This story appears in the March 2011 issue of Milwaukee Magazine. On that Saturday summer night, Daniel and Katherine Gute made the short drive from their River Hills home to the Milwaukee Country Club for an early dinner. They held hands walking into the restaurant and sat at a table near a window overlooking the […]
This story appears in the March 2011 issue of Milwaukee Magazine.
On that Saturday summer night, Daniel and Katherine Gute made the short drive from their River Hills home to the Milwaukee Country Club for an early dinner. They held hands walking into the restaurant and sat at a table near a window overlooking the Milwaukee River. They sipped chardonnay and shared a bowl of vichyssoise, a favorite soup of theirs, having a quiet, romantic evening.
But they must have known it was their last meal together.
It was July 17, 2010, just four days after their 53rd wedding anniversary.
Kitty and Danny, as they were known, were a vivacious duo who enjoyed life to the fullest, according to their friends and children. They penned funny lyrics to Broadway show tunes and performed them at dinner parties. They went skinny-dipping together at their hobby farm and jokingly named Kitty’s poodle “Dasis,” as in “Das ist gut,” or, translated from German, “That is good.”
Life had indeed been good for the Gutes. They had raised three daughters in a Georgian-style house with three chimneys just a block from Lake Michigan in Whitefish Bay. They vacationed in the Bahamas every Christmas with their girls and renovated a farmhouse in Manitowoc County as a family retreat.
Yet as committed as they were to their kids, the couple’s relationship came before anyone else. Even their children came second.
“Kitty has been easy to like, and easy to love. I love her dearly,” Dan wrote in his journal last summer. “She has a great sense of humor – and she has always had a consistent positive view of life. I have been blessed.”
But time had begun to let them down, as old age took its harsh toll. Though still physically and mentally sound, Dan, 79, had battled prostate cancer and was being treated for high blood pressure and macular degeneration. Kitty’s health was far worse. At 78, she was hobbled by an arthritic condition that wracked her joints with pain. And last June, she’d been diagnosed with Alzheimer’s disease. The constant pain and accelerated dementia had robbed her of her spark, her distinctive joie de vivre.
“I’ve lost her,” Dan told one of his daughters. The heartbroken husband and physician could not cure his own wife.
“I came home to find Kitty in the master bath,” he journaled the night before they died. “She had been there for who knows how long. She could not move. Her strength and balance are worse every day. When walking she can’t straighten up. … Kitty will not get better, for she continues a downward course both mentally and physically.”
As husband and wife, doctor and patient, the Gutes had devised a plan to end her inevitable decline.
“I talked at length with Kitty about our options – which are limited because neither of us wants to go to a nursing home,” Dan wrote. “I hope I will be able to act. I have been thinking about this for a long time. … I do not want to carry on in life without Kitty.”
On the day after their country club dinner, they were found in their car inside their garage. Dan was in the driver’s seat, Kitty next to him, slumped toward her husband. Both had died of asphyxiation after inhaling pure helium.
“It will not be easy,” Dan had written in his journal. The Gutes had told their family and close friends exactly what they planned to do, and why. They had chosen a method recommended by experts. Yet their suicide was still a shock to those who knew them. So many emotional and ethical issues were involved. Was this really the way to die with dignity?
Dr. Dan Gute was a retired surgeon, a scientist with an unquenchable curiosity and strong opinions on just about everything. He would dress in a bow tie, a crisply pressed white Oxford shirt, slacks and penny loafers, but he was just as comfortable in hiking shoes. Dan loved the outdoors. Years ago, as president of the town of Saukville, he helped limit the mining of a limestone quarry in the township.
Dan was the son of a doctor. Dr. Edwin Gute practiced medicine in an office across from Winkie’s variety store in Whitefish Bay. Dan was just 20 when his father died. Deciding to follow in his footsteps, he finished his undergraduate work at Northwestern University and applied to Northwestern’s medical school.
Like her husband, Kitty was an impassioned conservationist. Although she had tuberculosis as a child, she was an athlete, a tennis player and country club golf champion who rarely allowed herself a mulligan. Born in Chicago, she graduated with a bachelor’s degree in sociology from Smith College in Massachusetts, where she had known the poet Sylvia Plath. Kitty’s friends relished her infectious laugh and off-color jokes, usually told with an Irish brogue.
Known by her initials KAT or Kitty, Katherine Ann Tobin was the only child of Mary and Howard Tobin. She enjoyed a privileged childhood, attending St. Monica’s Catholic School in Whitefish Bay and Downer Seminary in Milwaukee. Her father was vice president of Northwestern Mutual Life and then president of Wisconsin Gas Co. He built a home for his family on a piece of land just north of what is now Klode Park.
