A Matter of Death and Life
Irvin D. Yalom and Marilyn Yalom

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PREFACE

We both embarked on academic careers after postgraduate training at Johns Hopkins, where I had completed a residency in psychiatry and Marilyn obtained a PhD in comparative (French and German) literature. We were always each other’s first reader and editor. After I wrote my first book, a textbook on group therapy, I was awarded a writing fellowship from the Rockefeller Foundation at the Bellagio Writing Center in Italy to work on my next book, Love’s Executioner. Shortly after we arrived, Marilyn spoke to me about her growing interest in writing about women’s recollections of the French Revolution, and I agreed that she had ample excellent material for a book. All of the Rockefeller scholars had been given an apartment and a separate writing studio, and I urged her to ask the director whether there might also be a writing studio for her. The director responded that a writing studio for a scholar’s spouse was an unusual request and, furthermore, all the studios in the main structure had already been assigned. But, after a few minutes of reflection, he offered Marilyn an unused tree house studio only a five-minute walk away in the adjoining forest. Delighted with it, Marilyn began work, with gusto, on her first book, Compelled to Witness: Women’s Memoirs of the French Revolution. She was never happier. From that point on, we were fellow writers, and for the rest of her life, despite four children and full-time teaching and administrative positions, she matched me book for book.

In 2019, Marilyn was diagnosed with multiple myeloma, a cancer of the plasma cells (antibody-producing white blood cells found in the bone marrow). She was placed on a chemotherapy drug, Revlimid, that precipitated a stroke, leading to an emergency room visit and four days in the hospital. Two weeks after she returned home, we took a brief walk in the park just a block from our home, and Marilyn announced, “I have a book in mind that we should write together. I want to document the difficult days and months before us. Perhaps our trials will be of some use to other couples with one member facing a fatal illness.”

Marilyn often suggested topics for books that she or I should undertake, and I replied, “It’s a good idea, darling, something you should plunge into. The idea of a joint project is enticing but, as you know, I’ve already started on a book of stories.”

“Oh, no, no—you’re not writing that book. You’re writing this one with me! You'll write your chapters and I'll write mine, and they will alternate. It will be our book, a book unlike any other book because it entails two minds rather than one, the reflections of a couple who have been married for sixty-five years! A couple very fortunate to have each other as we walk the path that eventually leads to death. You’ll walk with your three-wheeled walker, and I’ll walk on legs that can ambulate for fifteen or twenty minutes at best.”

In his 1980 book, Existential Psychotherapy, Irv wrote that it is easier to face death if you have few regrets about the life you have lived. In looking back over our long life together, we regret very little. But that doesn’t make it any easier to tolerate the bodily travails we now experience day to day, nor does it soften the thought of leaving each other. How can we fight against despair? How do we live meaningfully till the very end?

In writing this book, we are at an age when most of our contemporaries have died. We now live each day with the knowledge that our time together is limited and exceedingly precious. We write to make sense of our existence, even as it sweeps us into the darkest zones of physical decline, and death. This book is meant, first and foremost, to help us navigate the end of life.

While this book is obviously an outgrowth of our personal experience, we also see it as part of a national dialogue about end-of-life concerns. Everyone wants to obtain the best medical care available, to find emotional support in family and friends, and to die as painlessly as possible. Even with our medical and social advantages, we are not immune to the pain and fear of oncoming death. Like everyone, we want to preserve the quality of our remaining lives, even as we tolerate medical procedures that sometimes make us sick in the process. How much are we willing to bear to stay alive? How can we end our days as painlessly as possible? How can we gracefully leave this world to the next generation?

We both know that, almost certainly, Marilyn will die of her illness. Together we shall write this journal of what lies ahead in the hope that our experiences and observations will provide meaning and succor not only for us but for our readers.

Irvin D. Yalom Marilyn Yalom