In Love: A Memoir of Love and Loss

Brian begins to lose his memory after a hip surgery. He and Bloom guess that his memory issues are related to the anesthesia used in the procedure. However, Brian’s condition continues to worsen, worrying Bloom. Furthermore, Brian’s surgeon is skeptical that Brian’s memory issues stem from the surgery. Over the course of the six subsequent weeks, Brian becomes obsessed with the past. The more distant he acts, the more upset Bloom feels. Her communication with Brian has begun to dissolve, too. She feels like a pane of glass has been erected between them and that she is powerless to remove it.

At the end of 2016, Bloom begins to research Alzheimer’s. The information that she discovers online and her observations of Brian’s altered behaviors suggest that Brian has the condition.

Since the establishment of Dignitas’s rival Pegasos, there have been two organizations in the world that offer assisted suicide with relatively few restrictions (these include suicidal ideation, psychosis, and advanced dementia). Bloom has extensively researched both Pegasos and Dignitas. She and Brian choose Dignitas because their mission promotes dignity. Bloom supports their philosophy but has found many negative journalistic reports on their work.

Dr. G. conducts his second interview with Brian at the hotel. First he ensures that Brian hasn’t changed his mind about his upcoming accompanied suicide. Then he and Brian chat at length about the Dalai Lama. Meanwhile, Bloom wonders if Brian’s lucidity is a sign that they should postpone the appointment. She realizes that Brian is already leaving her and starts to cry. After Dr. G. leaves, Bloom and Brian go for a walk. Bloom is afraid of what will happen next, but she understands that Brian isn’t.

In 2019, Bloom begins to imagine seeing other people. Since marrying Brian, she hasn’t felt unhappy. However, her marriage has begun to resemble her last unhappy marriage. Brian’s Alzheimer’s has made him unfamiliar to her, but she can’t imagine hiring a caretaker for the man she once knew. While some people watch their partner devolve over the course of decades, Brian’s behavioral changes have occurred within just three years.

Bloom assumes the role of Brian’s caretaker. She stays strong in spite of her frustrations, doubts, and fears. She knows how to care for and love others. However, because of Brian’s Alzheimer’s, her efforts sometimes feel futile.

After Brian applies for his job as a university architect, he secures the position with ease. However, within just a few months, Brian’s boss and colleagues grow frustrated with him. The tenor of his tenure with the university changes, upsetting and confusing Brian. He doesn’t understand why his work dynamic has become uncomfortable. When he and Bloom visits the neurologist for tests shortly thereafter, they discover Brian’s Alzheimer’s, and Bloom provides the doctor with her assessment of Brian’s changed behavior.

Brian has enjoyed meditation for many years. He relies upon this pastime as much as Bloom relies upon gardening. Therefore, Bloom knows that something is wrong with her husband when he fails to attend his usual meditation sessions. At times he mixes up the dates and times of his meditation, while at others, he forgets the session address.

On Brian and Bloom’s shared birthday weekend, Bloom is overcome by grief. She wants to be happy but keeps crying while she and Brian are out together. She doesn’t know what will happen to her marriage but fears the worst. She and Brian try unsuccessfully to feign normalcy. In the days following, their communication worsens. Bloom gets particularly upset when Brian visits the doctor and gives her an inaccurate report of the visit. Other similar problems occur in the days and weeks following.

On the day of Brian’s MRI, Bloom and Brian wake up early. Their morning conversation reminds Bloom of other conversations they’ve had throughout their relationship, and she wishes things could go back to how they once were.

Bloom gets ready to leave for Brian’s appointment. In the mirror, she sees herself as an old, ugly woman. No matter what she does with her hair and makeup, she can’t correct her image.

At the MRI appointment, Bloom gets frustrated with the technicians’ behavior. She’s also annoyed with herself for choosing this particular facility. During the MRI, she holds onto Brian’s foot. When he starts wiggling his toes, the force of what it will to mean to lose him hits her.

Bloom notes changes in Brian’s behavior on the drive home. He also acts differently once they get back to the house. In the recent past, Bloom could dismiss these changes. Now she knows they are evidence of Brian’s Alzheimer’s.

Bloom reflects on her Alzheimer’s research while she and Brian wait for his second neurology appointment. She marveled at how many people are affected by the disease each year and was fascinated by the statistics surrounding women’s relationship to the disease. She reflects on this data and considers its relevance to her situation—particularly the Alzheimer’s forums’ recommendations regarding communicating with patients. She remains skeptical of some of these recommendations and struggles to apply others to her relationship.

The neurologist gives Bloom and Brian her read on Brian’s MRI. Bloom starts crying. The neurologist tells the couple how Brian’s condition will progress. Bloom asks questions and suggests alternative assessments, but the neurologist doesn’t amend her report.

Bloom and Brian hold each other and cry when they get home from the appointment. They cancel their plans so they can be alone together in the following days. One day, they go out to buy cards to send friends and relatives. They cry and hold each other at the store while trying to make jokes. The entire weekend passes this way. Meanwhile, the couple researches ways to die. One friend offers to kill Brian. Bloom suggests that Brian drown himself. Brian suggests that Bloom kill him. The couple considers the possible repercussions of these actions, realizing their options are limited.

Bloom’s research has revealed how meaningless the US’s right-to-die laws are. Her conversations with the director of End of Life Choices New York, Judith Schwartz, have informed her opinions. Schwartz explained that although some states have made progress in this area, even the most progressive states discourage assisted suicide. Therefore, Schwartz agreed that Dignitas was Brian’s best option. Bloom felt encouraged by Schwartz’s support. Per Schwartz’s direction, Bloom called Brian’s dentist after one of their phone calls. The dentist was reluctant to release Brian’s dental records. Bloom didn’t explain that she needed them for Dignitas, but the conversation was difficult.

S. informs Bloom that Dignitas needs a psychiatric assessment of Brian, as his psychiatrist and neurologist deemed him depressed in his paperwork. Bloom contacts both of them, begging for a reassessment. However, the doctors are reluctant to change Brian’s report.

Over the course of the following weeks, Bloom works tirelessly to procure the necessary psychiatric documentation for Dignitas. She finds an advocate in Brian’s meditation instructor, Donna, and draws strength from memories of their couple’s therapist, Rachel, who was also diagnosed with Alzheimer’s. During Bloom’s last encounter with Rachel, Rachel expressed her own interest in assisted suicide, and Bloom wished she could help her in the way Rachel had helped her and Brian over the years.