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11:16 a.m.: After saying goodbye, Ralph Harms takes a moment to look out the window at his dear friends gathered in his backyard before leaving them to drink the final portion of the cocktail provided by doctors for the death with dignity he sought after he was diagnosed with terminal skin cancer. (John Burgess/The Press Democrat)

Ralph Harms lived by his own rules. It was only natural that he chose to die on his own terms

The Santa Rosa man knew he would lose the race against cancer, so he moved up the finish line. This is the story of the final 2 hours and 43 minutes of Ralph’s life.

9:40 a.m.

Ralph Harms steps through the sliding glass doors onto his deck, where two friends sit at a circular glass table. An umbrella shades them from the Santa Rosa morning sun. Others will arrive soon.

It’s July 30, a Friday morning. Twenty minutes before 10 a.m.

Ralph wears cotton cargo shorts, white ankle socks and slippers. A gray T-shirt with the sleeves rolled up twice reveals slivers of a tattoo on each bicep, a heart on his left arm and a pair of boxing gloves on his right, inked long ago.

He’s a back-slapper and a knuckle-bumper who avoids formal handshakes but revels in playing host and being the center of attention. Especially being the center of attention.

He uses words like “kickin’” and “chillin’” and other pet phrases that his friends call “Ralphisms,” and he regularly sprinkles “baby” and “darlin’” — along with more colorful language — into conversations.

A pot of coffee is brewing, and pastries are on the way. “Who needs a cup of coffee?” he asks.

Hearing no takers, he claps his hands together and says, “OK, then,” and for a brief moment looks unsure how to proceed.

It is an uncharacteristic look for a man who has been so sure of everything all of his life.

He has always been a man with a plan, and today is no exception.

Ralph Carsten Harms has chosen this day, this place, this gathering with these friends, and his son and his daughter, to die.

Why we told this story

In mid-July, Ralph Harms told columnist Kerry Benefield he had chosen to use California’s End of Life Option Act to die with dignity after battling terminal skin cancer. He asked her to write a story about it.

Death with dignity is a complex, fiercely debated subject. Our focus in this story is to shine a light on Harms’ experience to show how California’s law works in the hopes that it may help those facing end-of-life issues better understand the choices they have on their difficult road ahead.

Read more on why we felt it was important to tell this story here.

Read Benefield’s first-person column on covering Harms’ life and death here.

A lump in his chest

For most of his 85 years, Ralph has been a picture of vibrancy and health. A 12-year U.S. Army veteran, he is a dedicated runner who finished 29 marathons, and an amateur boxer who competed in the Golden Gloves and went 45-8 in his career. Though he’s thinner than he was when he boxed across four weight classes, he is still muscular and fit. He can make the nearly 4-mile loop from his home and around Spring Lake at a pace that leaves a much younger person winded.

He does not look or act like a man who turned 85 in October.

He is, in many ways, a picture of vitality.

But his skin gives him away.

Ralph has dealt with, or, more accurately, not dealt with skin cancer for years. He jokes now about the price of his vanity — a lifetime spent getting tan and showing off his physique. His arms, legs and face are a visual history of the cumulative damage. Dozens of scars criss-cross his body where cancerous lesions have been surgically removed. Everywhere his skin is pocked with small scabs.

Ralph Harms loved to show off his physique, often wearing muscle shirt or simply going shirtless. The skin cancer he experienced in his later years led to numerous surgeries, ultimately ending in his terminal diagnosis in May.
Ralph Harms loved to show off his physique, often wearing muscle shirt or simply going shirtless. The skin cancer he experienced in his later years led to numerous surgeries, ultimately ending in his terminal diagnosis in May.

In January, he felt a lump on his chest, just beneath his right armpit. Two days later, it was bigger. The cancer that had ravaged his skin was now marching through his body.

If you do nothing, it will kill you, the doctors said. But Ralph would come up with a different plan.

It was a plan to beat cancer to the punch, a plan he wants to share with the public in the hope that it may help others who are staring an agonizing death in the face.

As Ralph’s disease progressed, so did the pain. Even worse was the ache of losing his wife, the woman who was his everything, to sudden cardiac arrest three years ago.

He never got to say goodbye.

Everyone agrees he hasn’t been the same since.

In the last weeks of his life, Ralph speaks of her often. It’s part reverence, part heartbreak. He met her when they were students at George Washington High School in San Francisco. Their love story is something he tells often to friends and strangers alike.

“Kathleen and I, the two of us together, when we would come up with an idea, ‘Let’s do it, babe,’ and we did. So, when I die — and I’m gonna in a couple weeks — there is no bucket list. We did everything we ever wanted to do.” ― Ralph Harms

An only child whose parents split up when he was 9 or 10, Ralph was rough and tumble. He got into street fights regularly. On Monday mornings at school he often showed up with a bruised face or bloody knuckles. Kathleen, whose locker was across the hall, noticed.

“She called me over and said, ‘Wow, you look terrible, man,’” he says. “She said, ‘I’ve got an idea, if you hang with me, instead of these guys, your life would be a whole lot better.’”

