By Susan S. Levine


Will’s parents must have decided together that Sandra would be the one to help them die. When living wills first became a thing, Naomi and Mel’s attorney advised them to make a videotape of themselves compos mentis affirming their final wishes. This was to be Sandra’s first assignment.
Naomi and Mel Krasnapol sat next to each other on the custom-made green silk sofa, its curving lines echoed by the coordinated glass-topped coffee table. Naomi crossed her ankles, always ladylike, posture erect, while Mel leaned back, his not yet stiff-jointed lanky arm behind his petite, plump wife; he seemed to inhabit space enough for two. Her parents-in-law were a complementary set, Sandra thought, like the foot-high Lladró nurse and doctor figurines that had been pushed out of the camera’s eye. Naomi was not a nurse, but she had managed Mel’s general practice at home until he became the diet doctor for Boston Brahmins. He then moved his office to Beacon Hill and his family to the Wellesley mansion in whose library they sat for the video. Mel and then Naomi read their identical scripts aloud, clearly and with determination, one after the other. Mel always went first, Sandra thought.

Mel and Naomi  looked into Sandra’s soul through the eye of the huge shoulder-held video camera. “I am not afraid to die—I am only afraid of suffering.” How had that conversation gone, she wondered, the one in which they chose her for this intimate encounter? How did they decide that she was the one who’d be able to hold the camera steady?
Sandra was always uneasy about Naomi and Mel’s apparent shrewdness in choosing her for this responsibility rather than Will or his younger brother, Andrew—or, for that matter, Sophie, Andrew’s wife. Sandra and her PILs—they called her their DIL—had fallen in puppy love with each other when Will introduced them. But the disappointments accrued each holiday, as Mel and Naomi realized that their heartfelt and elaborate observances did not tempt Sandra to depart from her strictly cultural Jewishness. Mel liked to tell a joke about a nervous bride reminding herself of the order of the ceremony: “First I walk down the aisle, then I stop at the altar, and then comes the hymn. Aisle altar hymn.” He would eye Sandra as he uttered the punch line, his ironic guffaw seasoned by equal measures of hurt, confusion, and self-righteous offense that she had not chosen to become observant. Once Sandra was so peeved by Mel’s condescension that she found a way to leave the seder table early, unspoken rejoinders in her mind about the fact that Will had “altared hymnself” before he married her.
Mel professed (too much) not to be disappointed that Will had become a professor (Princeton—philosophy and film) rather than a doctor, and Sandra knew he was pleased that she was a fellow healer. Naomi’s most acute disappointment might have been the discovery that Sandra, the highly organized psychoanalyst, was no balabusta: when Will and Sandra’s two-year-old son, Jonathan, asked what the “roaring machine” was, she gasped, “You mean you’ve never seen your mother use a vacuum cleaner, honey?” Her laughter perfused with astonishment, she repeated Jonathan’s unwitting revelation to Will and Sandra when they returned to pick him up on their way back home to Philadelphia after a long getaway weekend in Rhode Island.
Yet Sandra knew Mel and Naomi loved her despite their disappointments, and she loved them for this. She aspired to such generosity of spirit even as she sometimes thought of her PILs as oddly unsophisticated, simple.Material success was important to them—they collected fine objects, and dressed to fit their station—yet they were devoid of vanity. They were aware that evil existed, yet they reflexively searched for threads of decency within tapestries of malevolence. So they struggled mightily with the basic fact of Sandra’s life—that her birth parents had abandoned her, that they had not wanted or loved her. Sandra thought it a strangely childlike worldview, especially for Mel, who must have observed the vicissitudes of human emotion in his medical practice for decades. Not even Sandra’s adoptive parents, Doe (her mother’s cousin) and his wife, Daff—“Joseph” and “Daphne” having been beyond a tot’s phonetic capacity—could budge them. “It’s true,” Doe would say. “They just up and left. The nanny had to call child protective services.”
“How could they not have loved her?” Mel would ask, echoed by Naomi: “They must have thought they’d made other arrangements. No mother could walk away from her own child like that.”
Whenever Sandra told her all-time favorite joke, she prefaced it with the disclaimer that Naomi was a lovely person.
Two cannibals are sitting around a fire. One says to the other, “Gee, I really don’t like my mother-in-law.” The other says, “So try the potatoes.”
