In Love: A Memoir of Love and Loss

Nonfiction | Autobiography / Memoir | Adult | Published in 2022

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Part 1

Part 2, Chapters 1-13

Part 2, Chapters 14-29

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Themes

The Personal and Emotional Impact of Alzheimer’s

Content Warning: The source text deals with issues including terminal illness, assisted suicide, and mental health deterioration, including references to depression and anxiety.

The memoir’s central conflict revolves around Brian’s diagnosis with Alzheimer’s. Before Brian gets sick, Bloom and Brian’s life is idyllic. After meeting in middle age, they develop such a strong connection that they leave their respective marriages for one another. For roughly 15 years thereafter, Bloom and Brian’s love sustains them. However, Brian’s Alzheimer’s diagnosis forces the couple to reevaluate who they are as individuals and in relation to one another.

In Love centers the ways in which the disease changes the couple’s marriage and impacts them emotionally. In Part 2, Chapter 3, Amy Bloom acquaints herself with the progression of her husband’s illness, saying:

That steady loss, that steady unraveling, is sometimes paused but never stopped. The shape of the self is held together as well as can be, with the use of alternative pathways in the brain [...] by the person suffering and with backup from the person helping, until none of it’s enough and the vessel [...] begins to soften and drop its walls (58-59).

This passage acts as a narrative key to the memoir’s overarching thematic examinations. The gradual erosion of self that Brian experiences in turn alters Bloom’s sense of reality and identity. Here, for example, she depicts not merely the selfhood of the Alzheimer’s patient but also the boundaries between patient and caretaker as porous, resulting in an experience that is both intimate and alienating. Bloom elsewhere declares herself “as good a parent as I knew how to be” and as “a loving presence” (69). Yet in the face of Brian’s illness, Bloom loses these facets of her identity even as she dons a new role as caretaker.

The memoir centers both Bloom’s and Brian’s emotional evolutions to illustrate Alzheimer’s power and inexorability. Throughout Part 1, Bloom employs a steady narrative tone that reflects her attempts to maintain emotional composure. She describes Brian’s diagnosis, his decision to pursue accompanied suicide, and her work to enact his wishes in simple, accessible prose. Her stylistic choices reflect her state of mind. However, Bloom’s style and tone evolve over the course of Part 2, catalyzed by Bloom and Brian’s emotional challenges. In Part 2, Chapter 2, for example, Bloom rails against the “glass” she feels now separates her from Brian: “I was banging on it, screaming at him: Why is there a glass between us? Where did it come from? Take it down!” (55). Bloom is no longer capable of quashing her emotional distress at this juncture, and the emotionality of her language conveys the ways that Alzheimer’s has begun to alter her responses to Brian. The same principle applies to Brian, who has grown detached from the world and disengaged from his marriage as a result of his disease. Bloom’s authorial vulnerability and forthrightness throughout In Love capture the visceral ways in which Alzheimer’s can alter even the most secure, loving relationships.

The Struggle for Autonomy and Dignity

By the time of Brian’s diagnosis, he and Bloom have developed a distinct bond: They have built a life together but have maintained their autonomy and their individuality. However, their balanced dynamic begins to change when Brian starts to act in strange and unpredictable ways. As Brian starts to lose his sense of self, Bloom begins to question her role in her husband’s life. As Brian tells his Dignitas representative, he wants to maintain his autonomy over his mind, body, and future by dying while he is still himself. However, the nature of his condition poses inherent challenges in pursuing this goal, particularly given the bureaucratic obstacles surrounding assisted suicide. In embracing Brian’s decision, Bloom therefore helps him orchestrate his death, granting him authority over his identity and story by carrying out the wishes he might struggle to enact independently.

Bloom’s involvement in her husband’s death redefines her personal sense of autonomy and dignity. When Brian is first diagnosed with Alzheimer’s, Bloom is in denial. She doesn’t want her husband to die, but she also doesn’t want to watch him suffer. Her sense of powerlessness becomes clear in Part 2, Chapter 6, when she explains that daily life with Brian began “to require a level of effort” that Bloom last had to make when she was juggling multiple responsibilities, including “an unhappy marriage, a full-time job, a teenager, a toddler, and a baby” (67). Brian’s diagnosis isn’t Brian’s fault, but it requires that Bloom accept her own limitations while relearning what it means to treat her husband with the dignity he deserves. Because Brian’s doctors and specialists don’t consistently extend this dignity and respect, Bloom finds herself assuming multiple personas at once. As a result, she loses some of her independence, relying on others more often in order to sustain herself and support Brian. Her experience thus mirrors her husband’s and suggests that autonomy may actually require interpersonal support, particularly in the context of chronic illness.

Nevertheless, Alzheimer’s itself remains firmly outside of Bloom and Brian’s control. Their decision to work with Dignitas grants the couple control over their otherwise uncontrollable situation. The disease has stolen their joy in the present and their hope for the future, and the only way for them to reclaim their autonomy is to orchestrate Brian’s death. His accompanied suicide is painful for Bloom. However, it allows Brian to die with dignity and Bloom to say goodbye to her husband on her own terms.

The Power of Love and Commitment in Challenging Times

Brian’s diagnosis with Alzheimer’s challenges Bloom and Brian’s loving marital relationship. When the two meet in middle age, they decide to end their unhappy marriages and to cause a scandal in their small community to be together. By taking this risk, the couple proves that their connection is exceptional. In Part 2, Chapter 24, Bloom momentarily abandons her account in the present in order to detail her history with Brian in a declarative voice: “I married him despite all the very good reasons that no one should ever partner up for a third time—because early on, he reminded me of the best father figure” (195). Bloom’s honesty and vulnerability capture her affection for her husband and invite readers to empathize with the depth of her love.

Despite Brian’s illness, his bond with Bloom endures as Bloom attempts to prepare for her lover, partner, and husband’s death. Bloom incorporates anecdotes, imagery, and emotionality into her first-person point of view account to reveal her unique relationship with her husband and to convey the pain they experience in parting with one another. In Part 2, Chapter 9, for example, Bloom holds on to Brian’s feet while he is getting his MRI. When she tells him that he is doing great, “He wiggles his toes back at me. This is my Brian: getting through the MRI steadily, wiggling his toes, occasionally keeping time to the noise, letting me know he’s there. This is exactly who I’m going to lose” (91). This scene captures Bloom’s sorrow and grief: Her love for Brian is so strong that she struggles to imagine a life without him. At the same time, this scene conveys the ways in which Bloom and Brian’s connection fortifies them—here symbolized by their physical connection. Although the couple often cries together, they joke and laugh together too. Their capacity for humor, communion, solidarity, and sacrifice illustrates the power of their love. Brian’s diagnosis has hurled them into an unprecedented relational domain. However, the couple withstands these trials together.

In fact, Brian’s condition occasions new evidence of the couple’s bond. Bloom’s decision to support Brian’s efforts to die by assisted suicide is extremely difficult, and she often second-guesses its wisdom. Ultimately, however, it is selfless love for her husband that confirms her in her chosen course: She does not want to lose Brian, but she knows what Brian’s wishes are and allows these, rather than her own fear and grief, to guide her.