did not have her booze to help her sleep at night. In addition, due to her extended stay in hospital, Pat had lost her mind-control over the pain. When she got home from hospital, she was in absolute hell.

To get her some relief I got a prescription for 20 Quads (Quaaludes] from her doctor, and I gave her two. She stayed up to watch TV that night and I went to bed. When I awoke next morning, Pat was on the couch, a suicide note was on her chest. She had taken the rest of the Quads — 18 of them in hopes of dying to get rid of her constant, terrible pain. But the Quads did not kill her.

In 1984 Pat had again regained control of her pain when she was again hospitalized for six days by what was believed to be another strangled bowel.

During the six days, the doctors never did find out what caused her pain; but because the hospital gave her pain pills during her stay, they in effect once more destroyed her mind-control over her pain, she was in agony again until she could retrain herself. (During this period Pat asked me to contact the Hemlock Society, based in Eugene, Oregon, to find some drugs that I could buy in Tijuana that would just put her to sleep and allow her to die.) I wouldn’t; but thinking back, I could have saved Pat literally thousands of hours of agony if I had.

Two things happened in 1985. My stepfather put my 86-year-old mother in a nursing home. When we visited her, she was always tied in her bed and always sitting in her own waste. She didn’t know us, and when we fed her, she didn’t know what she was eating, nor did she know when we left. Pat only went with me twice. She said that looking at my mother and seeing herself in ten years or so just tore her up. So we quit going.

The second thing that happened was that Pat started having these terrible headaches.

The thing about the headaches was that they broke her concentration, and all her osteoarthritic pains came flooding back.

That plus Pat started complaining about her eyes. Playing cards, threes were eights, ones were sevens, hearts were spades, et cetera.

I took her to an eye doctor. He checked her with every instrument and machine he had, then said that while he couldn’t get her eyes back to 20/20, that there was nothing wrong with her eyes, that in any case he didn’t believe that the small correction that was needed could be the cause of her headaches.

Also, in 1985 Pat began having small memory lapses. So I think it was a combination of all these things: the headaches, the memory loss, the osteo pain, that scared Pat so badly when we went and saw my mother. Maybe she had a premonition, but she made me promise, “Don’t ever put me in one of those places; please kill me first. But don’t ever desert me there.”

In 1986 the VA discovered that I had prostate cancer. I went in hospital and had the prostate gland removed. I wore a leg bag for nine months before having an artificial sphincter implanted to control my incontinence.

When up and about again in 1987, I took Pat to a neurologist to learn why she kept having headaches. He gave her some kind of test that involved sticking 40 or 50 probes in her skull. Other than a slight excess of spinal fluid, he could find nothing that would cause headaches. He also did a spinal tap to investigate why the excessive fluid and found nothing out of the ordinary. Meanwhile, in 1987, Pat’s memory really disintegrated. She forgot my name at times, our son’s name, our friends’ names. She would be surprised that we had two dogs in the house, that we were married. She forgot where the bathroom was. For no reason, she would just spit on the rug. Every so often she would be delighted when I said I would spend the night after she asked me if I could.

When I would correct her as to my name, where we were, that we had been married 41 years, she would laugh it off and say she knew it. But once in a while after laughing it off she would get serious and ask, “What’s happening to me?”

I would say nothing, just age. But I didn’t know. Also, in 1987 her eyesight deteriorated to the point where we had to stop going to bingo because she couldn’t see the numbers on the cards. Later in 1987 Pat started to drink three eight-ounce glasses of wine every night to help kill the pain and allow her to sleep.

Pat’s eyesight and headaches continued to worsen in 1987, so I took her to another eye doctor with the same results. He didn’t know why she couldn’t see; that there was nothing wrong with her eyes. But the problem had to be in the brain, but he didn’t know where or how to treat it.

My prostate cancer came back in ’89. It started with sharp, knifelike pains in my left ribs and lower back area. I received 10 radiation treatments to my back that the doctor said would stop the pain. It didn’t. Seeing they couldn’t give me any more radiation for 18 months, they prescribed Percocet — two every four hours and gave me prescriptions in the amount of 180 every two weeks.

Meanwhile, Pat’s eyesight got to the point where she could not make out what was on TV if there was no motion. Further, she woke up with her headaches and osteo pain and went to bed with headaches and osteo pain. But she could only get to sleep after drinking her wine, which was the only painkiller she had.

