Midwifing Death

Taking my grandfather home. Letting my grandfather go. 

My grandfather’s eyelids flicker, and my grandmother says, “Look! He’s opening his eyes!” There is a crowd of family gathered around my grandfather’s bed to witness this wonder, and there is delight in my grandmother’s voice.

I am struck by how much shepherding a man out of life is like welcoming a child into it. I saw the same thing just a few months ago, when one of my cousins died. At the viewing, my aunt fluttered around his body, stroking his hair. When she saw me, she asked, “Jess, have you seen him yet?” and it was like she was asking me if I’d had a chance to hold the baby. Her grief was incalculable and uncontainable, but, in her last moments with her son’s body, she fell into a pattern that mirrored the one she discovered when she first took him in her arms.

I have encountered the concept of midwifing death before, but I always figured it required some sort of conscious, distinctly New Age process—possibly including the burning of sage bundles. Now I see that it is what families and communities do organically. And, now that I have become a mother and tended an infant myself, I can see that caring for my grandfather is not all that different from caring for my baby.

Frances was, for all practical purposes, helpless when she was born. But she came into this world with a will, and Ted and I found our lives reordered by her cries, reacting to her forceful presence and preparing for a future that, all of the sudden, stretched beyond our own span of days. My grandfather is helpless now, too, but he is past crying. His span is done. Those of us gathered around him are guided not by our hopes for the future but, rather, by the full weight of my grandfather’s lived life, by our experience of him and our knowledge of his wishes, and by our desire to ease his passage if we can.

My grandfather died a month ago. He died at home, surrounded by his family. He died in the house where he had lived for fifty years. He died in a bed that had been set up where the sofa usually sits, which is to say that he died in the same spot where he had watched about a million PGA tournaments and taken about a million naps.

During one of his last lucid periods, a nurse asked my grandfather a series of questions—the names of his children, the year, the name of the President—to test his coherence. He passed her test, and then he offered her twenty bucks to take him home. Kidding on the square was my grandfather’s signature comic motif. He was unconscious most of the time during his last days, and, before that, he had been mostly incoherent for awhile. But, to the extent that he communicated at all, he communicated his wish to be at home. When he was in the hospital, he would ask for his shoes, telling my grandma that he needed to get to work. He suggested that they sneak out down the back stairs. I realize that his mind was disordered by dementia, but I think it’s worth noting that his confused thoughts all tended in one direction: home.

My grandmother did not encounter any death panels. What she encountered instead was a social worker who was absolutely scornful of my her insistence that she and her family and neighbors could care for my grandfather at home, a social worker who refused to even tell my grandmother about the incredible hospice support available to her. So, if we’re going to talk about bureaucrats pressuring old people to die—I’m not at all convinced that we should, but that’s probably because I live in the fact-based community and I understand that insurance companies and hospitals engage in cost-benefit analysis all the time—we also need to also talk about the contrary pressure exerted by contemporary medicine. It’s not easy to let someone die naturally when there are so many means of intervention, so many ways to keep a body going. It’s not easy to stop feeding someone when IV drips and feeding tubes are an option. And it is surely not easy to stop feeding a man—your husband—whom you’ve been feeding for half a century. But keeping someone alive isn’t always the best kind of nurturing. We need to talk about that.

We also need to talk about the fact that the modern American way of dying is an aberration. Death—much like birth—has been medicalized. My grandma’s insistence that my grandfather die at home—so repugnant to the social worker—was completely consistent with human practice across time and across cultures. The hospice nurse was impressed that my grandmother knew how to change a bed with a patient in it. My grandmother explained that it was something she learned in Home Ec.—in Akron, Ohio, in the 1940s. My great grandmother probably knew how to wash a body for burial.

So, the idea that acknowledging and planning for death shouldn’t be a part of health care makes me angry in a raw and visceral kind of way right now. But that’s not what I want to write about. I want to write about how proud I am of my grandma and my family. I am so grateful for their courage, for their steadfast determination to take my grandpa home and let him die. I also want to thank them for giving me a new way to understand death. I have always feared its infinitude, but now I know that death can also be homely, small enough to fit into the front room of the house where my mother grew up. Now I understand—for the first time, really—that death is a part of life, and I am so glad that I was able to be there for that part of my grandfather’s life.

This essay first appeared on my now-moribund blog in 2009. At the time, the idea of “death panels” was powerful enough to derail efforts by healthcare professionals to make sensitive, sensible end-of-life planning a normal part of medicine. No one will be shocked to learn that, four years later, Sarah Palin continues to ride this hobbyhorse as she strives to remain relevant.