Naturally, Sandra had never recited this Garrison Keillor gem to Mel and Naomi. As penance for her pleasure, she imagined offering the joke as a gift to her imagined future daughter-in-law at the imagined rehearsal dinner prior to Jonathan’s imagined future wedding. But it would have been impossible for Sandra the psychoanalyst to deny that this joke carried just the right amount of aggressive weight, a certain satisfaction. So they had retreated, Sandra and Naomi, from initial infatuation to affectionate standoff, respect and love tinged by awareness and wariness of the ways in which they were alien to each other.
Years later, during her and Will’s final visit to Château Krasnapol, the two women stood before a spread of finery on Naomi’s dining-room table, which had once seated sixteen.
“Honey, which china do you like best? The Lenox or the Royal Tuscan?” asked Naomi. Sophie, the other DIL, had already had her first choice of sterling. Two sets of everything, of course. Sandra imagined all the briskets and fish bones these plates had once held.
“I’ll divvy up the linens myself unless there’s something you’ve had your eye on.” Suddenly Naomi’s voice broke, and, to Sandra’s astonishment, she began to cry. Sandra took her arm and guided her to the library, the scene of the videotaping so many years earlier. “What am I going to do?” Naomi sobbed between gasping breaths. “What will I do when Mel goes? You have a career. You and Sophie. If something happens to Will, you have your career. Mel is all I’ve got.”
Sandra—the psychologist so practiced in finding the right words—did not know what to say. She gave Naomi a hug and then went to the kitchen for a glass of water and a box of tissues. They sat together on the green silk sofa, Naomi’s small hand in Sandra’s.
The videotape of the recitations was nowhere to be found when the four of them cleaned out Naomi’s apartment after her death. They did, however, find a pair of diamond stud earrings loose among a mess of scarves, the stones so filthy that Sandra almost threw them away as paste. They later weighed in at almost two carats each. Sandra could not remember ever seeing them in Naomi’s ears—not even at the their fiftieth anniversary party, which was especially strange since Mel had given her a large diamond pendant that would have been the perfect match. The diamonds were turned into necklaces for Sophie and Andrew’s daughters.
Mel and Naomi moved out of Château Krasnapol in their late eighties so that he could die first and leave Naomi in the hands of their sons. Halcyon Heights—who could have thought up such a name?—was the most elegant retirement community on Philadelphia’s Main Line, near both Will and Andrew. Mel’s heart was failing and his prostate was toxic.
His death was not an easy one.
DNR. Everybody knew what that was. But who knew there was also a DNH—“Do not hospitalize”? Do not hijack this poor dying person to the ER at the slightest change in mental status, at the slightest bout of dizziness. Nobody told Will and Andrew about DNH until the final month of Mel’s life, until their ninety-year-old father had been prepped for a colonoscopy after a small amount of rectal bleeding only to learn that a heart attack within the previous six months is a contraindication for the procedure. No one had bothered to check Mel’s medical record; Will just happened to be there when the anesthesiologist ran down her checklist.
When Mel was moved into Halcyon’s nursing center, nobody recommended transferring him to hospice until after he became frankly, disturbingly paranoid. One morning he woke every patient on his hall by screaming that Naomi’s apartment was on fire. The next day he accused a male aide of offering to procure a prostitute for him. Two days later he accused Will of stealing from his estate, of trying to kill him off for the money. Will was deeply stung, though he knew intellectually that Mel was having a kind of waking nightmare. Mel was calm only when Naomi was in the chair beside his bed. The sons and their wives could not see that any good would emerge from telling Naomi of these indignities. But they knew they would have to find a way to do better for her when the time came.
Sandra realized that the kindest thing one can ever say is to wish someone a good death.
After Mel’s death, Naomi fared well for several years, better than Sandra or anyone else expected. Mel had always drummed into the boys that they should treat Naomi as though every day were Mother’s Day, and they responded to her requests possibly faster than Mel himself would have done. Andrew or Will, sometimes Sophie or Sandra, made on-demand ninety-minute round trips to Halcyon Heights to replace batteries that were not dead, or to help Naomi retrieve a voice mail. She never went to a doctor’s appointment without one of her sons.
At age ninety, Naomi developed a career of sorts, winning election as the residents’ representative to Halcyon’s board of directors. She succeeded in getting the dietitian to add vegetarian and low-sodium choices to the menu. She led the crusade to have better lighting installed in the hallways. She played bridge several evenings a week and swam laps in the pool daily. Her newfound near-orgasmic enjoyments—sliced mangoes and the picture window in her apartment—were disconcerting to her children and grandchildren, who’d never had occasion to suspect her of sensuality.