In 1989 her memory and mind were constantly playing tricks on her. She would get up in the middle of the night and roam the house, or unlock front and back doors, or pour glasses of water and set them about the house on the floor, on the sofa, on the arm of the easy chair, or she would light cigarettes and just snuff them out anywhere. (When we discovered she was doing this we thereafter hid the smokes.) I just couldn’t keep her in bed. I would ask her why she was getting up, and she would say that she was going home. When I explained that this was her home, her bed, her dogs, that I was her husband, she’d say, “Oh, thank God, I was so scared.”

Then she’d lie down for an hour or so, get up, and repeat the whole thing. This would happen two or three times a week, always the same thing: she wanted to go home.

In the middle of ’89, I really got in a down and out fight with our family doctor. I asked him why the hell he didn’t do something about Pat’s headaches, her eyesight, her memory lapses, and her pain. He started to blow me off again with “She’s getting old, this is fairly normal.”

But I told him, “Bullshit!" that I’ve been asking him to do something about her condition since 1985 and that he hasn’t done a thing; that there is something seriously wrong with my wife and I wanted to know what it was.

The doctor said something about, “Now you’re telling me how to practice medicine,” and I said, “No, I’m just asking you to earn all the money that I’ve been paying you over the years. And if you don’t know what’s wrong with her, then send us to some doctor that does and quit taking my money for doing nothing.” He made arrangements for Pat to have an MRI scan at a hospital. Another $1200 and they couldn’t find a thing wrong with Pat’s brain to explain her headaches or behavior.

Still, as time went on, her eyesight continued to fail, her headaches were just short of migraine, and her osteoarthritis pain was crippling. In desperation I checked her into a local hospital’s neurology ward for a complete checkup. They kept her six days and gave her every test they could think of that pertained to her symptoms. At least they said they did.

Of course, they also said they were giving Pat the very best of care. When I checked her into the hospital, I told the doctors and the head nurse that Pat was over 80 percent blind and that she would need help going to the bathroom, washing herself, and eating.

Their excellent care was to tie her in bed and allow her to sit in her own waste until I got there and raised hell. I showed up on the fifth day at noon time. Usually I came in the afternoon, but this time I came early, and there she was, tied to bed, sitting in some loose, some dried diarrhea — while groping blindly for her food, occasionally getting a fingerful of mashed potatoes or a piece of carrot.

I asked if this was their idea of taking special care of an extremely confused blind person and got a bunch of shit about somebody forgetting to write it down, but I had had it with them. I got hold of the headman in neurology and told him I was taking her home.

He said they were finished and, in their opinion, Pat had a condition known as Korsakoff Syndrome. When I pressed for plain English, he stated it was a brain deterioration caused by drinking large amounts of alcohol over many years. When I told him that Pat did not fit that category, he said, “Well, her extremely short steps, along with her confused mental condition leads us in that direction, that they could not find anything else."

When I asked him if Korsakoff patients go blind, he said, “No" that they did not know why she was losing her sight. So I took Pat home armed with Vitamin B-I to help fight off the Korsakoff-whatever they believed she had.

Near the end of ’89 I was out at the VA Hospital on a routine visit for my heart and lungs; when I mentioned that Pat had Korsakoff, my doctor at that time told me the foremost authority on Korsakoffs was Dr. Swenson at the UCSD Hospital on Front St. I contacted UCSD and made an appointment for Dr. Swenson to see Pat.

Dr. Swenson gathered all the information from the other hospital, the results of the brain probes and scans, spinal tap, MRI, then he ran 40 or 50 more blood and other tests over the next four to five weeks. He concluded that Pat did not have Korsakoffs, although there was a slight chance of an incipient stage. He could find no cause for her headaches, but he would prescribe Tylenol 3 with codeine to relieve the pain. (In all the years of taking Pat to doctors, Dr. Swenson was the first and only one to give her something that killed the pain.) Further, Dr. Swenson stated that her blindness was the results, as he explained it, of the little computer in the brain that translates the images received from the eyes into pictures, that computer had gone haywire and there was no way of returning it to normal. In other words, Pat’s sight would continue to erode until she was completely blind.

He couldn’t do anything about Pat’s osteoarthritic pain but stated positively that Pat had Alzheimer’s, with a touch of Korsakoff. He prescribed two different mood/calmer-downer pills and suggested a number of services offered to Alzheimer’s patients, including a visit twice a week by a nurse. I asked him if the nurse gave baths. He said no, they just take blood pressure and talk a while. Seeing that getting someone to bathe her was the only thing I was interested in, I declined his offer.

