“Dr. Belden, someone told me you’d be able to help me, if anyone could.”  The frail-looking, middle-aged woman stared up at Brian Belden with pleading eyes.  She huddled in the armchair that faced his desk.

“I’m not sure I understand what you want me to help you with,” he answered, tenting his fingers.

She leaned forward.  “I don’t want to be a burden to my family, Doctor.  People—a friend of a friend—said you can help.”

“What kind of help are you looking for?” Brian asked.  He stared over the rims of his glasses at her.

“I need you to help me... end my life.”  The woman drew in a shuddering breath and clamped her lips together.  “I can’t watch myself go downhill, give up all of my functions and rely on others for every little thing.  Only, it has to look like an accident, or a natural death.”

“Assisted suicide?”  He frowned.  “Is that what you’re talking about?  Because I don’t do that.  It’s a violation of the Hippocratic oath.”

The woman shrank back in her chair.  “I don’t know what you call it.  But I’ve talked to several people, and your name came up more than once.  Please, Dr. Belden!  You’ve got to help me.”

“Have your medical records delivered to my office.  I’ll review them and get back to you.”  Brian stood, indicating the consultation was over. 

The woman hesitated for a moment, and then stood as well.  “I’ll have my doctor send my records,” she promised.  “Please say you’ll consider helping me.”

“I can’t promise anything.  After reviewing your records, I’ll be in touch.”  He walked to the office door and opened it, gesturing for her to leave.  With a last pleading look at him, she scuttled out of the consultation room.   After watching to ensure she stopped at the payment window, he closed the door behind her and walked across the room to the window overlooking the parking lot, gazing at his potential client as the woman left the building and walked slowly out to her car.  If she followed through with her promise to have her medical records sent to him, perhaps he could move forward with his plans to help end human suffering.  Voluntary euthanasia, he called it... not mercy-killing.

A week later, Brian sat in his consultation room again with the woman.  “Mrs. Aldridge, please tell me about your condition and why you want to end your life,” he said.

“My life isn’t worth living, Dr. Belden.  My husband passed away a year ago, and I was diagnosed with Huntington’s chorea disease two months ago.  Thank goodness, I don’t have children.  But that also means I have no one to take care of me when I can’t take care of myself.  I’m not doing that.  I’m not.  If you can’t help me, I’ll find someone who will.”  She set her jaw and sat up a little straighter.

Brian’s heart went out to the woman.  He knew Huntington’s chorea was a disease of progressive deterioration, mentally and physically, and it inevitably ended in death after years—usually—of suffering.  It was a fate he would wish on no one.  Her records confirmed that she’d been recently diagnosed, although only one confirmatory test was recorded.

“I can help you,” he offered after a long pause.  “But you’ll have to have someone with you.”

“I can do that,” she promised, brushing away tears of relief.

Brian waited in the converted van that housed his “Thanatron”, a machine set up to deliver a fatal dose of insulin via an intravenous line.   The recreational vehicle was parked in a wooded area of the acreage he had purchased from Mr. Lytell’s estate.  It was private; invisible from his house, but near enough to be very convenient.  He tested the lights and set out his drugs and intravenous fluid bag.  He would not mix the medication until Mrs. Aldridge showed up.  Risking his license and reputation for his beliefs was one thing, but wasting supplies in addition was to be prevented if possible.  A quiet knock at the door caught his attention and he stepped over to the RV’s door.

“Come in.  Do you have anyone with you?” he asked. 

“Yes, my cousin is waiting in the car,” she replied.  He visually located the car, noted that its dome light was on, and verified that a woman was seated on the driver’s side. His client pressed a neatly folded handful of bills into his hand. “Here’s the fee you asked for.” 

Brian removed a money clip from his pocket and carefully counted out the bills, making certain she’d provided the full fee.  “Thank you.  Please lie down.”  He gestured to a slightly modified foldout couch.  When Mrs. Aldridge had settled herself, he placed a light blanket over her lower body.  “Are you comfortable?  Warm enough?”

“Yes...yes, I’m fine,” she replied.