They married four years later at 19.

They raised four kids, owned a bakery in San Francisco for 12 years and traveled the world together. They were decorated athletes and, after they moved to Santa Rosa in 1980, they ran a sporting goods store for seven years. And they cultivated friendships that lasted decades.

“Kathleen and I, the two of us together, when we would come up with an idea, ‘Let’s do it, babe,’ and we did,” Ralph says. “So, when I die — and I’m gonna in a couple weeks — there is no bucket list. We did everything we ever wanted to do.”

Two days before his death: Ralph Harms holds a picture of his late wife, Kathleen, who he loved since he was 15 years old. Ralph was never quite the same after she died in 2018.  (John Burgess/The Press Democrat)
Two days before his death: Ralph Harms holds a picture of his late wife, Kathleen, who he loved since he was 15 years old. Ralph was never quite the same after she died in 2018. (John Burgess/The Press Democrat)

10:08 a.m.

“Life is good,” Ralph says, clapping his hands and surveying the food that now covers the table on his deck. “We got stuff to eat.”

His son, Joe, the youngest of Ralph’s four children, is in the house. Scott Jones is on the deck with other neighbors Jeannie and Doug Green, friend Marcia Seim Bossier and another friend Harms met teaching a fitness class at the YMCA 30 years ago. Ralph’s caregiver is there, too. His daughter, Mary, and her wife, Linda, will arrive shortly, followed by neighbors Penny and Frank Briceno.

Ralph and Kathleen built this dun-colored single-story house on a corner lot near the northwestern cusp of Trione-Annadel State Park in 1985. The front yard is small but well-kept with bushes precisely pruned.

Two days before his death: Penny Briceno, a neighbor of 30 years, hugs Ralph Harms at the end of his goodbye party.   (John Burgess/The Press Democrat)
Two days before his death: Penny Briceno, a neighbor of 30 years, hugs Ralph Harms at the end of his goodbye party. (John Burgess/The Press Democrat)

Perched at the top of a hill, its three bedrooms sit four steps below the living room, dining room and kitchen. White carpet covers the floors. It is immaculate. The deck, bordered by a neighbor’s redwood tree on one side and a privet tree on the other, has been a central gathering spot for friends and neighbors for more than 30 years.

On Ralph’s last day, the phone rings often.

With his daily forays into his garden, his penchant for clearing leaves from neighbors’ property and his regular socializing — what he calls “ho, ho, ho-ing” — Ralph is deeply tied to this neighborhood. And to the people who sit with him today.

He has invited them here, to eat Jeannie Green’s homemade cinnamon monkey bread and drink a little coffee, to share stories and be near him when he draws his last breath.

The refrigerator in his garage is stocked with Coors Light — always bottles, never cans, cold ones to the left. When he’s gone, he hopes his friends will raise a toast to him.

One week before his death: Ralph collects his special order 20-packs of Coors light in bottles from his local Safeway along with bouquets of flowers he buys each week for the memorial he maintains for his wife, Kathleen.  (John Burgess/The Press Democrat)
One week before his death: Ralph collects his special order 20-packs of Coors light in bottles from his local Safeway along with bouquets of flowers he buys each week for the memorial he maintains for his wife, Kathleen. (John Burgess/The Press Democrat)

‘There is an option’

Ralph discovered the lump in his chest in early January. A CT scan and a biopsy followed. On Feb. 16, he met with an oncologist and had a follow-up video conference a week later.

Three weeks after that, he went under the knife. But there’s no way a single surgeon’s scalpel could undo the years of damage near-constant sun exposure had done to Ralph Harms’ body.

He would need chemo and radiation.

“They talked him into doing radiation,” son Joe says. ”My dad said, ‘I’m not coming up here five days a week.’ I said, ‘It’s 15 minutes. It’s a cup of coffee.’ He finally went for that.“

Ralph drew the line at chemo, though.

“He never wanted to do it,” daughter Mary adds.

Four weeks into the radiation treatments, his doctors’ optimism vanished. It was clear the cancer was winning.

“They told him it wasn’t working,” Mary says.

“My dad was like, ‘Just give me the no-shit version. Just tell me what it is,” says Joe.

That was May 10. A week later, he started hospice care. Doctors told him he would not likely live through August.

“When I heard there was no other way, that I was definitely going to be checking out, I said, ‘OK, I heard about this stuff that you can drink and it’s available.’” ― Ralph Harms

Ralph thought he had no choice but to let the cancer take its deadly toll, much the way he had watched it run its cruel and heartbreaking course with two of his daughters, who died of breast cancer.

But then a member of his medical team raised another option: He could legally end his life, and avoid more suffering.

“When I heard there was no other way, that I was definitely going to be checking out, I said, ‘OK, I heard about this stuff that you can drink and it’s available,’” he says.

His doctors told him he met the criteria for California’s End of Life Option Act: He was terminal — less than six months to live; he was competent to make the decision; and he was able to carry it out himself.

He would be able to face the end on his own terms, not cancer’s.

