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From the time she was young, Karen Oelschlaeger lived as if she knew the clock on her life was ticking. Whatever she was doing — traveling, volunteering, studying — she was all in.
As a teenager, she once left home at 2 a.m. to drive hours from her home in Charlotte, North Carolina, to the beach, just to see the sunrise. In high school, while her peers were planning proms and parties, she spent her free time volunteering for the Sierra Club’s Sierra Student Coalition and raising money for the Save the Children fund. During a year-long college study abroad program in Spain, she ate only Spanish food, spoke only Spanish and opted to rent a room in an apartment with a Spanish woman and her daughter, instead of living in the student dorms. And in 2007, before completing her master’s degree in social work and earning a law degree, she started a dog-walking and pet-sitting company – just to prove to herself that she could launch a successful business and fend for herself financially.
“That was Karen,” says her mom, Linda Oelschlaeger. “She was compelled to live more fully and dive deeper into experiences than most people. She was strong-willed, smart, passionate and funny.”
Meghan Place, a colleague of Karen’s who became a close friend, admired her directness. “We shared a passion for the same ideals and outrage at the same injustices, but she had a way of turning ideas into action,” says Meghan. “She’d say, ‘What are we going to do about it?’”
Karen making a speech as president of the Asheville-Buncombe League of Women Voters. (Karen Oelschlaeger)
But in May 2018, two days before her 34th birthday, that question became personal. Karen had a procedure to see if the ulcer she’d been diagnosed with three months before had healed. Afterward, she received devastating news: The nausea and vomiting she’d been battling for months wasn’t an ulcer. It was signet-ring cell carcinoma, a form of stomach cancer that grows rapidly and has about a 70 to 80% chance of recurring, usually within a couple of years. “Karen texted me the news, and I called her immediately,” recalls Eric Oelschlaeger, her older brother. “She said, ‘I don’t know anyone who has had stomach cancer and lived.’ She was in shock. We all were. And though we hoped otherwise, we all were thinking the same thing: There’s a very good chance she's not going to survive this.”
Karen followed her doctors’ advice and they treated the cancer aggressively – eight weeks of chemotherapy, followed by surgery to remove part of her stomach and small intestine, then more chemo and radiation. The painful nine-month ordeal left her fatigued, dehydrated, malnourished and unable to keep most food down. “Karen desperately wanted to live,” says Linda. “She loved food and travel and life. She had so many things she wanted to accomplish.”
Karen also knew the medical odds were against her, says Linda. She knew that if the cancer returned, the road ahead would include horrible suffering. And while she wanted to eke every last moment of joy and meaning out of her life, she also wanted to have a say in when it ended. As an attorney, Karen knew that she legally had that right, thanks to the Vermont Patient Choice and Control at the End of Life Act, which allows certain terminally ill adults to obtain a prescription for a dose of lethal medication. “Karen was such an independent soul. I wasn’t surprised when she began talking about that option not long after she was diagnosed,” recalls Linda.
In 1997, Oregon became the first state to put a Death with Dignity Act into effect. Today, medical aid-in-dying is effectively legal in 10 states, as well as Washington, D.C. The statutes allow certain mentally competent adults who have a terminal illness and are predicted to live six months or less to obtain a prescription for a medication to end their lives. (Doctors in different locations authorize a variety of different drug concoctions.) Not everyone who gets the medication utilizes it. Statistics compiled by the Death with Dignity National Center show that in 2019, doctors in five states – California, Hawaii, Maine, Oregon and Vermont – wrote 973 prescriptions for the medication, while 637 people died by ingesting it. In Vermont, more than 70 people have used the drug since the law went into effect in 2013.
Karen in Costa Rica in 2021. “Travel gave her something to look forward to,” says Eric Oelschlaeger, Karen’s older brother. (Karen Oelschlaeger)
Shortly after Karen’s cancer had recurred and spread, medical aid in dying joined her list of passions – and she spoke out about why it was important in a video for Patient Choices Vermont, a non-profit organization dedicated to end-of-life choice. “I was very, very clear starting back in 2018 that I wanted to utilize the death with dignity drug if the cancer came back,” Karen says in the emotional voiceover to a five-minute photo montage, which shows the brunette at various places she loved, like hiking trails and the beach. “I’ve always prided myself on my independence. And this illness has really been humbling. It has been humbling to watch my body fail – fail to support me, fail to do its job the way I’m used to. But also the loss of independence has been really hard. I’m very grateful to have an option to utilize on the day when I decide enough is enough, I don’t need to suffer anymore.”
Fighting for the Rights of the Dying
After her initial treatment, Karen felt better and was stable for nearly a year. She took a trip to Norway and saw the Northern Lights, a long-time dream. She visited her family in North Carolina a number of times. Then the nausea, vomiting and pain came roaring back. The doctors thought she had adhesions, a form of scarring in which abdominal tissues stick together, a common side effect after abdominal surgery. But during surgery for the adhesions in August 2020, they found that the cancer had returned – and it was widespread throughout her abdomen. “Karen was devastated. She was diagnosed with Stage IV stomach cancer and given weeks to months to live,” says Linda. “I rented an apartment near her house in Vermont so I could be with her till the end.”
Karen set her mind on getting a prescription for the medical-aid-in-dying drug, but since her oncologist was in New Hampshire, she had to start from square one. As Karen herself explains in the Patient Choices Vermont video, “When the cancer actually came back, I was in the hospital trying to line up appointments with medical providers who would help me. It is hard when you are dying and hospitalized, healing from a major surgery and grieving this major loss to go through the logistics of it.”
Her inner strength stunned even those who knew her best. “She was in unimaginable emotional and physical pain, and she was still determined to take control of her life and make the choices that were right for her,” says Meghan. “Karen was a firecracker of a human being.”
