Through the kitchen window, I could see my husband, Rick, in the back yard, his expression grim, his phone pressed against his ear. He was walking in tight circles as he talked, the way he does when he’s stressed. I opened the back door and heard a smattering of ominous, dreary words: Stroke. Fall. Hospital.

Rick’s parents were dead. My father was dead. Our aunts and uncles, nearly all dead. The only possible subject of the conversation was my 94-year-old mother, Adele Angier, who lived in Manhattan, a four-hour drive north of us. Having failed to reach me, my older brother Joe had called Rick. My mother had suffered a stroke while standing in the kitchen. She’d collapsed onto the tile floor and cracked open the back of her skull. Now she was in the hospital and mostly unresponsive. We’d have to go to New York as soon as possible.

Which hospital is she in? I asked.

Rick wasn’t sure, but he thought Joe had said something about Bellevue.

I am not superstitious. I don’t believe in gods or demons, kismet or curses. But come on, Universe: Bellevue Hospital again? Was that absolutely necessary? New York City has many hospitals, including several that are closer to my mother’s neighborhood than Bellevue. Our family has had little to do with any of them, but in the spring of 1977, when I was 19, I spent two devastating weeks at Bellevue, watching my 51-year-old father die of a malignant melanoma that had spread to his brain. I remembered the sight of his corpse in the hospital morgue, the pale violet tinge of his skin, the slight gape of his mouth, the fact that he looked so profoundly dead, he might never have been alive. For me, Bellevue became an embodied nightmare, and over the years, I avoided going anywhere near it. But now Bellevue was yanking me back. It was one nightmare nested within another: Just when you think you’re safely awake, you find it’s time for another round of fear.

It was Bellevue’s decision, in 1879, to open a pavilion for the insane that made its name a synonym for the loony bin. Its Manhattan location guaranteed that it would draw some marquee mental patients.

As one of America’s oldest and largest public hospitals, Bellevue carries tropes and metaphors handily. It opened in 1736 in a two-story brick building in Lower Manhattan as New York’s first permanent almshouse to shelter and treat the poor. After 60 years, its operations moved north to a property called Belle Vue Farm, where victims of yellow fever could be safely quarantined. The hospital adopted the name Bellevue in 1824.

Since then, Bellevue has claimed a string of medical firsts—the site of the nation’s first children’s clinic, the first emergency center, the first serious nursing school. Because the hospital served the city’s growing immigrant population, which brought a global panoply of illnesses, Bellevue attracted the nation’s top doctors and medical students. But it was Bellevue’s decision, in 1879, to open a pavilion for the insane that made its name a synonym for the loony bin. Its Manhattan location guaranteed that Bellevue would draw in some marquee mental patients, among them Eugene O’Neill, Delmore Schwartz, William Burroughs, Charlie Parker, and Allen Ginsberg, who cited Bellevue in his beat classic, Howl. The jazz bassist Charles Mingus wrote a song about his time in the asylum called “Lock ’Em Up (Hellview of Bellevue),” a fact I was unaware of when I thought I was so clever referring to Bellevue as Hellview.

It was the loony-bin link that first brought our family to Bellevue, in 1977. My father had been acting oddly for several weeks: He was no napper, but there he was, falling asleep during the day while sitting on the couch. He walked with his head bent over, dragging his feet on the ground. “Keith, you’re shuffling!” my mother cried. “You never shuffle!” But it wasn’t until my father hung up the phone on my younger brother mid-conversation, twice, that we knew something was wrong. We hurried over to his apartment and found him laid out on his bed, staring at the ceiling. We called an ambulance, but when the paramedics asked him whether he wanted to go to a hospital, he said no, so they left. We walked him out to the street and tried to hail a cab, but no cab would take a man who seemed slightly deranged. Slowly, step by mincing step, we shepherded him to the closest hospital. The doctor on duty asked us what was wrong with my father. We said we had no idea. He had always been emotionally volatile, we said. Could he be having what was then called a nervous breakdown? Without checking further, the doctor told us to take him to Bellevue. “It’s a good hospital,” he said, “and if your father needs mental care, he can get it there.”

At Bellevue, the emergency room doctor took one look in my father’s eyes and knew what was wrong. Some sort of tumor was pressing against his optic nerve. My father had been treated for a malignant melanoma on his back four years earlier, and the cancer had spread to his brain. A surgeon operated on my father the next day, excising a tumor the size of a lemon, but smaller malignancies scattered throughout his brain could not be removed. Chemotherapy would be useless. All we could do was wait.

Bellevue in the 1970s was a grim, shabby place. Not for nothing did Francis Ford Coppola choose it as a setting for The Godfather. The nursing pool was understaffed and overworked. We’d find my father slumped over in a chair, his head lolling toward his lap and nobody around to help us set him right. When he seemed to be in pain and my younger brother tried to get help from a nurse, she snapped, “Why do you care?” I refused to believe what was happening to my father. On April 18, 1977, he died.

At 94, my mother seemed by many metrics invincible. Her blood pressure and other vital signs were good. She almost never got sick. Her mind was clear. I told her she was pathologically healthy, that she should aim to enter the ranks of the centenarians.

Yet by other measures, she was not doing well at all. Her eyesight, which had once been excellent, was terrible and getting worse. Even with the brightest light, she could barely read. Her hearing was fading, too, and no hearing aids seemed to work. She had trouble walking. She was deeply unhappy. Joe lived in the apartment with her, but he was often at work on his own projects. Sometimes my mother would just sit in the living room, staring out the window.

The day my mother had a stroke, Joe was at his girlfriend’s place across town, and the woman who was supposed to be looking after my mother was either at lunch or doing laundry. On returning to the apartment and finding my mother unconscious in a pool of blood, the terrified woman called 911. Hospitals compete for patients, and apparently Bellevue’s ambulance got there first. My mother was delivered to the emergency room and admitted to the hospital before my brother or any other family member knew a thing about it.

The Bellevue of 2025 seemed a very different place from the gloomy Gothic megalith of my memory. The original brick and stone façade had been encased in a stylish glass solarium designed by the renowned architect I. M. Pei. You could buy coffee and pastries at the Panera in the lobby. We liked the nurses and aides far more this time around. And yet, Bellevue was still a noisy and crowded public hospital with rules and routines that seemed the opposite of salubrious. There was a strict limit on the number of visitors allowed in my mother’s room at any one time. Constant finger pricking for blood tests. A feeding tube shoved up her nose. An IV needle jammed into the back of her hand. My mother was mostly unconscious, but whenever a nurse or aide started working on her, she’d writhe and cry, “No! No! No!” We can move her out of there, we told each other, as soon as she’s stabilized and on the mend. After all, as David Oshinsky wrote in his 2017 history of Bellevue, “those with viable options almost always wind up going somewhere else.”

But my mother wasn’t stabilizing or on the mend. The blow to her head from the fall proved worse than the stroke that preceded it. Blood is toxic to neurons, one neurologist explained to us. The blood from the head wound was destroying the tissue of her brain.

My mother lasted two weeks at Bellevue, just like my father. She made it to the first day of April and so ended up dying in the same month that my father had nearly 48 years earlier. This time around, though, the universe added a grace note. A few weeks after my mother’s death, we were astonished to receive a sympathy letter signed by half a dozen members of the Bellevue staff, telling us what we needed desperately to hear: that it was an honor to care for our dying mother, and that we did the right thing by staying so near.