My Aunt Doris recently passed away, exactly two weeks before her birthday. She would have been 107.
I have been involved in health care for my entire professional life, as a hospital executive, consultant and professor of health care management. But the time spent with my aunt at the end of her life taught me more about living and dying than all my experience had prepared me for.
Doris lived in the same Manhattan apartment for seven decades. For years, she had stubbornly resisted moving into a relative’s home or assisted living community. When she was 103, she had a fall that landed her in the hospital, after which she agreed, reluctantly, to hire a live-in aide.
The aide was caring and capable, but over the next two years, Doris became exceedingly feeble and bedridden, her mind confused. Her breathing grew labored and her voice was practically inaudible when she told my wife, Amy, and me that she didn’t want to die with a “stranger,” whom we took to mean the aide.
When Amy said, “Doris, we would love for you to come live with us,” Doris, uncharacteristically, began to cry. With a look of gratitude, she whispered, “You would take me in?”
Dorisseemed moments away from death, and we wanted to honor her wish to be with family. It felt simple, naïvely so in retrospect, uncomplicated by the implications of an open-ended period of caregiving.
Her doctor felt that time was of the essence. With the help of a local home hospice agency, we readied our guest room and arranged for Doris to be transported to our New Jersey home.
As the ambulette crew delicately shifted a fragile Doris from her bed onto a stretcher, she appeared more a collection of bones than a person. Would she even survive this trip? She was nearly unresponsive, her eyes vacant. I held her frail hand, hoping she wasn’t frightened.
At our house, she lay nearly motionless in the hospital bed provided by the hospice agency. We began the vigil we were certain would not last long.
We hung some family photos that we had taken from Doris’s apartment on the wall next to her bed and sat at her bedside, describing each one. A photo from the 1940s showed Doris in a dark high-buttoned dress with pronounced shoulder pads, a look she called “handsome.” In another, from the 1960s, she was on a palm-tree-lined beach in California, posing happily with a few cousins. There was little sign that our story-telling was penetrating, but we persevered, hoping to spark familiar memories, like the Third Avenue Hudson Place waffle fries she loved and the 1940s maritime décor that caught her eye.
Doris stirred a bit over the next few days, her eyes becoming a little more focused. Then something of a miracle happened: Doris began a slow but steady journey back to her old self. Over the next few weeks, her cognition was almost fully restored. She began to feed herself and, with help, use the commode instead of the diapers she hated.
As winter gave way to spring, Doris sat in her wheelchair on our backyard deck. Her vision was weak, but she could make out the trees and see birds fluttering about. We had lengthy talks about her life. She was most animated when talking about her childhood. The eldest of four, Doris was born in Poland where she and her mother — my grandmother — remained while her father came to the United States in search of work and opportunity. They joined him in the United States when Doris was 7.
Doris entered the work world right out of high school. She was industrious and ambitious, eventually becoming an executive in a finance company. She never married, pouring herself into her work. When she retired at 91, she looked for volunteer work, becoming a docent at the New York Public Library.
Doris and I had formed a friendship years ago, when I became a young adult. Later, our children also developed close relationships with her, admiring her strength of character and feminist perspective that was shaped in the 1940s when she joined her company’s exclusively male executive ranks. She inspired us all, recounting how she walked everywhere in New York City: to her job, her volunteer work, the opera at the Met.
Now, living with us, Doris was determined to regain her strength and walk independently again. She returned to the exercise regimen she had been doing for years, mostly leg lifts, stretches and self-massages. Soon, Doris was able to raise herself out of her wheelchair and walk with the aid of a walker. She had a disciplined routine, counting her steps and charting her progress. Then she would sit back in her wheelchair and gaze at the trees in the backyard. She giggled when the dog licked her ice cream cone and her face. She delighted in the reawakening of her senses, asking to smell the newly blossoming lilacs.
Doris’s intellectual curiosity blossomed as well. We sat on the deck and talked every day. When the weather turned cold, our conversations moved indoors. She kept up with politics and her investments. A small circle of relatives who had visited her in New York came to visit her in New Jersey.
At one point she looked at Amy and me and said, “I never knew life could be so beautiful.”
After 17 months with us, Doris’s cognition again began to fade. I would initiate a discussion about my father — her brother — with whom she always had a special bond. He had passed away 15 years earlier. She stared at me blankly, conceding she did not know who I was talking about.
I then remembered an anecdote she had once told me and I shared it with her: When my father was a newborn, Doris rocked him in her arms while their mother was busy with household chores. “Oh, George, of course, my baby brother,” she said with a pleased grin, recalling a memory that was almost a hundred years old.
It often took a while to find the right trigger, the portal into a memory clouded by age and confusion. But once there, her mental wherewithal returned in full form. It remains a great challenge for caretakers, helping our elderly loved ones experience life that, no matter the constraints and limitations, no matter the place they live, is purposeful and enriching. We have a richer vocabulary for talking with our aging relatives about their health than about their dreams. And yet, what I discovered is that Doris thrived when she could make choices about how to spend her time, maintain control over her life story, and feel that those around her respected whatever autonomy she was capable of exercising.
In “Being Mortal,” Dr. Atul Gawande reminds us that meaningfulness is central to what we yearn for, and this doesn’t stop just because we get old. I came to appreciate that meaningfulness involved dignifying Doris’s desires, feelings, memories and even aspirations. In the journal The Gerontologist, Melanie Mallers and colleagues summarize research indicating that “lack of choice and self-determination can lead to poor physical fitness, decreased social support, and depression.” The will to go on can weaken when one feels stripped of empowerment in decisions made about one’s own life.
Among the more valuable lessons I learned is that actualization is feasible for a person of even significantly advanced age. A story Doris repeatedly told me in her last few months opened my eyes to this point. It was about a vacation Doris and her mother took in the 1950s. The motel housekeeper entered their room and appeared ill. My grandmother asked why she hadn’t stayed home. She replied that she needed the money. After insisting that the housekeeper lie down in her bed, my grandmother cleaned all the rooms assigned to the housekeeper.
This story was important to Doris because she revered her mother’s altruistic nature. But it also gnawed at her, fostering lingering self-doubt. Doris saw herself as incapable of exercising kindness in the manner of her mother. Although she was generous with time, advice and financial support, she could be brusque. She lacked confidence in the softer ways we reach others, through touch and expressions of warmth. As much as the story helped Doris celebrate her mother’s memory, it was a troubling reminder that she might have fallen short.
So we talked about generosity, about what giving looks like. It comes in many forms, hers just as valued as any other. In the end, she became gracious in ways I never thought possible. She talked about family as being something to cherish, to nurture. She initiated hugs rather than stiffening through them. Her final words, as she passed from life to death, a transition of merciful seamlessness, were “thank you.”
Amy and I thought that Doris would be living with us for a very short time, and we had invited her to stay with us thinking we could lend comfort to her in her final moments. But it transformed into something none of us anticipated, bringing new meaning to her life, even at 106.
She thanked us for this gift. But in learning about life, love, aging, meaningfulness and the power of connection, the gift was all ours.
Barry Eisenberg, Ph.D., is an associate professor of health care management in the School for Graduate Studies at SUNY Empire State College and a former hospital administrator.