THE GREAT- GRANDMOTHER | Lilit Sargsyan

She’s 97 years old. When she was born, the great depression of 1929 hadn’t yet happened. She lived through how many wars? Too many. She watched her own grandparents die, then her parents, her siblings, two of four children, and God knows how many friends. Why has she been spared? She has her theories on this. She thinks perhaps her childhood dream of crossing 100 years of age has been taken seriously by the universe. Or maybe she’s still alive because she needs to see her great-grandchildren, especially Sigmund, to a peaceful, happy existence. Or perhaps, her time won’t come until the lawsuit is settled, and she and her family finally get the compensation they deserve for the lands that were stolen from them early in the twentieth century.

This is just a cold, seemingly, but she can’t stop coughing and the fevers are wrecking her, especially at night, and Sigmund just showed up today and forced her to go to the ED. And now it’s pneumonia, and she’s on oxygen, in the ICU, “just in case,”although she heard one of the doctors outside her room say, “this was a really soft one, I can’t believe we accepted her.” She wasn’t sure whether to be insulted, pleased, confused, or all three. And what did they mean by “soft”? Sure, she didn’t have the muscle mass she used to, but she still walked three miles a day, every day, rain or shine. Especially rain.

The evening becomes harder. It’s harder to breathe, and the cough is choking her. The monitor beeps insistently. They walk in with a large contraption and change out her oxygen tubing for a much thicker bulkier one, they tell her she needs more oxygen, and this will provide more. They give her breathing treatments, and she knows some of the bags of fluid hanging are antibiotics. Last time she was hospitalized was in 2015 when her heart slowed down to 30 beats per minute and stayed there. She’d almost passed out but managed to drive to the hospital. Someone outside the door that time had called her “either brave or stupid, or both.” Humph. Three days later she had been discharged with a permanent pacemaker. They worried about her back then because of her age, she was 86, after all. Ha. She had to get the battery changed out last year, but she was back home early enough to still get her walk in that evening.

The hospital bed is deplorable. It’s soft and squishy in the worst ways, and the state of her bones and muscles requires something firm to be able to push off of even when simply shifting in bed. This bed just swallows her, like she’s the cheese in a soft-shell taco.

It’s six am, she’s barely slept, and breathing feels like a burden she’s very close to voluntarily relinquishing. They drag in yet another large machine and tell her they’re going to put her on positive pressure through a mask, which will help her with her oxygen problem and allow her to rest while the machine breathes for her. She’s too tired to fight, except to whisper that her dry mouth is killing her. They give her a wet sponge to suck on for a second and stick a large mask on her face and tighten it. There’s a clump of her hair that gets pulled and pinched underneath the neck strap, and it takes many minutes to explain this to the staff. She feels great relief when the hair is pulled out from the straps, but only for about thirteen seconds, at which point she becomes aware of how this mask is probably leaving a permanent imprint on her face.

It’s eight am, she dozed off for a little bit, the machine did in fact take some of the work of breathing away from her, as they’d said it would. Work of breathing. What a way to phrase things. These doctors invent ways to manipulate the English language just so that the general population mistakes confabulation for wisdom. She smirks to herself at that thought, which causes the machine to emit a high-pitched shriek that makes her eyelid twitch.

She’s not better, she can tell, and she feels like her lungs are filling up with even more junk. It’s hard to move, it’s hard to cough, she feels like a cylinder, just lying there, passive. Someone approaches her bedside. It’s Sigmund. She cannot be happier to see him, and suddenly she’s crying. I thought I’d run out of tears, crosses her mind, when is the last time I cried? It dawns on her that somewhere deep inside her mind she’d wondered if she was going to die that night and never see him again.

Sigmund is her youngest great-grandchild, and at twenty, he’s still so green, such a baby, but also, he’s technically an adult, and of all her family, the one who’s closest to her. She watched him grow up, she ushered him into this tenuous adulthood, and it was not right that he was the one helping her now. Or maybe it was the rightest thing in the world.

By mid-day, she’s truly drowning. The doctors come in. They’re telling her that if they don’t intubate her, she’s going to die, but that she may still die if they intubate her. She rolls her eyes. How do they know when and why she’s going to die, when she’s defied a million opportunities already? How do they know anything? They talk about the other option, which is to choose to be comfortable. Who wouldn’t choose to be comfortable, she wonders? They say they can give her morphine and “a benzo” to let her relax, be able to breathe, and just enjoy the last hours of her life. Not sure what exactly she’s supposed to “enjoy.” The pressure ulcer that she can already feel is forming on her tailbone, the fact that she needed to have someone else wipe her bottom ten minutes ago, or are they referring to the narcotic haze they are promising her in exchange for her agreement to not want to get better? They say “at your age” at least twice, each.

“At your age, it’s unlikely you’ll get off the ventilator.” Why, she wonders, when I speed walk for three miles every day?

“At your age, chances are your other organs will start to fail, like your kidneys.” Why, she wonders, if they’ve worked all this time just fine, and she knows people her age with only one kidney, and has two God-given kidneys?

