(The Root) — This is a story that begins with an end.
To be specific, it is about the end of a life that was very special to me. A life that taught me many things, lessons that I'm still learning as I evolve. A life that could have only been lived by one person. A life that was given the dignity of the kind of termination for which we all eventually wish.
This is a story about my father's beautiful death.
To keep it 100 percent real, Madison Gray Sr. and I were buddies, but our relationship was not without its tests.
I didn't always get along with my dad. I got into more than my fair share of trouble when I was younger, we rarely saw eye to eye on any number of topics and there was a great enough age gap between us (I was a late-in-life baby for him) that we sometimes seemed to be speaking a foreign language to each other.
But there was no doubt of my father's love for me, nor of mine for him.
There could be no better example than in June, when I came home to visit and went to his hospital bedside. He was tired, his mind was mostly gone and he spent most of his time asleep. His condition worsened as his always-youthful body began to realize, decades late, that he was well into his old age and that it was finally time for him to rest.
I walked into the hospital room and he immediately opened his eyes. Then he opened my eyes.
"Joey!" he shouted, his lungs seemingly having lost none of the strength he'd had in the years of having to get on my case for various reasons.
He was surprised to see me, since I had not been in town since Christmastime, and his glee brought a smile to my mother's face. It was the first time in months he had been so alert. I tried to speak to him and have a conversation, and he tried to keep up as much lucidity as possible to do the same.
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But the visit proved to be too much for him, as simply staying awake seemed to take all his strength. My mom and my sister had been his primary caretakers for the past year. They had helplessly watched him slide further into weakness. They were almost as exhausted as he was, but "Hey, it's Daddy," my big sis said. The two women shared the duty of his day-to-day care, but they knew of an inevitability that I had not spoken of with my brothers or my oldest sister.
I walked out of the hospital room with my mom and my girlfriend, who was tearing up. It all reminded her of her own father's passing two years before. My mom threw her arm around her shoulder, but had every expectation that I be as stoic as possible. I was a man, after all.
Sometimes, however, manhood means showing love. I went back into his room and hugged him, and kissed him on the forehead. He grinned and laughed a bit, then drifted back to sleep.
It was the last time I would ever connect with my dad.
One month later I was back, this time diverting my previous travel plans because my oldest sister told me that I should get home as soon as possible. She had already traveled back into town to be with him. Having worked as a geriatric nurse, she had the wherewithal to ask the hospital one important question: Is he a candidate for hospice care?
The answer to that was yes. And it meant that he didn't have long.
"He's waiting on you," my brother told me, as I packed my bags. Then it dawned on me: This man who raised a family, who served his country in war, who opened a successful business, whom everybody in Detroit knew in some way, who had been the picture of virility when his friends were becoming feeble at much younger ages — this man's number was finally being pulled.
"Goddamn it. How am I supposed to deal with this?" I selfishly muttered.
Saying Goodbye
When I got to Seasons Hospice and Palliative Care, a wing of the Detroit Medical Center's Sinai-Grace Hospital, I didn't know what to expect. I thought there would be a cloud of sickness and moaning, death singing its morose fugue. But that wasn't it at all, much to my surprise.
I met with Dr. Afzal Beemath, a young doctor who had been in palliative care for three years. He is now medical director of Palliative Medicine at Sinai-Grace, and he helps families like mine when this time arrives.
He explained to me that my dad had come to a point where continuing various medical procedures that would be administered in an intensive care unit would likely do more harm than good. What was most important was my father's comfort, and that his declining quality of life was as assuaged as possible, the doctor said.
This was a type of medicine that I really knew nothing of: a practice whose focus is as much on the loved ones of the infirm as it is on the patient. It gives alternatives that allow families to begin their healing process even before they are wounded by a death. It is a service of which I see few African-American families taking advantage, even though it would remove much of the emotional and financial toll of end-of-life care.
"Hospice and palliative medicine is taking all the weight off the camel's back," Dr. Beemath told me recently. "It gives patients relief. We don't abandon you; we help you."