Kitty Tobin and Danny Gute had known each other growing up in Whitefish Bay. But it was at a summer party at Pine Lake in the mid-1950s when things got romantic. Both were in their 20s. “All the guys were bringing dates,” says their oldest daughter, Mary Gute Witte, 48, relating the story her parents would tell. “And my dad’s friend said, ‘So why don’t you try Kitty Tobin?’ And he thought, ‘Well why not?’ That weekend they totally hit it off.”
Kitty had graduated from college and was looking for a place to live. Dan offered to help. “My dad was taking my mom around to look for an apartment and he thought, ‘Why am I doing this? I want to marry her,’ ” says Mary. “And then he proposed.”
Married at St. Monica’s church, the newlyweds moved to Boston, where Dan completed his residency at Massachusetts General Hospital and began practicing as a urologist. They returned to Wisconsin and bought a house across from Klode Park near Kitty’s parents.
For the three Gute daughters, it was idyllic – the park as a playground with tennis courts and a beach on Lake Michigan. “We loved to skate in the winter, just putting on our skates at our house and walking across the street,” says the second-oldest daughter, Susie Gute Rogers, who moved from Minneapolis to China in 2009 with her husband and their young sons.
While Kitty never pursued a career, she was always dashing off to a tennis game or golf lesson, leading the Junior League or meeting with the Green Tree Garden Club. And playing the role of doting mother. Mary remembers coming home from grade school for lunch every day. Her mother would slide out the cutting board from under the kitchen counter and make Saltine sandwiches with peanut butter and cream cheese.
On weeknights, the family ate dinner in shifts. Dan worked late, making hospital rounds, so Kitty fed the girls around 5:30 p.m., and when Dan arrived, she would sit with him in the den, near the fireplace. They would sip cocktails – vodka on the rocks with a twist – talk about the day and have dinner on TV trays. Around 8:30 p.m., after helping their daughters with homework, they would switch off the house lights and go to bed – always early, always together.
“Every light in the house was turned off,” recalls Susie, 46. “And they kept the temperature down. Our friends would come over to a dark, cold house and wonder where our parents were.”
Joan Rater lived down the street and shared a paper route with Mary Gute, her best friend. “Mrs. Gute was a terrific cook,” says Rater, who now lives in southern California as a producer and writer for ABC’s “Grey’s Anatomy.” “She made lamb chops, the kind of stuff that seemed like fancy food to me. They were fancy people to me. Mrs. Gute put me up for the tennis club. She nominated me as debutante.”
In high school, Rater was picked as one of four students to write a graduation speech. “It was my first bit of writing, and I thought my speech was funny, but I showed it to no one,” she says. She mentioned the speech to Dan and Kitty. “They told me to go home and get it, they wanted to read it. … They read it out loud and they cracked up. They were so effusive, so supportive. They made me feel like a star.”
It was not unusual to see Kitty and Dan openly express affection for one another – a hug in the kitchen, a kiss in the car. They argued, says a friend, but never loudly.
“They adored one another,” says Rater. “I said to Mary the night they died, ‘I was always struck by how much your parents loved to be together, and I wondered if you felt you were outside of their love.’ ”
The Gute family lived outside the boundaries of organized religion. Kitty was baptized a Catholic but left the church, says daughter Mary, partly because it disapproved of congregants marrying non-Catholics.
Dan was raised an Episcopalian and served as an acolyte for a time at Christ Church-Episcopal on Lake Drive. When he was 10, he and his sister were in a car accident. His sister and the driver were killed. Dan soon abandoned religion. “He thought the Bible was a beautiful book but didn’t take the stories literally,” Mary says. “He was a scientist.”
Nature was the Gutes’ church, Mary says. Dan was an avid sailor. Kitty contributed to the Nature Conservancy in Wisconsin and the Urban Ecology Center in Milwaukee, and for years, she sat on the board of Riveredge Nature Center near Newburg.
The Gutes bought a 350-acre farm in Manitowoc County and headed to their second home every Sunday. The girls caught salamanders along the creek banks and fish from the pond. Eventually, they sold the farm and bought a weekend condo in Elkhart Lake. After their kids had grown, they moved out of Whitefish Bay and bought a house in the country near Saukville. Their last move was into a home on Range Line Road in River Hills.
The Gutes were political conservatives. Dan was a libertarian who saw government as wasteful and corrupt, more a hindrance than a help. “Kitty was usually more moderate and expressed fewer opinions,” says her longtime friend and neighbor, Char Johnson. Kitty supported Planned Parenthood and several environmental causes.
But neither could be mistaken for a Democrat. “All I heard when I was growing up was how much they hated Kennedy,” Mary recalls. In their later years, their television was tuned exclusively to Fox News.
Dan was not shy about proselytizing. He sent daily e-mails to his son-in-law, Ned Witte, which Ned considered ultra-conservative screeds. Ned asked to be taken off Dan’s e-mail list, and Dan obliged.
