first person

Who Dies

COVID took my grandfather. But it wasn’t what killed him.

The author at age 3 with Grandpa Charles. Photo: Courtesy of the author
The author at age 3 with Grandpa Charles. Photo: Courtesy of the author
The author at age 3 with Grandpa Charles. Photo: Courtesy of the author

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We cremated my grandfather the week I was supposed to get married. The white dress I bought a year ago still hangs in my closet, next to the black dress I brought home with me to Virginia. I’d flown back from New York the first week in September, when he was still alive, when there was still a chance he could stay that way. But we all knew the odds. The black dress was a precaution and a reminder of how badly things had gone awry. I’d bought it when I still thought I would wear it to work in the summer. Then the pandemic happened, and it’s a funeral dress now.

My grandfather died from complications of COVID-19. The last time I saw him, I wore gloves and a plastic gown, and put a face shield on over a mask. I stood next to his hospital bed with my family. The doctor warned us not to touch him, but I did, gently, one gloved hand over his. That he should die without touch felt intolerable, a punishment for a man who didn’t deserve one. We reminded him that we loved him. My mother told him that the neighborhood bear had returned, that the farmers’ market had good carrots. Despite our alien look, he recognized us. The virus was bad, he said, but he’d fight it.

He tried. He lingered for several long days until the virus had its way. From the evening I got the call that he was sick until the moment my mother told us that he’d died, he fought. But he was 86 years old, which made him a high-risk COVID patient. His health had been declining, gradually, for months. The virus attacked his lungs, and then his heart, with lethal precision. In the end, he was no match for it.

That is a fact. I admit it. I write it out syllable by syllable, a ritual to exorcise grief. But the exercise fails me now, as it has failed me for weeks, because grief isn’t all that haunts me. My grandfather’s death, six months into the pandemic, is more than a tragedy. His fate is as political as it is biological. And I am furious.

In the corner of southwest Virginia where my grandfather lived, mask wearing is far from universal. In the reductive stereotype perpetrated by outsider journalists, the area is Trump country. My grandfather’s memorial service — small, socially distanced, masks required — could have inspired a David Brooks column: Trump voters mingled with the deceased’s Bernie Sanders–supporting grandchildren in Appalachia.

Later, when I walked into Kroger and saw all the middle-aged men without masks on, I almost approached them. I wanted to know: Did one of you kill my grandfather? But the men were a distraction. They were taking a risk, yes, and putting others at risk, but they weren’t the real problem. That problem is larger than a few men without masks, or the president who encouraged them. Trump served as a vessel for widespread ideas — and as an apologist for older sins.

My grandfather’s name was Charles Tibbetts. Although he lived in Virginia, he would want you to know he was not from the South. He was from Maine and crossed the Mason-Dixon Line only because my grandmother had died and he wanted to live near his only child, my mother. He spent most of his life in a series of odd jobs: at a factory, and a shoe store, and finally at an estate owned by the heirs of the Curtis Publishing Company, which once produced The Saturday Evening Post. My grandfather kept the grounds, and my grandmother cleaned the house. They had followed prior generations of our family into domestic work. My great-grandmother was a “laundress,” as my mother put it, and my mother herself cleaned houses to help pay for college. It was better, she once told me, when the families that paid ours didn’t try to clean up after themselves — they only made more of a mess.

In my grandfather’s spare time, he fished and went to church. Sometimes he carved wood: toys, furniture, and, once, a feeding station for the backyard chipmunks. Mostly he worked and drove my mother to her music lessons, an endeavor that eventually bore fruit. My mother went to college for music, the first person in her family to graduate with a degree. She married another college graduate, and together they raised two more.

Like my grandparents, I too wound up working for media moguls. Before I became a journalist, I belonged to the D.C. cohort of 20-something communications professionals. On the day a nonprofit gave me my first salaried job, I printed out the offer letter and drove out to my grandfather’s cabin to give it to him. He clutched it in his hands and cried. I would make $50,000, enough to pay rent for one bedroom in a house and to start paying off student loans. It was more money than he’d ever made in a year. My grandfather lived just long enough to witness what the think-tank world calls “social mobility.”

