Grandma is 96+ years old. She's an accomplished, strong-willed, tough old lady who has survived just about everything life can throw at a person: polio in childhood, over two dozen major surgeries, diabetes, and then two times in the last decade, cancer. Now she's very close to the end. She has been in a nursing home for four years, declining almost imperceptibly from day to day. Until last week, she could carry on a conversation of sorts. But then something happened. She lost the ability to move, even a little; she became agitated, her long-term memory collapsed, and she could not, however hard she tried, complete a thought (though she was able to say, and repeat, "This dying business doesn't bother me"). She recognized only one person, her eldest daughter, and it was not clear that she knew her own name.
For the last six months someone at the nursing home has had to help her with fork and spoon. Last week, we decided that to prop her up, sit her at the table, feed her cake and then propose that her insulin intake be increased was a senseless, bizarre procedure. A compassionate doctor suggested that it was time for insulin and other non-palliative medicines to be withdrawn. We readily agreed. We confronted the head nurse at the nursing home; she announced to us that the home's chief of medicine would reverse the order to withdraw insulin; Grandma must be fed ("We're a nursing home," she said, "we nurse"). Last Friday, we moved Grandma from the nursing home to our local hospice. Grandma immediately stopped eating and drinking. I would like to think that she chose to give up food, but there's no way to know. Her eyes have a glazed, far away look on the rare occasions that she is strong enough to open them. She fumbles with the sheets.
Nevertheless, on Monday, hospice told us that they couldn't keep her. She's not "actively dying" -- according to the official Medicare rules -- and is therefore not eligible for hospice. Where to take her? Unclear. We negotiated a two-week reprieve. Grandma will be allowed to remain in hospice as a private patient for fourteen days, but unless she starts "actively dying" during that period, she'll be expelled. We cried.
Yesterday, however, we were told that Grandma had taken a step forward. She's "entered her process" --another bit of hospicespeak. She's experiencing, we're told, sufficient pain to warrant morphine and her heartbeat has become rapid and irregular. She is "less responsive." Good news for Grandma, I guess. Unless she "plateaus" and stops "actively dying," she'll be allowed to stay to the finish, which, if there's any mercy, will not be very long.
Here's what Kent says about Lear, at the end. "O let him pass. He hates him/ Who would upon the rack of this tough world,/ Stretch him out longer."
January 17. Grandma died last night, having squeezed the last drop out of life and sliced through the last shred of bureaucratic red tape.