Everything seemed to deteriorate in 1990. Pat’s eyesight failed until she was 90 percent blind. She began taking two-inch steps, presumably from the Korsakoff syndrome, but later I realized that she was taking these little tiny steps because she was blind and couldn’t see where she was going. She took tiny steps all the time, even when I was leading her. Of course, I had to warn her about steps or ramps or to move her around so she wouldn’t bump into things in the stores. Even though I kept assuring her that I would not allow her to run into anything and hurt herself, she would not or could not step out or go faster. Half the time the reason for her reluctance was because she did not know me. Every once in a while she would leave go of my hand and ask, “Who are you? Where are you taking me?"

I’d explain that I was her husband of 41 years and that we were just shopping. Then she would say, “Oh, thank God; I was so frightened.” This seemed to be the pattern in her gray and black sightless world.

I always got up at 7 a.m., then maybe five minutes later or three hours later she would either baby-step out of the bedroom or I would find her standing in the bedroom staring at the wall, not knowing where she was.

I’d say, "Good morning, sweetheart. You’re up. Do you want to go to the bathroom?" And almost always she’d say, ‘‘No, I want to go home." After I explained that she was home, that I was her husband. I’d take her hand and she would baby-step into the bathroom. Then I’d pull down her pants, explain and coax her to sit on the toilet. She would forget how to sit on the toilet because, I believe, it was an ungodly painful for her to bend over and sit. Just walking was an effort until my three Percocets that I gave her every morning took hold.

I started giving her Percocet after learning from Dr. Swenson that Pat had Alzheimer’s. The doctor could see no harm in sharing out my pain killers, so I established a routine for Pat: three Percocet and two Tylenol with codeine, plus her regular medicine every morning. As I said, if she didn’t get the headache pills, she had a constant headache because the Percocet gave no relief to her headaches. Anyway three Percocet, two Tylenol with codeine, plus two downers when she got up. The same at 2:00 p.m., and me. Same at 6:00 p.m. At 10:00 p.m. the same again, plus three sleeping pills.

Even with all that medication, Pat would wake up just about every night, get out of bed if I didn’t hear and stop her, then baby-step into the living room or just to my side of the bed and stand there until I awoke.

‘‘Honey,’’ I’d say, “why are you up?”

"Who are you?" she’d ask.

Then I’d get out of bed. “It’s me, your husband," and I’d take her hand and lead her back to bed. All the time Pat would be saying, “Oh, thank God; I was so frightened.”

This last year it seemed that Pat was always frightened and scared. It was largely due to her blindness and loss of memory. We would be sitting on the sofa watching TV and holding hands. (At least Pat would pretend to be watching, but she couldn’t see; just listen.) Then out of the blue she would jerk her hand away and ask, "Who are you?”

Over and over the reassurances and the “Oh, thank God’s.” She was obsessed with the fear that I had gone away. Or she would turn to me and say, "You’re not going to put me in a home, are you?"

“No,” I’d tell her. “Never. I promised you that, remember."

Of course she didn’t, but after seeing my mother and what the hospital had done to Pat, there was no way that I would ever allow that to happen to her.

My heart (two bypass operations) and emphysema both started acting up in September. The heart started with the dull pains in chest and arms with overall weakness. As for the emphysema, one minute I’d be breathing normally then, taking a shower, I just couldn’t catch my breath. I was not too surprised by either. I recalled that some doctor at the VA had told me that open-heart surgery was only good for about ten years. In September it had been nine years. And the doctor had been telling me for the last two to three years that I was getting emphysema and that I had to stop smoking. So, while I didn’t like it too much, it was to be expected. Of course, expecting and facing are two different things. Before Pat got sick with Alzheimer’s, I figured that when the time came to reroute an artery or two that I’d just go into the VA hospital and have it done.

But with Pat in her condition, it was a different ballgame. There would be no going into hospital because I didn’t have anyone to leave Pat with. Not only did she need care but she needed 24-hour-a-day care. In many ways she was a three-year-old, barely potty trained. Not only did she have to be taken to the toilet, she had to be positioned, her pants pulled down, then encouraged to perform. And wipe and clean her when finished.

