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The day my mother was released from the local hospital where she had been treated for a hemorrhagic stroke, we transferred her to the rehab wing of a "skilled nursing facility"(read "nursing home") where physical therapists would work to restore her mobility, coordination, and speech. Medicare would cover 45 days of these treatments.

I had little hope, however, that they could restore my mother's gait, her command of language, or her capacity to reason. Those powers had already dropped away, step by gesture, word by syllable, syllogism by premise, over the past few years.

I knew too that my mother would not be leaving the nursing home at the end of the 45 days. This was not the first stroke she had suffered, only the latest and worst. Their effects, combined with her advanced Parkinson's disease and increasing dementia, made it impossible for my father and me to care for her safely at home any longer.

Before her illness, denial had never been part of my mother's nature. She was a woman who believed in facing up to facts, especially unpleasant ones. Among these was the fact that we all die. She was fond of quoting Psalm 90: The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labor and sorrow; for it is soon cut off, and we fly away. Ever since she'd attained three score and ten, she'd often professed her willingness to depart this life anytime the call came.

She was well on her way to the outer limit of the biblical fourscore years that day I engineered her removal to Fair Acres. Years ago she had taken every precaution to prepare for the day she would fly away, including updating her will and pre-paying for her funeral. But neither of us had prepared for the long slope of physical and mental decline.

My mother had watched both a younger sister and her closest friend die of breast cancer after suffering through agonizing radiation and chemotherapy. "I don't want that," she had told me, long before her own illness overwhelmed her. "It's too much pain for only a few more months of life." She little knew then how long her own private purgatory would last, nor how much pain it would cost.

For my mother, death, though an unpleasant fact to be faced, was "natural," and natural was the moral peg on which she hung decisions about her body. She had refused hormone-replacement therapy to alleviate her osteoporosis. To her, estrogen after menopause went against the natural order. A woman's body stops producing estrogen for a reason—so you won't go on having babies beyond your ability to care for them. Keeping her hormones at the level of a 20-year-old's was not in line with what she saw as nature's intent.

My mother had worked for decades as a medical secretary, absorbing whole dictionaries of Latinate terminology, yet "natural" remained a metaphysical issue for her. In her own private lexicon, "natural" referred to the created order, which by and large expresses God's purposes for the world. Health comes from working within that order. We violate its boundaries at our peril. But live long enough, and your bones will thin, your arteries plug up, your pancreas shut down. It's nature's way of showing you the door. Keep asking "what's natural?" long enough, and the answer, eventually, is death.

Facing this fact served my mother well enough for more than seventy years. She had done everything right. She was never overweight, ate a balanced, healthy diet, exercised regularly, took her vitamins, brushed and flossed. This temple of the Holy Ghost had been maintained in topnotch condition. Her only adult illnesses had been colds and flu. Then she developed Parkinson's disease.

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