A Matter of Death and Life

My friend, Linda, bought me a book of this title. It was jointly written by Irvin D Yalom and Marilyn Yalom. Linda had read several of Irvin Yalom’s books whereas I had never heard of him although he is, according to the back cover, ‘an internationally renowned psychiatrist’. Because they have the same surname, I refer to them here as Irvin and Marilyn as if I know them. I don’t.

Marilyn had been diagnosed with multiple myeloma (a cancer) and the idea was to write alternate chapters concerning how this diagnosis affected them both. At a certain point about two thirds of the way through the book, Marilyn was unable to continue and Irvine had to finish it himself. They had been married for sixty-five years so this was never going to be easy.

I found this book unnerving since I had recently lost my wife, Audrey, to cancer of the throat and it turned out that both Irvin and myself had a problem in common with atrial fibrillation and were on the same anticoagulant drug, apixaban, not a drug to be taken lightly.

Though both knew that her cancer was terminal, Marilyn tried two different approaches to fending it off. Neither of them worked but both of them left her feeling dreadful. And this led to a desire on her part to take a medical way out of life – something which is possible in California if two medical practitioners agree. Irvin was reluctant to accept that she felt this way since it would involve losing her entirely but, to put a stop to her suffering, he had to agree with her in the end that her life was no longer worth living.

The book struck a chord or two. The first was the similarity in our situations. The second was another point in common. Both Irvin and myself have been subject to irrational responses and thoughts. The one which struck me most was a constant desire to talk to my wife, knowing full well she was dead. In part, this was because in the later stages of the disease she was house-bound and I reported back to her even more than usual. But I continued to talk with her anyway. Which also brings up the subject of photographs, and here I note a difference. Irvin had a photograph of Marilyn printed, but found it too painful to look at and turned it to the wall. I had three made and look at them all the time.

This desire to talk to my wife, which I often give way to, is plainly irrational, yet Audrey had told me often in the past that I relied too much on logic so, who knows, she might approve of this development. Can these conflicting aspects of character be reconciled? Irvin believes they can and quotes the views of a professional contact (unnamed).

Memory is no longer believed to be a unitary phenomenon, rather, memory is comprised of distinct systems that can work independently, have different neuroanatomic loci, and can even work at odds with each other. He describes the dichotomy between “explicit”  (or “declarative”) memory versus “implicit” (or “procedural”) memory.

Explicit memory is conscious and is dependent on medial temporal lobe structures as well as the cortex of the brain.

Implicit memory is largely unconscious and often underlies skills, habits, and other automatic behaviors. It is processed in different parts of the brain: the basal ganglia for skills, the amygdala for emotional responses.

These two kinds of memory can operate independently, almost unaware of each other, and can even be in conflict with each other. (P 178)

This would explain, for example, why I keep on wanting to tell Audrey things, and often do, despite the fact that I am only too well aware that she has died. It would also give each one of us an out if we were embarrassed by our irrationality. It’s not me, doc, it’s my brain!

A third point of contact is that both Marilyn and Audrey were looked after by their husbands for many months, both wished to die at home, and both did. But that leaves Irvin and I on our own. If we develop a terminal illness there are no wives left to look after us as we looked after them. Personally, I would hope to pop my clogs by going to bed one night and not waking up the next morning. What I would want to avoid is a lengthy illness during which I would have to be looked after. Who would fulfill this role? There is no one I would wish to inflict this on, so how to leave the departure lounge if the need arises? Well, fortunately for people like me, Irvin has given us a detailed account of how this might be achieved. This is part of it.

Dr.  P first gives her some medication to prevent vomiting and then prepares the lethal drugs in two glasses. The first glass contains 100 milligrams of digoxin, enough to stop the heart. The second glass contains morphine 15 grams, amitriptyline 8 grams, and diazepam 1 gram. (P140)

Digoxin is available here in the UK by prescription only. It is derived from digitalis, so those of us wishing to use this method may have to grow our own foxgloves.

It is only to be expected that this book will deal with grief, and it does. Technically, I know what this word means but I have no feeling for it; if a word must be used at all, I am happier with the word ‘anguish’. However that may be, there are two occasions at least when it is suggested that we who are left behind can get over it in one, maybe two years. Inhabiting the irrational end of the spectrum as I now do, I find it surprising that anyone would want to get over it. I regard grief as my friend, keeping my wife’s memory fully alive. I realise, though, that if the person left behind is much younger than I am, they might want to marry again, or whatever it is people do these days, in which case getting over it might be a desired outcome, allowing them to ‘move on’.

Is this a good book? On one level it is; it is a well written account of two people facing the end of their relationship, how each of them deals with it, and how the survivor, Irvin, copes with his loss. Does it help others in the same or a similar situation? I can only speak for myself here, but the answer is no. How could it?