In 1997, Oregon became the first state to enact a law to allow people with terminal diseases to end their lives via self-administered medication. Nine states and the District of Columbia followed with death-with-dignity laws. A 10th state, Montana, has no law, but allows it under a state Supreme Court ruling.

California passed its version in 2015, after four decades of stops and starts and legal fights.

It was not without controversy.

The end-of-life debate is fraught with religious sensitivities and cultural taboos. Some say no one has the right to decide when someone’s time on earth is up and that helping a patient end their life violates the medical profession’s guiding principle to do no harm. But on the other side, supporters say it is a basic right for a terminal patient to decide how and when they die, especially when it alleviates extended suffering.

Ralph didn’t know about California’s law when he received his terminal diagnosis in May. He wonders if others suffering the same fate fully understand their options. It’s a question that dogs him. Ralph said it’s why he asked The Press Democrat to chronicle his final weeks of life.

“Every damn time I went (to the oncology and radiation clinic), the parking lot was full. The waiting room was full,” he says.

“If this many people are suffering, how many people know about this drug?” he asks.

The numbers bear him out.

Between June 9, 2016, when California’s law went into effect and December 31, 2020, 1,816 people have died through prescribed self-administered medications, according to the California Department of Public Health.

California’s law requires the Department of Public Health to track the numbers, but death certificates cite the underlying cause and make no mention of end of life medications.

“There is an option,” Ralph says.

Ralph Harms built a house just a few blocks from an entrance to Spring Lake Regional Park in Santa Rosa 36 years ago to be near its running trails. Two days before his scheduled death with dignity, Ralph takes one last fast-paced long walk around his chosen spot. (John Burgess/The Press Democrat)
Ralph Harms built a house just a few blocks from an entrance to Spring Lake Regional Park in Santa Rosa 36 years ago to be near its running trails. Two days before his scheduled death with dignity, Ralph takes one last fast-paced long walk around his chosen spot. (John Burgess/The Press Democrat)

‘It was his decision’

Ralph doesn’t use a computer and hasn’t in the three years since his wife died. He doesn’t use a cellphone either.

After his terminal diagnosis, he asked Mary to help him start the process to apply for the medications to end his life. Both of his children say their dad locked into his plan “almost immediately.”

As with most things in Ralph Harms’ life, there was no talking him out of it.

“He’s putting a date on something,” and it is a way to assert control in a situation largely beyond his control, Mary says. “I just feel like it was his decision, totally.”

Mary went to the website for American Clinicians Academy for Medical Aid in Dying and answered questions about her dad’s care and prognosis.

She got a referral for a local doctor to conduct the initial evaluation. From that doctor, she got the name of another doctor to do a second evaluation two weeks later as required by law.

(California lawmakers are debating SB380, sponsored by Sen. Susan Talamantes Eggman, a Stockton Democrat, which would reduce the waiting period between doctor evaluations from 15 days to 48 hours.)

“I just like being able to help him. I know it’s something he wanted to do. I think he’s afraid of what is going to happen to his body.” ― Mary Harms, Ralph’s daughter

Navigating the bureaucracy was straightforward, Mary said.

“It wasn’t hard at all,” she says.

“I just like being able to help him,” she says in mid-July. “I know it’s something he wanted to do. I think he’s afraid of what is going to happen to his body.”

Even after his diagnosis, Ralph felt strong most days. He still got up early, had his coffee and headed out before 9 a.m. for his four miles around the lake.

But the progress of the disease and the toll on his body was visible every time he looked in the mirror.

“All these nodules I have on my chest and back, they break through my skin, it smells like hell. It’s cancer. And you have to clean that stuff up, holy Christ,” he says. ”What the hell, there has to be something else. I just decided I wanted to end this whole thing.”

After a lifetime wearing shorts and, more often than not, going shirtless with no sunscreen, Ralph’s legs, arms and face are a visual history of the cumulative damage where lesions were removed.  (John Burgess/The Press Democrat)
After a lifetime wearing shorts and, more often than not, going shirtless with no sunscreen, Ralph’s legs, arms and face are a visual history of the cumulative damage where lesions were removed. (John Burgess/The Press Democrat)

Medications, mostly for pain, are lined up on his kitchen table as well as on the counter. The pills beat back the pain, but only to a degree. Most mornings, he feels OK, but the pain ramps up in the late afternoon, stealing his appetite and his ability to sleep. Some nights he spends hours in a rocking chair by the window because sitting up relieves the pressure in his chest.

The medication takes the edge off the pain, but it also makes him even more fatigued and renders his mind groggy. He doesn’t want the time he has left to be a blur.

“I feel like garbage with this medication,” Ralph says.

It is no way to live.

“No, man. No,” he says.

On June 28, Ralph underwent the second evaluation required by law. He was cleared by a doctor to receive the drugs.

It would mark the beginning of his journey to the end.

But first he had to get the medications.

The cost of ending his life was $700, but he pushed back.

“I said ‘Really?’ I have 12 years in the service, can you work with me?’” he said.

They relented.

The final bill was $550.

Resources for those facing end of life issues

Patients facing a terminal diagnosis should consult their physician about end of life options and care.