Brian sat down next to her and prepared her arm for the insertion of the intravenous line.  Carefully, he secured a tourniquet, selected a vein, and prepared the skin with an alcohol wipe.  As the alcohol dried, he spiked the IV bag and added one hundred units of insulin to it.  After the line was primed, he hung it on the stand next to the couch.

“How far away are you staying?” he asked, his needle poised above her arm.

“It’s a little hotel—Olyfant’s—right in town,” she told him, eyes fixed on the gleaming IV needle.

“You should be able to get there in under ten minutes,” he said.  “Drive straight there and go to your room.  Undress and go to bed.  The medication will start taking effect within thirty minutes, and peaks in two or three hours.”   

With skill born of practice, he swiftly accessed the vein and secured it with a strip of medical tape.  Compressing the vein with a finger, he used his teeth to remove the protective cap from the end of the IV line and attached it to the hub of the IV catheter. 

“Open the roller clamp whenever you’re ready.”  He elevated the small bag of fluid on a hook about three feet above the bed, and moved to the sink to wash his hands.  After a moment’s hesitation and a sharp intake of breath, Mrs. Aldridge opened up the roller clamp and elevated the small bag of IV fluid to deliver the 250 milliliters it held.  In less than five minutes, the bag was empty.  Brian clamped the line and pulled the catheter, maintaining pressure on the site for exactly sixty seconds.

“Is that all?” Mrs. Aldridge asked, with an apprehensive frown.  “It didn’t hurt at all.”

“That’s it.”  He helped her to rise and escorted her out to the door.  “Remember what I told you.  Straight to the hotel and into bed.  Take this capsule—it’s just a normal prescription-strength sleep aid anyone might have.”

“Thank you, Dr. Belden,” she whispered, tears trembling on her lower lashes.  “Thank you.”  She stepped out the door and he watched her walk to the car parked about twenty feet away, before turning back into the RV to clear away the used supplies.

The next morning, Brian perused the newspaper while drinking his coffee.  There was nothing about Mrs. Aldridge... but most likely, her body wouldn’t have been discovered before press time.  He hoped everything had gone off without a hitch.  But really, what could have gone wrong?  Based on his knowledge of drug metabolism, the method he had used should be foolproof.  With a shrug, he drained the mug of coffee and headed out the door for the short walk to the train station.  In fifteen minutes he’d be on the train, en route to his part-time job with the Westchester County Medical Examiner’s Office.

During the train ride, he mused over the path his life had taken.  During medical school, his fascination for the complex processes that kept the human body functioning had motivated him to excel in his studies.  By the third year of his internal medicine residency, living patients—with all of their messy multifaceted problems and complicated relationships—had become too frustrating.  Years of dealing with patients who did not listen or ignored sound medical advice had eroded his dreams of helping people as a physician, and the prospect of not having to talk to patients had developed a certain attraction.  Cadavers gave up their secrets freely, and didn’t try to conceal their noncompliance with medical advice.  Most of his non-physician friends—including the Bob-Whites—had not understood when he decided to switch to pathology.  But the clear answers provided by autopsy and analysis, unmuddied by patients’ ignorance or deliberate thwarting of medical interventions, appealed to him.

“But Brian, you used to say that getting involved with other people is what life is all about!”   He could still see Honey Wheeler’s hazel eyes, wide with shock, as he told her of his decision to leave Emergency Medicine for Pathology.

“That was before I knew how annoying and stubborn the average person is,” he replied, trying to laugh it off.  Honey didn’t pull away from him then, but as the months went by, she became more and more distant.  Peter Kimball invited all of the Bob-Whites to Cobbett’s Island the following summer, and when Brian declined the invitation due to his schedule, she went anyway.  When she sent the “Dear John” text, he wasn’t totally surprised.  Other women had been repulsed by his work, but none of them compared to Honey, anyway.  Without her, his world lost some color and warmth, but he pushed those feelings away.  In time, he no longer noticed their lack.

During the intervening years, he had cultivated a small, concierge medical practice for carefully selected patients who paid an annual fee for his services, and filled in hours as a part-time pathologist at the Westchester County Medical Examiner’s office in White Plains.  

