“I have failed him” is a confession that Amy Bloom utters more than once of her husband, Brian Ameche, in her courageous howl of a memoir. Spoiler alerts aren’t required to say that, ultimately, she does no such thing, even though ensuring that it’s so means making good on the ultimate pledge: helping her beloved kill himself.
Assisted suicide is the preferred wording at the Dignitas clinic in Switzerland, to where she and 66-year-old Ameche will eventually travel from their Connecticut home in January 2020, in order for him to down a fatal dose of sodium pentobarbital. They’ll fly business class, paid for by her sister, but the truer journey there takes months and involves endless paperwork and administrative delays, obstructive medical professionals (“villains”, she deems them), and a slaying range of bittersweet emotions. Because braided with the backstory of their offbeat midlife romance is Bloom’s account of watching her spouse fall victim to one of the world’s most prevalent but least understood diseases: Alzheimer’s.
The narrative flits back and forth in time as Ameche’s appointment in Zurich looms, and though never less than expertly crafted, this is a book whose temporal shifts can feel appropriately unmooring. Glancing over her shoulder, Bloom recognises that there were plentiful signs Ameche was suffering from dementia as long as three years previously: forgetfulness, abrupt lack of interest in activities he’d previously adored, subtle changes in his character and far less subtle changes in his handwriting.
As haziness invades the architect’s once-keen brain, Bloom meets it with a willed fog of her own, desperate to minimise, normalise. Surely their trip to Zurich, she reflects, could seem “almost normal” – except that when Ameche wanders off to the newsstand, she holds her breath until he returns. Raising glasses to each other on the plane, they’d ordinarily have said “Cent’anni” – Italian for “May we have a hundred years” – but can’t bring themselves to, knowing full well that they won’t get to share a 13th wedding anniversary.
Once he received his diagnosis in 2019, it took Ameche less than a week to reach a decision from which he wouldn’t waver. Not for him the “long goodbye” of dementia – better to die on his feet than live on his knees, he insisted. The trouble was, orchestrating his exit was already beyond him, and so began Bloom’s eerie internet trawling. She considered solutions involving turkey basting bags, the scoring of illegal drugs, and a futuristic suicide pod. An old pal from Ameche’s Yale football-playing days (the sport seems the likeliest cause of his illness) volunteered to shoot him if he could only wait a while. It wasn’t long before Dignitas emerged as the sole fully legal, pain-free option.
“Every day is an up-and-down,” she writes of the long, conflicted weeks that follow as she works to convince the Swiss of her husband’s suitability. “Rollercoaster ride makes it sound thrilling; it is not thrilling. The ups and the down both hurt, it’s a mistake to scream, and nothing moves quickly.” Bloom at once dreads and desperately needs the green light from Dignitas, because the consequences of not getting Ameche there before he’s deemed incapable of a sound decision appal them both.
Tears course through these pages leaving even phones “sodden”, and the couple nap frequently, “as if clubbed” (that verb says it all). Less expectedly, it’s also consistently funny. Very funny. Among those early warning signs? Wildly off-key gifts like jewellery suggestive of some “Seventies-boho, broke-ass mistress” or a $500 marled hoodie with tulle trim. “I’m still surprised that I didn’t look at that sweatshirt and think, I see that you have Alzheimer’s,” Bloom muses.
Heartache makes her savvy and sarcastic, a tone she pairs with a memorable descriptive shorthand whose economy underscores the ticking clock at her narrative’s centre, and all the ambivalence that represents for her. Landing in Zurich, for instance, they check in to a room that’s “hotel-pleasant”. As a couple, they were always “stickily close”, and she craves “leaf-shaking” end-of-life conversations instead of listless chat. “Agony and tedium” are the words she’ll find written on an index card when she unpacks back at home.
Her characterisation of Ameche before his illness, however, is full of life. Here he is, a large, good-humoured man adored by granddaughters and waiters alike, possessed of a working wardrobe best described as “gay Mafia hitman”.
As well as being a novelist, Bloom is a psychotherapist, intimate with all things “shrinky” (her word), and yet she details her own feelings – her anguish and anxiety and exhausted irritation – with disarming immediacy. She dips, too, into the fraught ethics of euthanasia. “I worry, sometimes, that a better wife, certainly a different wife, would have said no,” she admits.
In Love is her 10th book but first memoir, and she says in the acknowledgments that it has proven the most challenging of her career. (Bear in mind, too, that Covid lockdowns came into force very shortly after her solo return to the US.) It’s certainly profoundly personal and all the stronger for it, but she allows herself to take in the broader picture while venting. For starters, she’s angry with the red tape that makes a hard task harder, still less dignified. She’s angry at the fact that this “infinity pool” of a disease so disproportionately affects women, as sufferers and caregivers both. And of course, she’s really angry with other people for being alive when Ameche soon won’t be.
Curiously, the nature of Alzheimer’s means that she is, in a way, being expunged too. “Sometimes now with Brian, I am worse than alone. I’m gone from his interior landscape. Not that I have been uprooted, but that I am not there, and never was. These moments are scorching,” she writes towards the end. But then she’ll hand him a cup of tea and he’ll smile and thank her and she’ll realise that it’s “just as scorching to be present”.
The tea will invariably have a big spoonful of honey in it. If her humour – dark, stark but messily, warmly human with it – stems from a kind of survival instinct (coping mechanism is too pat), then the maternal nurturing that takes over, stopping her (mostly) from snapping over his chilly disengagement or their now-circuitous spousal bickering, feels equally elemental, equally fierce.
When the time comes to head to the industrial park outside Zurich where Dignitas is based, Bloom allows the reader into the room with her. Much of the intensity of what is about to take place is captured by a single, simple question that Ameche asks: “What time’s your plane?” In the circumstances, how could it be anything other than unravelling? And yet she takes his hands, kisses his weary face. It’s of such modest seeming kindnesses that extraordinary acts of love are composed, this startling book teaches.
• In Love: A Memoir of Love and Loss by Amy Bloom is published by Granta (£16.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
