premodernworld,howhewantedtolivewashischoice,
and the family’s role was to make it possible.
My grandfather finally died at the age of almost a
hundredandten.Ithappenedafterhehithisheadfalling
offa bus.Hewasgoing tothecourthouseinanearby
townonbusiness,whichitselfseemscrazy,butitwasa
priority tohim. Thebusbeganto movewhile hewas
gettingoffand,althoughhewasaccompaniedbyfamily,
he fell. Most probably, he developed a subdural
hematoma—bleedinginsidehisskull.Myunclegothim
home,andoverthenextcoupleofdayshefadedaway.
Hegot to livethewayhe wishedand withhis family
around him right to the end.
FORMOSTOFhumanhistory,forthosefewpeoplewho
actually survived to old age, Sitaram Gawande’s
experience was the norm. Elders were cared for in
multigenerationalsystems, oftenwith three generations
living under one roof. Even when the nuclear family
replacedtheextendedfamily(asitdidinnorthernEurope
severalcenturiesago),theelderlywere notlefttocope
with the infirmities of age on their own. Children
typicallylefthomeassoonastheywere oldenoughto
start families of their own. But one child usually
remained, often the youngest daughter, if the parents
survived intosenescence. This wasthelot ofthepoet
Emily Dickinson, in Amherst, Massachusetts, in the
mid-nineteenth century. Her elder brother left home,
married,and starteda family,but sheandher younger
sister stayed with their parents until they died. As it
happened,Emily’sfatherlivedtotheageofseventy-one,
by which time shewas in her forties,and her mother