Naomi still dressed as she had every day in Wellesley. A skirt and sweater set, a pantsuit rarely, always a brooch and earrings, and—without fail—lipstick. She looked perfectly turned out from across the large and elegant communal dining room or in the auditorium at a concert or lecture, but up close one could not help notice that her garments badly needed attention from a dry cleaner. She continued to paint her nails in pearlized white, but the polish was always worn and chipped. The dishes in her kitchen cabinet were no longer spotless. “Will,” Sandra would say in the car on the way home, “when I start smelling of old lady, give me three warnings and then take me out and shoot me.”
Will and Sandra were saddened by these deteriorations and discomfited, because Naomi used to be fastidious about her person and industrious in her home. She continued to work on mending, which she took from her large green woven sewing basket whenever she watched television, though Sandra wondered how there could always be a hem to repair. She herself loathed sewing of any kind. She once procrastinated for weeks before reattaching a button to a coat and was both mystified and relieved not to have found it where she’d put it, in the coat’s deep pocket. One day as she reached for The New Yorker in her analyst’s waiting room, she realized, mortified, that the button that had been sitting on the corner of his coffee table for more than a month was hers.
Sandra was exquisitely conscious of how different her priorities were from Naomi’s, yet she wondered if there might be a small girlish pleasure they could share.
“Will, do you think she’d like it if I offered to do her nails for her?”
“She might, yeah. I think she used to get a red manicure—no; pink, maybe—every Friday, when she had her hair done up like Jackie Kennedy’s.”
So at her next visit Sandra brought a selection of polishes. Naomi hesitated: temptation, disapprobation, then something undefinable flickered over her face. Finally she smiled and said she thought she would like a manicure. She took the bottles to the window, where the light was best, and chose a smoky shade of red. Sandra sent her to the bathroom as she covered the woven placemats on the kitchen table with layers of paper towels to catch drips. Naomi seemed to enjoy the ritual. “A top coat, too! You’re like a professional,” she said. But a couple of minutes after Sandra finished, Naomi had to use the bathroom again, and the polish got badly smudged. She appeared not to notice.
The first emergency hospitalization turned out to be just a urinary tract infection, likely attributable to dehydration. But Naomi had alarmed all her bridge friends by accusing them of cheating and storming out of the game room; after a shocked silence, they’d decided to walk down the hall to tell the on-duty nurse in the wellness center.
The emergencies gathered momentum and severity, and they almost invariably occurred on Friday nights as Will and Sandra were taking the first sip of their martinis. Pavlovian foreboding ensued every time the landline rang.
Sandra and Will were exhausted after more than a year of being on call. Desperate for two quiet weeks, they left for Newport after Sandra finished with her patients on a sweltering August Friday. But Will’s phone rang as they crossed from Connecticut into Rhode Island.
“Mr. Krasnapol? I’m calling from the Halcyon Heights wellness center. We’ve had to call an ambulance for your mother. She’s having what’s probably a sodium-hydration crisis, and our doctor is in the middle of office hours at his practice. They’re probably going to admit her for observation over the weekend until a rheumatologist can see her on Monday.” Protocol, naturally, prohibited the wellness center from initiating a call to Naomi’s own specialist. “I couldn’t reach your brother, even though your mother told us you were on vacation.”
Sandra left messages on Andrew and Sophie’s cell phones, then called Sophie’s office, only to be told that she was going to be in Amsterdam for the coming week. They must have confused the dates of their solo Naomi duty.
Sandra then reached Naomi in her hospital room. Naomi’s words, corrugated with pain, and withoutirony, emerged from the car’s speaker. “I’ll be all right. Don’t worry about me. Have a good time.”
As they pulled into the hotel parking lot, Will imitated Mel’s cadences.
How many Jewish sons does it take to change a lightbulb?
None. “Don’t mind me—I’ll sit in the dark.”
It was late, and Sandra and Will were too tired and dispirited to drive back to Philadelphia that night. They left after breakfast the next morning. Naturally, there was a two-hour jam around the George Washington Bridge, and they did not reach the hospital until late afternoon, bleary-eyed from the relentless sun glare, sapped by futile annoyance, famished. They went directly to Naomi’s room. She wept. “Oh, I feel so guilty, so guilty. I know how hard the two of you work.” Sandra almost cried, too, for the lost vacation and for the slow tragedy of Naomi’s decline, but she spoke truthfully: “We wouldn’t have been able to enjoy ourselves knowing that you were here all by yourself.”
