How We Die (9 page)
Authors: Sherwin B Nuland
Actuaries seem unable to accept a natural phenomenon unless it is so well defined as to fit neatly into a distinct and easily described classification. The annual report of the federal death accountants is very orderly—not very imaginative, and to my mind not completely reflective of real life (and real death), but nevertheless very orderly. I’m convinced that plenty of people do die of old age. Whatever scientific diagnoses I have been scribbling on my state’s death certificates to satisfy the Bureau of Vital Statistics, I know better.
At any given moment, some 5 percent of our nation’s elderly reside in long-term care facilities. If they have been there longer than approximately six months, the vast majority of them will never leave these nursing homes alive, except perhaps for a brief terminal sojourn in a hospital, where some young house physician will eventually fill out one of those very proper death certificates. What do all of these old people die of? Though their doctors dutifully record such distinct entities as stroke, or cardiac failure, or pneumonia, these aged folk have in fact died because something in them has worn out. Long before the days of scientific medicine, everyone understood this. On July 5, 1814, when he was seventy-one years old, Thomas Jefferson wrote to the seventy-eight-year-old John Adams, “But our machines have now been running seventy or eighty years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way; and however we may tinker them up for a while, all will at length surcease motion.”
Whether its overt physical manifestation appears in the cerebrum or in the sluggishness of a senile immune system, the thing that peters out is nothing other than the life force. I have no real quarrel with those who insist upon invoking the laboratory-bred specificity of microscopic pathology in order to satisfy the compulsive demands of their biomedical worldview—I simply think they miss the point.
As soon as I became conscious of life, I began the long process of watching someone gradually die of old age. The statistician has not yet drawn breath who can convince me that my grandmother’s state-certificated Cause of Death was anything else than a legalized evasion of the greater law of nature. She was 78 years old at my birth, although her yellowed immigration papers claimed she was only 73—twenty-five years earlier at Ellis Island she had chosen to be younger than truth would allow, because she had been told that the figure 49 would be more acceptable than 54 to the stern, soldierly AMERICAN official in the brass-buttoned uniform who asked those blunt questions she assumed were so crucial to her entry. So you see, I am not the first member of my clan whose fear of governmental rejection has led to a bit of perjury.
Three generations of my family shared a four-room apartment in the Bronx, six souls altogether—my grandmother, my maiden aunt Rose, my parents, my older brother, and I. In those days, it was unthinkable that an aged parent would be sent off to one of the few available Homes. Even if the will existed, which it rarely did, there was simply no way. Half a century ago, for people like us to so banish an aged parent was considered a coldhearted circumvention of responsibility, and a denial of love.
My high school was only half a block from our tenement house, and even the distance to my college was a walk of no more than twenty minutes. Each morning, my grandmother put a small sandwich and an apple into a brown paper bag, which I then squashed between my books and forearm as I went off to the verdant campus on the hill. At intervals along the way, I would be joined by chums whom I had known since PS 33. By the beginning of my second class of the morning, the bag had invariably become greasy from the thickly layered butter my adoring grandmother always slabbed too generously onto the Silvercup. To this day, I can’t see an oleaginous smear on brown paper without feeling the sweet pain of nostalgia rise up in my chest.
Very early every day, my aunt Rose and my father disappeared into the subway that took them to their dressmaking jobs in the garment section of Manhattan. My mother died when I was eleven, and I was my grandmother’s boy. Except for an appendicitis hospitalization, and two half-month periods when a monied relative financed brief intervals at a summer camp, I spent most of every day of my life in her close company. Without realizing it, I passed my first eighteen years watching her descent to death.
When six people live in an apartment of four small rooms, there are very few secrets. During her last eight years, my grandmother shared a bedroom with my aunt and me. Till the day I completed my last college assignment, my homework was done on a card table opened up in the center of our small living room, while the activities of the household went on within a few feet of me. When my studying was over, I would fold the table and its collapsible chair and stow them against the wall behind the open door leading from the short entrance foyer into the living room. If I left so much as a scrap of paper behind, I would hear about it from my grandmother.
