There are few deaths that can be considered truly good, but dementia must be one of the most hideous. Not that dementia actually kills you: it erases you by increments. Memories dissipate. Everyday tasks become baffling impossibilities. Eventually, the self is undone entirely.
Any remnants that survive can feel more a cruelty than a comfort. My nanna died when I was 12; towards the end she acknowledged only three people: my sister and me (who she thought were her daughters), and my mother, who she decided was called Bobbola (my mum is, obviously, not called Bobbola). We laughed about this because, taken seriously, it would be too dreadful to bear. When her stubborn body gave up, I felt more relief than sadness.
Yet there is another way. When the American writer Amy Bloom’s husband, Brian Ameche, received his diagnosis of Alzheimer’s disease in 2019, he decided that death would be better than years of vacancy and confusion, and did not waver until 2020, when his “accompanied suicide” was accomplished at the Dignitas clinic in Switzerland. He was 66 years old.
“I don’t want to end my life,” Bloom records her husband saying in this memoir of his illness and death, “but I’d rather end it while I am still myself, rather than become less and less of a person.” The problem for him, and therefore for Bloom, was that even in the few US states where assisted dying is legal, the legislation is so stringent that it’s essentially impossible.
“Right to die in America is about as meaningful as the right to eat or the right to decent housing. You’ve got the right, but it doesn’t mean you’re going to get the goods,” Bloom writes. Americans seeking an assisted death must, among other criteria, be diagnosed with a terminal illness that gives them less than six months to live, and be capable of self-administering and ingesting medications without assistance.
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Neither of these applied to Ameche, yet his case was no less bleak than that of someone with end-stage cancer. “What you will end up hoping, as a friend whose beloved got Alzheimer’s at 50 and lived to be 70 told me, is that your beloved forgets how to swallow,” is Bloom’s grim conclusion.
Dignitas doesn’t apply the same arduous burdens to those seeking a dignified death, but its processes are still exacting. “As my sister said, it’s like you do everything you possibly can to get your kid into Harvard and when you do, they kill him,” writes Bloom, who can make you laugh and break your heart in the same beat.
Half of In Love is the story of Bloom arranging Ameche’s death. The other, interwoven half is the story of their relationship — a midlife love match threatened by the strange change in his personality. Bloom describes her husband as considerate, intelligent, handsome and well-groomed. (One memory, fondly offered, is of him having his cataracts removed and being appalled when he sees clearly how his face has aged. “Six weeks later, he was getting an eye lift.”)
Yet in the last few years Ameche became thoughtless, disorganised and almost slovenly. “I spent three years trying to figure out who my husband had become and how it was that whenever he returned to me, from time to beautiful, relieving time, neither one of us could get him to stay,” Bloom writes, achingly.
This is not a misery memoir and it is without self-aggrandisement. She does not ask for pity and she does not present herself as a noble heroine. Her situation was an awful one. She handled it as well as she could, which is not always as well as she would have liked.
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Although the Alzheimer’s diagnosis helped to make sense of things, nothing could make Ameche better. “Every day is an up-and-down. (Rollercoaster ride makes it sound thrilling, and it is not thrilling. The ups and the downs both hurt, it’s a mistake to scream, and nothing moves quickly.)”
She compares his degrading brain to “some beautiful Egyptian jug of Nile clay and jute . . . the straw is pulled out, stalk by stalk, and then it’s not the jug it was, it can’t hold a thing. It’s a pile of clay and straw in the palm of your hand.” Securing the death that Ameche wanted became the last, binding effort of their shared life. It was done, as the title says, in love.
Writing about bereavement is a vulnerable act, not only because it demands emotional nakedness, but because it lays the memoirist bare to a comparison that will flatter few. Joan Didion’s The Year of Magical Thinking, nearly two decades old, is a still-raw and meticulously unsparing account of grief, and it overshadows the entire subject.
Bloom gets out from under that shadow. Here is an autobiographical book that, for once, does not induce the guilty thought in a reader: “I wish this terrible thing had happened to a better writer.” A sharp observer and an immaculate stylist, Bloom balances an admirable lack of sentimentality with the frank expression of her love for the man she felt slipping away and then helped to die.
Love means, sometimes, lying. “Most days, he seems to feel that I’ve got the situation well in hand . . . and that nothing bad will happen in the process,” Bloom writes of the period spent working on the Dignitas application. “This is not true, that nothing bad will happen, and therefore not comforting to me. It leaves me quite alone with reality but the way he feels is exactly what I want for him.”
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Love means, also, putting someone else first. Bloom’s support for Ameche in death matched what he gave her in life. It’s hard to imagine a more romantic statement addressed to a writer than Ameche’s words when he and Bloom got together: “You should be with a guy who doesn’t mind that you’re smarter than he is.” Hard to imagine, yet a more romantic statement does exist, and it’s the epigraph to In Love: “ ‘Please write about this,’ my husband said.”
In Love: A Memoir of Love and Loss by Amy Bloom, Granta, 240pp; £16.99
