By Anne Saker
February 29, 2012
The doctor’s hands can suddenly knock a bowl of granola to the floor. The doctor’s hands put up a fight when he brushes his teeth. What’s really frustrating these days, though, is that the doctor’s hands won’t cooperate in pulling up the doctor’s pants.
“That is really a bummer,” says a jovial Peter Goodwin.
Goodwin, 83, has practiced family medicine for more than 50 years, at OHSU since 1985. But after his diagnosis, even he resorted to the Internet to learn about the rare, progressive brain disorder that would rob him of movement. There is no treatment and no cure for corticobasal ganglionic degeneration. Prognosis: six to eight years.
That was six years ago. Today, he has less than six months. So sometime soon, the disease permitting, the doctor’s hands will perform a final task: to bring a glass to his lips and administer the drug that will cause his death.
This is the right that Goodwin fought for years to establish with his long campaign for the Death With Dignity Act, which Oregon enacted in 1997. He was one of the few doctors willing to speak publicly in favor of the controversial proposal.
During the campaign to bring the act to the ballot, Goodwin said publicly that were he to receive a terminal diagnosis, “I don’t want to go out with a whimper. I want to say good-bye to my kids and my wife with dignity. And I would end it. Damn right.”
Goodwin calls the measure his most significant legacy. Beyond the right to obtain aid in dying, he says, the law’s passage spurred medicine to focus attention on the needs of the dying, with more palliative care and hospice. In 2010 under the Death With Dignity law, 65 people died, the highest number since enactment.
But debates and politics are long behind him. Goodwin now parcels his precious hours for good-byes with friends and colleagues. On Friday morning, with Mount Hood gleaming in the distance from his Terwilliger Plaza window, he sat down with The Oregonian and talked for 90 minutes about a life of standing face to face with death … of others, and of his own.
“We just haven’t come to terms with the fact that we’re going to die, all of us, and to make concessions to that is really giving up hope.” On the contrary, he says; when at death’s door, “the situation needs thought, it doesn’t need hope. It needs planning, it doesn’t need hope. Hope is too ephemeral at that time.”
Born and educated in South Africa, Goodwin “started off as many physicians do, an arrogant know-it-all.”
Yet he puzzled over his inability to connect with patients “well enough for me to be satisfied and for many of them to be satisfied.” He took a year of study at the Medical College of South Carolina. There, a friend who was a psychologist listened to Goodwin wonder aloud how one patient would take advice to quit smoking, but another wouldn’t.
The friend simply asked why Goodwin wanted patients to stop smoking.
A ridiculous question, it would seem. “I thought to myself, oh, that silly idiot.”
Then with a shock he realized that his friend was pointing out the power imbalance between doctor and patient, which led Goodwin to question his motives in practicing medicine, which he says made him a better doctor.
“Why am I lording it over them? What am I doing to them when I talk to them about stopping smoking?” Goodwin says. “That is what he wanted me to think about.” His eyes have tears. “It was touching, really.”
He learned more from his mistakes than from his triumphs. “But it took me a long time to recognize my failures.”
He remembers a patient in the rural South African burg of Queenstown, a woman who had been in a car accident that broke her legs. “I pinned and used plates in both fractures, and neither of them got infected, which was an absolute miracle. She recovered, and she was eternally grateful to me.”
But larger to Goodwin than her gratitude was his mistake: “One leg, one foot was straight ahead, the other was off at an angle of about 30 degrees because I had pinned and plated that leg in the wrong orientation. She could never forget what I had done for her. When I looked at her legs, all I could say to myself was, ‘Good gracious, Peter, is that the best you could do?'”
“The fact that patients love you doesn’t mean everything.”
Goodwin’s wife of 50 years, Erica, was “my adviser, my guide,” a sensitive listener, “which is why our children grew up so well. It was lovely to be together, but losing her was a disaster.”
That great heartbreak came in October 2008. His wife suffered a massive stroke. Goodwin confronted a choice.
“She had said that she never wanted to die as an invalid. So I called her doctor, and he came to the house. I said, look she’s really stroked out. Let’s wait and see until the morning,” he says.
“That was, of course, really in a sense, going against all these sort of information that I knew was appropriate for a stroke patient. But she died the following morning, early. And I have no regrets about that. … I say good night to her every night.”
In the 2011 documentary “How to Die in Oregon” about the Death With Dignity Act, patients said they would know when the time would come to exercise their right. Goodwin can already see the window closing; he’s fallen a few times, and while he hasn’t been injured, he knows that he will not be as lucky as time passes.
When his doctors gave him less than six months, he obtained the drugs to end his life. “It’s given me a sense of relief.” The law requires a patient to give himself the drug, so Goodwin’s hands have never been more important to him.
He can still raise his right arm to shoulder level, but the right hand “is almost totally, ridiculously useless.” His left hand retains some function, although “sometimes it takes two rotations of my Sonicare toothbrush to get all my teeth.” The struggle to do up his pants again can take four or five minutes.
“I use four-letter words quite freely, and at times, I giggle because sometimes it’s really laughable what happens. Even when I knock things to the floor, I sort of think to myself: I did that twice before, but the last two times, I did it a lot better.”
He glances out the window, at shining Mount Hood. He has spent many a dusk watching the light play across the mountain.
“I may be the first person to have come up with this observation, but I don’t think so because I think other people have been unfortunate in the past, and so I think: Life is unfair. There you are.”
To treat that condition, the doctor offers his prescription:
“Be fulfilled. In other words, be happy with yourself. Recognize achievements and be proud of them then go on to further achievements. Know what you want to do and do it. Be happy. Know good friends. Be in love.”