“Grandmother” was not the name we used for the matriarch of our family, because “Grandmother” spoke only a few monosyllabic words of English. What my brother and I called her was the Yiddish equivalent, “Bubbeh,” and what she called us was Herschel (my brother’s name was Harvey) and Shepsel. To this day, everyone calls me Shep, and it is a memory of my Bubbeh.
Bubbeh’s life had never been easy. Like so many Eastern European immigrants, her husband had preceded her to the golden shores of America and had taken their two sons with him, leaving his wife for several years with four young daughters in a tiny Belarusian village. Only a few years after the family’s life was reconstituted in a crowded (because other relatives shared it) apartment on Rivington Street on New York’s Lower East Side, my grandfather and both boys died in quick succession, whether from tuberculosis or influenza is uncertain.
By this time, three of the four daughters were working in garment-industry sweatshops, so there was some money coming in. Taking advantage of a subsidy made available by a Jewish philanthropy, Bubbeh scraped together enough dollars to make a down payment on a two-hundred-acre farm near Colchester, Connecticut, and joined a large group of her countrymen who were doing the same. Like the others, she worked the land with the help of a series of hired men, one after the other, usually Polish immigrants who spoke no more English than she did. How this four-foot-ten-inch iron-willed dynamo survived that period is difficult to know, because the farm was not very productive. Its real income, barely adequate for day-to-day expenses, came from the small contributions of family and old-country friends who stayed at the place for short periods to escape the tuberculosis-threatened closeness of lower Manhattan’s Tenth Ward.
As their source of refuge and a wellspring of fortitude against the confusing hurly-burly of America, Bubbeh took on the role of what I can only describe as a Yiddishe
mater et magistra
to an extended group of struggling young immigrants. Though she could not speak a comprehensible sentence of English, she somehow understood the rules and the rhythms of American life. If there were “wonder rabbis” in the old country, the enlarging clan had found a female fount of oracular stature in this new one, and bestowed upon her the honorific
tante
, or “aunt.” As Tante Peshe, which translates only inadequately into Aunt Pauline, her strength embraced a large and needy congregation of self-appointed nephews and nieces, some of whom were barely younger than she.
mater et magistra
to an extended group of struggling young immigrants. Though she could not speak a comprehensible sentence of English, she somehow understood the rules and the rhythms of American life. If there were “wonder rabbis” in the old country, the enlarging clan had found a female fount of oracular stature in this new one, and bestowed upon her the honorific
tante
, or “aunt.” As Tante Peshe, which translates only inadequately into Aunt Pauline, her strength embraced a large and needy congregation of self-appointed nephews and nieces, some of whom were barely younger than she.
Eventually, the farm had to be given up when all but one of the girls married. But long before then, the eldest daughter, Anna, had died in her twenties of childbed fever, and her young husband had gone off to pursue his own life. Left in mourning with Anna’s baby, Bubbeh raised him on the farm as her own son. He was in his late teens when the farm was sold, and the Bronx period of our family life began.
By the time I was eleven, my aunt Rose was my grandmother’s only surviving child. One had died during infancy, and the others in this land to which they had brought their dreams. Bubbeh was then eighty-nine years old, a tiny, exhausted figure, who kept life’s fires aglow, barely, for the sake of her three young grandchildren: my brother and me, as well as my thirteen-year-old cousin, Arline. Arline had come to us two years earlier when her mother died of kidney failure; she later left to live with her father’s family when my mother succumbed to cancer shortly after my eleventh birthday. The record of Bubbeh’s long widowhood was an unrelieved chronicle of struggle, sickness, and death. Her hopes had been lowered one by one into the grave with her husband and six children. There remained only my aunt Rose and the three of us born in the land whose promise had turned to heartbreak.
