Last day of life all planned out, down to the polka

PORTLAND -- Lovelle Svart woke up Friday knowing it was the day she would die.

There was much to do. Her family and closest friends would be gathering at 11 a.m. in the Portland assisted-living center where she lived with her mother.

She directed trips to the grocery store and even called AAA to jump-start the dead battery of her 2006 Scion. She double-checked delivery of food platters. There would be pink roses on the dining table and a boom box in the corner to play the polka tunes she loved.

Lovelle made one last trip to a wooden footbridge in a nearby park where she had found quiet sanctuary recently as cancer spread from her lungs through her chest and throat.

The consummate planner, she had choreographed the day. She wanted to leave time -- five or so hours -- for storytelling, polka dancing and private goodbyes. And at 4 p.m., she intended to drink a fatal dose of medication, allowed by Oregon law, that would end her life.

A smoker since age 19, Lovelle found out five years ago that she had inoperable lung cancer. Radiation and chemotherapy slowed the cancer's spread but could not stop it.

In June, Lovelle's doctor warned her that she was likely to die within six months, making her eligible for Oregon's unique, 10-year-old Death With Dignity Act.

What some call doctor-assisted suicide and others call physician aid-in-dying or hastened death is one of the most passionately argued issues in U.S. medicine and politics. Proponents frame the question in terms of personal choice, death with dignity and freedom from pain. Opponents say assisted suicide violates the Hippocratic tradition of "First, do no harm" and undermines the doctor-patient relationship by turning physicians from healers into accomplices of death.

Far more people ask for a lethal prescription than actually use the drug. Either their symptoms overwhelm them before they make a final decision, or they find other ways to control the symptoms.

Lovelle, 62, was determined to keep control, if possible, of when and how she died.

On July 1, she filled out a consent form. By signing it, she agreed that she knew the medication would kill her and was aware of alternatives, such as hospice care.

By law, she also had to make two oral requests at least 15 days apart. Her doctor wrote the prescription for a lethal dose of barbiturate in late July, and she had it filled Aug. 7.

She was still unsure whether she would take the drug but said she took comfort in knowing it was there.

Once she knew she had less than six months to live, Lovelle decided to try to start a more open public discussion of dying, mostly through a series of online video diaries for The Oregonian.

Behind schedule

Friday morning, Lovelle stuck a yellow note on the door of her mother's apartment: "Please Do NOT Disturb. Unless Urgent. Thank you."

She delighted in Friday's blustery weather and a forecast that included possible thunder and lightning about the time she planned to die. "Oh, the woo-woo crowd will have a blast with that," she said.

AAA jump-started her car. When a friend later expressed shock that Lovelle had spent part of the last morning of her life dealing with a dead car battery, Lovelle explained:

"The car goes to my sister. I didn't want it to be dead."

In the living room, her family and friends sat and told stories and jokes. At times they laughed a bit too loudly, out of nervousness at the occasion.

A bit later, Lovelle and George Eighmey, head of Compassion & Choices of Oregon, an advocacy group that works with most of the Oregonians who end their lives under the Death With Dignity Act, danced a brief but rousing polka.

By midafternoon, the studiously punctual Lovelle was falling behind her schedule. No one complained.

But a little before 4 p.m., she began her final preparations by taking two pre-medication pills -- to calm her stomach and control vomiting. They were hard to swallow, given the tumors in her neck.

"It" would be in about an hour, she told her family. Time now to sit alone with her mom, Vi Svart, in her bedroom for the last time. The rest of the group sat in the living room, debating whether they wanted -- and whether Lovelle wanted them -- to be in the room with her at the end.

Lovelle's three siblings and her mother, despite deep misgivings about her decision to end her life, supported her in her choice.

"I feel so at peace," Lovelle said. "I've had such a good time. ... And today has been so wonderful.

"I'm really ready to go. I'm ready."

About 4:30 p.m., Lovelle announced she wanted "a hugging line" -- one last hug for everybody.

Lovelle stood in the center of the living room and embraced them one by one -- with tears and laughter.

Then one last cigarette break on her favorite sitting stone next to the parking lot. Afterward, Lovelle hung up her coat and hat.

"OK," she said to no one in particular. "I'm going to get into bed now."

