A while ago the celebrated American novelist and psychotherapist Amy Bloom found herself a shrink. Introducing herself, she explained that she wanted to kill her husband. The psychiatrist, whom she would rechristen “the Great Wayne”, said she wanted to kill him because she loved him. Bloom completely agreed. Her husband, Brian Ameche, a successful architect in his mid-sixties, was displaying the distressing and, frankly, irritating signs of early Alzheimer’s.
Time passed. The dementia did not. In January 2020 Bloom and Ameche flew business class to Zurich. On the 30th of that month, at the Dignitas clinic in the city’s suburbs, nurses placed an air pillow around his neck and Ameche drank a lethal dose of sodium pentobarbital. Twenty minutes later, Bloom’s hands still cradling his, her husband of 13 years died.
“It was terrible but it was not traumatic,” Bloom says over Zoom from the home they shared near New Haven, Connecticut. “I mean, it was probably the worst thing I’ve ever gone through and the worst loss, but it wasn’t traumatic because it was peaceful and painless and private and what he wanted.”
● Read an extract of Amy Bloom’s memoir, In Love
Was she aware, I ask, of the irony of that early exchange with Wayne — its juxtaposition of killing and loving — when she wrote about it in her grief-stricken yet remarkably clear-eyed new memoir In Love? “Yes,” she says. “Yes, I was.”
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They met in 2005, two liberal Democrats in a Republican town, both in unhappy relationships. Bloom, divorced but with three children from that marriage, was with a woman. Ameche, who had never wanted children, was still married. He suggested they “blow up” their lives and be together.
What was so special about him? “He was just a big presence, you know? He was a big guy with a big laugh and a big heart and really enthusiastic — and it’s not like I’m unenthusiastic. This is the kind of guy that you say, ‘Oh honey, there was that drag queen mermaid parade at Coney Island this afternoon, if we go now we can get there for the beginning.’ He’d be, ‘Let me get my hat.’
“You can,” she says, “sort of picture him just giving life a big bear hug.”
His dementia did not blow up their life. Instead it insidiously invaded it. She was married, as she puts it, “to a certain kind of man”, and that was why, she originally thought, she had needed to find the Great Wayne. But then Ameche began failing to complete projects on time and lost his job. Outside work, he would miss appointments or get lost on his way to them. His tastes shifted. He bought Bloom a sweatshirt with a tulle trim for $500; she is surprised that she did not conclude he had Alzheimer’s then and there. Worst, in a marriage largely conducted, or so it reads, through conversations in above-average restaurants, they no longer communicated as well.
“If you’re in middle age — and, no offence to half your readership, but especially if you’re with a middle-aged man — it’s a little hard to tell the difference between ‘I don’t wanna, I can’t, I didn’t hear you’ and ‘I don’t remember what you said’. But all those things came together to make me ask, ‘What is that? What’s going on?’
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“I felt a glass window between us. If you have a long, serious talk about a misunderstanding in your marriage and the other person doesn’t remember it, it’s hard the next day to be like, ‘Oh, I’m so glad we had that talk.’ ”
They remained physically close. He even, she writes, brought Viagra to Zurich. “He just brought it all the time,” she explains to me. “Really, he felt about it the way that people felt about canned goods after the war. You should just have a lot of it just in case.”
So they were still intimate? “We were, but all of the intimacy became altered because Brian’s ability to express himself with his usual articulateness and nuance began to fade. That’s part of what happens in the disease. Your brain is not functioning the way it did. People want to feel, ‘Oh that doesn’t change the inner person’, but of course it does.”
Mostly, she says, she was outwardly patient. Inside, she went up and down. “Not only are you trying to care for somebody but you’re also trying to manage your own sense of loss.”
When an MRI scan confirmed what the cognitive ability tests had foretold, Ameche told her that he wanted to end his life before Alzheimer’s took it from him. The philosophical foundations of the decision, Bloom says, were already there: he supported a “woman’s right to choose” — in fact he volunteered at an abortion clinic to escort women from their cars; he equally believed in the right to choose a good death.
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The book records he made up his mind in 48 hours. It does not describe how he did so.
“It’s funny. I wouldn’t say that there was a defining conversation. I would say that there was a series of small conversations in which he said several times, ‘This is what I want to do, and you love me and you’re going to help me.’ And he was right. He was right on all counts.
