I left yet another house call to Ora with a heavy heart.

“I wish she would just die,” I said to Aliza, the clinic nurse. “May the merciful God, whom Ora honored all her life through charity, Sabbath meals, blessings, and prayer, finally gather her beneath His wings and release her from this suffering.”

I loved Ora dearly. Visiting her home was one of the quiet pleasures of my work. Even when she was battling pneumonia or uncontrolled hypertension, I never felt I was entering the home of a patient. I was arriving as a guest.

Whenever possible, I scheduled my non-urgent home visits on Thursdays. The house was already alive with preparations for the Sabbath. Daughters stirred pots in the kitchen while grandchildren wandered in and out, stopping for a blessing, a quick visit, or a taste from one of the simmering dishes. The house smelled of couscous and soup.

After examining Ora, we would sit in the living room with bowls of dates, nuts, and fruit while stories filled the afternoon.

Usually Eliyahu, Ora’s husband, joined us. His white beard spilled over his buttoned shirt, his eyes always smiling. Ora – or one of her daughters – would place before him a bowl of freshly cooked food and thick slices of dark bread as he told us the story of their 70 years together. They had immigrated from Morocco in the 1960s, settled in a small village overlooking the Judean Hills, and raised 10 children. “Good people,” Eliyahu always said with pride. “Honest people. Hard-working people. Family people.” Every Sabbath and holiday they returned, filling the house with voices, laughter, and food.

If we declined lunch because more patients were waiting, Ora hurried into the kitchen and packed containers of couscous, soup, and homemade cookies.

“Take these for Shabbat, Dr. Ruth,” she insisted. “You work too hard to cook.”

Then Eliyahu developed Alzheimer’s disease. For years Ora and their children cared for him at home. They fed him, bathed him, wheeled him to the synagogue, and honored him until his final day. Ora never complained, never questioned God, never asked us to sedate him, even during sleepless nights. She accepted him as he had become – with tenderness, dignity, and peace.

When Eliyahu died at home, just weeks before his hundredth birthday, the entire village accompanied him to the cemetery.

During the days of mourning, it became clear that Ora was no longer herself. She sweetened her coffee – and ours – with spoonful after spoonful of sugar. She forgot how to cook, then how to clean, and eventually how to eat. Within months she lost the ability to speak and became incontinent. Her family was ready. Now it was the daughters, daughters-in-law, and granddaughters who organized themselves. Every day, 2 daughters came to cook, clean, bathe their mother, and fill the house with stories about children, weddings, births, and everyday life. The familiar dishes still simmered on the stove. The house remained exactly as it had always been. Only Ora was disappearing.

“Dad declined over nearly ten years,” one daughter asked me. “How is it possible that Mom has deteriorated in just a few months?”

“Alzheimer’s can be unpredictable,” I answered. “I believe losing your father hastened the decline.”

I tried antidepressants, but the light gradually disappeared from Ora’s eyes. Then, as so often happens in advanced dementia, she stopped eating and drinking.

At first her family patiently fed her puréed food by spoon. We searched for reversible causes – a urinary tract infection, pneumonia, anything antibiotics might cure – but found nothing. After several weeks, she refused even that, pressing her lips together and turning her head away from every spoon. Her children rushed her to the clinic for intravenous fluids.

“She’ll become dehydrated.”

Two days later they were back.

“What do we do now?”

I suggested a family meeting.

Only a few days later, 8 siblings and their spouses filled Ora’s living room. Bowls of nuts and fruit sat on the table, just as they always had. Ora herself sat silently in her armchair, frail and gaunt.

I explained the course of advanced Alzheimer’s disease. Because Ora had never left advance directives, the decision belonged to them. We talked about the tension between preserving life and preventing suffering. I reassured them that the popular image of “starving to death” does not reflect what usually happens at this stage of dementia.

“We can keep her comfortable at home,” I said. “We can give fluids subcutaneously, treat any discomfort, and allow her to die peacefully in her own bed.”

“And the alternative?” one son asked.

I explained the option of inserting a feeding tube through the abdominal wall into the stomach.

I did not hide my opinion. “Your mother has lived a long, full life. The evidence shows that tube feeding in advanced dementia does not prevent aspiration pneumonia or improve quality of life. Let nature take its course. Let God take her home. Aliza and I will stay with you and support you, whatever happens.”

The children deliberated carefully. In the end, they chose artificial feeding.

“In this family,” one daughter said quietly, “we will not let our mother die of hunger.”

The procedure was simple. Everything that followed was not. Ora repeatedly reached beneath her clothes, searching for the unfamiliar tube, and several times pulled it out. Each time we replaced it.

“What do we do?” her daughters asked.

The family responded by caring even more intensely. Someone was always at her bedside, holding her hand, gently occupying her restless fingers, bathing her, changing her, feeding her, and welcoming every visitor with the same familiar invitation.

“Sit down. Have something to eat. Take some food home.”

Months passed. They became experts in tube feeding. Ora remained impeccably cared for. We had agreed on one limitation: no hospital admissions. Everything else, they wanted.

Whenever Ora developed pneumonia, influenza, or a urinary tract infection, they chose treatment.

“Whatever she needs. We will not let our mother die.”

As one infection followed another, I suggested that perhaps it was time to stop treating every new illness. The family disagreed. Without complaint, they continued bathing her, changing diapers, massaging her skin, embracing her, kissing her.

I could no longer bear it. At the end of every visit, I found myself thinking, I wish she would just die.

Eventually I said it aloud to Aliza. “May she finally be released from her suffering.”

Aliza looked at me quietly. “Or from ours?”

Perhaps the suffering was no longer Ora’s. Perhaps it was mine.

A year passed. Then another.

The anticipation I had once felt before visiting Ora’s home slowly gave way to dread. I found myself hoping – even dreaming – that someone would call to tell me she had died peacefully in her sleep. I cursed the day I had stopped trying to persuade the family and agreed to the feeding tube.

Then, at last, she died.

On the morning of Rosh Hashanah, her grandson called. “She’s having agonal breathing.”

When I arrived, the family had already understood. One by one, her children, grandchildren, and great-grandchildren approached her bed, whispered their farewells, and recited the Shema, the Jewish declaration of faith.

I remained until her final breath. For the first time in years, I felt relief.

My greatest surprise came during the shiva, the traditional 7-day Jewish mourning period.

Someone brought out 3 thick photo albums documenting the previous 2 years.

A grandson’s wedding. A granddaughter’s graduation. A bar mitzvah. A military promotion. A doctorate. Every family milestone had ended with a visit to Grandma Ora. Someone would place a spoon in her hand, gently guide it toward the smiling face of the bride, groom, child, or graduate, and together they would offer a spoonful of honey.

These were the very 2 years during which I had walked into this house burdened by sadness, frustration, and sometimes anger, silently repeating to myself, I wish she would just die. I turned page after page. Hundreds of photographs.

In every one, Ora’s face was the same expressionless face I had come to know. Yet the faces around her told a different story. Brides, children, scholars – all smiling, accepting a spoonful of honey from the grandmother they adored.

Only then did I understand. Ora had never ceased to be the center of this family. Every additional day of her life had been a gift to hundreds of descendants. She remained woven into their lives. No celebration felt complete without coming to Grandma Ora, tasting honey from her hand, and preserving the moment in a photograph. They were not keeping her alive because they could not let go. They were keeping her within the life of the family because, for them, she still belonged there.

As I left the shiva, I found myself thinking, What do you understand, anyway?

For the first time, I wished that I, too, had been invited to taste a spoonful of honey from Grandma Ora’s hand.