The Long Goodbye

For five months, I was my parents' death panel. And where the costly chaos of Medicare failed, a team of salaried doctors and nurses offered a better way

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Courtesy Joe Klein

The phone call came on a cloudy morning in Iowa. I was interviewing Senator Chuck Grassley in his farm kitchen, surrounded by a sea of corn. Mom was back in the hospital again. She had pneumonia. She wasn't eating. "If we don't put in a feeding tube," my mother's internist told me, "she won't survive on her own."

Mom had always been vehement about how she wanted to go. "Just pull the plug. Let me die," she would say, with more than a hint of melodrama. "I don't want to be a vegetable." But was she a vegetable now? She had been suffering from dementia for several years and at times seemed to be living on a different, prohibitively weird planet populated by angels, murderers and secret paramours. At one point, I called from the road, and she told me she had taken a lover. He was in bed with her right now. They had made love three times. (She was 91.) "Where's Dad?" I asked. In the other room, she said. Which was true, both literally and metaphorically: Dad was also suffering from dementia but of a less florid and more truculent variety. He rattled between wild rages and utter forgetfulness; he was intermittently incoherent, having lost much of his ability to locate words.

Over time, though, Mom's angels and imaginary lovers disappeared, and an eerie dullness set in. She was rather limited in her responses now. "That's nice," she would say when I told her about my children and grandchildren. "I love you too," she would say. She never initiated conversation, but occasionally I could still make her laugh. Vegetables don't laugh.

"If we don't put in the tube, how long does she have?" I asked the doctor. He wasn't sure. He was the sort of doctor who was allergic to certainty or even to ballpark estimates. "We've taken care of the pneumonia, but she's not eating," he repeated. So weeks? Days? She needs nourishment, he said. I was in Iowa. My brother was in Asia. I didn't want to sign a death sentence without even seeing her, without giving her a chance to rally. "O.K.," I told the doctor. "Put in the feeding tube. I'll be there as soon as I can."

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