At the time, my family began to see the relief given to our circumstance.
In the hospice, my father lay there, his breathing labored but short in a neurological response to the stimulus around him: my family coming to say goodbye. Over the course of the weekend, a host of relatives and friends had come to share stories about him. Stories I had never heard. I learned things about my dad, and maybe about myself. My sadness didn't abate, but as the hours turned into days I was much better prepared.
These were the things Dr. Beemath encouraged. He knew that having loved ones around, even if there was distance between some of us, would prove cathartic for all of us. Apparently, this is the purpose of hospice. It is not really a place to which someone goes to die; it is a place in which the living get to eulogize the dying while they are still with us.
"We helped calm your family down, we helped them recognize the bigger picture," Dr. Beemath explained. "When 20 people came in and they came with 20 stories about Dad, you get the picture that he lived 20 different lives.
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"If we had more outreach programs to educate people about things like this, it would make a big difference."
Facing Reality
Early in the health care reform debate, former Alaska Gov. Sarah Palin criticized President Obama's plan for reform for fostering "death panels" to determine who among the elderly should get medical care. Looking back, I can't believe how ridiculously insulting that argument was.
Medicare, which is constantly under fiscal threat, is largely used by the elderly, many who do not have the insurance coverage to take care of their needs. Conservatives have yet to come up with a plan that would help families actually make their most difficult decisions, and thus the cost of dying remains pointlessly high in this country.
In 2009, Medicare paid more than $50 billion for doctor and hospital bills in the final two months of patients' lives, but an estimated 20 to 30 percent of this spending had no effect. However, up to 20 percent of Americans spend their final moments in an ICU, according to CBS News.
What's more, a University of Pittsburgh study shows that a disproportionate number of African Americans remain in an ICU until they die, never knowing of the options my family had when it came to my father. Studies suggest that a cultural divide exists when it comes to making this decision. Research done by Duke University Medical Center shows that blacks may seek aggressive treatment for diseases even when chances of survival are low. This also suggests that because many prefer this method, they may not be aware of hospice options.
According to Hospicenet.org, patients and their families should know they can discuss hospice care at any time between themselves, physicians, spiritual advisers and friends. "At any time during a life-limiting illness, it's appropriate to discuss all of a patient's care options, including hospice. By law the decision belongs to the patient. Most hospices accept patients who have a life expectancy of six months or less and who are referred by their personal physician," the website says.
It was early on a Monday morning when I got up and prepared to drive my mom to the hospital to see my dad. They had been married more than 40 years and seemed to have seen it all — everything from the 1967 riots to a black president.
The phone rang and after a silence, my mother gasped. The moment had arrived. I took the phone from her, and a nurse explained everything.
Dad decided to make his move as independently as he had lived.
In silence, in solitude. In Dignity.
Perhaps he did it as the sun rose over the Motor City, cascading over what had been the Black Bottom, where he grew up.
Three-quarters of a million people were waking up to begin their daily gamble. But Dad had played his last hand.
He never showed his cards.
Finding Peace
My siblings and I, along with other family, began the process of giving him a proper burial. Death is a business. There are funeral homes, insurance, obituaries, finance, debates between relatives. It's like planning a wedding within a week, and it's one of those things that you never realize you can do until it's put to you.
But I was satisfied that at least my dad didn't have to be bothered with all this. His process of expiration was about taking his final journey, and it was helped by medical professionals who paid attention to what we needed. Because of that, there were no wounds caused by the indignity of suffering in a hospital, the way far too many people exit their lives.
By the end of the week, we were burying my old man. My mom stood over his casket, weeping. My oldest brother and sisters greeted and hugged relatives. Even though I realize this happens with every family, somehow there was something that felt very cultural about it. Very black.
My other brother put his arm around our mom's shoulder and simply said, "He's resting."
And so were we all.
Madison Gray is a Brooklyn, N.Y.-based writer and Web journalist. Follow him on Twitter.