The Bitter End

In the two weeks leading up to my grandmother's death from lung cancer last January—three months shy of her 92nd birthday—she was transferred through four separate health-care facilities and six different beds. First, there was a hospice, where she was not allowed to receive more than just "respite" care. Next, she was moved to an assisted-living facility, where she fell, twice. After her second fall, she was strapped to a gurney and pulled along a bumpy sidewalk through a snowstorm to an awaiting ambulance. She was taken to the emergency room at New York's Lenox Hill Hospital. Ten hours later, she was assigned to a bed. She stayed for three days before being transferred to another hospice, where she died minutes after she arrived. If my father hadn't redirected the ambulance driver who took her from Lenox Hill to the second hospice, she would have died in the back of a van headed in the wrong direction.

At each stop along the way, my grandmother was handed off to a new set of doctors, nurses, social workers, and case managers. Again and again, she was poked and prodded and tested and assessed. At the first hospice, her health initially seemed to improve, so she wasn't sick enough to stay. But in assisted living, she declined, precipitously, so was too sick to stay. At Lenox Hill, she didn't need the ongoing treatment that would warrant taking up a bed. So she was punted from place to place, always either too close to death or too far from it. It was a pointless nightmare: a Kafkaesque labyrinth of doctors and hospitals and paperwork. When she came out of her semi-conscious state in her room at Lenox Hill, one of the first things she said was, "Why aren't I dead yet? Can't we just get this over with already?"

Until her last few weeks, my grandmother had enjoyed a long, full, fiercely independent life—the kind of life, in fact, that many people would envy. Despite being legally blind, she lived alone in Manhattan, visited museums regularly, took the bus all over the city to meet friends for lunch, and went to Shakespeare in the Park and lectures at NYU. One Friday night a few years ago, I called her and got the answering machine. When I didn't hear back, I called again, and then, as I began to get nervous, again. Finally, around 10 p.m. she called me back, laughing. She'd been out drinking wine with her friends on the rooftop of the Metropolitan Museum of Art.

Though we were separated by six decades, in some ways we were a lot alike. I moved to New York because of my grandmother. She taught me how to make an omelet like Julia Child, gave me an appreciation for red caviar, showed me how to tie silk scarves, and introduced me to the magic of what she called the "golden hour"—that small slice of the early evening when people have turned on the lights in their apartments but haven't yet drawn the blinds. At dusk, during that golden hour, we used to take walks through Greenwich Village and peer up into the stately townhouses that lined the side streets. I adored those moments. I adored her.

She was not some doddering cliché of elderly living. She was astoundingly brave. She learned to use the Internet at age 85 so that she could send e-mails to relatives in Florida and read Frank Rich's column online. She was also blunt and unsentimental on the subject of death. She believed in the circle of life, and often joked that she would come back as a petunia. A couple of times she tried to prepare me for the possibility that I might one day discover her body in her apartment. She told me that if it happened like that—if she died quietly, peacefully, as she went about her day, or, even better, in her sleep—it would be a blessing. At the time, the idea terrified me. Now it seems like a dream.

When she was diagnosed with terminal cancer in the fall of 2007, my grandmother set about preparing for her death. She finalized her will. Together, we picked out charities whose missions she supported and she gave them sizable donations. Last fall I hosted her final Thanksgiving dinner, and nobody at the table, least of all her, shied away from the truth: this would be her last family gathering.