She needed washing, dressing, doing her hair, applying make-up, and leading her around because she was about 95 percent blind near the end. I had to cut up her food and feed her. But mostly, she needed a familiar voice to constantly reassure her that she was in her home, with her dogs, sitting on her furniture with her husband of 41 years.

With blindness it seemed that she developed this terrifying horror of being a burden and lived in constant fear that we would put her away where nobody knew her and she knew no one. So ... if I had a heart attack or a stroke, going in hospital was out.

I talked to Pat about this on a couple of occasions when she was lucid and flat out asked her if she wanted me to take her with me when my time came, or did she wish to make other arrangements such as going to live with Sheila and Bill, our son and daughter-in-law, who is a nurse. She said no, never.

She always claimed that she died on the operating table during her strangled bowel operation and that it was beautiful, and when I went, she was ready because she had had enough of pain. I agreed with that because the Pat that I married, had three children with, and spent 41 years with was gone. In her place was this terrified, blind, confused lost soul, encased in a constant agonizing pain that she could neither understand nor tolerate unless anesthetized with my pain-killing drugs. Death would be a welcome blessing: no more dirtying herself because she forgot she was not on a toilet. No more leaving her house in search of her house because she could not remember where she lived. No more standing in the middle of the living room before dawn calling, “Bill, Bill!” in terrified tones, and when I get there, “Oh, thank God! I didn’t know where I was; I was lost.”

No more spitting out food like a baby because you forgot how to swallow. No more spitting on the rug, or undressing in the living room, or insisting you have to go to the toilet while we’re out shopping — only to do nothing when I bring you home. But most of all, with death you will have peace. Peace from the demons of uncertainty and suspicion; peace from the sounds that blindness magnifies and twists into danger and terror. And peace from pain.

The godawful, spirit-trampling, cruel, cruel pain that has tormented and twisted and broken you for over 35 years.

So it was settled in my mind. When I had the big heart attack or stroke that should kill me, prior to dying I will have to take Pat with me, because it was her wish, and there was no alternative. There wasn’t enough money to put her in a home, and even if there were, she hated homes, and I had promised not to ever put her in one.

The series of events leading up to Sunday began, I believe, on Tuesday, 18 December, 1990, when I went to the VA hospital for my quarterly checkup at the urinary clinic. Prostate cancer has metastasized into my lower back, ribs, and shoulder. The doctor, checking the prostate scar, found a really sore red spot that had not been there before.

He asked me how long the spot had been sore, and I told him just now, as far as I knew, because it hadn’t been sore before. When I asked him why it was sore, he said, “Well, you do have prostate cancer. This is just another spot,’’ and let it go at that.

I don’t know if it was from worrying about a new cancer or that the prostate cancer had spread to my colon, but I think my chest pains began that night and worsened each day thereafter. I remember that I gave Pat a sponge bath on Thursday and took a shower myself, and for some reason my emphysema and heart acted up so badly that I had to step outside the tub to catch my breath before I toweled off. My heart was pounding so loudly that I could hear it in my bad ear, and I had chest pains and weakness on both arms and shoulders.

I knew I was having a heart attack, but it wasn’t as bad as the one I had back in ’81. Anyway, it took maybe five minutes before things calmed down and I could dress myself and Pat. Thursday was also the day that I made a dental appointment to have all her old mercury fillings removed and replaced with something else.

The 60 Minutes program of Sunday last had featured a story about all the woes suffered by people who had their teeth filled with mercury amalgam, and most of their complaints were Pat’s complaints: blindness, overall pain, forgetfulness. Seeing the doctors couldn’t help Pat, I figured I had nothing to lose if I had hers removed. I was figuring seven to eight hundred, but the dentist quoted 14 to 15 hundred. I backed off and decided I could get all her work done in Tijuana, where my own teeth were fixed, for about one third of U.S. prices.

Anyway, I planned on taking Pat to T town Saturday, but when Saturday came, my emphysema, chest pains, and extreme limb weakness stopped me from even taking Pat down to Thrifty’s for her usual ice-cream cone. I just felt terribly weak and achy.

Even taking Pat to the toilet and tidying her up was exhausting.

(Our son) Scott was going someplace, and because I was feeling so beat, I gave him money and told him to pick up some Chinese food for supper. So that’s the way Saturday went.

I probably took eight to ten nitro pills. Sometimes they eased the pain in my chest and sometimes just increased the heartbeat in my ears and did nothing for the pain. It was because of this constant chest pain and lack of breath that I realized on Saturday that I was having a heart attack and that I didn’t have a will of any kind.