Will went to get them something from the cafeteria, so the two women were alone. Even the touch of the blanket brought tears to Naomi’s eyes, so Sandra touched her hand gingerly. She was surprised when Naomi gripped firmly and pulled Sandra close to her. “I do not want this. I do not want it.” No minced words. No ambivalence. Words spoken when neither son could hear them. Was she afraid to let them down, to acknowledge that she was ready to stop mothering them? Could she only say this to the “child” with whom she had been least close? Although there was the deepest trust possible in Naomi’s plea, Sandra felt exposed, wondering if Naomi was blind to Sandra’s ambivalence—or relying upon it.
Sandra put her own discomfort aside. “I won’t let them hurt you,” she said. “I’ll do everything I can. I promise.” Naomi nodded, her gaze notarizing this solemn contract.
Naomi remained in the hospital for almost a week, after which she was still not well enough to return to her apartment. Will, Sandra, Andrew, and Sophie were relieved to know that she’d finally be in the nursing center, where the staff could monitor her symptoms and prevent further useless ambulance trips.
Yet the two sons and their wives had now become the naive ones, disappointment and disbelief mounting almost daily. Despite their efforts, Naomi seemed to be in precisely the situation they dreaded. For every couple of weeks there was something—an unexplained fever, a fainting spell, a fall—that would require the nurses to send Naomi to the hospital yet again. That was the protocol. Once there were two emergency room visits in as many days.
Her physicians seemed to regard Naomi as a collection of unconnected components. The neurologist said, “Your mother does not evidence signs of dementia.” The cardiologist: “Her heart is very strong.” The nephrologist: “She’ll be fine as long as she eats a can of anchovies every day to keep her sodium level up.” The internist at Halcyon, a Russian man whose voice never rose above a whisper, came and went like a ghost, never there to talk to the two sons. He did nothing to try to coordinate care. Every few days he told Naomi she’d be back in her apartment before she knew it. Naomi, after decades of deference to doctors, was full of disdain. “He doesn’t know his ass from his elbow.”
Naomi’s sons were taken aback that their mother knew this vulgarity, let alone uttered it. They were paralyzed by love, duty, and indecision when they heard her beg God to let her die. And they were utterly disoriented when, for the first time in her life, their mother, a doctor’s wife for sixty-four years, refused to obey her physician’s order for physical therapy.
Will related this exchange to Sandra after dinner that night. His sense of helplessness—resignation—grated on her.
“Will, do you realize that we’ve screwed this up?” She restrained herself from saying “you and Andrew”, even though both she and Sophie had let their husbands make all the decisions. “Your mother is being tormented in exactly the way she didn’t want. Just like your father. She is dying. Dying. That’s the reality. She knows it; we know it. But fucking Halcyon and the fucking doctors have got their heads up their asses. Somebody’s got to make them do their jobs!”
Will flinched, as though she’d hit him. He sat down heavily on the kitchen chair, the one whose caning needed to be replaced. He put his elbows on the table, propping his head in his hands. He gripped his scalp, tangling his wiry brown hair. The kitchen reeked of congealed Chilean sea bass remains.
“What were we supposed to do?” Will said. “When should I have told them no? Last week? Yesterday? Is now the right time? I don’t know.”
“Will, let me go talk to them tomorrow. Please. Maybe I can
Sandra’s words were drowned out by a sudden thumping from the pantry as the washing machine entered the spin cycle.
Will had to raise his voice, and that seemed to release his suppressed rage. “To do what? Say what? Do you think you have special power because you’re an analyst? Do you think you can do any better?” He practically screamed, “You tell me: Which fucking test did she not need?”
“I. Don’t. Know.” Sandra recoiled at her own harsh retort. “But I know that what’s going on now isn’t right. It’s got to be time to think about hospice. Why isn’t anyone saying this? They’re supposed to be the experts. I don’t get it. It’s time to be thinking about her dignity.”
“Fine. You want to go? Then go. Just stop ranting about it.”
“All right, I will. I’ll set it up first thing in the morning. I’ll cancel patients if I have to.” Sandra got up to rearrange the load of towels in the still-rocking washing machine. It was not the moment to say how disrespected, how minimized, she felt. But her last sentence brought Will back; she had not canceled a patient in years.