He’d seen enough of the results of human suffering caused by illness—and of human suffering inflicted by the actions of others.  Movements such as Hospice, and legislation like that passed in Oregon that allowed physicians to assist people to determine their own fate, still left too many people at the mercy of incurable disease and degenerative conditions.   Living wills and advance directives only came into play when the person was near death, and could be overruled by family members or physicians who didn’t accept the person’s wishes.  He had a better answer.  His device, the Thanatron, allowed the living, sentient person to make a final decision and to carry it out.  In the past three years, he’d helped six people to control their destinies.  But he was no Dr. Kevorkian, blabbing about his process to anyone who would listen.  Brian Belden gave people privacy in death.  He was a true humanitarian, although probably that was not the kind of involvement with people Honey had in mind when she’d made her comment. 

Well, to be precise, it wasn’t the kind of involvement he’d originally had in mind, either.  But now, he saw his brand of involvement as a higher calling.  He accepted referrals for that humanitarian work only through a confidential source who used the name Mr. Big.

He smiled as he disembarked from the train at his stop, and whistled as he strode toward the building where he worked.  The Bob-White call made its way into his impromptu melody, but no answering call could be heard.

Woman Found Dead at Olyfant’s Hotel, blared the headline in the Sleepyside Sun’s leading story the next morning.  Brian unfolded the paper with a snap and scanned the story.  Everything had happened just as he’d planned.  According to Paul Trent’s story, Mrs. Aldridge had been in Sleepyside to do family research and sightsee in the historic small town.  Her cousin had left her at the hotel for a few days’ stay, and intended to return to Sleepyside for her at the weekend.  Olyfant’s was not quite the dump it had been when Brian was a teen, so that actually made sense—Hawthorne Street had been gentrified and Fred Olyfant had grabbed the brass ring, ramping up his hotel to appeal to tourists.  The cousin did acknowledge Mrs. Aldridge had recently been diagnosed with a medical condition, but she seemed to be in perfect health when last seen.  The Sleepyside librarian confirmed a lady from out of town had been in to view the historic records archived in the library.  “It seems to have been a heart attack, cause unknown,” stated the coroner, a local funeral director.  Brian snorted, but his lips curved in a satisfied smile as he dropped the paper into the wastebasket.  

Over the next three months, Brian received no confidential inquiries via his White Plains post office box address.  It was an unusually quiet interval, but he was glad of the quiet.  He preferred that nothing should happen that risked his name or reputation after one of his clients controlled their destiny via his Thanatron.  Just as he was starting to wonder if there was anyone left who found life burdensome, his receptionist brought him a manila envelope containing records on a new consultation. 

Meticulously, Brian opened the envelope and started reading the enclosed letter before examining the records.  Roger McGill’s kidneys had failed four years earlier.  Dialysis had kept him alive, but although he’d been placed on a transplant list even before starting dialysis, he had not matched up with a donor yet.  McGill was in his early fifties and had been accustomed to an active life; hunting, deep-sea fishing, and scuba diving were among his hobbies.

I can’t participate in most of the activities I enjoy, the man had written.  I’m tethered to a machine three days a week for four hours a day, and the dialysis center is thirty minutes from my home.  Right there, it ties up time I’d rather use in other ways.  The treatments make me weak and tired, and I have to watch everything I eat or drink.  This kind of life is not worth living and I’m ready for it to end.  A friend told me to contact you.  Please help me.

Picking up the receiver of his office phone, Brian called the McGill number.  When the answering machine beeped, he hesitated for a moment.  The man might be at dialysis, and if he didn’t leave a message, it might mean days or weeks of delay before he could catch the McGills at home.  But recorded messages could be preserved and played again later in a court case.  A second beep signaled that his time was up.  “Bleeping machines!”  He hung up and ran a hand through his hair.  Drumming his fingers on the desk, he had an internal debate on the advantages and disadvantages of leaving a message.  Finally, he decided to take the chance, and re-dialed the McGill number.  This time, he was prepared for the beep.  “This is Dr. Belden.  I received your letter.  Please call my office for a consultation appointment.”  He gave the number and ended the call.  The minimal details were innocuous enough that he believed the risk was negated.

