Photo: Mishelle Lane of "Secret Agent Mama."

In her youth, Sarah was a beauty queen. Once I saw her Furman University pageant picture. A full hour-glass figure in a modest, aqua, one piece-polyester swim suit. As I stood at the front of the church sanctuary following my father's funeral I turned to shake the hand of the next person in the receiving line. It was Sarah. Still spunky, her hair had thinned. She'd colored it red and she sported the same load of moxie I remember about her from the days she chaperoned our church youth group. She expressed her condolences for the loss of my father. I asked her about her sons–brothers, one and two years my senior. And then I told her I was sorry about Joe. That through Facebook, our old youth group shared the news of his unusual death. Fit, tan, black-haired and handsome as ever, his heart had exploded in his chest, killing him almost instantly. Still seemingly a tad shell-shocked and a bit raw, she agreed how odd it all. Then she said, in typical Sarah-style rapid speech: "When I get to heaven, I'm goinna have to have a talk with God. I mean, Joe was fit and then he up and died. And my mother, she's 100 and still living, just lying in a nursing home unconscious?!" Her eyes watered slightly, rimming in red.

Two days later, C., my friend, the social media guru, tweets me, asking what I thought about creating a Facebook page for caregivers. I tweeted back questioning the issue of managing the time and the demographic. Her reply: "We are the demographic." This mother of two diapered and raised her two daughters as infants and now enjoys the success of their post-college youth as well as her own career. On weekends she travels across one long Southern state and then another and relieves the caregivers of her husband's father, age 100. One of her duties in his old farm house, is lifting him up from bed and changing his adult-sized diaper.

My middle sister mentioned to her friend the one or more weekends-a-month the last five years she'd spent on the road driving from North to South Carolina to relieve my oldest sister from the caregiving demands of my mother and father and then my father. The friend one-upped her and told my sister she'd visited her own mother in the nursing home every weekend the 20 years her mother lay in the bed unconscious.

Most likely in the case of Sarah and in the case of my sister's friend, a feeding tube had sustained the lives of their respective parents. In December, my sisters and I conferred and decided not to put a feeding tube in my father. Deciding not to put in a feeding tube was consistent with Daddy's living will. For nearly a year he had increasingly been losing his ability to feed himself, to swallow. A tube would insure nutrition and sustain life when he could no longer perform these functions at all. For a brief time in the interim, my oldest sister drove to the skilled nursing facility to feed our father one of his meals each day. The staff spoon fed Daddy the other two meals of the day. When my sister painstakingly fed our father, she was always joined by other daughters and sons, dressed from their workday and looking tired.

Those trips for mealtimes, fortunately, were short for my sister. Daddy lost consciousness eight days before his death. Two days before that, he had not been able to swallow food or drink. He was medicated for pain. My mother's last days were similar. We had had to make like decisions once we were certain the end was near.

There had not been the issue of a feeding tube with mother. When the end came for Daddy, we were at Peace and experienced a tremendous sense of relief. It had been a traumatic half-a-decade as our parents health had descended rapidly. In retrospect, we kept thinking: "What if? What if we'd made the decision to put in a feeding tube?" Our father's iron-willed proclamations could have, in real probability, come true. He would have lived to be 100, as he often said he would, even days before he lost consciousness. He could have lived, another decade-plus. Unconscious. In a bed. Kept alive.

Quality of life. In the end, these days of souped-up science, it comes down to this. Tough decisions. Miracles of modern medicine? Extension of life? It comes with consequences. Damn serious ones.

Every family has to make the decisions that they feel are consistent with their own values, spiritual teachings and definitions of life quality–and their loved one's wishes. When it is you and your family, and not someone else and their family, life hurls from the philosophical abstract into brutal reality.