Sandra entered Naomi’s dimly lit, non-descript room as an aide was guiding her back to bed from the bathroom. Large photographs of the three grandchildren—her and Will’s Jonathan and Sophie and Andrew’s two girls—decorated the wheelchair-banged dresser next to the television. Sandra had only a couple of minutes before she was to meet the director of nursing and the social worker; the doctor, naturally, was not available.
“How am I?” asked Naomi with a strange passivity in a newly rough, almost masculine register. It was a plea from a woman whose sense of duty to life would not relinquish its grip. Sandra kissed the deep-wrinkled cheek and held the soft hand. “Mom, I don’t know yet. Is there anything specific you want me to ask them for you?”
“No, dear. Just how I’m doing.”
Sandra suddenly could not imagine the world without Naomi’s gravitational force in it. Would people and objects fly apart? Become weightless, untethered?
Sandra remembered the look that had passed between them that afternoon in the hospital when she promised to protect Naomi, and it fortified her. “Mom, do you want us to meet here, with you?”
“No, dear.” That roughness in her voice, so alien. “You’ll tell me what I need to know.”
As she walked to the conference room, Sandra passed other residents. Some using walkers, some parked outside their rooms in wheelchairs, watching the various comings and goings. Some were barely recognizable as the formerly sociable denizens of Halcyon’s formal dining room. As always, one emaciated, hunched man was positioned near the nurses’ station so that he would not have to moan in solitude. Naomi did not want to live like this.
Nurse Jackie—as patients and staff had christened her when the TV show first aired—was waiting outside a small windowless conference room. Elaborately swirled letters on the brass pin adorning the blue cardigan she wore over bright yellow scrubs proclaimed jacqueline elmont, rn. A young woman wearing a high blond ponytail and lavender ballet flats—tilda cohen, msw—was seated at the table flipping through a chart, giving the impression that she was studying for a final graduate school exam.
“Thank you both for meeting on such short notice,” Sandra began. “All of us are confused—my husband, my brother-in-law, sister-in-law, and I. Frustrated. I thought it would be helpful to get a sense of how you see Naomi, given your experience. We’ve only done this once before, and my father-in-law’s final weeks did not go well.”
Nurse Jackie summarized what they knew already: that there was no definable physical reason for Naomi’s decline. “We didn’t really expect her to stay in the nursing center for this long, but she’s not strong enough to be on her own. And the longer she lingers here, the less she seems to try.”
“Yes,” said Sandra. “That’s exactly what we’ve noticed. And yet she’s clinging to life.”
Nurse Jackie continued. “She’s badly deconditioned now from having been in bed for so long, and if she doesn’t start physical therapy within the next couple of days, she will lose any chance of walking. She’ll be in a wheelchair and very weak; she certainly wouldn’t be safe on her own. But all her organs are functioning pretty well, and there are no signs of anything shutting down. So she might well live for quite some time in a weakened, dependent condition.” Jackie’s voice brightened. “Now, with a week or two of intensive PT, she might be able to go back to her apartment with a part-time aide. Tilda, do you have anything to add?”
“I’ve been in to talk with her every few days,” said Tilda. “She’s really a sweet lady, one of the most popular of the residents. The ladies from the bridge club come every day—honestly, everybody at Halcyon Heights adores her.”
“How does she seem to you?” Sandra asked.
“She tells me she’s fine. On every visit she forgets that I’ve seen the pictures of her grandchildren, but she always remembers to ask about my prep for the LCSW exam. She’s so sweet.” Not the most sophisticated assessment she’d ever heard, Sandra thought. Was Tilda not aware that Naomi was treating her like a granddaughter and not like a social worker?
Sandra addressed herself mainly to Nurse Jackie. “Naomi says she wants to die. Did you know that?” She deliberately used the D-word so that the two women would know that she wouldn’t tolerate any pussyfooting around.
Tilda started; Jackie looked uneasy.
Sandra continued, “She doesn’t have much appetite, and she doesn’t seem to want to get out of bed except to use the bathroom. She’s absolutely clear about not wanting to go to the hospital again, so we finally got the DNH order, as you know. She’s not happy and not comfortable. I don’t think she’s depressed, but she’s anxious. I think she’s anxious about dying, but at the same time she seems anxious to die.”