Dan couldn’t resist drawing people into debates about politics, the economy, investments. Health care naturally was a favorite topic. In his years as a surgeon, he had practiced at Columbia Hospital in Milwaukee, St. Alphonsus Hospital in Port Washington, and St. Joseph’s Hospital in West Bend, where he was chief of staff. Over the years, though, he grew frustrated with the Byzantine insurance regulations and eventually started his own private practice. But his frustrations grew. In 1992, at age 62, he retired.
Dan’s mother, Florence, lived into her 80s and spent her final years as a cancer patient bedridden in a nursing home. Kitty’s parents also died in nursing homes, in severe pain and, in the end, lost in a fog of dementia. The experience made deep impressions on Dan and Kitty. This was not how they wanted to go, they told their daughters. “There is no way I want to die in a nursing home. No way!” Kitty said.
Many aging parents have made a similar vow, but the Gutes gradually, methodically, formed a strategy to act on it. Dan wrote a three-page letter on June 7, 2010, titled “Dying with Dignity, or To Die Well.” Addressed to no one in particular, he explained his intent:
“I am still able to think rationally and to plan. My medical background has been a constant help with my caring for Kitty. … I had had the idea of dying well in the back of my mind for eight years. … I hope I can make the right call.”
Rapid advances in medical technology have greatly prolonged life expectancy and changed views on how to die. Cases of patients in a “persistent vegetative state” have raised legal and ethical dilemmas. Landmark cases such as Karen Ann Quinlan and Nancy Cruzan gave rise to the so-called “right-to-die” movement.
Tracy Schroepfer is a UW-Madison associate professor of social work who has researched the issue. In a 2006 study, she interviewed 96 terminally ill seniors. Nine said they had specific plans to hasten their deaths – through suicide or ending renal dialysis, for example. Nine others said they had considered hastening their deaths but did not have specific plans.
“There are many people who are fiercely independent and want more of a choice about what happens at the end of their lives,” says Dr. Timothy Quill, a bioethicist at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y. What scares them, he says, is “they know that once they’re in the [medical] system, they can’t turn it off.”
Doctors are trained to cure, and death can be seen as failure, as surrender. To combat the enemy – and appease desperate family members – they prescribe medications or perform surgeries with slim chances of success.
Most patients also feel obligated to fight to the end for the sake of their families, Quill says. “They don’t want to let them down. So they agree to high-risk surgeries and aggressive treatments,” enduring added pain and debilitating conditions.
In intensive care units, nursing homes and assisted living units, “people still die in severe pain,” says Schroepfer. “Shouldn’t we have figured this out by now?”
The Gutes bought a home in Tucson, Ariz., after Dan’s retirement. They spent winters there playing golf and entertaining. In 2002, they were visited by Anne Wanzer, one of Kitty’s college classmates, and her husband, Dr. Sidney Wanzer.
Once an internist with Harvard University Health Services, Wanzer is a nationally known authority on death and dying. He had co-written two groundbreaking articles in the 1980s for The New England Journal of Medicine, arguing that a
physician could ethically hasten the death of a hopelessly ill patient.
Wanzer published a booklet through Hemlock Society USA called The End of Life: How to Deal with the System – A Practical Guide for Patients and Families. In it, he outlines how to make a living will and do-not-resuscitate orders, and details methods of “hastening” the end of life: physician-assisted suicide, stopping aggressive medical treatments, not eating and using helium.
Wanzer sent a copy to Dan and Kitty. “It summarizes everything about end of life I have been studying for thirty years or so,” he wrote inside the cover.
Five years later, Wanzer expanded his work into a full-length book, To Die Well: Your Right to Comfort, Calm, and Choice in the Last Days of Life. Wanzer makes a strong case for allowing people greater choices in how they die, and lays out the ethical and medical debate about issues such as overmedication of terminal patients and physician-assisted suicide.
“If Dan had a bible, it was Wanzer’s book,” says Dr. Bruce Wilson, the Gutes’ doctor and friend. Wilson says he had “hundreds” of conversations with Dan and Kitty about end-of-life issues. “Both of them said to me, ‘We feel very strongly about how we want to go out, when it’s time.’ ”
The helium method was promoted by British author Derek Humphry, founder of the now-defunct Hemlock Society, a right-to-die group that supported physician-assisted suicide. In his best-selling 1991 book and video, Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, Humphry gives explicit directions on how to end a life by inhaling helium, showing how to hook a tank of helium to a plastic hood with plastic tubing, and securing the bag over the head with straps.
