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jclarkdawe
08-05-2009, 12:07 AM
Protagonist is an 87-year-old man who has been a rancher all of his life. He is in the early stages of Alzheimer's with minimal effects from the disease. He is also just been diagnosed with prostate cancer that has gotten into his hips and back, causing pain that is manageable. With these conditions, the protagonist is capable of riding on a horse for about ten hours per day and camping.

I need another disease that does not impact his physical condition as a result of medication. Protagonist doesn't believe in suicide, but may want to die if he chooses to not take his medication. Although this can be defined as suicide, he chooses not to believe so.

One possibility I've thought of is congestive heart disease. With a drug like lasix, he would be able to perform physically at the level I need him to, while having a fatal reaction from hypokalemia if he fails to take his potassium. And death from hypokalemia doesn't sound especially bad, particularly when you compare it to death from cancer.

I'm wondering if there are some other possibilities. Any help is appreciated.

Best of luck,

Jim Clark-Dawe

mscelina
08-05-2009, 12:10 AM
let me think...how about severe epilepsy perhaps? Some of the adult onset cases of epilepsy, if not controlled by medication, can cause seizures severe enough to bring on a fatal stroke.

Samantha's_Song
08-05-2009, 12:19 AM
He could have Insulin dependent diabetes, but if he didn't take his insulin, his death would be rather nasty and messy. I know, I forgot my insulin once, when I was 12 yrs old. and ended up in hospital for a fortnight. He'd be pissing himself and puking his guts up, even if empty, he would also be drinking gallons of water. having an overdose of insulin could be fatal too, but not as messy as the not taking it. If he overdosed he would just be all sweaty, trembling, maybe have nerve spasms, depending on what he was doing. He'd also feel overwhelmingly tired and eventually slip into a coma if he didn't take glucose. You can accidentally overdose, so no one would know he meant to do it, especially at his age.

Palmfrond
08-05-2009, 05:41 AM
Bone metastases hurt a lot - your character isn't going to get by on Tylenol. He's going to need narcotics that probably would make him too sleepy to ride ten hours a day or epidural anesthesia that would keep him from doing much more than getting back and forth to the bathroom.

As far as another disease that would kill him if he doesn't take his medication: few diseases are fatal in the short term. Stopping potassium or an anticonvulsant or even insulin isn't likely to kill him right away, only make him sick. An independent old rancher seems like a character who would allow himself to freeze to death (supposed to be quite pleasant once the shivering stops). Lie down in the snow and never wake up. And not exactly like committing suicide.

Samantha's_Song
08-05-2009, 11:50 AM
That's what happened to my Polish great grandfather, although it wasn't actually intentional, they found him, sitting on a rock, some months later.


An independent old rancher seems like a character who would allow himself to freeze to death (supposed to be quite pleasant once the shivering stops). Lie down in the snow and never wake up. And not exactly like committing suicide.

RJK
08-05-2009, 07:33 PM
The diabetes/insulin route sounds workable. Forgetting to take the insulin and eating high sugar foods would put him into a sugar coma and kill him without treatment.

Another possibility, less predictable, would be extreme high blood pressure. Medication would control it. not taking it would push the blood pressure to lethal levels, eventually causing a stroke.

I'm curious about the 87 YO who can ride a horse for 10 hours a day. Most healthy 37 YO's would have difficulty doing that.

Tsu Dho Nimh
08-05-2009, 07:39 PM
How FAST does he have to die?

If you just want him dead - have his horse throw him. My great-uncle died on a hunting trip from that. He was 95 or so.

A sudden and fatal heart attack is not unlikely at that age.

And some old people just slow down, go into a "decline", stop eating and die.

cbenoi1
08-05-2009, 07:53 PM
> Protagonist is an 87-year-old man
> ...
> Protagonist doesn't believe in suicide, but may want to die
> if he chooses to not take his medication.

There is a point where a string of bad news late in someone's life is enough for that person to stop things they like and wait for death. I've seen it many times. An uncle of mine stopped dialysis for no other reason than being 'tired of it'. Another family member stopped eating when her daughter had a car accident that left her paraplegic. A neighbour with emphyzema suddently stopped going out with friends. They all died within weeks.

It's not suicide. It's not a disease either. It's about not loving life anymore and letting nature take back what it had loaned 87 years ago.

Just a different angle.