Except our social mobility looked a lot more like stagnation. My mother spent much of her early childhood near the poverty line; decades later, so would I. With time, our financial situation improved. But progress was slow, and the results were fragile. Even after the Affordable Care Act, health-care expenses sometimes threatened to pull us under. My brother and I have a genetic disease. He could stay on my mother’s health insurance until he turned 26, but her own premium had soared to over $900 a month. She decided to drop her plan and pay for my brother’s until Virginia opted to expand Medicaid under Obamacare. This isn’t extreme poverty, which some economists define as life on $2 a day or less, but it’s something just as pervasive and persistent: a middle-class life threatened on all sides by catastrophe. Whatever social mobility my grandfather had set in motion now exists mostly as theory, not inhabited reality.

No amount of good fortune can ward off the indignities of age forever. So writes the Preacher in Ecclesiastes: For everything there is a season, a time to be born and a time to die. I had the funeral home print that passage in my grandfather’s funeral programs. It was a reminder that nobody escapes death. But even if money can’t buy you immortality, or inoculate you against COVID, it can buy other precious things. Like time, or a good death.

Sick, in and out of hospitals, and possessed of limited means, my grandfather belonged to a sacrificial category of person in America. This category has always existed, but the pandemic has exposed it and expanded its borders. It has become so difficult to pretend that American free-market capitalism is anything but brutal that conservatives have largely given up trying. Barely a month into the pandemic, Dan Patrick, the Republican lieutenant governor of Texas, suggested that elderly Americans should be “willing to take a chance” on their own survival to keep the economy open for their children and grandchildren. “Those of us who are 70-plus, we’ll take care of ourselves,” he said. The Catholic writer R. R. Reno called wearing masks “cowardice” and warned of “a demonic side to the sentimentalism of saving lives at any cost.”

I read Reno’s essay when he published it. I even wrote about it, months ago, and thought of it again at my grandfather’s deathbed. I did not feel like a sentimentalist. But I knew that others agreed with Reno and Patrick. Trump is one of them. My grandfather wasn’t, but in a sense he got overruled.

What distinguishes a sacrifice from a regular death? Not ceremony, which is present in all funerals. The difference is intent. Sacrifice is deliberate: Someone makes an offering in return for a boon, such as a good harvest, a healthy baby, power, love. Sometimes the offering is only prayer or a voice raised in worship. Other times, it costs the supplicant a bit more. But the effort is supposed to be worth it. The idea is that if we appease the gods, or the invisible hand of the free market, we’ll prosper.

But people rarely volunteer to sacrifice themselves. When Patrick said the elderly should be willing to “take a chance” on their own survival, he wasn’t really referring to himself, with the economic privilege and the top-notch medical care he could count on to protect him from harm. He was really talking about my grandfather.

We spent much of my grandfather’s last year on earth navigating an elder-care system that was not designed to ensure his survival. Like millions of elderly Americans, my grandfather’s care was covered by a combination of public and private insurance: a United Healthcare Medicare Advantage plan and a Medicaid supplement offered by Virginia. But it didn’t buy him decent care. His Medicare Advantage plan offered full coverage for only 20 days of rehab at a time; once the clock ran out, a $176 daily co-pay kicked in. For reasons known only to United Healthcare, the company repeatedly refused to spring for a longer period of care.

This became a problem. My grandfather needed repeat visits to local emergency rooms for a persistent infection, and a pattern emerged. A hospital would admit him, conclude correctly that he needed rehabilitation, and transfer him to a skilled nursing facility for short-term care. That’s when the clock would start. He had 20 days to get better, and if he didn’t, he was on his own. United Healthcare wouldn’t pay for more time, and we couldn’t afford his care on our own. In July, even after his condition worsened, he was discharged from rehab as soon as his insurance ran out. My mother wound up having to take him back to the hospital, and the clock started all over again.

Each hospital visit introduced a new risk of infection. So did each stay in rehab. Subject to lax regulation and uneven enforcement, nearly half of all nursing facilities suffer from what one federal report calls “persistent problems” with infection control. In August, my grandfather once again passed through the revolving door between hospital and rehab facility. He spent two weeks in quarantine as a precaution. Then he acquired a roommate with a cough. After he finished a course of antibiotics for his latest infection, he spent a brief interval at home before he had to be rushed back to the hospital. This time, he had COVID-19.

