Fighting for a peaceful death: a personal essay.

209 I HAVE ALWAYS referred to my grandmother as YaYa. She was the center stalk of the Hu family grapevine. As the matriarch, she sat and talked with everyone and learned from them details about each and every family member. Born in 1908, she lived through both World Wars and struggled to build a new life in the United States. She was 92 years old at her death. For someone who endured so much suffering, it’s remarkable how well her body and mind had weathered the years. My grandmother was born in Fujian, China. Her family left there to resettle in Hong Kong and then in Taiwan during the Second World War. By 1962 my dad was at Columbia University in New York City and by 1965, Grandma settled into her little apartment on 111th and Broadway, where she lived for 35 years until her death. She meandered through the local stores and bought the necessities of life. Despite her marginal English, she got by with many smiles and hand gestures. Most often, she would take her goods to the counter (where the checkout folks knew her well), smile, and reveal her food stamps. She trusted they would take the appropriate amounts. She mumbled a few words and held up a few fingers. No one knew how much communication was actually accomplished, but she maintained her independence. The lessons of life were transmitted from her smile and her gentle hand. Small, pale, and wrinkled, her hands reached out and stroked yours. She would pet you, as she gossiped about all her children and grandchildren. Her opinions and lessons were made clear, as she told stories from her long life. When she got to the main point of the story, she would squeeze your hand, both of her little hands squeezing the importance of her story into yours. Until 2 years before her death, YaYa had the pleasure of wonderful health. Pain and cough seemed to be her only complaints. The pain was vague and chronic. Raising two fingers into the air, she would request, “two pills.” Two Tylenol® seemed to be the answer most of the time. Her cough was not a real cough, but an active clearing of the throat: Ah-ah-hem-hmm. For the most part, however, YaYa did not believe in Western medicine. With the exception of the drugs for pain and cough, her faith was in God and in her Chinese herbs and medicines. She had a constant supply of Chinese remedies for all ailments. Who really knows if they did any good or any harm? Nevertheless, YaYa made regular appointments with her doctors. Initially she fired them left and right. Finally, Grandma settled on a young cardiologist who somehow earned her trust. He followed her only chronic medical problem: atrial fibrillation. She allowed him to check her eyes and blood pressure and to listen to her heart and lungs. However, she had no interest in or patience for preventive medicine. No colonoscopy, no mammograms, no visits to the gynecologist. Holding her finger up in the air and shaking her whole arm at you, she would kindly let you know her views. “When the heavens have these things determined, there’s nothing we can do,” she would say. The atrial fibrillation seemed to cause her few problems until the 2 years prior to her death. She was admitted to the hospital three times. The first was for rapid ventricular response and near syncope, and the others were for gastrointestinal bleeds. The first bleed was perhaps due to excessive anticoagulation. Endoscopy at the time of the second showed a large clot, but she refused the recommended postbleed endoscopy. She took