“Well, Mrs. Krasnapol, I don’t see anything that screams ‘hospice’ to me.” Sandra could see Nurse Jackie imagining Medicare’s paperwork requirements. “Your mother-in-law is not in an active dying phase. It’s very unusual to call in hospice for psychological rather than medical reasons. I’ll arrange for our psychiatrist to see her when she’s in on Thursday.” Jackie’s pager buzzed, and she turned around briefly to silence it. “Hospice would certainly provide more personalized care than I and my staff can. And I suppose the hospice nurse would test her with a bit of exercise, to make sure. Hospice could always be canceled if she perks up and decides to do PT.”
Hospice urging a patient to accept ameliorative treatment? Wasn’t that inconsistent with the principle of palliative care? The picture they were painting was not clear. Something was not in focus for Nurse Jackie. Tilda shifted in her chair, reached up, and redid her ponytail. Nurse Jackie looked at her watch.
Sandra considered what had been said and what hadn’t. It was all about doing, all about action. Steps they—the professionals—could take. Not what should be done and what shouldn’t. Not about how to understand what Naomi wanted. Was it possible that they, too, had become so attached to Naomi, seduced by her solicitousness of them, that they were having trouble being objective?
Maybe I need to help them with this, she thought. Aloud she asked, “Is there something I’m not asking?”
The nurse and the social worker looked at each other, and Sandra saw their jaws set in tandem. Their hesitancy, their resistance was palpable. The two of them must be paralyzed in the face of the sons’ devotion, afraid that Will and Andrew would crumble at the truth.
“What would you do if this were your mother? Please—I really want to know what you think.”
Tilda looked terrified. Nurse Jackie looked down and sighed, perhaps remembering other such moments. Perhaps dreading yet another inevitable loss. Even if you work with the oldest of the old, Sandra supposed, death cannot be easy to accept.
Then Jackie drew herself up in her chair. “I think if it were my mother, I’d push to call in hospice. I wouldn’t want her to suffer anymore.”
Finally. Sandra felt as though the molecules of air had gelled around her, suspending her near the other side, in the opaque but silk-thin divide between life and whatever comes next. Between what we know and what we don’t.
Jackie and Tilda looked at her with concern.
“Thank you,” Sandra said, “I’m very grateful for your frankness.” This had been the most difficult clinical interview she’d ever conducted; she’d had to give them permission to give her permission. You did not have to be a psychoanalyst to have managed this conversation, but Sandra knew she wouldn’t have been able to find the right questions and tone if she had not been one.
“Mrs. Krasnapol,” said Tilda, “sometimes a dying person needs permission from the living. And maybe it’s time to tell her she can let go.”
My God, she’s right,thought Sandra.  Did I know that this is what I was going to have to do today? Sandra realized that she had underestimated young Tilda, whose comment had been perfectly timed.
Will asked later, but Sandra could not remember how the meeting ended. She only remembered feeling shaky and yet detached as she walked back to Naomi’s room. An immense window-wall in the central atrium overlooked a garden filled with browning yellow chrysanthemums. The morning’s heavy rain had crushed the fountain grasses. She put her hand on the cool glass and inhaled citrus and cinnamon, Halcyon’s bespoke potpourri.
Sandra was practiced in saying difficult things to people, but surrendering to death had never been a choice she’d had to outline for anybody. Naomi had no practice in dying, and Sandra had no training in helping people die. She had no idea what she would say. However, she knew how to listen. She would have to rely on that.
Sandra was also aware that she was impatient for Naomi to die. Was she still disappointed that Naomi hadn’t become a bestfriendmother to her? It wasn’t because Naomi hadn’t tried. But did Sandra’s willingness to help Naomi die simultaneously gratify her wish to tell her own birth mother to fuck off? Unlike my birth mother, this tiny wrinkled woman has mothered me. She has been loving and loyal in her ambivalence, as I’ve been. For all these decades. So devoted she won’t allow herself to let go.
But they all were impatient for this ordeal to end, their irritation in continuous conflict with empathy and dread. Was there a distinction between helping a tired old lady let go and assisting a suicide? Still, this was Naomi’s existential ordeal, Naomi’s decision. Sandra’s job was to give Naomi a neutral, clear-eyed description of her choices. Neutral, that is, within a matrix of caring. Caring without imposing her own feelings. Permission without the slightest nudge. She thought back to Mel and realized that trying to give him permission to let go would have been disastrous. He’d been so paranoid that it would have felt to him like attempted murder. But Naomi might be ready.
Sandra entered the darkened room and sat on the faux leather armchair next to the bed. Naomi was dozing. Sandra leaned back and closed her own eyes, gathered her thoughts. She was startled by Naomi’s voice. “So how am I?”