A week later, Roger McGill and his wife sat in his conference room.  “The transplant team said I have antibodies that make it hard to find a match for me.  I haven’t been able to use my time-share in the Keys for the past year, because the place is so far from the dialysis center I don’t have any time to spend at the beach.”  Roger’s skin had a waxy pallor, although the pouches under his eyes were purplish.  Brian noted the slight tremor of the man’s hand as he absent-mindedly fingered the area on his forearm that looked like a swollen, raised vein.  “Then I got an infection six months ago and had to have a new dialysis access created.  I’m sick of it and sick of the burden to my family.”

“Roger!”  Betty McGill dabbed at her eyes with a crumpled tissue.  “You know I don’t mind.  I just want to help you stay active and as healthy as possible.”  Betty was a thin, wiry woman whose clothing was worn but spotlessly clean and pressed; her sparse hair stood out over her head in a short frizzy perm.

“That’s just it, Betty.”  Roger coughed and took a minute to catch his breath.  “You’ve done everything I could have asked, and you’re wearing yourself out for me, and nothing’s helping.  The transplant coordinators act like they don’t even want to hear from me.  I’m done with all that.  I’m ready to go and I want to choose the time and place, while I still can.”  He pursed his lips, controlling his breathing with obvious effort.

“I know we’ve talked about it,” Betty agreed with a sniffle.  She blew her nose on the abused tissue.  “I support your decision,” she said with a watery smile that wasn’t convincing enough to suit Brian.  He remained silent and allowed the silence to stretch out for thirty seconds as he studied the faces of the couple.

“There’s nothing I can do unless I know both of you are fully committed.” he finally said.  “Contact me when you’re both certain of your choice.”  He stood to signal the meeting was at an end, and walked around his desk to shake hands with Roger.  He suspected it wouldn’t be many days before he received a confirmatory call.

Brian was right.  Two days later, Betty McGill called him herself.  “Roger has convinced me your process is what he wants, what will make him happy.”  Her voice caught at the last word.  Brian thought she was finished, but with a little gasp of breath, she started again.  “The transplant coordinator told us again today that his chances of a good match were low due to his antibodies and recent infection.  He feels like he’ll never get the chance for a transplant.”

“All right.”  He gave her the address and stressed that all plans would be cancelled if the McGills didn’t show up by the assigned hour.

The McGills kept their appointment.  Everything went off without a hitch, and Betty McGill left a message on Brian’s personal answering machine to notify him that Roger had died peacefully, as he wished.  Brian felt no twinge of guilt as he listened.  He had enabled a fellow human being to exit a life of pain and suffering on his own terms, according to his wishes.  He whistled softly as he tidied the kitchen of his small apartment.  When the telephone jangled again, he frowned.  It was rare for him to be called on a weekend.  He was still debating whether to pick up the phone or let the machine take the call, when the tape began to play.  It was Betty McGill.

“Dr. Belden, I just wanted to let you know that the transplant center called fifteen minutes ago.  A perfect match just became available.”  A sharp intake of breath could be heard.  Brian straightened, a frown ridging his forehead as the line went silent.  He wondered whether Betty had hung up when a choked sob let him know she was still there.  “Why?  Why couldn’t he wait just a little longer?  Why didn’t you do anything to talk him out of it?”  Her voice broke completely as she asked the question and Brian could hear her sobbing until a click told him she had hung up.

He continued to perform his regular weekend chores, but found it hard to focus.  His mind kept returning to Roger McGill’s haunted face, and his voice, begging for a dignified end to his life.  I was right to help him, he thought.  But then Betty’s sobbing voice took over.  Why didn’t you talk him out of it?  Brian knew Roger might have had a good life after a kidney transplant, able to spend time with his family and pursue the activities he loved.  It was hard to be certain which path would have been the correct one.

In the following weeks, he forced himself to put Roger and Betty McGill into a locked box in his mind called old business.  Busy with autopsies and other forensic investigations he performed with the Medical Examiner’s office, he was satisfied to pass time without clients for his outside business.  But when the weeks stretched into months, he began to wonder if his word-of-mouth referral system had totally failed.

As the first green buds began to emerge on the trees, he found a single letter addressed to him in an unfamiliar handwriting in his private post office box.  Pocketing it, he locked the box again and headed for home to read the letter.

