I pace my mother’s hospital room.

“Joseph’s nervous,” she says.

“I’m not nervous at all,” I respond.

And I’m not, just unnerved — and restless and bored and mildly freaked out by where I am, the oncology wing of West Penn Hospital in Pittsburgh, my hometown.

My mother’s right hip is fractured. It’s not a bad break, but she is eighty-five and suffers from hypertension, thyroid dysfunction, arthritis, scoliosis, multiple myeloma, chronic pain, depression, a bum heart, and a thousand secret wounds.

The fracture was uncovered by her oncologist, hence her brief assignment to this wing until we arrange her transfer to a rehab facility within a few blocks of my parents’ apartment. Jim, the young doctor who’s been looking in on her, figures it will be at least two months before she’s walking on her own.

“She’s a doll,” he says of my mother.

As a rule I am slightly combative toward physicians, but I feel an instant affection for Jim when he puts his arm around me as we shake hands. I like that he’s Italian and from Buffalo, New York, a die-hard working-class town like Pittsburgh. This — along with his black hair, and the thick stubble he develops as his shift wears on, and his unfeigned boyish smile — makes me trust him.

Jim and I chat outside the room, and I tell him that my best friend, Philip, died nearly four years ago just down the hall from where we stand. As we talk, I can see the telephone that I used to call the priest. I planned never to set foot in this hospital again, much less this very corridor.

Jim listens intently, and I’m embarrassed at my sudden impulse to lay this news on him. I smile and change the subject to football: the Steelers and the team he grew up worshiping, the Buffalo Bills.

I am in Pittsburgh not only to see my ailing mother, but to announce to her and my eighty-nine-year-old father, a retired millwright from the Edgar Thomson Steel Works, that the inevitable has arrived: they can no longer live independently, and we — my sister and I and our spouses — will soon seek for them the “next level of care”: assisted living.

This day has been looming for years, and my mother’s broken hip — a kind of rite of passage among the elderly — has hastened its arrival. My parents’ habitual response, whenever my sister or I have broached the subject of assisted living, has been to deny any need for assistance, despite the fact that they’ve been merely making do the past few years. They are not easy to reason with, and we’ve been waiting for some cataclysm to settle the matter. Something like a broken hip.

Though I left Pittsburgh nearly twenty-nine years ago, my sister, Marie, remained here. Every filial responsibility that I’ve escaped by living five hundred miles away in North Carolina has stormed down on her. She is distraught and weary, while I am riddled with guilt over how little I’ve been able to do to ease her day-to-day burden. Thus, the difficult task of laying down the law about assisted living justly falls to me.

Driving up here from North Carolina this morning — a trek my wife, Joan, and I have made at least a hundred times in our twenty-seven-year marriage — I contemplated what I would say to my parents. Joan slept while I drove and watched the sun poke up from behind Big Walker Mountain, then gradually retreat behind the hoary Old Testament clouds of grayest West Virginia. I thought about our sons, Jacob and Beckett, in all likelihood still asleep, old enough now — at seventeen and thirteen — to remain home for thirty-six hours or so while Joan and I saw to a bit of dirty work.

Dread hung over our car. We passed dead deer sprawled along the shoulders. Just as we reached the center of the New River Gorge Bridge — until recently the longest arch bridge in the world — we were blinded by a blizzard. Beneath us stretched an ancient abyss. I turned on the lights and the windshield wipers and the defroster and slogged ahead.

I am disturbed by the stylized theater of the hospital room, its insistence on austerity, the hum of its machines, its cold chrome. Attendants and nurses appear from the wings on cue. The cockpit-like bed, with its dials and bars and trusses, contains the patient, my mother, who wears a delicate light-green gown, her hair a wavy white shimmer. There is something about her today I cannot quite pinpoint. She gleams, as if a girlish self, long interred in the crypts of age and regret, has been released. She will not stop smiling.

Every four hours morphine trickles into her vein from an IV. Her usual daily dose of forty milligrams of Oxycontin has been doubled. My mother, a lifelong teetotaler, is loaded — God bless her — and enjoying every moment of it.

Morphine has vanquished her constant pain and permitted her a whimsy she would never have otherwise permitted herself. At one point she refers to me as her “little boy.” She laughs sweetly at her gaffes. I’ve never known her to be so cute — or, really, to be cute at all. I’m growing attached to this new version of her. She begins a dozen reminiscences but nods off, like a junkie, before she can finish.