Sandra sat up in the chair and took a deep breath, clearing her mind of everything outside this room, readying herself for the most careful listening she had ever done.
“Okay, Mom, here’s what they said. The most important thing is that it is entirely up to you now. You have a big choice to make, and you only have a couple of days to decide. You can start physical therapy, and they think that could help you get strong enough to go back to your apartment. But if you don’t begin that in the next day or so, you’ll have become so weak from being in bed that it will be too late for it to help. After that, you might be well enough to leave the nursing center, but you’d need to move into assisted living. Do you understand?”
“Yes. If I don’t do it now, it’ll be too late.
“Exactly. And the more active you are, the stronger you’ll feel.”
“What should I do? What do you all think I should do?”
“We don’t know. The other thing . . . you’ve seemed anxious. I told them that I don’t think you’re depressed, but they suggested having the psychiatrist talk with you later this week. Would that be okay?”
“What could she do for me?”
“There might be a medication
Naomi emitted a dismissive sound.
Sandra realized that she had taken a step away from full truthfulness, from the imperative of the encounter; she had momentarily let Naomi down. She thought of the game in which you try to find something, and the other person guides you by saying “Warmer” or “Colder” with each step you take. The offer of psychiatric help had been a stride toward “cold.”
Sandra took another deep, quiet breath, again clearing her mind of all considerations but Naomi’s.
“Mom, Will and Andrew and Sophie don’t know yet what I learned today, but . . . .” Naomi’s eyes were tired but steady. “We all feel the same. We love you. You were a wonderful wife and you are a wonderful mother. You’ve treated Sophie and me like daughters, not daughters-in-law. You have been an amazing grandmother, the very best. We want you to stay as long as you want to be here. We will miss you terribly when you’re gone. But we’re all right. You’ve taken good care of us. You don’t have to worry about us any longer.”
Naomi fumbled with the sleeve of her bathrobe and withdrew a crumpled tissue. She tried to wipe moistness from the corner of her mouth, but her arm fell back across her chest. Sandra got a fresh tissue and did it for her.
“Sandra, dear, I’ve had enough living. I’ve held up the my side of the family long enough. My brothers and sisters are all gone. I’ve had enough.”
Sandra’s heart pounded, and even as she knew she had to put her own feelings aside, she heard herself say, “You might feel better in a few days, if you do some physical therapy and get a little stronger.” She realized, astonished, that she was afraid to let Naomi go.
Naomi spoke softly, kindly. “I don’t want to feel any stronger, dear. I’m ready.”
Sandra remembered the video. “I am not afraid to die—I am only afraid of suffering.”
Push her, test her. So that we know beyond a doubt that the wish is hers.
“Mom, how about the bridge club? I saw Esther in the hallway, and she is so eager for you to be back. Wouldn’t you like to play with the girls again?”
“Sandra, Esther was here this morning, nagging at me again. Do me a favor: tell her that Naomi has played enough bridge.”
It happened shockingly fast. The next day, a Tuesday, the hospice team arrived. The nurse called Will that afternoon to say that she thought Naomi might have a couple of months left.  


Early Wednesday morning, the nurse called the house, but Will had already left for his eleven o’clock seminar in Princeton. “Anybody who wants to should come or call immediately,” she said. “It’s probably a matter of hours. I’ve got her on morphine, and she’s quite comfortable. She can’t speak any longer, but she’s understanding everything.” Sandra called everybody and gave them the nurse’s cellphone number. Within minutes, Naomi heard love, gratitude, and tearful goodbyes from all three grandchildren. But when Will and Andrew arrived at Halcyon Heights, they were already orphans. Bereaved but dry-eyed, in equal measure guilty and relieved.


Copyright © Susan S. Levine 2024 

Susan S. Levine is a psychoanalyst and clinical social worker with forty years of experience. She is the author of Useful Servants (Jason Aronson, 1996) and Loving Psychoanalysis (Jason Aronson, 2009)—a finalist for the Gradiva Award for best clinical book—as well as the editor of Dignity Matters (Routledge, 2018), to which she contributed an essay on Hitchcock’s Vertigo. She has taught clinical writing at the Psychoanalytic Center of Philadelphia for many years. "Dignity" is one of seventeen (and counting) stories about Sandra Krasnapol's world. For more information, please visit SusanSLevine.com.

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