The inevitable result was described in Chapter 9 of Wanzer’s book: “When helium – an odorless, nonflammable and nonexplosive gas – is used, a prompt, easy and almost certain death has been obtained by terminal patients,” he writes. “I have learned of extremely few failures, unpleasant symptoms, or unexpected outcomes. … Unconsciousness occurs within 45 to 60 seconds, and all patients’ hearts stop within 15 minutes, usually sooner.” The helium forces the air out of the bag on the person’s head, and he or she is asphyxiated.
Humphry’s video and Wanzer’s books were found in Dan’s briefcase after the Gutes died. Wanzer’s To Die Well was bookmarked to Chapter 9.
“My book is not advising people to do something,” Wanzer says in an interview with Milwaukee Magazine. “It is simply pointing out the options some people have chosen. I can understand how people can criticize, particularly those who have strong religious feelings … [but] there’s nothing in religion that should conflict with our goals of making death as easy as possible when it is inevitable.
“I’m the first person to recommend [aggressive treatment], if there’s reason to believe it will help,” says Wanzer, now 81. “It’s really a matter of probabilities, and a lot of time people may push for something that has a 5 percent chance of helping. Sometimes you have to dig in your heels and say, ‘That’s strongly unlikely and I advise you not to do it.’ Most of the time, through a general conversation, you can steer a patient to the proper course.”
In his book, Wanzer devotes an entire chapter to dementia and addresses the “dilemma” of end-of-life wishes for people with Alzheimer’s. He lays out a list of advance directives that patients might include in living wills.
The Gutes did not have a formal living will. But they detailed their wishes and intentions in writing and in many discussions with family and friends. While wintering in Tucson, Kitty and Dan were part of a tight-knit group of longtime retirees from Milwaukee. Dan belonged to a men’s breakfast club that would meet every couple of weeks, retired professionals all – doctors, lawyers, an investment manager, a college professor and the like.
Each member of the group was asked to choose a focal point for their discussions, says Bill Johnson, who, with his wife Char and their three daughters, lived next door to the Gutes when they were in Whitefish Bay. “Dan’s focal point was end-of-life issues. We all found it very interesting. Very few people really spend time looking into this. Dan’s background as a physician really gave him an insight.”
One day, Dan matter-of-factly informed the men’s club of his suicide plan. He said he had purchased two tanks of helium for each home, and explained how and why he and Kitty would end their lives. “I think this was the first time he spoke about it publicly,” Bill says. “At our age, we’ve all seen a lot of people going through a lot of suffering because of their health, so it was one of those things people were reflective about. This was a very intellectual group. I know some didn’t agree with Dan. Did I agree? Not completely. But I felt it was his decision.
“You don’t think about this when you’re younger because everything’s ahead of you,” adds Bill. “But as you age, you see what happens to your friends. Some of it is quite tragic. It was very difficult for Dan to picture Kitty in such a deteriorating situation.”
Dan was relatively healthy. He could have lived for many more years, according to his doctor. He could have considered consigning Kitty to a nursing home. But he was prepared to make the ultimate sacrifice.
“I will be taking my own life because I do not want to live without my darling wife of 53 years,” Dan wrote. “It has to be performed soon, when I still have the ability to do so.”
Char Johnson thinks she understands his decision. “Dan could not have morally said to Kitty he wanted to continue living and she had to go alone. I don’t think he had a choice.”
Physician-assisted suicide is only legal in three states. Oregon in 1997 became the first state to pass a law allowing residents who are terminally ill – certified that they have six months or less to live – to end their lives with lethal medications prescribed by a physician. A similar law was passed in Washington in 2008, and a state Supreme Court ruling made assisted suicide legal in Montana in 2009.
The issue is hotly contested. On one end of the spectrum, the Final Exit Network argues the Oregon and Washington laws are inadequate because only those who are terminally ill are allowed to receive lethal drugs. The 3,000-member group, an outgrowth of the Hemlock Society, believes people who are not terminal should also be permitted to end their lives.
“There are many illnesses, awful illnesses, with no time limit,” says Jerry Dincin, Final Exit’s president. “And you can suffer for years and years – Parkinson’s, Alzheimer’s, ALS, Huntington’s disease, strokes.”
Members of his group who wish to hasten their own deaths must provide a letter from their doctor corroborating their medical condition, Dincin says. With approval from a Final Exit Network committee, made up of three physicians, patients can request voluntary “exit guides” to advise them. Two guides will visit the patient’s home to discuss methods. At the patient’s request, the guides also can be present for the suicide. Dincin emphasizes that an exit guide is not allowed to purchase, operate or handle any equipment – pill bottles, syringes, helium tanks. Guides legally can attend a suicide as long as they don’t actively assist or participate.
Since 2004, between 200 and 250 people have died in the presence of an exit guide, Dincin says. “More than 50 percent of the people we have supported are religious. They rationalize their action by saying they believe in a loving God, and a loving God would understand.