“At your age, delirium is very possible, and that’s going to make it difficult to get you off the ventilator.” Why, she wonders, when she remembers every year like it was yesterday, every wedding, every grandchild’s birth, every book she’s read, and what she had for breakfast every day this past week, too? Her memory’s just fine, as is her disposition and attitude. They’re trying hard here to foul up those last two.

“At your age, you’ll probably get a hospital-acquired infection and may even die from it.” Why, she wonders, when the last time she had the flu was in 1985, and the last time she took antibiotics was twenty-six years ago after a spider bite got infected because she swam in the ocean? Was this doctor even born then?

No, she isn’t ready to die, she still has a stack of books on her bedside table at home as tall and crooked as the tower of Pisa to read with her new cataract-free eyes. She hasn’t yet visited Utah’s Arches, the one park that has somehow evaded her, and Sigmund is going to pick her up and drive her there next month. She still wants to make another round of all her favorite restaurants, and the Atlantic ocean, that flaky goddess, still owes her a calm swim. And Sigmund, her dearest one. She still has Sigmund to see deeper into adulthood.

So no, she isn’t ready to go yet, and “yes, please, hurry up and intubate me so we can get this pneumonia over with, I am a busy woman and have my life to get back to.”

She motions with a finger for Sigmund to come over, and whispers in his ear, with some struggle to get breaths in between words: “Make sure they don’t do me dirty and keep me on this thing forever. Make sure I get back to my life.”

And so, they intubate her, and she’s indeed in a bit of a narcotic haze from the fentanyl flowing into her veins. She can still hear the doctors standing around pontificating about her chances of extubation and survival. Maybe if they stop talking and start working, I’ll survive, she thinks.

And she does. The 97-year-old great-grandmother is successfully extubated on the fifth day of being on the ventilator, even as a twenty-two-year-old man lies dying in the same ICU. She hears them talk about him too. “How tragic, to die from leukemia at that age, how unlucky,” the voice of one her doctors. She feels sad for the young man, but her mind takes her straight to Camus, that wisest of all philosophers. Revolt, be free, and live with passion. The mottos of her life. He, too, died so young, killed in a car accident. How absurd indeed. These thoughts trigger a memory of how three years ago she decided to work again and managed to get herself hired at Bath & Body Works as a floor salesperson, spending her days talking about skin and body products to people who didn’t yet appreciate their youth. She lasted an entire six months before quitting on account of her manager being a quarter her age and not knowing how to do inventory. Maybe I’ll get another job, she thinks.

With the help of her nurse, she sits in a chair a few hours after coming off the ventilator. She takes her first halting steps around the ICU the next morning with the high flow oxygen device in tow, the cannula taped to her cheeks lest it fall out. She still needs help wiping her bottom, but at least she can do her business sitting on a bedside commode now as opposed to like a half-baked vegetable in that awful bed. Sigmund is at her bedside all the days.

Three days later she is moved out of the ICU into a lower-level ward. She hears the ICU team joke that she’ll likely outlive them all. Why are all these doctors always speaking so loudly? Don’t they think we can hear them?

A week after that she leaves the hospital, insisting to get out of the wheelchair and walk her “97-year-old backside out of this hellhole on my own two feet.”

***

Three weeks later, Sigmund walks into the ICU to let everyone know that his great-grandmother was out jogging “to get back into shape for our road trip,” according to a text she’d sent him that morning, when she was hit by a drunk driver, thrown into the air and onto the car, then tossed into the street at a jarring angle, breaking her neck on impact. I guess it was her time, Sigmund said.

It turned out that his great-grandmother had really appreciated everyone who’d helped her get better from her pneumonia. She had, in fact, felt some remorse at her ornery attitude, and hoped that everyone would forgive her.

At her funeral the next day, Sigmund looks at the faces of family and friends. He loved his great-grandmother; she was his person. He isn’t naïve enough to have thought she’d be around forever, what with her being in the zenith of her tenth decade on this Earth. Nonetheless, he misses her already.

He muses how absurd life is, how unpredictable, how comically ironic. How she subverted everyone’s expectations during her illness, then got herself killed in a freak accident while exercising. And what a view it must have been, a 97-year-old woman flying above the traffic in exercise gear. I bet she would’ve laughed to have seen herself, and to see us all gathered here in this abominable heat, standing around looking like sheep, Sigmund thinks. What a waste of time, life goes on, get out of here and go live it, he can almost hear her muttering. That is how she lived her life, learning lessons and moving forward, having new experiences even at 97.

Sigmund looks around once more at the dozens of people indeed standing around looking sheepish. He looks up to the sky, smiles, and walks away from the funeral. Yes, he has indeed learned a thing or two from her. It’s time to pack for his road trip to Utah.

Lilit Sargsyan is a pulmonary, critical care and sleep physician practicing in Houston, where she lives with her family. Sargsyan writes poetry, essays and short stories about life as a physician, mother and a human. Her work has appeared in The Pharos, The Journal of Medical Humanities, CHEST Journal, The American Journal of Surgery, Human Ties Digest and Doximity. In addition to writing, Sargsyan loves reading, music and puzzles. She can often be found with a book under a tree.