I received your name from a confidential source.  He said you could help me.  Due to a recent diagnosis I need to see you asap to discuss.  Please contact me at the following number: 914.555.0666.

Dick Kreidschen

Three days later, he received an office visit from the letter-writer.  The receptionist ushered in a youngish, weasel-faced man with dark hair, who stopped just inside the door of his consultation room and stood stiffly, eyes darting around the utilitarian office space.  Although not necessarily a vigorous-looking man, there was nothing unhealthy about his appearance.  His color was good, skin hydration was good; he was well-dressed but in an ordinary way.

“Are you Kreidschen?” Brian asked. 

“Yes.  Is this private?  I don’t want anyone else to know details of my medical condition,” the young man continued, with a furtive glance toward the office’s single window.

“Yes, you will have complete privacy,” Brian assured him.  “Can I take your jacket?  Have a seat.”  He waved his arm toward the pair of simple Danish modern armchairs that faced the desk.

“I’ll hold my jacket.”  Kreidschen shrugged his jacket off and sat down in the chair furthest from the window.

“All right.  What can I do for you?” Brian asked as he took his seat behind the desk.

“I’ve recently been diagnosed as HIV-positive.”  Kreidschen drew his brows together in a grimace.  “I can’t—won’t—live like this.  I heard you can help me end it all.”

“Tell me more,” Brian urged him.  “There are medications you can get to keep from going into full-blown AIDS.  Have you been seen by a specialist?  An AIDS clinic?  How long has this been going on?”

“Of course I’ve been seen by a specialist.”  Kreidschen looked angry for a moment, and gripped the arms of his chair.  Then he took a deep breath, almost audibly reminding himself that if he wanted Brian’s help it wouldn’t be a good idea to antagonize him immediately.  After a couple of deep breaths, he stood and began to pace the floor of the compact room.  “I went to the local AIDS clinic after some bloodwork came back out of whack.  After a few rounds of tests, they called me to come in for the bad news.  They referred me to a clinic for medicine and I went for awhile.  I feel fine now.  But it’s too late.  There’s no cure and I won’t live like a monk for what time is left to me.”

“Live like a monk?”  Brian’s eyebrows rose in question.

“You know.  Be celibate.” Kreidschen stopped pacing and scrubbed at his face with his hand.  “That’s not healthy for a man with my… needs.  You know it’s dangerous to get a buildup with no way to release it.  Taking matters into my own hands would be sinful.  And even with condoms, I can’t find a woman who’s willing to… you know.”

“You’re not married?”  Kreidschen wore a plain gold band on his wedding ring finger, so Brian had assumed he was married.

“No.  That bitch—my ex-wife—this is all her fault in the first place.”  Kreidschen resumed his pacing.  “If she hadn’t insisted on going against the Godly order of things, I would never have needed to turn to other women.  But no!  She accused me of terrible things, things I never did.  Just because I tried to exert my rights as head of the family, she accused me of trying to dominate her.  She actually said I was abusive!”  He ran an agitated hand through his hair.

“Well, were you abusive?”  Brian leaned back.  He didn’t have to help a potential client, just because they asked for his help.   This man was seriously starting to tick him off.

“Of course not!”  Kreidschen glared at him.  “I tried to help her conform herself to the divine order of things, but she was willful and disobedient.  I had to chastise her, but no, I wasn’t abusive in any way.” 

Brian liked the man less by the minute.  “What about children?  Do you have any children?”

“Sure.  A boy and a girl, five and six years old.  I wanted more, but my wife refused.  You see how once again, she was refusing to submit to God’s plan.”  He stopped pacing, hands jammed into his pockets.

“Mr. Kreidschen, please tell me exactly what you are asking of me.  You look able-bodied and I can’t go along with any plan that leaves your children un-provided for.”

“I don’t want to live—I can’t live without my needs being met.”  He was pacing again.  “My ex forced me out of the marital bed and after the blasted Jezebel gave me this damned disease, I can’t get another woman to give me the time of day.  I’ve been told you can help me to end my life without it looking like a suicide.  My children—well, I have a small insurance plan through work and they can have that.  My wife—ex-wife—will have to find a way to support them if she runs through that money.”   He strode over to stand by the window, apparently forgetting his earlier caution about being seen.