“We feel very keenly this is a human right, that your life is your own,” he adds. “Given dire medical circumstances, there is no public interest in keeping you alive if you don’t want to be.”
On the other end of the spectrum is the group Not Dead Yet, operating within the Center for Disability Rights in Rochester, N.Y. The group was formed in 1996 after the acquittal of Dr. Jack Kevorkian, who facilitated the suicide of two nonterminal women with disabilities.
“We felt assisted suicide statutes, as they were being proposed by advocates, were targeted for old, ill and disabled persons,” says Stephen Drake, research analyst for the group. “Since then, what’s been put on the table has expanded dramatically.”
He cites a 2007 case in Arizona, where four exit guides were criminally charged after helping a 58-year-old woman kill herself with helium. The Phoenix woman suffered from chronic mental illness but was not terminally ill. Two of the guides pleaded guilty last year to facilitation to commit manslaughter.
To Drake, the right-to-die movement is heading down a slippery slope, pushing for assisted suicide of people who are nonterminal or physically unable to commit suicide on their own – including those with disabling diseases.
“When it comes to the euthanasia of children and adults unable to express a wish to die, I believe the goal for many is to have some sort of medical panel evaluate the request for killing the individual,” he says.
President Barack Obama’s 2009 health care bill included provisions to have Medicare pay for optional consultations between doctors and patients about end-of-life preparations. Former Republican vice presidential candidate Sarah Palin famously blasted the proposal as a step toward government “death panels” that would order elderly citizens to be euthanized. In response, Democrats dropped that part of the bill.
But a 2010 study by the British Medical Journalseemed to undercut the criticism. It showed patients with terminal lung cancer were in less pain and more mobile after receiving palliative care (treatment designed to improve the quality of life for those with serious medical conditions) and guidance of treatment choices. Moreover, the patients lived nearly three months longer than those receiving standard care without end-of-life consultations.
Ultimately, backers of palliative care won out. Under new Medicare regulations issued in January by the Obama administration, Medicare will cover “voluntary advance care planning” by doctors – including options for end-of-life care and directives to forgo life-sustaining treatment.
Such approaches are largely an offshoot of the hospice movement. Founded in London in the 1960s and embraced in the U.S. in the 1970s, there are now 4,700 hospice care programs in this country.
Hospice care is offered in private residences, hospitals, nursing homes or freestanding independent facilities. Covered under Medicare, hospice is ministered by a team – social worker, nurse, chaplain or rabbi, physician – that dispenses pain medications, feeds and bathes the patient, helps with legal matters, plans funeral services, and does whatever else is needed in a patient’s final days.
According to the National Hospice and Palliative Care Organization, the median survival period for patients in hospice was 21 days in 2009. An estimated 41 percent of all deaths nationally occurred in a hospice program, which advocates call woefully low.
Cases like the Gutes’ suicide shock our sensibilities because we assume most people with a life-threatening illness want to go out swinging, says Mike Bernhagen, a director at Rainbow Hospice Care in Jefferson, Wis. But often we forget to ask: How would you want to live out your remaining years? A 45-year-old woman with breast cancer might want to join an experimental trial of chemotherapy. A 90-year-old man with emphysema might decide to stop all attempts to keep him alive.
Bernhagen co-produced a documentary on end-of-life care titled Consider the Conversation,scheduled for release this spring. “Most people are not afraid to die,” he says. “They’re afraid of the dying process: ‘Am I going to suffer? Am I going to die alone? Am I going to be a burden on my family? Will I have to leave my home?’ ”
Physicians still resist talking to patients about these concerns. In a survey of nearly 4,100 doctors published in 2010, only 44 percent said they would discuss do-not-resuscitate preferences with a terminal cancer victim, and only 26 percent said they would discuss hospice care.
Without such discussions, Bernhagen asks, “How are we to reconcile this friction between an increased quantityof life due to the technology of medicine and the decreased qualityof life as it’s prolonged?”
Even hospice care can be difficult for patients and families. “You can write your own scripts and surround yourself with angels, but it’s not always pretty,” says Dr. Wilson, whose mother suffers from advanced dementia. “You’re demented, you’re choking on your own saliva, you’re unable to feed yourself.”
Within the Gute family, hospice was seldom mentioned. “We already knew the answer, so there was no point in asking,” says their daughter Susie.
The Gutes had discussed their end-of-life plan with their daughters off and on for the past 10 years. “I remember talking about it when they were completely healthy, and there were no issues,” says Susie. “It just got more serious as Mom got worse.”
Beginning in late 2009, Kitty’s health took a turn for the worse. On a business trip to the West Coast in January 2010, the Gutes’ son-in-law, Ned Witte, stopped by to visit Kitty and Dan at their Tucson home. “I was struck by how physically impacted Kitty was,” he says. On a walk in the yard, she was unsteady. Her arthritis – polymyalgia rheumatica, an inflammatory disorder that causes severe joint and muscle pain – also had gotten worse.
