Updated at 10:23 p.m. ET
Former first lady Barbara Bush died Tuesday at the age of 92, according to a family spokesman.
A statement issued on Sunday by the office of former President George H.W. Bush said that Bush had elected to receive "comfort care" over additional medical treatment after a series of hospitalizations.
"It will not surprise those who know her that Barbara Bush has been a rock in the face of her failing health, worrying not for herself — thanks to her abiding faith — but for others," it said. "She is surrounded by a family she adores, and appreciates the many kind messages and especially the prayers she is receiving."
Former President George W. Bush said in a statement:
"My dear mother has passed on at age 92. Laura, Barbara, Jenna, and I are sad, but our souls are settled because we know hers was. Barbara Bush was a fabulous First Lady and a woman unlike any other who brought levity, love, and literacy to millions. To us, she was so much more. Mom kept us on our toes and kept us laughing until the end. I'm a lucky man that Barbara Bush was my mother. Our family will miss her dearly, and we thank you all for your prayers and good wishes."
President Trump and Melania Trump called her an advocate for the American family, with great achievements in the cause of literacy. The president ordered that U.S. flags to be flown at half-staff at the White House, federal buildings, U.S. embassies and military posts in Barbara Bush's honor.
Former President Barack Obama and Michelle Obama said they were grateful for her generosity to them and said the way she lived her life was a testament to public service as an important and noble calling, that she was an example of humility and decency.
Bush will go down in history as one of just two women to be both the wife of a U.S. president and also the mother of one. She was as famous for her undyed hair and fake pearls as she was for her self-deprecating humor, and she made it clear — from the moment she moved into the White House — that she was going to be a different kind of first lady from her very glamorous predecessor, Nancy Reagan.
"Barbara Bush certainly wasn't afraid to laugh at herself," said first lady biographer Myra Gutin. "She worked very hard to show that she was just a real person."
Gutin says Bush was popular in part because she was a throwback to old-fashioned values and because she pushed back against popular conventions of beauty.
When she was about to become first lady, she quipped, "My mail tells me that a lot of fat, white-haired, wrinkled ladies are tickled pink."
"That's vintage Barbara Bush," says Gutin.
Her down-to-earth image was all the more remarkable for someone who grew up in a suburb of Manhattan as part of the aristocracy and married aristocracy as well. The daughter of a magazine publisher and granddaughter of a state supreme court justice, Barbara Pierce was home from boarding school at a holiday dance when she met George Herbert Walker Bush — the son of a U.S. senator from a prominent Yankee family.
She described falling head over heels in her memoir. "Sweet sixteen and never been kissed, has been written about me and it was true," she quipped. "I floated into my room and kept the poor girl I was rooming with awake all night, while I made her listen to how Poppy Bush was the greatest living human on the face of the earth."
They got engaged just before Bush shipped off to war. When he returned, she dropped out of Smith College to become Mrs. George Bush.
She would then make some 30 moves following her husband, through naval training and to Yale University, where she delivered George W. Bush — the first of their six children — and then to Texas, where Bush would start his career in the oil business.
Political aide and family friend Chase Untermeyer says that was a formative experience for this elite young woman from the East. "No matter what your background is, if you go to dusty, West Texas in the late 1940s, you are very much down to earth because the earth is all around you," he said. "There wasn't much fanciness about that lifestyle, and it was a great leveler."
"Barbara Bush spent her 20s and 30s in the traditional role of wife and mother," recalled former neighbor Charlie Younger years later. "She was the June Cleaver prototype. She would dress in a dress, being the perfect mom, the perfect wife, cooking, cleaning — all the things that full-time, stay-at-home moms did back then."
When her husband dived into politics, Barbara Bush dutifully took on the role of political wife, campaigning for him. But longtime family friend Rob Mossbacher Jr. said her supportiveness should not be mistaken for submissiveness.
"She was as far away from a 'Stepford wife,' or some sort of namby-pamby, you know, 'sweetness and light' [wife] that you could get," Mossbacher said.
Indeed, Barbara Bush — known as the "Silver Fox" — could be as tough as she could be charming. Her grandkids named her "The Enforcer." But the rough-and-tumble of politics roiled her at times — especially, as she herself said, attacks aimed at her son, George W. Bush.
"Sometimes I just wanna give people a piece of my mind," she once quipped. "But of course, as George would say, 'Wouldn't be prudent!' "
When her second son, Jeb Bush, first considered running for president as had his father and brother, Barbara Bush demurred: "We've had enough Bushes," she said. But in 2015, when he jumped in, she changed her tune, and at 90 years old, she hit the campaign trail to try to elect a third President Bush.
True to her character, Bush couldn't hold back when she was asked by CNN about Jeb Bush's then-bitter rival, Donald Trump, who had called her son "dumb as a rock."
"I'm sick of him," she said. "I don't understand why people are for him."
Perhaps her best-known barb was aimed at her husband's 1984 vice presidential opponent, Geraldine Ferraro, who had called him rich and out of touch. Bush shot back that she couldn't say what Ferraro was ... but it rhymed with rich.
"It was a spontaneous quip that might best not have been made public," said former Bush aide Craig Fuller — but "you didn't find her backing down."
On issues of policy, Bush tended to tread more lightly. She was said to privately support abortion rights, but on the record would hold her tongue.
"I believe if you are an elected official, you can speak up," she explained. "But if you haven't run for dogcatcher, never publicly."
"Barbara Bush understood the political version of the Hippocratic oath, 'First do no harm,' " said McGill University history professor Gill Troy. "Mamie Eisenhower always said, 'Ike runs the country and I make the lamb chops.' And Barbara Bush definitely embraced that."
Bush also tried to avoid making waves in selecting her pet cause of literacy. She tirelessly promoted literacy as a way to help solve everything from teen pregnancy and inner-city violence to AIDS.
"If every man, woman and child in America could read, write and comprehend, we could find easier answers to so many of our other social problems," she said.
Bush was also a best-selling author, beloved for the books she wrote in the voice of her dog Millie.
But her role as first lady, wife and mother actually sparked something of a backlash, when she was chosen to speak at Wellesley College commencement in 1990. Some students protested the choice, saying that a woman most famous for her husband's career wasn't the ideal role model.
But true to form, Bush took no prisoners, and she told her audience of graduates that family should trump career.
"At the end of your life, you will never regret not having passed one more test, winning one more verdict, or not closing one more deal," she said. "You will regret time not spent with a husband, a child, a friend or a parent."
Bush's personal life included some challenges, including the death of a 3-year-old daughter from leukemia and, years later, a bout of depression that left her feeling "like driving into a tree."
But all in all, Barbara Bush considered herself blessed, especially, as she often said, for whom she married.
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