Without medical aid-in-dying, some patients choose to die violently. Sheryl Randall was one of them.

There was a stark difference between who Sheryl Randall was most of her life and who she had become when she tied a rope around her neck last year.

Randall, 67, was a financial planner in Evergreen. She liked to travel. She loved to hike. She had strong opinions, lots of friends and a big laugh you could hear no matter how far ahead or behind she was on the mountain.

Her laugh echoed, friends say.

“I can hear it in my head,” says Janet Williamson of Evergreen.

About five years ago, Randall started having trouble eating. She went from doctor to doctor in search of why she couldn’t keep food down. She started losing weight and energy until she stopped showing up for the hikes she used to take every Wednesday with friends. In time, she couldn’t hike – her greatest joy. Eventually, there were days when she couldn’t walk or get out of bed at all. Brushing her teeth or holding a book exhausted her.

Randall was first diagnosed with multiple sclerosis, but later doctors said she had a mitochondrial disease that was slowly attacking her organs. Food became difficult for her to swallow. She subsisted mainly on pear juice and brown rice, weighing every morsel she ate, trying to keep her weight up. But nothing worked. By winter 2015, she was down to about 80 pounds.

“She told me the last time I talked to her that she had about 40 minutes of energy a day,” says her friend, Joan Edmunds of Denver.

As Randall grew weaker, she became impatient with herself and friends, lashing out over things that in healthier days they’re sure wouldn’t have mattered to her. The most she could do was sit on her deck watching the seasons pass or lie in bed listening to recorded books about places she still hoped to travel.

“Her world was closing in on her,” says friend Janet Prehn of Arvada. “It was so sad to watch this awful progression as she just continually, continually, continually, continually went downhill.”

Randall arranged for hospice workers to help as her body broke down. She refused care from friends.

In the winter of 2015, she phoned Williamson, who has stage 4 breast cancer, to ask if she ever thought about suicide.

“I said I did,” Williamson says.

Williamson asked Randall what quality of life she had.

“She said ‘None. I don’t want to live this way.’”

Williamson urged her friend to move to Oregon or Washington, where aid in dying is legal.

“She said ‘I can’t get there, I can’t move that much.’”

Williamson offered to drive her.

“She said, ‘I can’t drive in a car that long.’ She had waited too long in hopes that she would get better.”

About a month later, in March 2015, Randall wrote letters to a few friends saying she had suffered too long and had enough. She notified Jefferson County Sheriff’s office, calling or writing – her friends aren’t sure and the department isn’t saying – to tell them where she lived, how to get into her house and what she was about to do. Then she hanged herself.

As methodical and thorough as Randall was in every other aspect of her life, her friends have no doubt that she researched her options. They cringe to think of her combing the web for the surest way to die. The thought of her threading a rope around her neck haunts them. And they kick themselves as the would-haves and should-haves play in their minds.

Given Randall’s fierce sense of friendship, they’re sure that she didn’t want them taking the legal risk of helping her die. They’re also sure, given her independence, that she didn’t want them trying to talk her out of it.

“But I wouldn’t have,” says friend Nancy Kranzow of Denver. “I understood why she did it. Her life wasn’t her own any more.”

“She was obviously amazingly desperate to do it the way she did,” adds Edmunds. “She was very, very ready to go.”

The Jefferson County Sheriff’s Department wouldn’t release its report on her suicide, citing privacy reasons.

Randall’s sister, who lives out of state, asked The Independent not to reveal Randall’s identity in this story. “She was a very private person,” she said.

But Randall’s friends – seven of whom agreed to be interviewed – say she would have wanted her story told if it could help spare others. Now that voters will have a chance to decide whether to legalize medical aid-in-dying in Colorado, one friend after the next said her story needs to be heard.

“It would have been so much easier to know she could just take something and it would have been over,” Prehn says.

Five states – representing 16% of the U.S. population – currently allow medical aid in dying. They are Oregon, Washington, Vermont, Montana and California. Colorado is the only state slated to consider a ballot initiative this November.

The proposed End-of-Life Options Act is modeled after Oregon’s, which was the first state to pass a medical aid-in-dying law in 1997. Since then, 1,545 people have had prescriptions written under the law and 991 have died from ingesting the medications. Last year, there were 218 prescriptions filled and 132 used.

Colorado’s proposal, like Oregon’s law, would require patients to be 18 or older, mentally capable, residents of Colorado, confirmed by two doctors to be terminally ill (with six months or less to live), and able to administer the medication themselves. Most commonly, doctors prescribe a barbiturate or a mix of drugs, including a sedative. The aim: a death more peaceful than Randall’s.

“The violence of what Sheryl did, it was awful,” Kranzow says.

“We were all shocked. Hanging herself. I can’t fathom going through something like that,” adds Prehn.

It’s hard to know how many cases like Randall’s there are in Colorado because the state health department doesn’t keep statistics on how many terminally ill take their own lives.

Compassion & Choices, the national group behind the aid-in-dying movement, coalesced at the height of the AIDS epidemic when terminally ill patients were committing suicide by jumping off balconies, kneeling in front of trains and other violent means. They committed to working to ensure more peaceful deaths. As president Barbara Coombs Lee tells it, the ability to die peacefully “is a core value of a life well lived.”

“People take actions that are desperate when they’re powerless in the face of an approaching, certain, horrific death,” she says. “We know this tragedy of violence among the terminally ill is totally preventable.”

Advocates say aid-in-dying not only assures peace of mind for patients, but also for their family and friends. Suicides like Randall’s, Coombs Lee says, leave survivors “with a lot of difficult images, second guessing and guilt wondering how could they have prevented it, how could they have relieved the desperation.”

The Archdiocese of Denver opposes the measure on grounds that human life is sacred at every stage. Its spokesperson did not return phone calls seeking further comment.

Some disability activists also oppose the ballot initiative, fearing that, in the face of lifelong care and medical expenses, the law could be misused to euthanize people with disabilities.

Like Randall, Carrie Ann Lucas, a disability lawyer helping lead the opposition against the ballot measure, also has a mitochondrial disease. Although she realizes such conditions “can manifest in a million different ways,” she wonders if psychiatric care could have prolonged Randall’s will to live. In any case, Lucas says doctors are terrible at evaluating quality of life issues and fears that – either because of pressures from depressed patients or insurance companies’ cost concerns – physicians may prescribe lethal drugs rather than mental health treatment. She also notes that aid-in-dying prescriptions are similar to lethal injections used in the death penalty.

“As we know from several botched executions in Oklahoma, that’s not necessarily a non-violent death, either,” she says.

Randall had left specific wishes that there be no service after her death. So, instead, her friends gathered one morning in June for a hike in her memory.

The air was crisp and the sun bright as they trekked along Mount Falcon. They tried to remember how much fun Randall was and how much life she had. They missed the echo of her laughter on the mountain.

But nobody on that trail that morning could forget what they all imagined about Randall’s last minutes. Nobody could accept that their friend, in her death, felt relegated to the underground.

“Maybe I’m projecting my own feelings on Sheryl,” Preen says. “But, then, I knew her quite well. I feel like she wouldn’t want anybody else to go through what she went through if there was a better way to do it.”

Photo courtesy of Nancy Kranzow

A recovering newspaper journalist and Pulitzer finalist. Her criminal justice reporting includes “Trashing the Truth,” with Miles Moffeit, and “The Gray Box.”