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A daughter's story: 'Flipping the switch' before physican assisted suicide

by Erika Aguilar | Off-Ramp®

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Carl Angelo, 67, shot himself after fighting stage four bladder cancer for about ten months. His daughter Tiffany Angelo sees her father's death as a choice; and she only wishes the law would have allowed her dad physician-assisted end-of-life options. Courtesy Tiffany Angelo

The light from a laptop splashed on Tiffany Angelo’s face and lit up a part of the living room that afternoon. She typed quietly while her father slept the pain away on the couch. He had been spending most of his time in that room lately, and not by choice. Ten months before, Carl Angelo, 67, was told he had stage four bladder cancer.

Every three weeks, Tiffany Angelo would fly from her home in Redlands to Warren, Ohio, to spend the weekends with her father. The year was 2010.

Carl Angelo was a proud Italian man with an extended Catholic family. He was kind. He wanted people to like him and if that meant putting himself in uncomfortable situations, he was okay with that. But everyone has their breaking point.

“When your health is going downhill and you have cancer, you agree to one thing, after another, after another because each thing in and of itself is not so bad,” said Tiffany Angelo. One urostomy bag sucked. Two bags became dreadful. The pain was the worst, and one day it became impossible.

With her back toward the couch, Tiffany Angelo heard her father wake up from his medically-induced nap. He began to pace, and then he walked up to the desk she was working at.  

“I hear his voice behind me and he says, ‘Honey, I want to die,’” she remembers.  “I know Dad,” Tiffany told him while still typing on the laptop. She knew he was in pain. They talked about it all the time but her fingers started to move slower on the keyboard as Carl Angelo continued.

“No, what I mean is if I could flip a switch and have all this be over, I would,” he said.

“I don’t blame you, Dad. I don’t blame you,” Tiffany replied, still not turning around.

He kept hammering: “But really, if I could …”

Tiffany Angleo stopped and turned around. “I had to look him in the eye,” she remembers. He was looking for consent.

Carl Angelo had finally accumulated the arsenal of pain medications he needed to live with cancer. Oxycodone, Fentanyl patches … there were enough drugs in that apartment to kill a horse, Tiffany Angelo says, but it wasn’t enough of a sure thing for him to die by those drugs -- his biggest fear was suffocating to death.  

“I didn’t know he had a gun,” she said.

After that eerie conversation with her father, Tiffany Angelo left to visit her mother about 10 minutes away, as Carl Angelo asked her to. Come back at 6 p.m., he said.

"I was pretty cool that day,” Tiffany Angelo remembers. “And by cool – not just calm and collected – but I was pretty badass and I don’t know where that person came from.”

She spent the late afternoon at her mother’s retelling the conversation she had with her father hours before. She talked about how Carl Angelo worried about legal consequences she and her brother could face if they knew he was going to kill himself. Physician assisted suicide wasn’t an option in Ohio in 2010. It still isn’t. And at that time, California lawmakers were just starting to talk about legalizing it. It would be another six years before California doctors and terminally ill patients would be allowed to choose end-of-life options.

Tiffany Angelo doesn’t have many regrets about her father’s suicide but one of them is that she wished they would have been able to communicate more openly about it. She wished he didn’t have trepidation about the laws, about how it would feel, about what his family would think. “He shouldn’t have had to worry about that,” Tiffany said. “He should have been able to be honest with people and say, ‘Look, this is where my cutoff point is. I can’t do that.”

“The extent that he had to go to protect me, in particular, was stupid,” she said. “You shouldn’t have to use a self-defense weapon to blow an organ up to die in 2010.”

When six o’clock arrived, Tiffany Angelo drove back to her father’s two-bedroom duplex in Northeast Ohio. The trees had just turned red; it was three days before Halloween. Carl Angelo lived in the type of neighborhood where you didn’t lock the front door when you were home, but this time Tiffany Angelo had to use her key to get in.

“There is a weird silence to a house with death in it,” she remembers. “Maybe you just don’t realize how much noise a living thing makes until it’s not making it anymore.”

After fighting bladder cancer for ten months, there were only two places Carl Angelo spent his days: on the couch or in the bathroom but Tiffany didn’t find him in either of those rooms. Then, she spotted the TV screen in the reflection of the bathroom mirror. The set had been twisted to face the spare bedroom. The sound was turned up; sports was on. Carl Angelo was a big Ohio State college football fan.

“I thought, ‘Alright, you got to walk into that room,’” Tiffany said.

No one ever entered the spare bedroom. It was more of a medical storage room. There was an air mattress in there for when Tiffany would visit, but these days, because Carl Angelo had preferred the couch, she was staying in her father’s bedroom.

But before she walked in, Tiffany Angelo knew. She just knew. “He went in there because he didn’t want to mess up the other rooms,” she said.

Everything from that moment, on that day, happened in snapshots for Tiffany. Her eyes took single, zoomed in photos.

His eyes were empty, fixated on the ceiling.

His mouth hung open.

His chest had two tiny drops of blood.

His body lied on the mattress.

And next to it on the floor was a 9mm semi-automatic silver pistol.

“I didn’t want the whole picture,” Tiffany Angelo says. “I have a billion, literally a billion, flash photos in my brain of my dad and I didn’t want that photo. And once you take that picture, it’s in the permanent archives and I didn’t … I didn’t want it.”

Carl Angelo served as a medic during the Vietnam War. He knew where the heart was. A gunshot to the chest was his way of flipping the switch.

Detectives from the Trumbull County Sheriff’s Office came after Tiffany Angelo called 911 to report her father’s death. They were kind, she remembers, but they were thorough. After all, there was a dead body in the house and a gun, and she was the only person there.

After about two hours of questioning, the coroner arrived and took Carl Angelo’s body away. They asked Tiffany if she wanted to see her father one last time. She tried but the good parts of her dad were gone. All that was left was the icky parts, she said. And that was okay for her.

“He was an adult who made a choice that a lot of us would have made,” Tiffany Angelo said.

She and her brother hung out at the apartment that night. They got drunk and watched old Ohio State football games in their father’s honor. They told the best stories about him and purged the place of every cancer-related thing he had. “Everything that proceeded this was the horror show,” she said. “Cancer was the disaster. This was the end of the disaster.”

Of course, she and her family would have liked one more month, Tiffany says, but goodbye was coming no matter what. Carl Angelo was in so much pain. He stopped eating. He got pleasure out of nothing. There was no unfinished business. They hugged; they kissed; they said I love you all the time. Their fears for what cancer had next for him was horrific, she said. “Still, it took courage because I knew he was afraid of suffering … He was afraid,” she said. “We were proud of him.”

But Tiffany Angelo wishes her dad knew that.

On October 28, 2010, Carl Angelo left a suicide note on the computer, apologizing:

“I’m so, so, sorry,” it read. “I love you all. Please know you have done everything you can and so have I. I just can’t take the fear and pain anymore.”

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