Some doctors may have religious or ethical reservations about recommending end of life options, but there are other resources available.

The American Clinicians Academy on Medical Aid in Dying provides information on the organization’s website, which also allows patients or their loved ones to seek doctor referrals. It can be found at www.acamaid.org

10:10 a.m.

As promised, Jeannie and Doug Green arrive on that Friday morning with a massive tray of pastries — scones, croissants and muffins, as well as Jeannie’s homemade monkey bread. They have spent countless hours here on this deck since Ralph and Kathleen moved in 36 years ago.

After setting the food down, Doug Green wants to share a story privately.

The day before, three buddies took Ralph to lunch at Mary’s Pizza Shack on Summerfield Road. It was like old times, except for the box of See’s candy on the table.

After his lunch of salad, bread and a beer, Ralph asked Green for a favor.

“Would you mind taking me to Doyle Park Drive?”

Earlier in the day, Ralph underwent a procedure to disable his pacemaker so it wouldn’t fight the medicines that would eventually stop his heart.

It almost didn’t happen.

A week earlier, he came home to find a message on his answering machine saying there was was a problem with his upcoming appointment.

Ralph fretted all weekend. On Monday, he learned that the technician assigned to deactivate the pacemaker had refused, citing a religious objection.

Ralph was furious.

At that moment, he was unsure whether his plan to die on Friday could proceed.

“I hooped and hollered,” he said. He called the situation “a cluster and the second word starts with ‘F.’”

“There would be two things fighting in my chest,” he said. “The fact that the machine wants to keep my heart going and the concoction wants it to stop? Unless they do that (the procedure), the concoction I drink Friday will not work.”

In the end, other arrangements were made, and the pacemaker procedure, a relatively simple and non-invasive one, was back on.

“He has less than 24 hours to live and he’s thinking of somebody else.” ― longtime friend Doug Green

Ralph wanted to thank the woman who intervened and made it work.

“Thank God for her,” he said.

The one-pound box of See’s candy sitting on the table throughout lunch, the one that got a little water spilled on the white wrapper, was for her.

But without a pacemaker, he could no longer drive, and he needed Green’s help delivering the candy to her office.

“He has less than 24 hours to live and he’s thinking of somebody else,” Green says, his eyes welling with tears.

10:11 a.m.: Ralph Harms carries a box containing the four-part medication to end his life and apple juice to ease the terrible taste of the final medication. The final lethal combination of sedatives and pain medication allowed him to die peacefully in his own bed two hours and 12 minutes later. (John Burgess/The Press Democrat)
10:11 a.m.: Ralph Harms carries a box containing the four-part medication to end his life and apple juice to ease the terrible taste of the final medication. The final lethal combination of sedatives and pain medication allowed him to die peacefully in his own bed two hours and 12 minutes later. (John Burgess/The Press Democrat)

10:13 a.m.

Marcia Seim Bossier stands to speak.

Her friendship with Ralph took hold nearly three decades ago when she joined his fitness class at the YMCA. She’d just had a baby, and she wanted to get back in shape. She promised she would try it for a week, but Ralph encouraged her, and after the first week told her he’d see her Monday. She kept showing up at 6:30 a.m. for 29 years.

She holds a page of typed notes.

“We don’t really have a ritual for this experience we are witnessing,” she begins, her voice quavering slightly.

She speaks of Ralph’s indomitable will, his ability to connect with people, his vitality. She also speaks of the cancer and the pain he’s enduring.

“How can a spirit as vividly alive as Ralph’s be stilled?” she says. “Though Ralph respects the rules of sports, he’s not above a little wheeling and dealing … if he can’t get to the finish line in the way he wants, on his own two feet, then he can move the finish line a little bit closer.”

Standing on the other side of the table, Ralph sips his coffee and listens, chuckling occasionally.

“Very nice,” Ralph says as Seim Bossier folds her sheet of notes and sits.

There is a brief silence.

Ralph breaks it, saying he’s ready to start the procedure.

“So, what do you think? Take the first deal, get it going? Alright. Cool.”

The guests say nothing.

Ralph walks through the sliding glass door and into the house to take the first dose.

“How can a spirit as vividly alive as Ralph’s be stilled? Though Ralph respects the rules of sports, he’s not above a little wheeling and dealing … if he can’t get to the finish line in the way he wants, on his own two feet, then he can move the finish line a little bit closer.” ― Marcia Seim Bossier

Four bottles, three doses

The medications, in four individually wrapped bottles, arrived in the mail in mid-July. The brown box, about half the size of a shoe box, sits open on Ralph’s kitchen counter, right next to the coffee pot.

The first two bottles are metoclopramide and ondansetron, are taken in combination, to prevent nausea and to make sure the later drugs stay down.

The next bottle, to be taken 30-60 minutes later, is digoxin, which slows the patient’s heart. It typically activates within 60 minutes and is simply an insurance policy that the process does not take hours.

After that dose, the patient typically waits 30 minutes before taking the final round, which, in the majority of cases will end the patient’s life. It is a lethal combination of sedatives and pain medication, including morphine, diazepam (Valium) and amitriptyline. It puts the patient into a deep sleep almost immediately.