On paper, my grandfather had certain advantages, like a loving family and comprehensive insurance. But a family’s love can’t regulate health-care facilities. And no insurance plan can make up for injustices so large they can swallow a person whole. Valley Health Care Center, my grandfather’s last rehab, is now the site of a major COVID outbreak. At least 175 people have contracted the virus at Valley since August, and 16 have died. Some conservatives, including Trump, may consider this an acceptable sacrifice to make on behalf of the economy. But I don’t believe anyone benefits from mass death and suffering, or that the elderly and infirm should be made to feel like detritus while they are still alive, as my grandfather was. Toward the end of his life, his spirits began to flag. He wanted to go home, but he was never well enough to spend more than a week or two in his own bed. “They’re treating him like he’s already in a body bag,” my brother complained when the insurance company refused to cover a longer rehab stay. Soon enough, it was true.

“I lift up my eyes to the hills. From whence does my help come?” asks Psalm 121, the passage we used for my grandfather’s funeral sermon. The next verse supplies the answer: “My help comes from the Lord, who made heaven and earth.” Without a health-care system that prioritized actual health care, it would have taken divine intervention to keep my grandfather COVID free. Personal responsibility had nothing do with it.

Hours after I found out my grandfather had COVID, I watched Trump posture in front of the White House on the last night of the Republican convention and boast, inaccurately, that America was recovering from the pandemic. The camera pivoted to the audience, and I saw Wilbur Ross, our 82-year-old Commerce secretary, nod off, maskless and comfortable. Eventually, the hammer will fall, I told myself. Weeks later, it did, when Trump got sick.

My grandfather was dead by then, and I wanted justice, even though I knew a virus wouldn’t give it to me. Nobody deserves death by COVID, and in any case, the discrepancy between Trump’s material circumstances and my grandfather’s meant that Trump was much more likely to survive. “I’m a perfect physical specimen,” he said after he recovered. This is obviously false. Trump’s recovery was a testament to the power of money to keep someone going well after their personal habits would have killed other, poorer men. Presidents have always enjoyed their luxuries, and Trump, rich since birth, boasted more advantages than most. When he got sick, the disparities in how he was treated compared with my grandfather felt like personal insults. A helicopter ferried Trump to the hospital. He had the best doctors. He stayed in a special suite with a real view. He even got to go for a joyride in an armored SUV to wave to his supporters.

Back in Virginia, my mother fumed and sent me angry messages about the president. She had shingles, and the anger and the stress so agitated her symptoms that a doctor told her to stop working. She had already lost thousands of dollars in income, a consequence of the months of caregiving she had provided my grandfather and, more recently, of bereavement. I scratched at my legs until the skin broke and scabbed over, then I scratched them again.

Trump got better. My family hasn’t, and neither have millions of others. Misery is a pandemic in its own right. With more than 230,000 Americans dead from a virus that could have been contained, multitudes have plunged into mourning. Black seniors my grandfather’s age have been killed at twice the rate of elderly whites. Some 13 million people have swelled the ranks of the unemployed, and one in three families with children now face food shortages. The same Republicans who offered up the elderly as a sacrifice to the market have opted to let children go hungry. Capitalism has become hyperbolic, the most evil version of itself. That transformation is driven not by the virus, but by a top-down emphasis on productivity over humanity. Maybe I am guilty of the demonic sentimentalism that Reno described, but I worry we are edging ever closer to old territory, where some members of society — the old, the sick, the weak, anyone viewed as insufficiently industrious — are judged unworthy of life.

My grandfather’s life was important, and not just to me. He was a human being who deserved the same level of dignity and peace that more fortunate men can purchase. He didn’t have to die the way he did, in a small, cold room, separated from everyone he loved. All his hard work, all his responsibility, meant a pittance in the end. There is no justice but a fairer future.

*This article appears in the November 9, 2020, issue of New York Magazine. Subscribe Now!

COVID Took My Grandfather. But It Wasn’t What Killed Him.