Ned noticed Dan and Kitty had been clearing out closets and bureau drawers. “It was very clear they were never going back to that house. They were purging, purging,” he says. You could hear the clock ticking.
Last April, while still in Tucson, Dan and Kitty made Skype video calls to two of their daughters – Susie in China, and Connie in Boston. They calmly passed along necessary information. “We talked about practical stuff: who the Realtors were, condition of the house, what to do,” Susie says. “To be honest, not until the very, very end did I know that it was really going to happen. ”
Halfway across the world, Susie was certain she’d never see her parents again. “I kept begging them, ‘You have to wait for me to come home. You can’t do it when I’m in China.’ ”
Days later, Dan and Kitty watched Humphry’s video again. Their friends had been told. Their daughters had been prepared. There would be no loose ends.
But they couldn’t do it. “It was so hard to do mentally,” says Susie. “My dad was horrified by it himself. But he knew he wanted the end result.”
Dan called Susie and asked her to come home. She dropped everything and flew to Arizona.
In May, the Gutes put their Tucson house up for sale and prepared for their trip home to Wisconsin. Dan drove his Infiniti, while Susie took the wheel of Kitty’s Subaru, her mother in the passenger seat.
Back in Wisconsin, Kitty’s dementia became more apparent. It was the small things Susie noticed: Her mother stopped doing the laundry. And when shopping one day, she didn’t remember the brand of peanut butter she had always bought for her family.
“It was when I was living with them that I understood why they were talking about doing it,” she says.
It was difficult for Dan to take care of Kitty. The Alzheimer’s combined with the arthritis made it hard for her to stand and walk. Dan would call his son-in-law Ned or high-school grandson Nick for help. “Kitty has fallen again and I can’t pick her up,” Dan would say. “I have no one else to call.
The daughters and their husbands held a family meeting with Dan and Kitty one evening. “She clearly needed a nursing home – clearly– which was everything they did not want,” Susie says.
Tearfully, they urged their parents to hire a home care nurse or at least a house cleaner to help out with the laundry and household chores. “Why are you crying,” asked Kitty. “I’m not that bad, am I?”
Dan resisted. “He didn’t want anybody in the house,” Mary says, sympathizing.
Dan Gute was an Army veteran, a sailor, a wine collector, amateur photographer and watercolor painter. But at his core, the former surgeon was a repairer, a fixer, known jokingly by one acquaintance as Dr. Duct Tape.
But Dan Gute could not fix his ailing wife.
“I really miss your mom,” he said to Mary. “I’ve missed her for a while.”
And nothing would bring her back.
A second attempt to end it came in late June.
At her parents’ home in River Hills one day, Susie opened the door to a hallway closet. Inside, leaning against the wall, were two tanks of helium. “I freaked out. I ran out, crying. I didn’t want to see it.”
Her parents had been talking and reading about death more and more since they got home from Arizona. “I didn’t want it to be real, and it was becoming real,” she says.
Her husband and children were due to return to their home in Minneapolis from China in a week. So Susie drove to Minnesota to be with them.
A couple of weeks later, Dan and Kitty drove up for a visit. After spending much of the time with their grandsons, Dan and Kitty left for home on a Sunday. But unbeknownst to their children, they stopped at a motel somewhere in the middle of Wisconsin. “The night before, he gave me the spare keys to his car,” Susie says. “I said, ‘Is this like the last supper?’ And he said, ‘Something like that.’
“The next day we kept waiting for a call, waiting for a call,” she continues. All of Monday went by, and still no call. Her husband called Dan’s cell phone, but no answer.
Then on Wednesday, Susie’s phone rang. It was her father. “We just couldn’t go through with it,” he told her. Susie was relieved. “I thought it was off. I was so happy. And I’m thinking, ‘Well we’ve got to get Mom into a nursing home.’
“But then I thought about it. It wasn’t off. It’s not going to change.”
Dan had lunch the next day with his friend and doctor, Bruce Wilson. “I’m exhausted,” he told Wilson.
“That must have been so wrenching to go through that and not carry it off,” Wilson says. “Think of the strain. To go against your basic biological instinct to stay alive would be so stressful. When it came right down to it, he couldn’t muster it.”
The Fourth of July was always a big deal for the Gute girls when they were growing up in the old home in Whitefish Bay. A neighborhood parade started at Belle Avenue and North Shore Drive in front of their house, and in the evening, everyone streamed into Klode Park with their blankets to watch fireworks over the lake.