The four-part medication to end Ralph Harms’ life: two anti-nausea medications mixed together, one to slow the heart, and the final lethal combination of sedatives and pain medication.  (John Burgess/The Press Democrat)
The four-part medication to end Ralph Harms’ life: two anti-nausea medications mixed together, one to slow the heart, and the final lethal combination of sedatives and pain medication. (John Burgess/The Press Democrat)

It’s so strong, the patient must drink it within two minutes or they could fall asleep before finishing the full dose.

After that, the patient enters a deep coma, not unlike surgical anesthesia. They are completely unaware of their surroundings.

The entire process is like watching a video in fast-forward. The act of dying doesn’t change, but the speed of it does.

10:24 a.m.

Five minutes after Ralph takes the first dose, he emerges from the house.

“What do we got here, people?” he says as he begins cutting up the pastries. “Good stuff,” he says as he puts a small piece of cinnamon bread into his mouth.

“Everybody good on coffee?”

Ralph has planned out his final weeks meticulously, but in many ways, they aren’t much different from his usual life — a creature of habit, he prefers not to stray from his routine.

Ten days before his death: Joe Harms, left, and his father, Ralph, spend a night together watching the NBA finals with pizza and beer in a bottle.  (John Burgess/The Press Democrat)
Ten days before his death: Joe Harms, left, and his father, Ralph, spend a night together watching the NBA finals with pizza and beer in a bottle. (John Burgess/The Press Democrat)

He’s an early riser who gardens daily.

He regularly walks as many as five miles a day out his front door, around Spring Lake and back home. He eats out with friends and answers their constant phone calls.

One evening, his son comes over, and they eat Mountain Mike’s pizza, and sit in the TV room watching the Milwaukee Bucks beat the Phoenix Suns in the NBA Finals.

On another day, he spent the afternoon reminiscing with a running buddy. They were on the back deck, snacking on potato chips; Coors Lights on the table.

Ralph spent 15 years volunteering as assistant coach for Santa Rosa High’s track and field and cross-country teams. For the last few of those years, he coached with Doug Courtemarche, his teammate with Empire Runners.

“We were competitive as hell,” Courtemarche says. “I couldn’t catch Ralph to save my life.”

Nearly as legendary as his speed and tenacity, was Ralph’s joie de vivre after races, Courtemarche says.

“Ralph was notorious for bringing Henry Weinhard’s after our 10Ks,” Courtemarche says.

The reporter turns to Ralph: You were drinking beer after races? At 9 a.m.?

“Is there a law against it?” Ralph says, sipping from a bottle of Coors Light in the afternoon sun. “If there is, I haven’t heard of it.”

On his kitchen table is a paper calendar, with appointment reminders and tasks still to be done.

He is leaving nothing to chance, and he wants to create as little burden as possible for those he is leaving behind.

He wrote his own obituary and selected the shirtless running photo to be published with it. He describes his amateur boxing record, his 13 marathons in 12 months, his Master’s national ranking in eight track events at age 62, and his two age group world records in relay running with Tamalpa Runners in Marin County.

He also tells of completing his stint in the U.S. Army Reserve only to reenlist and pass the military fitness qualifications to be accepted as a Green Beret at 44.

And he writes of his decades of volunteering: As an assistant track and cross-country coach at Santa Rosa High, as a decadeslong champion of Double Punches Boxing Club and as an instructor and supporter of the YMCA into his 80s.

Another detail he took care of was a call to Daniels Chapel of the Roses funeral home, to tell them of his plan and arrange for his body to be picked up.

One week before his death: Ralph Harms floats slowly upward on his first hot air balloon ride at sunrise over the vineyards of Sonoma County seven days before he ended his own life. (John Burgess/The Press Democrat)
One week before his death: Ralph Harms floats slowly upward on his first hot air balloon ride at sunrise over the vineyards of Sonoma County seven days before he ended his own life. (John Burgess/The Press Democrat)

A week before his final day, Ralph deviates from the plan and does something unexpected.

Joe had purchased a hot-air balloon ride for his parents as a Christmas gift in 2017. Three months later, though, Kathleen died. Joe found the tickets recently and arranged to take his dad.

Just after 5 a.m. on July 23, Joe picked up his dad and took him to the Charles M. Schulz Sonoma County Airport. Lifting off at 7 a.m., they floated over Sonoma County for 90 minutes, soaking in the beautiful view.

It was something Ralph had never done.

“Great, great,” Ralph said after gingerly climbing out of the basket. “That was super fun. I enjoyed that.”

When they touched down, riders were offered a glass of champagne and Mike Kijak, the pilot, recited The Balloonist’s Prayer:

The winds have welcomed you with softness.

The sun has blessed you with his warm hands.

You have flown so high and so well

that God has joined you in your laughter

and sent you gently back

into the loving arms of Mother Earth.

'You hate losing good friends’

Ralph knew that his last day would be tough on his friends and family, so two days before, he threw a party for himself that he hoped would be more festive.

It was bittersweet.