My father keeps vigil in the recliner next to my mother’s bed, holding his cane, which he refers to as his bastone. At his back, a window reveals clouds shrouding Bloomfield, the last of Pittsburgh’s Little Italys, a neighborhood of narrow streets and narrower houses piled on top of each other. Automobiles dart across the Bloomfield Bridge. My father says nothing except to solemnly concur when the subject of my mother’s certain recovery comes up, even though she has a solid two months of physical therapy facing her. It will be two, maybe three, weeks before she can even put a foot on the floor.

Were she not on pain medication, I suspect my mother would seize on this hip fracture as a sign of God’s will, the end of the line. I can’t remember a time when she wasn’t threatening to die. But now, suddenly awake, she claims she’ll do whatever it takes to get well.

“You better believe it,” my dad says.

“We have to talk about what’s going to happen,” I say, having put off my mission as long as possible.

“I’m not going to assisted living,” states my mother: curt, abrupt, the stone wall I knew all along I’d be busting my head against. But there’s no turning back. I promised Marie that when things got ugly, I’d dig in and, no matter what, refuse compromise.

“Well, Mother,” I say, steeling myself for the brawl that’s sure to follow, “that’s what has to happen.”

“If that’s what we have to do,” she says. My father leans forward in his seat, waiting, as I am, for some wounded outburst, but that’s it. Not a lick of fuss. My mother, jacked up on narcotics, is agreeable, even pacific. My father rises from his chair, moves to my mother’s bed, and — with the sudden flexibility of a yogi — curls up along the foot of it, his head resting on his propped elbow, a big smile on his face. He gazes at my mother, who smiles back almost coquettishly and reaches out to hold his hand. They kiss. They talk tenderly to each other. My father glows as if he’s had a hit of something, too.

We talk about my older son, on the verge of graduation from high school and entry into college, and my younger boy, who just won the county spelling bee. My sister’s son and his wife are expecting a baby, my parents’ first great-grandchild. My mother says her grandsons are “marvelous,” a word I’m sure I’ve never heard her use. She is so proud, she says. “Aren’t we, Joe?” she asks my dad, still lying at her feet and looking dreamily at her.

“You better believe it,” he says again.

A nurse strolls in and asks my mother what she’d like for dinner. She smooths my mother’s hair with a familiarity that at another time would have caused my mother to attack.

We stay until my mother’s meal arrives. She peers at the questionable mishmash and declares, “Looks good” — another sign of her altered state. “You three go get something good to eat,” she says. “I’m not going anywhere.”

Joan and I have to leave in the morning for North Carolina — back to our boys, back to work, back to worrying about my parents from afar — but for now there’s an unusual, welcome lull. We hug and kiss my mother and tell her we love her. Then my parents kiss on the lips and exchange I-love-you’s — something I’ve never heard them say to each other.

Joan and I wait in the hall for my dad. It’s like a scene from an Ingmar Bergman film: the aged and tottering wheeled through endless, stark corridors lit by searing gray light. Death’s antechamber. Joan cries. My dad joins us and does not seem to notice. “You kids hungry?” he asks.

On the way out we cut through the waiting room with the naugahyde sofa where I spent the night when my friend was dying. A crumpled hospital blanket is discarded in one corner. The cabinet of board games is open, and a couple of children work a puzzle. The television is on. A few people sleep or stare straight ahead.

When we reach the ground floor and hit Liberty Avenue, I start to get the car from the parking lot, but my dad says he wants to walk the five or so blocks to the Pleasure Bar, where we’ll have dinner. It’s cold, even though Easter is a week away, and there are patches of ice on the sidewalk. A prickly snow needles down. But my dad takes off, leaving us to catch up. Whatever spell resuscitated him in my mother’s hospital room, he is still under its effects. He’s not even using his cane as he barrels down Liberty Avenue into the frozen night like a man half his age, intent, confident. Joan and I have trouble keeping up.

The Pleasure Bar is a vintage Italian restaurant, a place of cheer and comfort, and my vintage dad is in a good mood: calling the waitresses “honey,” ordering wine, insisting Joan and I get anything we desire; it’s all on him. It’s always been on him. And so we comply, ordering food for which we have no appetite.