Last summer, Dan Gute decided to go to the Fourth of July parade, alone, driving there from his River Hills home. The stress weighed heavily on him. Wearing a crisp white shirt and a pair of slacks, he walked through his old neighborhood, stopping to chat with friends he’d known for decades.
He stopped and made a cell phone call to his friend and one-time neighbor, Char Johnson. “You’ll never guess where I am,” he said to her. “I’m standing in front of your house on Belle Avenue.”
“He was making the rounds, going to see all of his friends,” she recalls with a smile. “Dr. Gute was making the rounds.”
That same weekend, Kitty Gute played in a golf tournament at the Milwaukee Country Club with her girlfriends. She signed up with a partner and challenged another twosome.
One of her opponents that day was Tory Folliard, who owns a Milwaukee art gallery. Folliard met Kitty 20 years ago on the golf course. “She had a great short game, putting and chipping,” Folliard says.
“Our last game was just two weeks before her death. She wasn’t the same Kitty. She was out of sorts.But she hung in there through our long, five-hour match. After the game, Dan picked her up and they went right home. That was the last time I saw her.”
Like many of the Gutes’ friends, Folliard won’t judge how the Gutes chose to die. “I think it must have been the right decision for them,” she says. “Who wants to be put in that position, to be a burden?”
Jack and Phoebe Lewis, friends and Arizona snowbirds from Bayside, say they can understand, too. “It’s the same way I feel about abortion,” says Jack, a member of the Tucson breakfast club. “I don’t like abortion, but I can see where it might need to be done.” These are personal choices that should not be restricted by government regulation, he says.
Adds his wife, Phoebe: “I respect what they chose to do. I strongly agree you should not force people who don’t have any future to look forward to living in pain.”
Milwaukee businessman Sheldon Lubar knew Dan Gute’s father and first met Kitty and Dan when they lived in Whitefish Bay. “They were the kind of people you just recognized as having extraordinarily high and unselfish standards,” says Lubar. He heard of their suicides through the Milwaukee Country Club. “I had no inkling this was something they had planned,” he says. “If we had talked, I would have tried to talk them out of it. It just seemed to me it was a little early.”
Still, Lubar says, “It was a very brave and heroic ending for them. They obviously came to the decision that life – if they couldn’t have it the way they wanted it – wasn’t worth it. I would question their decision, but I wouldn’t condemn it.”
Some friends did disapprove. “It bothered a lot of people,” says Bill Johnson.
“It was a blow to me,” says a longtime friend who declined to be named. “I’m not in agreement with what they did.”
The friend leveled blame at Bruce Wilson for not talking them out of it, says Wilson.
“The abruptness is hard to grasp,” says Johnson. “Everybody liked Dan and Kitty so much. It was a very sharp loss. You kind of feel rejected.”
By mid-July, each of the Gute daughters were tethered to their phones. With Susie in Minneapolis and Connie in Boston, it fell to Mary, who lived minutes away from their parents, to keep tabs on them. She called several times a day, holding her breath until she would get an answer.
“She was really anxious and consumed by worry,” says Mary’s friend Joan Rater. “She knew it was going to happen. It seemed a fait accompli. But it was all very surreal to her.”
An entry in Dan’s journal on Friday, July 16, reflects his desperation: “Yesterday was a bad day,” he writes. “I am hoping that sometime this weekend I will have the guts to deliver us both from a more dismal situation.”
Dan spoke with each of his daughters on Saturday, July 17. He told Mary that he and Kitty hoped to have dinner at the Milwaukee Country Club, a belated anniversary celebration.
That same day, Susie called her father’s cell phone from her home in Minneapolis. She forced out the words.
“So… it’s on again?” she asked.
“Yeah,” said her father. “You know that, Susie.”
In a journal entry apparently written after he spoke with his children, Dan reflects fondly on his family: “Mary has assured me that she and her sisters will be able to take care of details when we depart. … A dad and grandfather’s well-being is very much dependent on the situations existing with all his offspring. They sounded so happy at this time – I loved it.” He ends the page on an ominous note: “Tonight or August, that is the question.”
The next day, Mary got a call from Connie. “Have you heard from mom or dad?” she asked. Mary had not. She called her father. No answer.
That afternoon, Ned drove Mary and their teenage son Nick to a movie theater, then went into his Downtown office for a couple of hours. After picking up Mary and Nick from the movies, the three went out for dinner. Again, Mary called her parents. Again, no answer.
They immediately headed to her parents’ home, a sense of foreboding overtaking them. The closer they got, the more they feared the day had come.
Winding down the long driveway through the woods, they could see the house was dark. The front door was locked, and through the living room window they saw no movement. They walked to the back door of the garage, Nick hurrying ahead, Ned next, Mary trailing behind. As Nick peered into a garage-door window, he could he see his grandparents sitting in their car, motionless.
