Life, Death on Her Terms

This is a guest post from Susan B. Schaffer, the oldest of three daughters of Beatrice Belopolsky, of Burlington. Susan can be reached at

My mother was my best friend. As she approached 90 years old in excellent health, I occasionally wondered how this woman, who continued to live life with such fierce independence, would eventually leave this earth.

The matriarch of a family of three daughters, she had continued living a full life after being widowed 30 years before. She served actively on community boards, lent a hand with her six grandchildren whenever she could, and traveled the world in her unique style. She was a source of wisdom, in a quiet, commonsense way, and yet remarkably she remained completely open to learning from others. She was ageless, fitting into any group, not as a fifth-wheel elderly parent, but as a contemporary who was interested in others, happy to meet new people and have new experiences.

And so in January 2009, when Mom suddenly began reporting vague aches and pains and her typically sharp reasoning became somewhat fuzzy, I was concerned by the uncharacteristic behavior and sudden signs that she was slipping, both physically and mentally. We began the search, through a series of medical appointments, to determine the cause of these sudden changes.

In April, she was diagnosed with squamous cell cancer of the mouth. Eventually, after meeting with Mom, hearing about her active life, and looking at her blood tests, which were remarkably normal, Mom and her oncology team agreed that concurrent radiation treatment with antibody therapy was a reasonable option. Mom was realistic. She knew the treatment might not work, but she “had to give it a try.”

After two difficult months of radiation and chemo, the treatments ended on her 88th birthday. We all looked forward to Mom’s regaining her strength and her humor, but she didn’t rebound as quickly as we had hoped.

After Labor Day, we learned that the treatment had not worked; the cancer had spread and her life expectancy was now measured in months. It was the only time throughout the ordeal that I saw Mom cry. She told me that she was not afraid to die, but she was afraid of the pain and suffering to come. She wanted to be in control of her life and was thinking about whether she could just stop eating, but feared that would be just as painful.

I felt torn, wanting to hang onto every remaining minute of her time with us, but understanding her dilemma. I suggested that she discuss her options with my husband, Elliott, a family doctor and geriatrician.

Mom and Elliott had a long talk, and Elliott shared information with her about people who forgo food and water – that not only do they not experience increased pain or hunger, but in fact generally those people enjoy a peaceful death with little or no suffering. Mom decided that this was the course she wanted to take, but she was not ready to stop taking nourishment just yet.

Once Mom’s closest friends and family heard about her prognosis, they all arranged to visit her. She quietly and individually met with her brother and each of her six grandchildren and their significant others. She smiled as her great-grandsons rolled around on her bed. The morning after saying her goodbyes to her loved ones, Mom quietly informed her daughters that she was ready to stop eating and drinking.

Her choice itself was not a surprise, but the timing was a shock. We quickly arranged for one of us or an aide to be with her at all times, expecting her strength to fail precipitously. Each morning, I would approach her apartment with trepidation, wondering how much closer to death Mom had traveled overnight.

Amazingly, I found that each day Mom’s spirits grew lighter and more peaceful. There was an immediate and dramatic change the day after Mom made her choice. It was as if she realized that she no longer had to struggle – that she had taken control – and she found comfort in that.

The stream of friends and family continued, and Mom would doze lightly between visits. The rabbi came to visit and came back to chat with her each day thereafter. At first we thought we should protect her from so many visitors – that it would tire her too much – but then we asked ourselves, “Protect her for what?” She was always cheerful during these visits – nostalgic about her life and relationships – and open to discuss her decision, which almost everyone found somewhat shocking.

At the end of the first week, Mom was so comfortable that she wondered, “When is something going to happen?” We assured her that it generally takes no more than two weeks for a body to slip away without food and water. Mom continued to deny feeling any hunger. She did express appreciation for the few sips of water that she took with her pain medication; we soothed her dry mouth with a spray that helped replace saliva, and that seemed to satisfy her.

At no time in the days that passed did Mom appear to be suffering. She lived those last days with a tremendous grace that touched everyone who was privileged to spend time with her. We talked about death; she was clearly not afraid of dying. She frequently smiled and acknowledged what a good life she had lived. Mom expressed curiosity about what she would experience after death and whether she would see her parents or her husband, but then quickly dismissed her curiosity with a cheerful acceptance of her fate.

On Day 11, Mom became less responsive. On Day 12 she peacefully slipped away.

Mom taught us much at her life’s end and particularly in those last 12 days. Witnessing her grace, her humor, her wisdom, and her compassion for all whom she touched in the extraordinary circumstance of her passing was an experience that I will never forget. Seeing her take control of her death, much as she had of her life, was empowering to everyone who was with her and who heard of the circumstances of her death. I am so proud to be her daughter.