Hors d’oeuvres on platters covered the pingpong table in the garage. Mary dropped off extra wine glasses. And as usual, the fridge was packed with Coors Light — in bottles, of course; no cans.

On one end of the table were posters Seim Bossier made featuring their friend’s “Ralphisms.”

“I’ve had more damn fun.”

“They’re just a bunch of candy asses.”

“Hello, darlin."

Two days before his death: A friend adds a "Ralphism" to a collection of well-used phrases from Ralph Harms during a farewell party two days before his scheduled death. (John Burgess/The Press Democrat)
Two days before his death: A friend adds a "Ralphism" to a collection of well-used phrases from Ralph Harms during a farewell party two days before his scheduled death. (John Burgess/The Press Democrat)

The posters are spread out, an invitation for others to add to them. Throughout the night, guests do, as if they’re signing a yearbook.

“So what the hell?”

“What’s up with that?”

And, “It is what it is,” make the cut.

Ralph moves among the guests, filling wine glasses, making sure everyone has what they need. He stays busy. A number of times, usually spurred by a guest coming to bid him goodbye, his eyes fill with tears.

When Carl Jackson, a friend and 30-year competitive running buddy, begins to say goodbye just after 6 p.m., Ralph does his best to keep it light. He reminds Jackson he has forwarded his Press Democrat subscription to him through the end of the month.

With a smile, he says, “Then, you are on your own.”

“Unfortunately I’m going to be on my own anyway, Ralph,“ Jackson says as Ralph pats his own chest, his eyes brimming with tears.

Two days before his death: At a goodbye party with friends, Ralph Harms, center in blue, regales his friends with old stories at a farewell party at his Santa Rosa home.  (John Burgess/The Press Democrat)
Two days before his death: At a goodbye party with friends, Ralph Harms, center in blue, regales his friends with old stories at a farewell party at his Santa Rosa home. (John Burgess/The Press Democrat)

Ralph puts his arm around his friend. He tells him to take care, raises his glass and says, voice breaking, ”Have a good night.“

“I will, Ralph,” Jackson says, moving his walker up the driveway.

“You hate losing good friends,” Jackson says, shaking his head, but Ralph doesn’t hear. He is already back in the garage with other guests.

As evening falls, Ralph holds court. Food and drink are moved from the pingpong table to the back deck. Eight neighbors sit in the fading light, refilling wine glasses, giving live updates on a grandson’s Little League game in Gilroy and laughing.

Lots of laughter.

Ralph sheds a few tears, offers two-armed hugs and reminds most of them he’ll see them Friday.

Two days before his death: Neighbor Felipa Jones hugs Ralph Harms for the last time after the goodbye party.   (John Burgess/The Press Democrat)
Two days before his death: Neighbor Felipa Jones hugs Ralph Harms for the last time after the goodbye party. (John Burgess/The Press Democrat)

10:42 a.m.

Ralph stands up and approaches his caregiver, asking if it’s time for his second medication.

Wait until 11 a.m., Ralph is told.

He sits back down. For the second time this morning, Ralph seems uncertain how to proceed.

His voice cracks as he talks about the neighborhood movie club, the bocce team, the regular get-togethers with the people sitting with him now.

“It was good people having fun,” he says. “A lot of bottles of wine got emptied.”

“Barrels maybe,” Frank Briceno says to knowing laughter.

Ralph, ever the host, points to the still full platters of pastries. “You guys better start eating this stuff here.”

Softly, and directly to Ralph, Seim Bossier asks if he hurts. “Oh yeah. Big time,” he says. “It started yesterday afternoon.”

He takes a sip of coffee from a cream-colored ceramic mug. It’s 10:48 a.m.

‘It gives me enough time’

Ralph chose July 30 to die, for a reason.

Eight years earlier on that date, he suffered a near-fatal cardiac arrest while golfing in Sebastopol with his son and Doug Green.

Ralph had just hit a decent recovery shot that put him on the green at the fourth hole, Joe says.

“He comes up and says, ‘That’s how you do that,’ clapped his hands and fell over backwards,” Joe says. “I said, ‘That shot wasn’t that good.’”

But his dad wasn’t goofing around.

Joe, using the technique that his dad had taught him on the fly just a few years before, pumped his dad’s chest until medics arrived.

“I was pretty calm, talking to him, telling him he’s gotta get up and come home because mom will be really mad at me if I don’t bring him home,” Joe says.

Ralph says he chose July 30, in part because it felt meaningful, coming exactly eight years after the day he almost died. There was another reason.

“It gives me enough time to make phone calls,” he says. “’See you later, baby,’ kind of thing.”

10:56 a.m.: Ralph Harms wanted friends nearby for the last hours of his 85 years of life. After talking to each friend alone and taking the second of three medications that will hasten his death, Ralph silently watches his friends from the back door of his Santa Rosa home.  (John Burgess/The Press Democrat)
10:56 a.m.: Ralph Harms wanted friends nearby for the last hours of his 85 years of life. After talking to each friend alone and taking the second of three medications that will hasten his death, Ralph silently watches his friends from the back door of his Santa Rosa home. (John Burgess/The Press Democrat)

10:50 a.m.

