Is it possible to plan a "good death?" Can one gracefully leave this world to the next generation? Can one live meaningfully until the very end?
Prompted by a serious medical diagnosis, longtime Palo Alto residents Irvin and Marilyn Yalom probe these questions in "A Matter of Death and Life," which the duo wrote just before Marilyn died by medically assisted suicide in 2019.
Married 65 years, both Yaloms already were widely published authors — translated into many languages — when they began writing their book in spring 2019 after Marilyn was diagnosed with multiple myeloma, a cancer of the plasma cells.
Irvin, a psychiatrist and leader in the field of existential psychotherapy, had some 20 fiction and nonfiction titles to his name. Marilyn, a cultural historian, French professor and early director of Stanford's Center for Research on Women, had published at least 10 books.
With her prognosis bleak, Marilyn persuaded her husband that they should document, in alternating chapters, the experience of her illness and likely demise from the disease.
"We now live each day with the knowledge that our time together is limited and exceedingly precious," the two, both in their late 80s, write in the preface. "This book is meant, first and foremost, to help us navigate the end of life."
As scholars, both Yaloms are steeped in the great philosophers' contemplations on exemplary life and death, and have wrestled in their own work with themes of mortality.
In "American Resting Place," co-authored with their son, the photographer Reid Yalom, Marilyn documented how 400 years of gravestones, graveyards and burial practices reflect changing American ideas about death, class, gender and immigration.
As a psychotherapist, Irv had counseled countless patients, including many with terminal illnesses, about facing death, and written extensively about their — and his own — death anxieties.
"Of all the ideas I've employed to comfort patients dreading death, none has been more powerful than the idea of living a regret-free life," Irv recalls in the book.
Sitting together in their yard, admiring the trees, "Marilyn squeezes my hand and says, 'Irv, there's nothing I would change,'" he writes. With four children, eight grandchildren and extensive world travels in addition to their professional accomplishments, both Yaloms feel they've seized their days to the fullest.
Even as death approaches, the pair celebrate "magic moments," such as the evening they abandon television and Marilyn pulls "Martin Chuzzlewit" down from the bookshelf and begins reading aloud. "I purr in ecstasy, listening to each word," Irv writes. "This is sheer heaven: What a blessing to have a wife who delights in reading Dickens's prose out loud." He recalls the day — more than 70 years before — when the two had first bonded over their mutual love of books as classmates at Roosevelt High School in Washington, D.C.
When chemotherapy fails and Marilyn is placed on immunoglobulin therapy, she begins inquiring about medically assisted suicide — legal in California since 2016 — in the event the new treatment does not work.
Irv is horrified, but Marilyn is at peace. Though sad to leave the people she loves, "The idea of death does not frighten me," she writes. "I can accept the idea that I shall no longer exist. ... After 10 months of feeling awful most of the time, it's a relief to know that my misery will come to an end."
After some weeks the couple is told the immunoglobulin therapy, too, has failed.
Marilyn accepts various tributes and goes about saying her goodbye, and giving away her treasured books to a large network of friends and colleagues. "It's weird to realize that if I want to do anything, I'll have to do it quickly," she writes.
Ultimately, about a week before Thanksgiving 2019, she chooses to end her life, ingesting lethal medication in the presence of Irv, their four children, a physician and a nurse. (She was among the 405 people to use California's End of Life Options Act in 2019, according to the annual tally from the state health department.)
Shortly before, Marilyn had reviewed the writings of Greek and Roman philosophers on how to live and die well. "For all the philosophical treatises and all the assurances of the medical profession," she writes, "there is no cure for the simple fact that we must leave each other."
The final chapters are written by Irv, recounting the agony of grief and his halting attempts to resume some kind of normal life — including venturing out to a Barron Park Senior Lunch at the Corner Bakery.
After more than 70 years with Marilyn beside him, he struggles with the idea that "something can have value, interest and importance even if I am the only one to experience it, even if there's no Marilyn to share it with.
"It's as if Marilyn's knowing about a happening is necessary to make it truly real," he writes.
He rails at the irrationality of this. "I've been a full-time student, observer and healer of the mind for over 60 years, and it is difficult to tolerate my own mind being so irrational," he writes.
Reached at his home in late May, two months after the book's publication, Yalom said he's been busy with the "strong feedback," including virtual book talks with large audiences all over the world. The book is licensed for publication in 25 countries, some already in print and others likely between now and the end of next year, according to literary agent Sandra Dijkstra.
Yalom, who turns 90 this month, continues to work on his next book and also to do single-hour therapy consultations.
"I'm growing old now and my memory's beginning to disappear," he said. "I'm not seeing ongoing patients anymore but I think I'm able to do a lot for some people just in the single hour."
His new book is intended as a training manual for young therapists. "I'm always writing, and as long as I'm writing I feel very well," he said.
He also takes walks daily to a nearby park, where he's had a bench installed in memory of Marilyn. Yalom said he enjoys sitting on the bench, taking in the surroundings and thinking of her.