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Happily, the manager at Brookline Village was willing to forgive Dad their very public battle and let me move them into the on-site nursing home, called the Fairways. I told Dad it was necessary for Mom to go there because of the intricacies of the feeding tube, which wasn't entirely true. And then I reminded him, "You always said you wanted to be with her. Maybe you should go in too. It'll help Mom recover." He agreed, then forgot we'd had the conversation. It took three more such talks--one with their internist--to get him into the facility, and even then, Dad would try to break out. He occupied the elevator in protest one day; I had the nurses give him a tranquilizer. And I must admit, I could see his point. The nursing home was first-rate, with a wonderful staff, but it was a death factory. People went in and didn't come out. The fellow in the room next to Dad's, a stroke victim, roared and cried incomprehensibly throughout the day, a terrible sound. "Why can't we just die at home?" Dad asked. It was a fair point, but I couldn't give the real answer: because it was safer for them in the nursing home and, as I soon learned, the quality of medical care--which was provided by the Geisinger system--was much better than what they'd been receiving.
My first conversation with a Geisinger doctor, Victoria Devan, was refreshingly different in a no-bull sort of way. I told her I had mixed feelings about Mom's feeding tube, that Mom had left clear instructions against prolonging her life--but I'd been out of town, I'd wanted to see if she would recover her appetite, and I wasn't sure how many days she'd have if we didn't put in the tube. Devan said she understood, "but we should keep a close eye on it. When they lose their appetites, they're usually telling us something." Devan also told me that Mom would have had weeks, perhaps a month, more of life if we hadn't inserted the tube. What a relief: clear, simple sentences. When I asked Devan about it later, she said she'd been relieved as well. "You got it," she said. "Sometimes the family members don't. Sometimes they want us to do all sorts of things that just aren't realistic, and we have to be very patient about walking them through the reality of the situation. You understood where it was heading."
A week later, I checked in again with Devan. Mom was eating less than 10% of her meals. "Maybe we could reduce the amount of food she's getting through the tube and see if her appetite revives?" I asked. Devan agreed but told me once again, gently, that the odds were that Mom wasn't coming back. And she was right. After another week had passed, my brother came home from Asia, and my wife and children joined me in State College for a meeting with Dr. Charles Maxin, who was Devan's senior colleague. He seemed like a figment of Norman Rockwell's imagination--calm and reassuring and flagrantly decent. Like Devan, he didn't mince words. Mom wasn't responding; we were only prolonging the inevitable. He told us her death would not be painful. I looked around at my family and asked if anyone had any objections to pulling the plug on Mom. No one did.