“Are they there? Are they there?” Mary cried out. Nick ran to his mother to hold her back. She fell to the ground, sobbing, screaming, undone.
In the garage was a one-page note: “Do Not Resuscitate. Do Not Call 911,” it said. “I am sorry for whomever finds us, but it was the time to end our lives. In this random world, it was our free choice. …
“This is not an act of depression,” the note continued. “This act … is to keep us from slowly dying in a nursing home – constant deterioration is worse than dying in the matter of minutes on our own volition. … My wonderful wife of 53 years has been getting worse mentally and physically for well over a year. As her husband and soul mate, I do not wish to live without her.”
It was signed: “Daniel B. Gute, M.D.”
An autopsy report released by Dr. Brian Peterson, Milwaukee County medical examiner, lists Dan Gute’s manner of death as “suicide.” Kitty’s death is classified as “undetermined.”
“It’s a hard one,” says Peterson. “If they agreed to do it together, it’s a tandem suicide. If someone’s demented, can they give consent, can they understand what they’re doing? In the world of forensic pathology, there are two equally valid possibilities, and we have no way to choose between the two.”
“If indeed she had the capacity to consent and sign, it’s a pact,” says Donna Cohen, a University of South Florida professor who has studied assisted suicide and suicide-homicides among the aged. “Suicide pacts are extremely rare. They account for less than one-half percent of all suicides” – just 150 of some 30,000 suicides annually in the U.S.
Cohen, however, questions the state of mind of the Gutes in their last days. “Even though they were strong-willed about living and dying arrangements, it’s quite possible they were depressed,” says Cohen, a former editor of the Journal of Mental Health and Aging. “The questions I would want answered in this situation: Were they getting the right help in dealing with depression? When men caregivers perceive there is nothing else they can do, [depression] could precipitate this act.”
The Gutes’ friends dismiss the idea that Dan and Kitty killed themselves because they were depressed or that Dan somehow coerced Kitty into agreeing to suicide.
The whole idea started with Kitty, says Wilson. “Her own father died of dementia. She told me in my living room, she told me in her living room, she told me in my office. … Kitty forged the way.
“There’s no mystery here,” Wilson continues, defending his longtime patients and friends. “It’s not like Danny spirited off, murdered his wife and then killed himself.”
The Gutes knew their actions would not be well-received by everyone and deliberately raised this issue with people, says Char Johnson, who knew the couple for 45 years. “They felt they had a pact together.”
Their decision gave her pause, says Char. “You see a couple making that choice, and you ask yourself, ‘Well, what should I be thinking of doing?’
“They were pioneers,” she decides. “I really feel that’s what they were – pioneers.”
Found among the Gutes’ possessions were two notes written by Dan. The first was dated June 7, 2010, the second July 16, 2010, two days before the Gutes died. Both notes spoke of the pact. Each was signed by Dan and Kitty Gute.
A memorial was held for Daniel and Katherine Gute at the Milwaukee Country Club. Three-hundred people
attended. The Gutes’ daughters sang a song to their parents in three-part harmony, and longtime friends toasted the couple with stories of their effervescent and fulfilling lives.
In an online guest book, acquaintances shared their recollections: “When I was in my early teens, I mowed Dr. and Mrs. Gute’s lawn on Shore Drive,” wrote one friend. “One day, while walking with her, Mrs. Gute told me: ‘I am so lucky. I am deeply in love with a man who is deeply in love with me.’ That moment has remained clear in my memory for over 40 years.”
“I am happy they were able to go on their own terms,” wrote another friend. “I only wish we could provide this option to everyone. Thanks to Dan and Kitty and their daughters for being so open about this matter. … And I do believe in God.”
Their daughters themselves acknowledge mixed feelings.
“Yes, part of me really hates it all, but the alternative was really not any better,” says Susie. “I think it was a good thing. I don’t like saying that, but I do think it was a good thing.”
“Do I have reservations? Kind of,” Mary says.” I miss them. But what was ahead for my mother would have been terrible and heartbreaking. I’m proud of what they did.”
Her parents inspired her to evaluate her own end-of-life choices. Two years ago, Mary was diagnosed with a rare lung disease that one day could be fatal. If and when she becomes terminally ill, she says, she will move to a state where physician-assisted suicide is legal.
“His last act was so consistent, I’m in awe,” she says of her father’s will in carrying out their final wish. “He hoped they could make a choice in death – to ‘die with dignity,’ he would say. ‘Your mother and I are going to die with dignity.’ And he knew my mother was losing that.
“There was a commitment and a love between them,” Mary says. “In life and in death, they made a promise to each other that maybe only one in a hundred million commit to. Their story is a love story, really. It’s a tender love story.”
Kurt Chandler is a senior editor at Milwaukee Magazine. Write to him at firstname.lastname@example.org.