Barbara Bush, first lady of the United States from 1989 to 1993, died at her Houston home Tuesday, a family spokesman said. She was 92.
The wife of former President George H.W. Bush was the matriarch of the last great American political dynasty. When her son, George W. Bush, was elected president in 2000, she became the first woman since Abigail Adams to have served as first lady to one president and mother to another. Another son, Jeb, served as governor of Florida and ran unsuccessfully for president.
“I’m a lucky man that Barbara Bush was my mother,” former President George W. Bush said in a statement posted on Twitter. “Our family will miss her dearly.”
Known as the “silver fox” for her trademark mane of white hair, she had been in failing health in recent years and had been hospitalized in recent weeks. After she was discharged from the last hospital stay, the office of George H.W. Bush issued a statement on April 15 explaining her decision to be at home: “Following a recent series of hospitalizations, and after consulting her family and doctors, Mrs. Bush, now age 92, has decided not to seek additional medical treatment and will instead focus on comfort care.”
The statement did not identify the health conditions, but media reports have said that she has chronic obstructive lung disease (COPD), congestive heart failure, and other medical issues.
“The goals of comfort care are not to help the patient live as long as possible, but to live as comfortably as possible,” says MeiLan Han, MD, a volunteer spokeswoman for the American Lung Association. She did not treat Bush and was speaking in general about the conditions.
COPD is a chronic lung disease that makes it difficult to breathe. It is most often caused by smoking, although nonsmokers can get it as well. COPD and heart failure often happen together.
Bush had smoked for about 25 years before quitting in 1968, which she wrote about in Barbara Bush: A Memoir.
“I had been a smoker since age 18 and knew I should quit but just never did,” she wrote. Then, as she recovered from minor surgery, a nurse found her smoking in her hospital room while she was still groggy from medication.
The nurse came back the next day and “read her the riot act,” telling her she was an addict and a disgrace, Bush wrote.
“Addicted? Me? I couldn’t forget that nurse, and on New Year’s Day I quit. It was terrible. For about six weeks I would wake up in a cold sweat.”
During her years as first lady, she became known for her tart tongue — sometimes putting people in their place with a blunt comment — but also for her devotion to literacy. She founded the Barbara Bush Foundation for Family Literacy. She focused on early childhood education for preschoolers along with adult literacy for their parents. The passion for literacy was ignited during the 1980s, when statistics found that 35 million U.S. adults could not read above the 8th-grade level.
Her book C. Fred’s Story: A Dog’s Life, about of one of the Bush family’s pampered dogs, raised $100,000, which was donated to Literacy Volunteers of America and Laubach Literacy Action.
After leaving the White House, she continued to donate her time to worthy causes, including being ambassador-at-large for AmeriCares, a health-focused relief and development organization, and as a board member for the Mayo Clinic Foundation. She also supported other organizations, including the Leukemia Society of America, Ronald McDonald House Charities, and the Boys & Girls Club of America.
She and George H.W. Bush met at a school dance when she was 16. They kept in touch as he served in the Navy and married on Jan. 6, 1945. They had four sons, George W., Jeb, Marvin, and Neil; and a daughter, Doro.
Another child, Robin, died in 1953 at age 3 after fighting leukemia. During that time, according to published reports, Bush’s hair turned white, and she later kept it that way.
Bush projected a down-to-earth outlook and had a self-deprecating wit. In the spring issue of the alumnae quarterly for Smith College, her alma mater, she was featured in a photo and wrote in the class notes that “I am still old and still in love with the man I married 72 years ago [now 73].”
She also became an unlikely fashion trendsetter, after she wore a triple strand of faux pearls to her husband’s inauguration in 1989. Later, after the look became popular, she explained they were there to hide the wrinkles in her neck.
Her granddaughter Jenna Bush Hager, a contributor to the Todayshow, appeared briefly on the show Monday and talked emotionally about her grandmother, calling her a fighter and “the enforcer,” the nickname that reflected Bush’s habit of pointing out the errors of others’ ways when necessary, especially arrogance. She also was known for her belief in the importance of putting family first.
George H.W. Bush is often quoted as saying, “We are two people but we are one.” Jenna noted that her grandfather ended every day saying, “I love you, Barbie.”
While public appearances of both Bushes declined in recent years, they took part in the coin toss at the 2017 Super Bowl between the Atlanta Falcons and the New England Patriots.
COPD causes an obstructed flow of air from the lungs. Patients often have breathing difficulties, a cough, mucus production and wheezing. Long-term exposure to irritating gases or other substances, most frequently cigarette smoke, is the cause. The disease also makes patients more vulnerable to other conditions such as pneumonia, Han says.
“As lung disease advances, patients become more fragile,” Han says. “As it progresses, it can lead to respiratory failure.”
COPD can also affect how well your heart works, Han says. Experts don’t fully understand all the reasons, but COPD can increase heart disease risk, including heart attack.
While COPD and heart failure are two different conditions, both can cause shortness of breath when you are exerting energy such as walking or climbing stairs.
COPD patients often use medicines that are inhaled to help open the airways, called bronchodilators. Heart failure medicines can help decrease the strain on the heart.
Comfort care includes hospice and palliative care, according to the National Hospice and Palliative Care Organization. Hospice care is delivered by a team of professionals including doctors, social workers, home health aides and many others. Palliative care is patient- and family-centered care; its aim is to optimize quality of life, doing so by ”anticipating, preventing, and treating suffering,” the organization says.
Comfort care could include morphine to ease pain, Han says. And the morphine, while helping ease the pain, can also depress the respiratory system. Comfort care may also include:
- Living where you are most comfortable
- Taking medications that keep symptoms controlled
- Declining extra hospital care, or extreme measures such as CPR if your heart stops
It’s usually given to someone who is expected to live 6 months or less.
Besides her husband and children, Bush is survived by 17 grandchildren and seven great-grandchildren.