Her hazel eyes open wide in the dark. She lies in bed, paralyzed. She knows she won’t be able to sleep anymore. She has had another terrifying nightmare.
Anouk Kijlstra is a 37-years-old bailiff office employee. She was born in Groningen, where she still lives. About two years ago, she started experiencing disturbing life-like dreams, panic attacks, and a severe form of depression.
She greets me in her house with a bright smile. On the white walls are hanging motivational posters about happiness, love and family (“Live, laugh, love”, “Home is where your heart is”) and her smile pops out in a dozen photos. There isn’t an object out of place.
The illness appeared quite late in her life, a few months after her mother’s death and the end of an important relationship. “Depression is like a time bomb. It grows slowly and slowly, and then boom” she explains calmly. Her voice is high-pitched and somehow childlike.
Depression is one of the most common illnesses in the Netherlands. It is caused by a complex interaction of social and psychological factors, as well as a genetic predisposition. Anouk fits in the picture since her mother and grandfather underwent pharmacological treatments for depression and panic attacks.
Anouk recalls that in her last years her mother couldn’t do a lot of things, not only because of depression but also due to her medical condition. Nearly 20 years before passing away, Els Kijlstra was diagnosed with COPD (Chronic Obstructive Pulmonary Disease), a degenerative illness. She decided that she would not want to continue living once her condition would have become unbearable.
“My mother was just like me. We liked to go shopping, and we talked a lot. She was my best friend.” Anouk says.
In 2018, Els, at the age of 63, had an acute respiratory crisis and was urgently hospitalized. One week later, very weakened, she was brought home. On Sunday, the 17th June, Anouk spent the whole afternoon at her bedside. They chatted as they always had done.
In 2002 the Netherlands became the first country in the world to legalize euthanasia. Terminally ill patients in a hopeless condition can ask their doctor’s intervention to end their lives. The patient must be visited by two doctors, and family doctors are not under obligation to provide the service personally. The law applies only from 12 years old, but the government is currently considering including younger children.
Last year 6,361 people chose euthanasia (performed by the doctor) or assisted suicide (self-performed, with the doctor’s assistance), which amounts to 4.2% of the total deaths in the country. Els, instead, opted for deep continuous palliative sedation. This procedure is applicable only when the estimated life expectancy is lower than two weeks. The patient receives a massive dose of anaesthetic and remains unconscious until their natural death.
Anouk understood her mother’s choice. They discussed it when they accompanied together Els’ 83-years-old mother in her euthanasia the year before. Together they had washed her body, had combed her hair and had dressed her for cremation with her elegant brand-new clothes and heels.
But she did not expect to have to do it all over again so soon. This time, all alone.
As she progresses in her story, Anouk goes back multiple times to her father’s phone call.
From that moment on, she doesn’t remember sharply what was in her mind, she says. She felt overwhelmed by the flow of events.
Els’ hands did not tremble, as they frequently did, when she drank her last Bacardi Cola with her family and closest friends and said she loved them all. “Before I was afraid of dying. But now not anymore. I know that when people are ready, they are very relaxed. She didn’t put it in words, but it was like she was saying ‘finally’” Anouk recalls. “We said ‘Good night, have a nice journey’ and she fell asleep to never wake up again.”
However, something went wrong.
On Monday afternoon, Els woke up. She was confused. She yelled for her husband. Until that moment, the Kijlstra family had tried to hang on as usual.
The doctor injected her more drugs. But after two hours, Els was awake and talking confusedly again. The doctor increased her dose and she fell asleep. But then another time she woke up.
This happened six times.
That evening is Anouk’s worst memory. “It was terrible to say goodbye again and again. When someone dies, everything in her face changes. In the last moments, it’s like a fish, seeking for air.”
After her death, Anouk washed her mother’s body. Her skin was thin and dry, so she accidentally cut it open and had to wrap the arms with plastic tape. She put her a diaper on. Then she assisted the morticians sewing her lips together. While explaining, to overcome the language barrier, she acts out those gestures with her own body. The charms on her silver bracelets clink softly.
I ask her if, all considered, she regrets having done it herself.
In the first months after Els’ death, Anouk acted as she was somehow recovering from her grief and pushed back her increasing sense of apathy and dismay. But inside she felt “burned”.
“I was sitting here like a little bird.” Anouk says sitting on her living room couch. “I didn’t want to go to work, I didn’t want to see my friends, I didn’t want to do anything. I just wanted to sleep. Then one day I told myself that it had to stop. I called my father and asked him to bring me to the doctor. I wasn’t able to drive myself.”
During Anouk’s depressive crisis, she had a hard time explaining what she was going through: “My head was always full, full of nothing. My therapist told me that I had to be active” she says.
To overcome her mental health issues, Anouk tried EMDR therapy (Eye Movement Desensitization and Reprocessing), usually used for post-traumatic stress disorder. It was ineffective. So, she started a medication. This, accompanied by therapy, made her feel considerably better. After two years, last month she decided to interrupt the cure.
In the bright living room, on a shelf, Anouk shows me two small black and golden urns. One of them contains some of her mother’s ashes. Another urn is at her family home. She scattered the remaining ashes in the sea of Bodrum, Turkey, where they used to go on holiday together. It was her mother’s favourite place.