“I’ll need to have a copy of your medical records, and I’ll have to validate the information you’ve given me,” Brian finally said.  He stood up.  “Get me your records and give me a week to review them.  After that, I will let you know if I can help you.”

“I’ll have them for you within forty-eight hours.”  Kreidschen reached to shake Brian’s hand, but Brian didn’t respond.  Kreidschen’s lip lifted in a sneer.  “You’re like all the rest,” he ground out.   Seeming to think better of his surly attitude, he pasted a stiff smile onto his face.  “Thank you for seeing me.  I’ll be in touch.”

Dick Kreidschen sent his medical records to Brian’s P.O. box, and after checking the man’s address, Brian took time the following day to visit the courthouse in Putman County to examine the public records for reports of spousal abuse.  An hour later, he walked out of the building.  His mind was churning and he had a bad taste in his mouth thinking of his would-be client.  One thing was certain:  he could not enable this man to achieve his wish for death.  It went against every fiber of Brian’s being to consider leaving two small children without financial support from their father, and it certainly appeared that Dick Kreidschen’s ex-wife might have had some grounds for her claim of cruel and inhuman treatment.  His expectation that she should submit to him in all things was diametrically opposed to every relationship he could think of in which the two spouses loved and respected each other.  Certainly his sister Trixie would never submit unquestioningly to anything her husband Jim requested of her, if it wasn’t consistent with what she thought was right.

Still, the man had an incurable disease.  Was Brian going against his own convictions about death with dignity by choice, in the face of certain future suffering, pain, and financial burden before inevitable death?  Was it actually fair of him to bring other people into the equation, when Kreidschen was the one who was actually involved?

For several days he debated his decision internally.  A week after reading the records, he still had not fully made up his mind.  Faces of anonymous small children floated across his mind when he tried to sleep at night.  When Kreidschen called for another appointment, Brian knew his reflection period had come to an end.  His would-be client would expect a final decision that evening.   

“Well?  What’s the verdict?”  Kreidschen stood before him with arms crossed, a defiant look on his face.  His clothing and hair were disheveled in comparison to his first visit.

“I can’t help you, Mr. Kreidschen.  That’s my final verdict.  I’m sorry, but that’s the way it is.”  Brian had not invited his would-be client to sit, nor had he sat down himself.  They remained standing, just inside the door of the office’s consultation room.

“But why?  I’ve proven to you I have a fatal disease.  Why should I have to waste away and suffer for who knows how long, with no relief for my needs?”

“Why should your children be deprived of your financial support, when you have a good job now and can expect to be able to work for quite some time?” Brian retorted.

“This whole thing is my ex-wife’s fault, so let her support them.”  Kreidschen’s voice rose.  “It would serve the bitch right.”

“Whatever you may think about your ex-wife, why wouldn’t you care about your kids?  I think they’re innocent parties here.”

“I told you, I have an insurance policy that makes them the beneficiaries.  They’ll be okay.”  Now the man’s voice was placating.

“You have my final verdict.  You could earn more and provide better support to your family by getting into a clinic, taking medicine, and continuing to work as long as you can.  You’re asking me to enable you in abdicating responsibility and taking the way out that is easiest for you, without considering your obligations, and I won’t do it.”

“Damn it, you were my last hope.  I have a good mind to report you to the New York Board of Medicine.”

“You do that.”   Brian felt quite comfortable in making that response.  There was no documentation of his extra-curricular activities, and he knew if it wasn’t documented, it wasn’t done.  “You have my final verdict. What you’re asking takes no consideration for the needs of your children, or even your ex-wife.  It was your choice to have sex with other women; that wasn’t your ex-wife’s responsibility.   I believe that getting involved with other people is what life is all about, and when you came to me, you got me involved with your ex-wife and children.”

Dick Kreidschen swore under his breath, but Brian was firm.  He opened the door and indicated his visitor could leave.  Kreidschen stalked out the door, turning once to shake his fist.

Getting involved with other people is what life is all about.  If that was really so, maybe he needed to give his family and old friends another chance. 

Maybe so.