“Why don’t you talk loud enough for the whole damn hospital to hear you?”

I’ve just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma’s room.

The nursing assistant whfo showed me in glares across the curtain at the other inhabitant.

“You shut up,” she tells the person firmly, “or I’ll smack you with a bedpan.”

Then, she leaves us alone.

I’m glad to have made it in time. Grandma has been on the cardiac wing for a week, and most of that time I’ve been waiting for the call telling me that she’s gone.

Sitting down beside her bed I ponder the poignancy of returning to the very hospital where I was born to say goodbye to someone who welcomed my arrival so many years ago.

When I was a kid in Syracuse, New York, Grandma always made the trip up from Ridgewood, New Jersey for holidays and birthdays. On summer vacations, we’d stop by her home on our way to the Jersey Shore. When I was in college near Atlantic City, I’d hop on the Garden State Parkway and visit her on weekends; we’d hang out and talk about books, sports and life. As a teenager, I’d lived in North Carolina, and when I moved back there after graduate school, tired of the Northeast’s hustle and bustle, Grandma and I stayed connected through letters and saw each other whenever I was on a road trip.

Now she’s no longer verbally responsive. I reach over and pick up one of the greeting cards from her bedside table. Reading it silently, I hear the lady behind the curtain grumbling and fumbling loudly with what sounds like her purse.

Whatever happens in the next moments, like it or not, she’s along for the ride, I think.

Grandma had always been a bit formal. When it came moral courage, social decorum and academics, she’d set the bar high, and her judgments could be really smart. Once, as a teen, I’d sent her an excited letter about a snowstorm — a rare event in the South — and she’d sent it back to me covered with red-ink markings pointing out all of my spelling and punctuation errors.

As I’d gotten older, though, I’d learned to see beneath her formality and efforts to instruct. I’d come to appreciate her loyalty to family and friends and her reliability — and the fact that, although her approval might at times feel conditional, the love in her heart never was. She delighted in hearing about my exploits on the baseball field, for example, and although she always expected a winning season, every loss — and there were many — was shrugged off as she found a silver lining or a way to blame it on the umpires.

Lying in the hospital bed, she appears to be in a light coma, something I’ve seen countless times as a hospice social worker. Somehow, each shallow breath seems even more tenuous when it’s someone you love.

“Grandma, I’m here with you.”

Her eyes twitch slightly, and her respirations increase. She’s listening.

The lady behind the curtain exhales a loud, exaggerated breath, eager for me to wrap things up. I feel a rush of anger and toy with the idea of threatening to toss her out the window but quickly refocus. I know why I’m here.

I leaf through the other greeting cards, selecting one with a spiritual theme invoking the unseen world in which Grandma had always placed so much trust.

After describing the dove soaring into the heavens and reading the psalm on the cover, I read her the message inside. It’s written in a shaky hand: “Dear Mary, I am praying for you. Hope you get better. If I don’t see you again in this world, we will meet in the next one.” The signature is illegible.

I pause, then notice that things on the other side of the curtain have become quiet. No more annoyed-sounding breaths or throat-clearings — no more smart-alecky comments.

I hope she’s asleep, I think. She’ll probably start snoring next.

Memories play through my mind. The musky smell and ethereal yellow light of the basement of Grandma’s home, where I’d spent hours as a child imagining magical encounters. I see her carrying paper grocery bags full of my favorite foods (rye bread, spaghetti and ice cream), offering encouraging phrases about “the lilies of the field,” sending me cut-out newspaper articles whenever she came across one that made her think of me.

“Grandma, do you remember the poster you gave me with the quote from Thoreau about following the sound of your own unique music wherever it leads? I appreciate the way you always encouraged me to listen to my heart and to go my own way,” I tell her.

I place my hand gently on her shoulder.

“Remember when we went to the diner downtown, and you told me stories about your family when you were growing up? Thank you for showing me how important family is, and how important it is to carry the memories and tell the stories of the people we love.”

Grandma’s respirations increase again. Still listening.

“Thank you for being my Grandma,” I say. “I love you.”

I hear the woman behind the curtain pull tissue from a box and blow her nose. Probably allergic to kindness or something.

I state the obvious: “Your body is winding down, Grandma, and your journey is almost over. I don’t know if you’re still fighting to live, or if you’re ready to die. If you’re fighting, I’m right beside you, sending you strength. But if you’re tired, if there’s even a small voice within that’s ready to let go, it’s okay to listen to that voice.”

I pause and let the silence expand. A bedside phone rings next to the lady behind the curtain, and I cringe, expecting her to begin a conversation.

The ring cuts off abruptly.

“Not now,” the voice whispers, full of emotion. “Don’t call back.”

I hear the phone click and feel warmth expand in my chest. She’s with us.

“Grandma, all the people you love will be okay,” I say. “We understand that soon it will be time for you to go. You always did your best, Grandma. You did a good job. It’s okay to go.”

After sitting silently for several minutes, I clear my throat to say goodbye. The lady behind the curtain blows her nose again, and I look at the curtain more closely. The sunshine streaming through the window illuminates the cloth, and I see her silhouetted in the hospital bed, hands clasped, head bowed. She is praying.

“I’m going to get moving now, Grandma. I’ll carry your story with me for the rest of my life, and I’ll carry your spirit. I wanted to see you again before you go. I wanted to say goodbye.”

It takes me ninety minutes to drive from Ridgewood to Whiting, where my other grandparents live. When I step inside their home, my grandfather tells me that they’ve just gotten a call that Grandma has died peacefully.

I think about the lady behind the curtain. I’m glad that she was there to bear witness.

Scott Janssen is a social worker. This piece was originally published in Pulse — voices from the heart of medicine. 

Image credit: Shutterstock.com