So while Scott was out, Pat was sitting beside me on the couch pretending to watch football on TV (I say pretending because she couldn’t see her hand in front of her face, but she thought she was fooling Scott and me by facing in the general direction and echoing whatever remark I might make about a good catch or some such).

Anyway, I made out a will, which I also intended as a farewell note. Nothing changed Saturday night. My chest pain and arm weakness seemed to remain about the same, whether I took pain pills or not. I took two Percocet at 9:30 p.m. and gave Pat two, plus two mood pills. At ten I gave Pat three sleeping pills and we went to bed. I woke up at 4:30 a.m. Sunday morning and took two Percocet and went back to sleep. I got up at 7:00 a.m. Took all my pills: two blood pressure, heart and emphysema, and two more Percocet. Then I got the Sunday paper and sat at the kitchen table, reading and drinking tea. My chest pains, arm weakness, and heart pounding in my ears didn’t start until 7:30 a.m. Then they seemed to come all at once. I drank another cup of tea and finished the paper and ignored the chest pains until I went to the toilet again around 8:30 a.m.

Because Percocet is a narcotic and I take between 10 and 14 a day, they tend to bind me up unless I counter them with a laxative. My usual routine is to awaken around 1:30 to 5:00 a.m., take two Percocet, because it takes the pills 40 minutes to an hour to kill the cancer pain. Then I take two more Percocet, plus my regular pills, when I get up at 7:00 a.m.

Percodan tablets contain an opiate, some codeine, and aspirin. When people complained about what aspirin was doing to their stomachs, the pain killer was reformulated with Tylenol instead of aspirin, and the Tylenol version is Percocet.

In any case, I guess it was the straining that brought on the severe chest pains and heart attack. A couple of things ran through my mind when the pain hit. One, I was full of pain pills, so they had to be godawful pains in order to feel them over the Percocets. Two, the pain was so bad that I thought I was going to die right here and now. And three, I wondered why in hell I had been thinking that I would have all the time in the world to take Pat with me before I died, when I have known people to just fall over and die without word one.

And because of the weakness in my arms and pain in my chest, I just knew I didn’t have any time left and that I’d better go and do it before I died from heart attack or stroke and wouldn’t be able to do it.

I didn’t think of not dying. What flooded out all reason was the fact that she just couldn’t survive in this world without me, that she didn’t want to survive without me, and after all the terrible suffering that she had endured over the years that she, more than anyone I knew deserved the peace and relief of death.

So I got my gun down from the closet and shot her. She opened her eyes for a second there and I saw life. I couldn’t believe it. But I wouldn’t have her end her days on one of those life-support machines. She hated them so much that it would be the final insult.

So I cocked the gun and shot her again.

Bill was in law enforcement all his life, first in Detroit, then the San Diego Police Department, the US. Marshal's office, and finally as a detective for the 11th Naval District. He was the funniest man I’ve ever known, and could have made it as a stand-up comic. Any neighbor will testify to the loving care and patience he gave his wife. None of this kept him out of the downtown jail snake pit until I called his old patrol partner who’d moved out of town.

Partner knew which buttons to push and got Bill transferred to the North County facility m Vista, which is marginally less crowded. But even in Vista the pain pills Bill needed ten times a day were only given to him twice — while disappearing at a rate of about ten a day from the bottle he brought in. One Percodan or one cigarette goes for $5 apiece inside the slammer. Partner rattled a few more cages, and this situation suddenly got sorted out.

“I offered to plead manslaughter," Bill told me, "and save the cost of a trial, but they won't go for it.”

"Somebody wants to build his career on you?”

”I don’t think so," he said. "There’s really no way they can change the law ”

"Why not?”

"If I walked for this, it’d turn into open season. Anybody could get an instant inheritance or divorce.”

"Yeah. I suppose so. People are living longer and getting poorer all the time. And those goddam nursing homes.... That’s no way to go”

"What difference does it make? I've got two years at best, and most of that in some hospital. Any hospital is a prison.”

Visiting hours were changed and my letters were returned, until Bill called a couple of weeks later from Donovan prison, Otay Mesa, where he was being held. Official word was that he was to be flown to a Northern California location to do six years in one of those places where they put cops to keep the general population from killing them. Bill was being pressured to get off the phone, but he managed to tell me that waiting for an official flight usually turns into sitting around until a busload can be made up. At the moment, I don’t know where he is.