When Brian Ameche, the husband of Amy Bloom, knowing her taste for simplicity, bought her “a very expensive … sweatshirt with tulle trim”, she might have guessed something was amiss. Looking back, she was “surprised that I didn’t look at that sweatshirt and think, ‘I see that you have Alzheimer’s’”. By this time Brian had begun to forget things, to lose his way and, most distressingly, to become distant with his wife, with whom he had lived in rare concord since their late-life marriage in their 50s. And yet, as I observed in my father when my mother was in the grip of this disease, denial is its almost inevitable attendant. Those closest to the sufferers often find they cannot bear to acknowledge what is happening.
Bloom’s sharply observed, often witty, eminently moving memoir charts the gradual progression of the illness from her slow recognition that her husband was not himself, to an eventual diagnosis, followed by a fraught search for a means for them to end his life. For “once Brian had finally been diagnosed it took him less than a week to decide that the ‘long goodbye’ of Alzheimer’s was not for him”.
Because of their “eye-of-the-needle” requirements, apparently libertarian laws in the US mean that assisted suicide is all but impossible there. The “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 comments with typical tartness. An old friend offers: “‘If you think you don’t need to go right now, and you want to wait awhile, I can just shoot you myself, in a year or two, in a field.’ Brian hugs him.” His brother, making a similar suggestion, jokes: “I’d be fine in jail. I don’t go out much anyway,” at which Bloom comments: “I have never liked the man more.” Finally they discover Dignitas, the Swiss organisation that assists those whose medical conditions lead them to choose to end their lives rather than endure the miseries of a “natural” death. Here begins the process of fulfilling the exacting demands required to take this mortal step, of which the patient’s own “discernment” is considered paramount.
The book is written in short chapters, giving a sense of pace to echo the urgency that now ensues – the couple must achieve their goal before Brian’s mind is too disrupted for the decision to be judged truly his, a requirement that is the sine qua non of the Dignitas process. The account begins on 26 January 2020, in the final stages of this ordeal, with what is to be Brian’s last journey. But it is interspersed with snatches of their history, during which we learn to love the handsome, greedy-for-life Brian, who declares to Bloom: “You should be with a guy who doesn’t mind that you’re smarter than he is, who doesn’t mind that most of the time you’ll be the main event … I don’t know if I can be that guy … but I’d like a shot.” To which Bloom appends, “We married.” It is the swift but telling glimpses of that life together – she an ironic, intellectual, bisexual Jew, he a sporty hedonist from a devout Catholic family – that give the book its peculiar poignancy.
But if Brian is the subject, it is Bloom who is the hero of this story. The disease renders her husband incapable of making the necessary tough decisions, of first wheedling and then railroading doctors who persist in the false diagnosis of depression that would prevent Dignitas accepting him as a candidate. It is she who must decide what to tell her children, and whether or not to prepare the grandchildren for the loss of their adored “Babu”.
The end of the story is told as frankly and unmawkishly as the rest. An anti-emetic is supplied to ensure the patient doesn’t vomit up the prescribed lethal dose. But Ameche takes his time before downing it. “I know I’m going,” he says. “I’m ready. I’m just not going to hurry.” This is the most painful moment in an account that is not exactly free of painful moments, not just because of what is about to happen, but because some of the last minutes he will spend with Bloom are taken up with old football anecdotes. “I cannot manage to look interested in these stories,” she writes, “because I’m not. He says nothing about our life, our love, our children and grandchildren.” The effectiveness of the anti-emetic wears off, and he must be asked yet again if he wishes to go through with the procedure. He swallows a second dose, this time alongside the drug that kills him, falling silent so that Bloom suddenly longs for the football stories. She sits there until he is “gone from the world”, and she must take the forlorn trip home without him.
But he isn’t gone. Because, as Brian enjoined her, she has written about him with all the brave-spirited, undaunted love to which the book bears stupendous witness.