The further Karen got into the process, the more she recognized its flaws. Two physicians must confirm the patient’s residency, diagnosis, prognosis and mental competence, and all requests for the control of the timing of their death must be voluntary – and those appointments need to be in person. There is a mandatory waiting period between the two requests and another one between receiving and filling the prescription.
Karen believed the requirements – especially the in-person appointments – were unnecessarily burdensome for terminally ill patients, particularly since so much of health care has pivoted to telemedicine – and she knew that advocates in Vermont had introduced a bill to change the Patient Choice and Control at the End of Life Act to allow telemedicine appointments. So, weighing around 80 pounds, ravaged by pain, fatigue, nausea and vomiting, she swung into activist mode one final time.
First, she did the Patient Choices video, in which she explains, “I had to physically go get myself in front of this doctor, which is hard when you’re dying. I was profoundly malnourished and dehydrated and vomiting pretty much constantly, so it’s rough to drive 45 minutes and sit in a waiting room and have to get dressed and engage with someone you know you might puke in front of. So, yeah, I think removal of that requirement would just be a huge relief.”
Karen traveled as much as possible in the months before her death. “She never lost her passion for adventure,” says Alex Ballantyne, Karen’s longtime friend and former boyfriend. (Karen Oelschlaeger)
A week before she died she did an interview with Vermont Public Radio. In it, she says, “I did not know if I would be alive for this interview today, because, you know, my symptoms have gotten really bad again. I think one reason I made the time to voice my opinion about the telemedicine requirement is, if it can make a difference for someone else during such a difficult time of their life, and just anything to spare them any additional suffering, or burden, during what is such a challenging time emotionally, physically, spiritually, that would be worth it.”
Embracing Life, and Death
After the recurrence, Karen tried immunotherapy in a last-ditch effort to prolong her life. It didn’t help. “We talked a lot about death in those eight months after the recurrence,” says Linda. “She hoped there would be life after death and that our souls or spirits would be reunited. At one point, she said, ‘I’ll always be with you, Mom.’”
But Karen was even more focused on life and reclaiming as much of it as she could. In November 2020, she flew to Asheville to visit Eric and his family. In December, she went to Glacier National Park in Montana. In January 2021, she went to Costa Rica. A photo she posted to Facebook shows her standing on a rocky shore in a leopard-print swimsuit, smiling broadly, hands planted confidently on her hips. “She bought that swimsuit for the trip,” says Alex Ballantyne, a longtime friend and former boyfriend. “She never lost her passion for adventure.”
Two weeks before she died, Karen called Eric and said, “I need you to buy a private jet so I can get to Lima, Peru,” Eric recalls. “She was joking, but only half joking,” he says. “Travel gave her something to look forward to, and that kept her going.”
Even so, she was suffering horribly. She hadn’t had a meal since before Thanksgiving. In the final few months, she couldn’t even keep ice or water down. “There can be a lot of pressure in our society to keep fighting, keep fighting, keep fighting, especially as a young cancer patient,” Karen says in the Patient Choices video. “And I think what folks don’t always realize is sometimes that ‘keep fighting’ is really just a lot of prolonged physical suffering that gets worse and worse.”
On the evening of Saturday, April 17, Karen said goodbye to Eric and his 10-year-old daughter, Ava, whom Karen adored and who had been visiting Karen in Vermont for several days. Karen called Linda midday on Sunday, April 18, and asked her to come over and rub her feet, the only part of her body that didn’t hurt to be touched. “Karen had the blinds drawn, which was unusual, and she asked me to leave not long after I arrived,” recalls Linda. “Several hours later I texted her to see if I could come over and get her IV nutrition ready. She said, ‘No, I’m thinking about taking my drugs tonight.’ I said, ‘May I come over?’ and she said, ‘Yes.’”
Karen with her niece Ava. (Karen Oelschlaeger)
Karen had her medications prepared and a schedule for taking them in place. She texted friends and family to say “I love you.” “When she texted me, I told her how much I loved her. I told her she was magical and brave and magnificent,” says Meghan. “She sent me a voice-to-text response and said 'I love you' 12 times."
That night, Karen took a cocktail of medications including an anti-nausea drug. Around 10 p.m., she took the drug that would end her life.
“Talk about bravery, this little girl of mine, she looked at me, paused ever so slightly and swallowed that medication,” says Linda. “I don’t know if I could do that, even if I was suffering as badly as she was. We said ‘I love you’ to each other. Within five minutes she was in a coma.”
Per Karen’s request, Linda put on a version of “Asleep” by The Smiths, with the lyrics:
Sing me to sleep
Sing me to sleep
And then leave me alone
Don’t try to wake me in the morning
'Cause I will be gone
Don’t feel bad for me
I want you to know
Deep in the cell of my heart
I will feel so glad to go.
For the rest of the night, Linda rubbed Karen’s feet. She sang her lullabies and brushed her hair and held her hand. “Those were sacred times,” Linda says. By Monday morning, April 19, 2021, her firecracker of a daughter, who had burned so hot and so bright, was gone.
In Karen's obituary, which she wrote herself, she encouraged others to live by her example. “In lieu of flowers,” she wrote. “Live your best life now — just in case.”
Thanks in part to Karen’s advocacy for changes in Vermont’s Patient Choice and Control at the End of Life Law, Act 39, to allow telemedicine appointments, Vermont Senate Bill 74 was signed into law on April 27, 2022. According to reporting by Patient Choices Vermont, with the passage of this bill, patients can now make medical aid in dying requests by video telemedicine if the doctor deems it medically appropriate. The bill also eliminates a 48-hour waiting period for a patient to receive end-of-life medications.