Tragic metamorphosis: Ethical debates turn personal for U. professor
The moment Brooke Hopkins' heart stopped beating, Peggy Battin found herself in a scene whose ending she had written time and again.
Doctors, nurses and aides swarmed Hopkins' hospital bed, urgently working to save his life. Battin watched in horror as his eyes rolled back and his face grew ashen. A burly aide screamed at her to get out, but she didn't budge. She couldn't leave her husband of more than 20 years. Not now. Not ever.
"Oh, my God," she thought. "This could be it."
It was a time of decision and pain that Battin had described often through decades of studying the issue of death. Beginning in the 1970s, she was a pioneer in the field of medical ethics, specializing in end-of-life questions. Suicide. Euthanasia. Do Not Resuscitate orders. When and how to die. These were the knotty subjects she debated and discussed in the classroom and courtroom.
Yet it was always about other cases, other people, other situations.
In one unexpected episode in City Creek Canyon on an ordinary November weekday, Battin's personal and professional lives collided.
She knew by heart the arguments for not resuscitating fatally injured patients. She had defended vigorously a person's right to be the final architect of his own death. Yet she also knew her husband well enough to believe he would want to live even if completely paralyzed. But what if he hadn't? Could she have signed a do-not-resuscitate order? Or worse, if he asked her to help him end his life, could she have done it?
Hopkins' life-altering accident on Nov. 14, Battin says, "has presented me more than an intellectual challenge to the views I've been defending over the years. It is a deeply personal, profoundly self-confronting challenge."
Michael Battin has witnessed his mother's metamorphosis.
"Not a single part of her world is the same as it was six months ago," he says. "It is the most fantastic irony you could imagine."
A quiet day
On that fall morning, 67-year-old Hopkins decided to unwind by riding his bicycle up the Salt Lake City canyon. The retired University of Utah English professor had just finished teaching a Mark Twain class to a group of elderly students and was planning a shindig for them at his home that evening. He set out about noon after making a giant pot of his famous chili verde.
Battin had a cold, so she opted to attend a couple of philosophy lectures at the U. and work in her office. When she couldn't reach her husband on his cell phone by 5 p.m., she had a fleeting sense of foreboding but dismissed it.
As she drove up to their Avenues home and saw a police officer talking with her neighbors, she knew something bad had happened to Hopkins. Yet, somehow, she also knew he wasn't dead.
"It wasn't conscious," she says. "I just felt it."
Hopkins had collided with another cyclist riding up the canyon as he was coming down. Hopkins, wearing a helmet, was thrown off his bike and landed facedown on the side of the road. The other man's bike was destroyed, but he was not injured.
Within minutes of the accident, an LDS stake president came by, noticed Hopkins was not breathing and said a prayer. Next came Denise Ward, a LifeFlight nurse who also works in the respiratory ICU at Intermountain Medical Center. She turned Hopkins over and began chest compressions while another passerby performed mouth-to-mouth resuscitation. Hopkins was then taken to the University Hospital under the name "Trauma Denali," given to all unknown patients.
After Battin heard the news, she left a note for the party attendees and drove herself to the U. Medical Center. There she saw the beautiful body she had loved lying utterly motionless, like Michelangelo's "Pietà."
Late that night, Battin called her daughter, Sara Battin Pearson, in Seattle and her sister, Sally Hogenauer, in Long Island, N.Y.
"Oh, Sally," she sobbed into the phone. "Something terrible has happened. Brooke's had an accident. His neck is broken. He's paralyzed from the neck down."
Battin's voice revealed a horrible, pleading desperation.
"Do you want me to come out there?" Sally asked.
"Oh, no," Peggy said, suddenly calm. "I'll be OK."
Hogenauer, Pearson, Michael Battin, also of Seattle, and Hopkins' sister, Lisa Wheeler, all got the same stoic message. They booked flights to Utah anyway.
Four decades earlier, it was another family crisis that prompted Battin's lifelong interest in end-of-life care.
Her parents, Bill and Peggy Pabst, professionals with doctorates from Columbia, raised their two daughters to focus on their minds, not their bodies.
Your stomach hurts, your head aches, your arm stings, you go to school, Hogenauer recalls. "School was more important than anything."
Young Peggy was programmed from birth to ask questions, to consider the pros and cons of every situation, right down to what to buy at the grocery store. If you buy carrots, she would reason, you might have to cook them, while if you bought cauliflower, you could eat it raw.
"She had a philosophical, intellectual approach to everything," says Hogenauer. "You don't get things done that way. You just talk about them."
When Peggy was 20 and Sally 18, their mother fell ill. Though they could see tumors growing out from her ribs, nobody used the word "cancer." It was a dirty word, unmentionable in polite society.
Instead, people kept telling their mother she would be better in the spring and that everything was going to be all right.
"The conspiracy of silence continued to the end," Hogenauer recalls. "She had no chance to say goodbye to anyone."
Battin remembers her mother taking agonizing steps from her bed to the bathroom, sitting down midway and moaning, "Why does it have to be so hard to die?"
Their mother's death propelled both girls into their futures: Hogenauer became a hospice nurse and bereavement counselor. Battin took a more cerebral path, exploring an individual's right to say when enough is enough.