It’s 10 minutes until Ralph is to swallow the medication that will slow his heart. At that point, he will have just minutes to be able to speak and visit. He begins to call his friends, one by one and in pairs, from the deck into the house. He has planned individual goodbyes with everyone here.

A hummingbird hovers over the deck long enough that most guests notice.

Many people believe hummingbirds are people who have died returning to say hello, Ralph’s caregiver says. It is 10:57 a.m.

Harms knows death. Maybe too well. He lost his two oldest daughters to breast cancer. Connie died in 1992. Her sister, Judee, died 12 years later. Ralph says he has seen what cancer looks like in the end.

Connie moved into Ralph and Kathleen’s home as she battled, and eventually died, of the disease. She was just 32.

“I’d go over and pick her up out of bed” while his parents changed the sheets, Joe says.

“They handled it really well,” he says. “We had Connie up there at their house ... my mom and dad took care of her until she passed.”

Ralph may have appeared to have handled it well, but he was gutted.

“You are never, ever supposed to lose your kids,” Ralph says. “But when Kathleen died, it was like, ‘Jesus. Come on, man, that ain’t right.’ I would have done anything to still be with her.”

Kathleen’s death, so sudden and so unexpected, left him unable to say goodbye. But watching his daughters suffer through drawn-out, excruciating battles with cancer was a different kind of agony.

This choice Ralph has made gives him a chance to offer his farewells, but not extend his suffering.

There is no good way to go, he says. But this is the best way for him.

One week before his death: Ralph Harms places new flowers for his wife, Kathleen, on a shrine filled with photos of their travels over their 63 years of marriage.  (John Burgess/The Press Democrat)
One week before his death: Ralph Harms places new flowers for his wife, Kathleen, on a shrine filled with photos of their travels over their 63 years of marriage. (John Burgess/The Press Democrat)

On a table in his living room, Ralph maintains a shrine to Kathleen. Two poster boards are filled with photos of her — traveling in France, Mexico, Yosemite and Hawaii; playing tennis with Mary; laughing. In every photo, Kathleen’s smile is bright.

In one, a shot that Ralph points to specifically, Kathleen holds her hands just below her chin.

Her grin is huge.

“That shows how happy she was — somebody did something — and she’s going, ‘Isn’t that great!”

Her ashes are there, so, too, is her death notice.

For more than three years, Ralph has made sure to have fresh flowers sitting next to the photos. Today, there are red roses.

“I get flowers every Friday and other ones I pick,” he says.

Next to the bouquet of roses sits a four-leaf clover plant.

“This was for St. Patrick’s Day,” Ralph says. “She died on March 20, I bought her that a few days before. It’s still alive. It’s not super healthy, but it’s still alive.“

11:04 a.m.: Ralph Harms drinks the second part of a medication that will slow his heart, an hour and 19 minutes before the combination of drugs ended his life peacefully as he wished. (John Burgess/The Press Democrat)
11:04 a.m.: Ralph Harms drinks the second part of a medication that will slow his heart, an hour and 19 minutes before the combination of drugs ended his life peacefully as he wished. (John Burgess/The Press Democrat)

11:05 a.m.

Joe stands in the kitchen holding a pint glass of apple juice. He walks from the kitchen, through the living room and past the guests on the deck. He descends four steps and goes down the hall into his parents’ bedroom.

Joe combines the digoxin with the apple juice and shakes the mixture over the sink. His father, holding the container himself, has to slug it down.

“Just like a shot glass,” Joe tells his dad. “Suck it all down. Don’t spill it.”

This is the medication that will slow his heartbeat.

Ralph drinks it. “Now we just wait a while, huh?”

It’s 11:06 a.m.

11:08 a.m.

Standing in his kitchen, Ralph turns to his caregiver and asks who will pronounce him dead. He wants to make sure he’s really gone.

The job will fall to the caregiver, Ralph is told.

“I don’t want to wake up in some damn box,” Ralph says, laughing.

Clearly he is anxious now. He moves between the house and his guests on the deck, unsure what to say or what to do.

11:15 a.m.: At a contemplative moment, Ralph Harms leaves his friends to drink the last portion of the cocktail provided by doctors for the death with dignity he sought after he was diagnosed with terminal skin cancer. (John Burgess/The Press Democrat)
11:15 a.m.: At a contemplative moment, Ralph Harms leaves his friends to drink the last portion of the cocktail provided by doctors for the death with dignity he sought after he was diagnosed with terminal skin cancer. (John Burgess/The Press Democrat)

It’s time. Ralph is encouraged to lie down. It’s time to get comfortable.

Unexpectedly, Ralph turns to the reporter. “So, any last questions, my dear?”

It’s 11:20 a.m.

'He’s in a lot of pain’

As the disease progresses these final days, Ralph occasionally winces in pain. His son takes notice. His dad has “the highest pain threshold of any person I know.”

He recalls the time, when working at the San Francisco bakery he owned, a tall rack of trays right out of the oven were about to topple over. Harms moved to keep it from falling on an employee. Each pan left a burn that made his dad look like he had stripes on his skin, Joe says. He never complained.