-cb

jclarkdawe
08-05-2009, 10:23 PM
let me think...how about severe epilepsy perhaps? Some of the adult onset cases of epilepsy, if not controlled by medication, can cause seizures severe enough to bring on a fatal stroke. Possibility, but I'm not sure how much my protagonist can rely on this happening.


He could have Insulin dependent diabetes, but if he didn't take his insulin, his death would be rather nasty and messy. I know, I forgot my insulin once, when I was 12 yrs old. and ended up in hospital for a fortnight. He'd be pissing himself and puking his guts up, even if empty, he would also be drinking gallons of water. having an overdose of insulin could be fatal too, but not as messy as the not taking it. If he overdosed he would just be all sweaty, trembling, maybe have nerve spasms, depending on what he was doing. He'd also feel overwhelmingly tired and eventually slip into a coma if he didn't take glucose. You can accidentally overdose, so no one would know he meant to do it, especially at his age. Diabetic coma is definitely a possibility.


Bone metastases hurt a lot - your character isn't going to get by on Tylenol. He's going to need narcotics that probably would make him too sleepy to ride ten hours a day or epidural anesthesia that would keep him from doing much more than getting back and forth to the bathroom. He's going to leave for his trip within a couple of weeks of going to the doctor. He's going to be popping Tylenol like candy, but it's still manageable. One of the reasons for his timing is wanting to go before the pain becomes overwhelming.

As far as another disease that would kill him if he doesn't take his medication: few diseases are fatal in the short term. Stopping potassium or an anticonvulsant or even insulin isn't likely to kill him right away, only make him sick. I understand it won't be immediate, but I'm looking at something that would kill you within 30 days. Idea is to stop taking your pills to avoid the cancer. An independent old rancher seems like a character who would allow himself to freeze to death (supposed to be quite pleasant once the shivering stops). Lie down in the snow and never wake up. And not exactly like committing suicide. That had been my original solution, and I can still make it work. Problem is he'd have to take an affirmative action to accomplish it.


The diabetes/insulin route sounds workable. Forgetting to take the insulin and eating high sugar foods would put him into a sugar coma and kill him without treatment.

Another possibility, less predictable, would be extreme high blood pressure. Medication would control it. not taking it would push the blood pressure to lethal levels, eventually causing a stroke. Could, but I've known people to live quite a while with blood pressures that would make you wince,

I'm curious about the 87 YO who can ride a horse for 10 hours a day. Most healthy 37 YO's would have difficulty doing that. I had a friend, who at 92 was told by his wife not to ride anymore. Went out and bought himself a cart and a nice little Morgan and started driving for the next three years. Only stopped that when he died.


How FAST does he have to die? Within 30 days of making the decision. Gradual process is not a problem.

If you just want him dead - have his horse throw him. My great-uncle died on a hunting trip from that. He was 95 or so. He can't die by accident. He has to plan it.

A sudden and fatal heart attack is not unlikely at that age.

And some old people just slow down, go into a "decline", stop eating and die. a lot do, but this would be wrong for my character.


> Protagonist is an 87-year-old man
> ...
> Protagonist doesn't believe in suicide, but may want to die
> if he chooses to not take his medication.

There is a point where a string of bad news late in someone's life is enough for that person to stop things they like and wait for death. I've seen it many times. An uncle of mine stopped dialysis for no other reason than being 'tired of it'. Another family member stopped eating when her daughter had a car accident that left her paraplegic. A neighbour with emphyzema suddently stopped going out with friends. They all died within weeks. He's had a string of bad news. His wife just died, he's got cancer, he's got Alzheimer's. Your uncle sounds like my character where a conscious decision is made to die, rather than an unconscious one.

It's not suicide. It's not a disease either. It's about not loving life anymore and letting nature take back what it had loaned 87 years ago.

Just a different angle.

-cb

He's got to make the decision. It would be simpler if he'd just put a gun to his head, but that's not going to happen. However, death doesn't have to be even within 24 hours. Thirty days of dying isn't a problem to the story, but he won't do something that's unpleasant. He doesn't care if his family knows he wants to die, and his family will support his decision, although he'd prefer something where he doesn't have to discuss it.

Thanks for all the help.

Jim Clark-Dawe

Calla Lily
08-05-2009, 10:42 PM
Squirrels, Jim. Squirrels.

He trains them, he feeds them, he Pavlovs them to the point of instant response to him whistling the opening bars to "Sweet Adeline." Then at the appropriate moment in the book, he paints his nekkid body with 10 lbs of nut butter, puts his lips together, and blows.