“My first response was to say, ‘You don’t have to do that. I will take care of you. We will be together. I will protect you. I will love you. You’ll be home as long as you can be home.’ And he said, ‘I know all that. That’s not what I want to do. This is what I want to do: I want to die painlessly and peacefully as myself.’ He was very fond of saying, ‘I would rather die on my feet than live on my knees.’ ”
She made it clear that she was not prepared to commit a crime for him, but did she not have qualms or questions about Zurich? “Oh, I had lots of qualms and questions but I kept them to myself because I felt that what was important was to support him and, in any case, I was not in any way morally opposed to what he wanted to do.”
Neither of them was religious. Neither, she writes, possessed “conventional moral compasses”, by which it turns out she simply means they were not preoccupied by what others might think. Their problem was the law. Even in the nine states, plus the District of Columbia, that have a right-to-die law people cannot avail themselves of it until they are certified as having only six months to live. Britain is worse. Only last week the Lords voted against an amendment to a health and care bill that would have required the government to draft legislation on assisted dying.
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The Zurich option costs. Even a tourist-class flight would take Zurich well out of reach of most Americans. Dignitas, a not-for-profit organisation, charged Bloom about $10,000, and it too has lengthy protocols that disadvantage clients with dementia. Too far gone and you are deemed unfit to decide your death, but if dementia is at an early stage and you are thought capable, you probably do not yet want to die. For a while a neurosurgeon and a psychiatrist refused to rule out a diagnosis that Ameche was depressed. He wasn’t, but if he had been that would also have rendered him ineligible for an “accompanied death”. Bloom calls this pair the “villains” of the story and can only guess at the inner motives for their obstructiveness. In Love’s heroes are the Dignitas staff (alongside Ameche, obviously). “I think,” she says, “if the worst thing you can say about people who have gone out of their way to help you is that they’re bureaucratic, that’s OK.”
In Zurich, Ameche and Bloom shop, dine and visit Chagall’s stained-glass windows (stained glass is one of Ameche’s hobbies). They meet the friend who has flown out to accompany Bloom home. In the clinic on the day, Ameche is calm. He drinks a glass of anti-emetic and regales the Dignitas staff with his exploits as a footballer at Yale. She resents it that he is not talking about their life together, his work or family. The stories go on so long that the anti-emetic wears off. He takes a second dose and falls silent. He drinks his final drink. She flies home. “I was doing a lot of thinking and a lot of crying and a lot of feeling, and eventually you get to your destination.”
She had envisioned taking to her bed but it turned out she was no good at pulling the covers up on the world. After a few days, she sent her daughters home. “And then it was the pandemic, and the world completely changed.”
A daughter, her wife and their three-year-old girl escaped New York to spend lockdown with her. For the first time in our sometimes clipped conversation, Bloom smiles at a memory. “There was something about seeing them in an earlier stage of life and making their way happily married and raising this beautiful little girl. I was very grateful to have life emerge around me and with me.”
For a year she worked on In Love, which Ameche wanted her to write and, she is sure, to publish: “He was not a shy person.” It came out in America this month to excellent reviews and compliments from family and friends. The feared backlash from the religious right simply did not happen.
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“The book is not an argument. This is our story. Everybody makes their own choices about these things and I am really struck by the hundreds and hundreds of emails I’ve gotten from people wanting to tell their story about similar life-and-death experiences.”
I quietly put aside my little list of moral and practical objections to voluntary euthanasia, helpfully available on the BBC News website.
And the grief, two years on? “It just comes with you, you know? Like a scar of a wound or a limp. It doesn’t stop you. It’s just with you.”
I ask if she can contemplate having a new partner. She chooses privacy on such matters.
Does she dream of her husband’s death? “I don’t dream about his death. I do dream about his life sometimes. I had a great dream about him in which he was in a bright orange sports coat, which is something he never wore. He was ushering people into the Yale Bowl, which is the football stadium at Yale university. He was just encouraging people to find their seats. It was a great dream.”
There he was, helping others to a bit of what he also wanted. Despite the setting for its final scene, I regard his and Bloom’s story as American. They believed in therapy, in couples therapy, in the Great Wayne. Ameche had a mindfulness teacher called Donna. Slightly to her embarrassment, Bloom employs a reader of tarot cards. The couple seem part of a culture that believes problems are fixable, or if not fixable then improvable. America’s Declaration of Independence enshrined the right to pursue happiness. Americans do so methodically, or so I suggest to her.
“I think that’s a nice thought. I don’t know that people actually in America go about it any more methodically than people in any other country but there is that feeling that happiness exists and you have the right to pursue your version of it, up to a point. It doesn’t,” she concludes, “seem like a bad thing.”
In Love, A Memoir of Love and Loss is published by Granta on April 7 at £12.99
