My Grandmother’s Last Lesson

In the summer of 2006, I went to live with my grandmother, Esther, in the Bronx while I had an internship in nearby Manhattan. She and I had always been close, but these three months solidified our connection. She taught me how to navigate New York public transit and thorny college friendships. I taught her how to navigate AOL and countless cable channels. She learned to respect my morning quiet time, and I learned to appreciate her chatty every time.

Our closeness continued over the next 15 years, and then in March of 2020, the pandemic took our relationship to a new level. While I couldn't see her in person, I called every single day, and these conversations quickly became variations on a theme: shared complaints about the isolation, uncertainty and boredom relating to this new COVID era.

Sometimes our talks turned existential, where she would question the meaning of her life, at this moment, as a 91-year-old woman. In her mind, she was spending her limited savings on rent for a studio apartment in a retirement community where, because of the threat of the virus, her daily activities now consisted of eating three lukewarm meals in her apartment and taking two outdoor masked walks—alone.

The one new skill she learned during these months was how to Zoom—kind of. On most Sunday mornings, our extended family assembled online for a video chat. Fifteen minutes prior to each call, I would phone her and talk her through the painstaking steps that I hadn’t even realized were steps: find email with Zoom instructions, click on blue hyperlink, click Join Video and Join with Computer Audio, adjust laptop screen to see head (and not forehead).

Once her Zoom box came on the screen, though, it was entirely worth the pre-call agita. We were able to see Esther’s face, and more importantly she was able to see ours. We updated each other on our COVID lives (eat, work from home, walk, watch TV, sleep, repeat) and we commiserated about our slow-passing days and collective concern about the future of our world.

‘Zoom calls were hardly sufficient for Esther’s extroverted spirit, and she grew increasingly unhappy and disoriented.’

But these Zoom calls were hardly sufficient for Esther’s extroverted spirit, and she grew increasingly unhappy and disoriented with the social isolation from her family and friends. When it became clear that New York State regulations were not going to allow on-site visits in the near future, we took matters into our own hands. We negotiated with the residential staff to take Esther out for a family weekend at my parents’ nearby home and, provided that she return with a negative PCR test, no further quarantine would be needed.

My parents, aunt, sister and I eagerly awaited her arrival, but it was clear from the moment she walked through the door that this was not the same Esther we knew. She was slow, fragile and quiet of voice. A simple walk around the block required multiple breaks. And the next morning, she was unable—or unwilling—to rise from bed.

The fear, loneliness and inactivity brought on by the pandemic had essentially stripped her of her will to live and some combination of her body, mind and spirit began to wither. She lay there, vacillating between closed and open eyes, sleeping and lost in thought. We watched, bewildered, as her physical strength and interest in communicating with us waned. Yet in the moments when she was alert, she seemed relaxed and peaceful, and spoke about feeling ready, even eager, to die. She would look up at us and say, in a flash of dark humor, “Why is this taking so long?!”

The hospice agency referred by Esther’s long-time primary care provider informed us about what to expect during the dying process. They then guided us in how to keep her most comfortable at home through each evolving stage. With their skilled support, we tenderly cared for her over the next week as her body slowly shut down. When her breathing and heartbeat finally became imperceptible, we knew that her wish had been fulfilled.

We each had one last private moment with her, and then watched with a mix of deep sadness and relief as her body was gently carried away. She had completed the hard work of dying, and now we had to begin the hard work of mourning.

We planned another Zoom call for the following week, on what would have been her 92nd birthday. Fifteen minutes before the scheduled hour, I reached for my phone out of habit, only to realize that there was no one who needed computer coaching on the other end. My grandma—on her own terms—had already selected “Leave Meeting.”

Elana Kieffer directs the Center for Healthy Aging at The New York Academy of Medicine.

Photo: Elana Kieffer, right, with her grandmother in white and other relatives.