Fade to black.



You're welcome. :D

JoNightshade
08-05-2009, 10:56 PM
I'm in favor of the diabetes thing, specially because it's so common (the more conditions you pile on, the less likely it feels - but if they're common to old age/infirmity, it's more plausible). Man, I used to take care of this 81 year old guy with diabetes... he'd lost both his legs, and his wife had advanced Alzheimer's. He was allllways trying to sneak sugary foods. I mean, it wasn't like he wanted to die at all - in fact he was hanging on for his wife. But he was like, damn, I'm 81, I got no legs, no energy, and now you're telling me I can't have the one little pleasure of eating something good? His family wanted me to be the food police, but he was an adult, I let him do what he wanted for the most part.

Also I think the simple will to live factors in a whole lot into someone's survival. Someone on the edge who really wants to live can hang on for a long time. Someone who isn't so much on the edge but doesn't have the will to survive may just die regardless of how strictly treatment is followed.

Oh you know what I just thought of. If he's out there riding around and hurts himself somehow... what about gangrene? I was just thinking of Gus in Lonesome Dove. He doesn't "commit suicide" per se - but god damn if he's going to let anybody cut off his legs.

cbenoi1
08-06-2009, 04:12 AM
> Your uncle sounds like my character where a conscious decision is
> made to die, rather than an unconscious one.

My point is that those people did NOT make the decision to die or suicide. They rather decided to stop being on the receiving end of personal care, be a permanent ball and chain for their families and society, and that they have lived and seen enough that there is no more pleasure in living. It's a different mindset altogether. That the consequence of that decision leads to death (or increased risks of death) is immaterial in this thought process.

-cb

jclarkdawe
08-06-2009, 05:42 AM
Squirrels, Jim. Squirrels.

He trains them, he feeds them, he Pavlovs them to the point of instant response to him whistling the opening bars to "Sweet Adeline." Then at the appropriate moment in the book, he paints his nekkid body with 10 lbs of nut butter, puts his lips together, and blows.

Fade to black.



You're welcome. :D Unfortunately, the story takes place out west, where there are no trees and only ground squirrels. And ground squirrels are to squirrels like, well you think of a simile.


I'm in favor of the diabetes thing, specially because it's so common (the more conditions you pile on, the less likely it feels - but if they're common to old age/infirmity, it's more plausible). Man, I used to take care of this 81 year old guy with diabetes... he'd lost both his legs, and his wife had advanced Alzheimer's. He was allllways trying to sneak sugary foods. I mean, it wasn't like he wanted to die at all - in fact he was hanging on for his wife. But he was like, damn, I'm 81, I got no legs, no energy, and now you're telling me I can't have the one little pleasure of eating something good? His family wanted me to be the food police, but he was an adult, I let him do what he wanted for the most part.

Also I think the simple will to live factors in a whole lot into someone's survival. Someone on the edge who really wants to live can hang on for a long time. Someone who isn't so much on the edge but doesn't have the will to survive may just die regardless of how strictly treatment is followed. Agreed, but he has a timetable to die within. He can't just wait.

Oh you know what I just thought of. If he's out there riding around and hurts himself somehow... what about gangrene? I was just thinking of Gus in Lonesome Dove. He doesn't "commit suicide" per se - but god damn if he's going to let anybody cut off his legs. Gangrene is nasty. He won't want to die that way.


> Your uncle sounds like my character where a conscious decision is
> made to die, rather than an unconscious one.

My point is that those people did NOT make the decision to die or suicide. They rather decided to stop being on the receiving end of personal care, be a permanent ball and chain for their families and society, and that they have lived and seen enough that there is no more pleasure in living. It's a different mindset altogether. That the consequence of that decision leads to death (or increased risks of death) is immaterial in this thought process. I wasn't meaning to insult your uncle, who I respect. He had a lot of courage.

The loss of the will to live is a passive act, where your subconscious mind accepts that maybe fighting isn't the best approach to life. It may also enter your conscious mind, but because a loss of will to live doesn't have a disease to fight, it's hard to figure out what to fight.

On the other hand, someone who commits suicide makes an active decision where they decide suicide is a reasonable solution to their problems, whether it is an internal problem such as going to jail or an external problem, where the problem affects their family. Many people who are diagnosed with diseases such as cancer, where the disease is terminal or expensive to their family, will commit suicide. This is entirely a conscious act.