A natural alliance
Battin arrived at the U. in 1975, armed with a master's degree in writing, a doctorate in philosophy from the University of California at Irvine and a one-year appointment. That same year, Hopkins came fresh from Harvard with a background in 18th- and 19th-century British literature. Both were assigned to teach the required class Intellectual Traditions of the West.
He was a handsome, lanky outdoor enthusiast, gourmet cook and such a talker. She was a fair-haired, rigorous thinker, questioning every assumption, always arguing the opposing point of view.
"We had a ferocious discussion," Battin says of their first exchange, "then lunch. The rest is, of course, an extraordinary history."
In 1976, the young couple bought a house together and 7-year-old Sara, Peggy's daughter from a previous marriage, came to live with them. Her son, Michael, visited on holidays and summers. Hopkins nurtured Sara as his own and taught young Michael the pleasures of hiking, fishing and camping.
Ten years later, Hopkins and Battin were married in their home, surrounded by articulate, artistic friends and colleagues. They traveled to exotic locales, danced all night in undiscovered backwoods blues joints and tasted every variety of spicy dishes and good wine.
Over time, Battin became a key figure in the emerging national field of bioethics. She cranked out essays, compiled collections and edited volumes on death and medicine. Soon she was known for such titles as The Least Worst Death, Ethical Issues in Suicide and, more recently, Ending Life: Ethics and the Way We Die.
She helped convince the academic world that applied ethics had an important role to play in the philosophical arena. Even Battin's prize-winning fiction drew on real medical cases.
Still, her approach was intellectual, not personal.
Once on a long drive to visit a college in the Northwest, Pearson got a glimpse of her mother's ambivalence.
"I knew where she stood on every issue, what she was for and against and why," Pearson recalls. "But for the first time, it became clear that just because she defended a person's choice for physician-assisted suicide didn't mean that's the choice she would make for me or my family."
A changed reality
As she paced the hospital halls or huddled with family and friends, Battin had to figure out how she was going to stitch together a new life with Hopkins.
What parts of her career could she hold onto? How would she manage all the new information, deal with doctors, run the household and meet her husband's emotional needs?
She had to be with him, but also keep her sanity. To that end, Battin disappeared for hours every day. She took long walks in the hills and shed 20 pounds without even trying. The house was verging on chaos, with sticky notes of every color plastered around the kitchen and dining room, scrawled with to-do lists and random thoughts.
When her daughter tried to organize the notes on the refrigerator, Battin lost it.
"Damn it," she sobbed, "Leave my sticky notes alone."
Not long after the accident, Battin was to speak at a conference in Lisbon, Portugal. It was important for her career, she felt, but she was conflicted about going and her children objected. Michael Battin feared Hopkins could die at any time. Pearson thought she should cancel.
"Mom, you are a trauma patient's wife," Pearson pleaded. "You have to be there for him."
So conference organizers arranged for her to speak via video satellite, a welcome compromise.
Now, Pearson has come to realize that those hikes, work and other diversions have kept her mother grounded.
"I am so impressed with her ability to take this as a new way of life," Pearson says. "She's lonely in the house. She misses him, but she deals with it and keeps going in her own way and in her own world."
Battin's sister also sees a new Peggy -- gentler, more aware of real life. The two now feel closer professionally and personally.
"There is no question that this is transforming her," Hogenauer says. "It is humanizing her on many levels."
Hopkins sees the changes, too.
"Peggy has become more herself through this," he says through the ventilator in his breathy baritone. "She has always asked questions, now just asks more of them, and some that other medical people often don't even think about."
Battin meets every challenge "with aplomb, not to mention her enormous generosity with other people," he says. "Those things were in her character to begin with. Now they've become more acute and refined."
In the academy
It has felt at times as if Hopkins' accident undercut everything Battin thought about medical ethics.
Recently, she was talking with fourth-year medical students and faculty about a child who needed help eating and breathing. When one student said, "You'd never want to be on a respirator or with a feeding tube," Battin thought about how those devices, although invasive, had been saving her husband's life all these months.
"I felt a distance from these conversations," she says. "I see a lot of things in a more close-to-the-ground way than I did."
At first after an accident, many people with spinal-cord injuries say they want to die. Research shows that if they make it to the end of the first year, most are ready to embrace life as it is. Even in his darkest moments, Hopkins has never wanted to end his life. He has a fierce desire to continue on, seeing his limitations as an "adventure."
But what if he told Battin he couldn't go on?
"You can't imagine anything more intensely personal, because I love this person," she says, her voice cracking, tears in her eyes. "But there are two components to love -- love is partly wanting to be with him, but it's also wanting what's best for him and wanting to want what he wants. What he wants and needs might be different from my self-interests."
Some years ago, the couple went to see the film "Whose Life Is It Anyway?" about a paralyzed sculptor who begs to be allowed to die.
"I always swallowed that movie whole, but now I see it in a much more textured way," Battin says. "Part of me wants to go back and look again at anything I've ever written. I don't know whether I'd tear it all up. I don't even know how I would make it more nuanced in academic presentation, 'cause there's no way to explain it."
In time, Battin's perspective may change and expand in unanticipated ways. She and Hopkins are documenting the experience on a joint blog and plan to write a book.
"We have cried a lot together, and that is very therapeutic," Hopkins says. "We have had to go back and forth and refine our ideas, retelling the story to one another, and that brings people closer together."
Many relationships fall apart under these conditions, he says. "But our love has deepened and deepened and deepened."