But the pain he has trouble bearing, something he can’t hide, is the loss of his beloved Kathleen.

“He misses my mom,” Joe says. “He’s in a lot of pain.”

Ralph Harms with the love of his life, Kathleen, who died of a cardiac arrest in 2018.
Ralph Harms with the love of his life, Kathleen, who died of a cardiac arrest in 2018.

11:22 a.m.

Joe has one last gift for his dad.

He is creating a slideshow of photographs on a laptop. There are photos of Ralph and Kathleen. Mostly Kathleen. Joe sits in the TV room, across the hall from his dad’s room, preparing the images he wants his father to see in his final moments.

Across the hall, Ralph Carsten Harms is now in bed.

He is weeping.

11:33 a.m.

11:33 a.m.: Ralph Harms reaches for the final dose of medication, a combination of sedative and pain medication, that would allow him to die peacefully in his own bed 51 minutes later. (John Burgess/The Press Democrat)
11:33 a.m.: Ralph Harms reaches for the final dose of medication, a combination of sedative and pain medication, that would allow him to die peacefully in his own bed 51 minutes later. (John Burgess/The Press Democrat)

It is time for the final dose. Ralph struggles to drink it. It’s exceedingly bitter and can cause a burning sensation. Joe adds apple juice to help it go down.

“It tastes disgusting and it feels like it’s stuck right here,” Ralph says, pointing to a spot just below his Adam’s apple. He gags heavily. His cough is deep and loud. Finally, he is able to relax some, lie back and settle into bed.

Mary stands nearby. Joe starts the slideshow.

The computer is propped up on a pillow to his dad’s left.

The son tells his dad he can watch it as he goes. Ralph opens his eyes for a few seconds and then closes them again.

He is asleep.

He will never awaken.

11:47 a.m.: Joe and Mary Harms wait with their father, Ralph, who rests peacefully in his own bed after ingesting the medication that would end his life 35 minutes later. Harms chose to die on his own terms after discovering his terminal skin cancer would mean a slow, painful death.  (John Burgess/The Press Democrat)
11:47 a.m.: Joe and Mary Harms wait with their father, Ralph, who rests peacefully in his own bed after ingesting the medication that would end his life 35 minutes later. Harms chose to die on his own terms after discovering his terminal skin cancer would mean a slow, painful death. (John Burgess/The Press Democrat)

‘It’s been a great life’

His final weeks offered Ralph a chance to reflect on the decision to end his life.

He doesn’t second-guess the call.

There are no regrets.

"If I was 40 years old and and my wife and two older daughters were still here, along with my two kids, hell yeah, I would take the chemo. I would go to the moon and back to keep living,“ he says.

But the disease is coming for him. It’s stalking him. It’s relentless.

Ralph knows he can’t beat it.

What he can control is how and when he goes.

“When my two daughters died, it was horrible thing,” he says. “When Kathleen died, my world basically ended. I’m trying to keep the pieces together for Joe and Mary. It’s been a great life, an outstanding life.”

“I’m lucky from that standpoint,” he says. “I’ve got two good kids.

“The three of us got through it so far,” he says. “Mary has her wife for support and Joe has a great bunch of buddies.”

11:48 a.m.: Ralph Harms rests peacefully in his own bed, taking only five breaths per minute, about 35 minutes before a cocktail would hasten his death.  (John Burgess/The Press Democrat)
11:48 a.m.: Ralph Harms rests peacefully in his own bed, taking only five breaths per minute, about 35 minutes before a cocktail would hasten his death. (John Burgess/The Press Democrat)

11:48 a.m.

Ralph, his eyes closed, has been quiet and still. Suddenly, he emits an abrupt snoring noise. It startles his children, who stand at his bedside.

His breathing and his pulse have slowed. He now makes loud, intermittent gurgling noises. He has lost control of his tongue and larynx. It is reflexive. He is neither aware, nor in pain.

He is dying.

His friends, sitting on the deck just steps from Ralph’s bedroom, raise a glass to their friend.

“Here’s to Ralph.”

They chat quietly. The sun is turning hot.

A few more minutes pass. Mary steps onto the deck, not from the house, but from the garage. The group turns to her.

“He’s gone.”

He died at 12:23 p.m., she says.

Mary turns and walks back into the garage.

Ralph’s deck and his home, for the first time in a long time, are quiet.

A few seconds tick by.

A friend raises a bottle of Coors Light.

“He pulled it off,” someone says. “He had a plan.”

It is 12:32 p.m.

About the journalists

Kerry Benefield is The Press Democrat’s community columnist. Since 2003, she has covered politics, schools and sports.

John Burgess has been a photojournalist with The Press Democrat for 30 years. He has photographed food, sports, Barack Obama’s inauguration and everything in between.

Staff Photographer John Burgess contributed to this story. You can reach Staff Columnist Kerry Benefield at 707-526-8671 or kerry.benefield@pressdemocrat.com. On Twitter @benefield.

Kerry Benefield

Columnist, The Press Democrat

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