Then there are the in-between people, like your uncle. Life has become unbearable, as a result of a disease, and maybe other factors. Many of them understand what their future is and would prefer not to face it, whether because of pain, financial cost, emotional cost, or whatever.

They are unwilling to actively commit suicide, nor do they want to passively wait for what happens. These people decide to stop their medical treatment, with the knowledge, although not absolutely, that by refusing their medical treatment they will die. The people that I've met in your uncle's type of situation clearly understand this, and you can be sure their doctors tell them repeatedly.

One of the central points of my book is whether refusing medical treatment or passively allowing yourself to die is wrong. For example, in both of those circumstances, a Catholic priest would tell you that you're committing suicide. It is an unique mindset, and I think it takes a lot of difficulty for people to come up with a decision, although they find it hard to find people to talk to.

-cb

Thanks for all the help.

Jim Clark-Dawe

JoNightshade
08-06-2009, 07:44 AM
Gangrene is nasty. He won't want to die that way.

Well then he's just a sissy and I shall have nothing to do with him. ::washes hands::
:D

GeorgeK
08-07-2009, 09:29 PM
You wouldn't need any new diseases for what he already has. Bone pain from prostate cancer in an 87 year old would often be treated by castration. Get rid of the testes and there's almost no testosterone to feed the cancer. Their bone pain is already improving by the time they are in the recovery room.

He's a rancher. He feels better the next day and decides to ignore the doctor's advice of no riding horses for six weeks. He saddles up and rides out for a picnic lunch. The riding tears a stitch on the stump of the spermatic cord and the arteries start to bleed. If they ligated the stump high it can even bleed internally and all he'd notice is the fuzzyness of thought and dizziness before he blacked out.

GeorgeK
08-07-2009, 09:32 PM
Well then he's just a sissy and I shall have nothing to do with him. ::washes hands::
:D

But see if you had washed your hands sooner, maybe he wouldn't have got the gangrene
:)

Samantha's_Song
08-07-2009, 09:46 PM
:roll:


But see if you had washed your hands sooner, maybe he wouldn't have got the gangrene
:)

BillTrain
08-12-2009, 10:55 AM
Maybe something to do with warfarin? Lots of older people are on warfarin for artificial heart valves, atrial fibrillation etc. You have to have your blood monitored frequently to make sure you're not at risk of bleeding. If your character has early dementia, and mixes up his pills, he could quite easily be at a bleeding risk. The first signs of too much warfarin would be easy bruising. Too much warfarin is reversible (either with time or with meds), but if your character kept taking his pills even after the bruises appeared, he could quite easily get some kind of bleed and die (especially if he's riding horses 10 hours a day). Just a thought.
Cheers,
BT

RainbowDragon
08-13-2009, 11:31 AM
Rabies? He could choose not to get the shots.

(Morbid thought inspired by mention of squirrels, though skunks and raccoons, foxes and bats are much more commonly infected).


Squirrels, Jim. Squirrels.

:D

jclarkdawe
08-15-2009, 01:27 AM
You wouldn't need any new diseases for what he already has. Bone pain from prostate cancer in an 87 year old would often be treated by castration. Get rid of the testes and there's almost no testosterone to feed the cancer. Their bone pain is already improving by the time they are in the recovery room. He'd have problems with the estrogen therapy frequently used. Limp dick is a reason for sending a bull to slaughter. There's no way he'd agree to castration.


Maybe something to do with warfarin? Lots of older people are on warfarin for artificial heart valves, atrial fibrillation etc. You have to have your blood monitored frequently to make sure you're not at risk of bleeding. If your character has early dementia, and mixes up his pills, he could quite easily be at a bleeding risk. The first signs of too much warfarin would be easy bruising. Too much warfarin is reversible (either with time or with meds), but if your character kept taking his pills even after the bruises appeared, he could quite easily get some kind of bleed and die (especially if he's riding horses 10 hours a day). Just a thought.
Cheers,
BT I use warfarin (US name is coumadin) in another story, and don't want to reuse it. Other than that, I'd be thinking about it.

I've decided the most consistent with the character would be him riding off one night (it will be November so definitely cold enough) and letting himself freeze. It's not guaranteed, but he doesn't want the sure thing. He wants to let fate have some control in the result and remove some of his responsibility.

Thanks for all the help.

Jim Clark-Dawe

GeorgeK
08-16-2009, 04:21 AM
[quote=jclarkdawe;3927137]no point