In many ways, Lovelle fits the pattern of Oregonians who choose to end their lives under the Death With Dignity Act.

Like most, she had cancer. She was in her 60s. A former Oregonian research librarian, she was well educated and insured. Not formally religious. White. Enrolled in hospice care.

And fiercely independent.

She was chosen Miss Cafeteria at Crater Lake Lodge in the summer of 1963. She loved surfboarding and polka-dancing and both her first and last names, "because they are different, and I like things that are different."

And she liked, as she was the first to admit, being in control.

Lovelle decided it was more important to die by taking the lethal drug while she had a degree of control over her body than to wait for nature to take its course. But how to decide when?

Her symptoms -- shortness of breath, stomach distress, weakness and pain -- were intensifying. If she waited too long, she would be unable to swallow the lethal potion.

"If you do take it ... "

On Sunday, Sept. 23, after a painful, restless night, Lovelle decided it was almost time.

Swallowing was more painful than ever, like choking on broken glass or razor blades, she said. She had barely eaten in two weeks and started taking morphine to dull her pain.

She told family and friends to come Friday.

Lovelle sat on the foot of the bed, while 10 others gathered around. A photograph of Lovelle as a curly-haired 5-year-old stood on one bedside table; on the other was a glass tumbler containing the liquid medication along with a container of morphine and Lovelle's ever-present mug of Gatorade.

With some help, Lovelle yanked off her shoes and socks and slipped partway under the covers.

Eighmey stood by her bedside. He has attended more than three dozen deaths.

"Is this what you really want?"

"Actually, I'd like to go on partying," Lovelle replied, laughing before turning serious. "But yes."

"If you do take it, you will die."

"Yes."

Ever the detail person, she reminded him that she wanted her glasses and watch removed, "after I fall asleep."

Eighmey warned her that the clear liquid would taste bitter. She needn't gulp it. She would have about a minute and a half to get it down.

Lovelle dipped her right pinky into the glass and tasted.

"Yuck," she said. "That's why I need the Gatorade."

Holding the glass, Eighmey asked her again to affirm that this was her wish.

Yes, she replied.

Someone asked, "Can we have another hugging line?"

One by one, they came to the head of the bed for hugs and teary whispers.

"Sweet dreams."

"It's all right."

"I know."

"Thank you for being my big sister."

"All the church is praying for you."

Lovelle was sitting up in bed, three pillows propping her up.

She held the glass tumbler in her right hand, raised it to her lips and drank. It was eight minutes after 5.

"Most godawful stuff I ever tasted in my life," she said, making a face before taking a sip of Gatorade and water.

She lay back and scrunched down under the covers, glasses still on to see her loved ones.

She reached for her mother, who leaned closer, then lay down next to Lovelle, stroking her hand.

"Are you OK, honey?"

"I'm fine, Mom."

"You're not sick?"

"No. I'm peaceful. It stopped raining, the sun's out. And I've had a wonderful day."

Her eyes closed.

"It's starting to hit me now."

For a while, no one moved or spoke, as Lovelle drifted into a coma. Then Lovelle's mom asked for a prayer. Others spoke up with prayers and memories, which prompted other stories.

Lovelle lay motionless but for the gentle rise and fall of her chest. Her heart slowed but didn't stop.

About an hour into the vigil, Lovelle's mom lit three white candles. "She's still with us," she said.

Hours passed. Eighmey was surprised how long she was lingering. But not her family.

"I hate to say this," one said with a smile, "but this is just like her."

"A little spitfire," agreed another.

"One last reminder that she's the one in control."

Jane O'Dell, a volunteer for Compassion & Choices, sat at Lovelle's bedside all evening, holding her right hand, whispering to her, monitoring her breathing and pulse.

About 10:30 p.m., more than five hours after she had taken the drug, O'Dell signaled that Lovelle's breathing had become shallower and more labored. Her pulse dropped, her skin turned pallid and her fingernails bluish. It was more than a minute between breaths.

Family and friends resumed their bedside vigil, and silence again fell over the room. Lovelle's chest stopped moving.

Eighmey leaned over at 10:42 p.m. and put his ear to her chest to listen for a heartbeat. He stepped back, shaking his head and spoke in a quiet voice.

"She's gone."