It must have been after my mother died that I first began to be conscious of just how ancient Bubbeh was. Since earliest memory, I had amused myself from time to time by playing idly with the loose, unresilient skin on the backs of her hands or near her elbows, gently drawing it out like stretched taffy, then watching in never-lessening wonder as it slowly resettled into place with an easy languor that made me think of molasses. She would slap my hand sharply when I did this, in mock annoyance at my boldness, and I would laugh teasingly until her eyes betrayed her own amusement at my feigned disrespect. In truth, she loved my touch, as I loved hers. Later, I became aware that I could produce a shallow pit in the tissues of her shin simply by pressing the lisle-stockinged skin hard against the bone with my fingertip. It took a long time for the pit to fill back in and disappear. Together, we would sit silently and watch it happen. With time, the pits became deeper and the filling-in period grew longer.
Bubbeh moved from room to room in slippered feet and with great care. As the years passed, the walk became a shuffle, and finally a kind of slow sliding, the foot never leaving the floor. If for any reason she had to move a bit faster, or if she was upset at one of us kids, she became short-winded, seeming to find it easier to breathe if she opened her mouth widely to draw in the air. Sometimes she let her tongue hang forward just a bit over her lower lip, as though in hope of absorbing some extra oxygen through its surface. I didn’t know it, of course, but she was beginning the gradual slide into congestive heart failure. Almost certainly, the failure was aggravated by the significant decline in the amount of oxygen that aged blood is capable of taking up from the aged tissues of the aged lung.
Slowly, her vision, too, began to fail. At first, it became my job to thread her sewing needles, but when she found herself unable to guide her fingers, she stopped mending altogether, and the holes in my socks and shirts had to await the few free evening moments of my chronically fatigued aunt Rose, who laughed at my puny attempts to teach myself to sew. (In retrospect, it seems hardly possible that I would one day be a surgeon; Bubbeh would have been very proud, and very surprised.) After some years, Bubbeh could no longer see well enough to wash dishes or even sweep the floor, because she couldn’t tell where the dust and dirt were. Nevertheless, she wouldn’t give up trying, in a futile effort to retain even this small evidence of her usefulness. Her persistent attempts to clean became a source of some of the small daily frictions that must have made her feel increasingly isolated from the rest of us.
In my early teens, I saw the last traces of the old combativeness disappear and my grandmother became almost meek. She had always been gentle with us kids, but meekness was something new—perhaps it was not so much meekness as a form of withdrawal, an acquiesence to the expanding power of the physical disablements that were subtly increasing her separation from us and from life.
Other things began to happen. In time, Bubbeh’s decreasing mobility and unsteadiness made it impossible for her to get to the bathroom at night, and so she slept with a large Maxwell House coffee can under the bed. Most nights, I would be awakened by her awkward attempts to find it in the dark or by the sound of her weak stream hitting its tinny inside. Many were the times I lay motionless in the predawn blackness, peering across the room at Bubbeh crouched uncomfortably alongside her bed, the coffee can held high under her nightgown with one unsteady hand as she tried to stabilize her tottering body against the mattress with the other.
I could never understand why Bubbeh had to get up so often for those nocturnal bouts with the coffee can, until many years later when I learned of the marked reduction in bladder capacity that occurs with age. Unlike many old people, Bubbeh never became incontinent, although I’m sure there were minor episodes I never knew about. Not until her very last months was she sometimes betrayed by the faint odor of urine, but even then only when I stood very close or hugged her frail form snugly against my body.
Bubbeh lost her last teeth when I was in early adolescence. She had saved all of them in a small change purse kept toward the back of the top drawer of a bureau she and Aunt Rose shared. One of the secret rituals of my childhood was to sneak into the drawer and gaze for a few moments in awe at those thirty-two yellow-white objects, no two of which seemed alike. To me, they were so many little milestones of my grandmother’s aging and the history of our family.
Even without teeth, Bubbeh somehow managed to eat most food. Toward the end, she lacked the strength even for that, and her nutrition suffered. The inadequate intake added to the usual decrease that aging causes in muscle mass, and it changed the configuration of her body, making her seem shriveled in comparison with the stalwart, slightly stoutish old lady I had once known. Her wrinkling increased, her complexion faded into a uniformity of mild pallor, the skin of her face seemed to hang ever more loosely, and the old-world beauty she had retained until her nineties was finally lost.
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