My father decides on trippa (tripe) — cow stomach. It arrives steaming, coated with marinara and garnished with sautéed wedges of green pepper. It is coiled, honeycombed, yellowish. He covers it with black pepper and digs in, a fork in one hand and a heel of Italian bread in the other. He has always loved tripe, but my mother refused to cook it because of the smell. So he ate it mainly in Italian taverns in East Liberty, our former neighborhood, now blighted. “Out of this world,” he says about the ghastly dish.

My dad is guts; and he eats guts this evening because, by God, he understands that what’s ahead for him and my mother is going to take guts. But for now the cure for all ills is man­giare — to eat.

After dinner my dad double-times it back to the car in the hospital parking lot, the cane resting on his shoulder like a carbine. He sits up front with me for the ride home and instantly nods off. The ashy snow blows across our headlight beams and twirls beneath the streetlights. It’s as if spring has been called off and it’s winter again, bundled folks slogging along the sidewalks, trying to get home. I make the left over the Bloomfield Bridge and head for the other side of the river, where my parents moved to be closer to my sister.

By the time we get to my parents’ apartment, my dad is old again, swallowed up by his big winter coat and the wiles of time. It’s all been a bit too much. Joan and I get him settled in the spare room, where he sleeps every night in the little bed that was mine before I left home all those years ago. We tell him we love him, those words that have been said over and over and strike me as so useless, though true; and my dad assures us he loves us, too. A little rest and he’ll be ready to go at it again tomorrow, he says. “That’s right, Dad,” I whisper and then close the door.

Out of habit I amble into the kitchen and open the refrigerator.

There is a scene in Thomas Wolfe’s novel Of Time and the River in which Eugene Gant, Wolfe’s alter ego, stands transfixed in front of the Pierce family’s legendary refrigerator: “The great icebox was crowded with such an assortment of delicious foods as he had not seen in many years: just to look at it made the mouth begin to water, and aroused the pangs of a hunger so ravenous and insatiate that it was almost more painful than the pangs of bitter want.” He goes on to enumerate the mythic inventory of the Pierces’ larder.

Wolfe’s button-busting prose also describes my parents’ refrigerator when I was growing up. My friends and I would stagger, famished, into our kitchen after playing ball — and, as we got older, after long nights of revelry — and examine the stupendous, orderly contents of my parents’ icebox. The meats: salami, chipped ham, capicola, roast beef, corned beef. The cheeses: Swiss, brick, Muenster, provolone, and Fontinella. The labeled, packaged leftovers: pasta, eggplant, artichokes, fried chicken, homemade pizza. An assortment of olives, pickles, mustards, and breads. Fresh produce in the crispers. The shelves stocked with jams, jellies, and marmalade. Breyers ice cream and Isaly’s Klondikes in the freezer. My parents loved for us to raid the fridge, even at 3 AM. Sometimes they’d wander downstairs and sleepily observe our gluttony for a few minutes before passing benediction and returning to bed.

The progeny of poor immigrants, my mother and father lived through the Great Depression and World War II, traumas from which they never fully recovered. Food was and is their currency — a sign of achievement, a declaration that they and their kids (especially their kids) were not only as good as anyone else, but better. “Look what they eat,” my mother has always liked to quip about the so-called well-to-do.

Tonight there is hardly anything in their fridge: milk and juice, a few yogurts, scant leftovers in Tupperware, a package of ham, a wedge of cheese, and on the shelf eggs, butter, condiments, and ginger ale. Very little in the freezer. This is under­standable, I tell myself, grabbing the lone can of Iron City beer and the cheese. They are old, and it’s just the two of them now.

The cheese is provolone, a staple in our house when I was a boy. My mother packed cubes of it in wax paper for my school lunches. Back then, when my extra-Italian extended family took pictures on holidays and feast days, it was customary for the person with the camera to prompt, “Say provolone!” rather than Say cheese, and we always complied, belting out gleefully, “Provolone!” as the camera flashed.

I look at the provolone in my hand and notice that it’s not completely enclosed in its plastic wrap. An entire corner, hard and dry, peeks out. And then it hits me with a finality that nearly knocks me over: my mother and father are in trouble. It may seem odd that a faultily covered hunk of cheese would fill me with such sorrow, but that speck of inattention, that very dismissible oversight on the part of my parents, is the final, incontrovertible evidence that their time has come.

I set the cheese back in the fridge, drink the Iron City at the kitchen table, then check on my dad. He is sleeping peacefully on his side in the little bed, his millwright’s hands clamped together as if in prayer.