Not to Be

In the middle of a gusty October three years ago, The New York Times published an obituary under the headline “Sue Hubbell, Who Wrote of Bees and Self-Reliance, Dies at 83.” The story is charming and noble in equal measure, the account of a woman who started over in the middle of her life after her marriage crumbled, following the wide road and the hum of hives. She fixes cars, keeps bees, drives miles for a perfect piece of pie, raises a son, writes it all down, publishes eight books, and is, at moments, “outrageously happy.” Who doesn’t love an obituary like this, where all the action happens in the last half? Who doesn’t want a divorce if it tips everything over into honey and liberation! But I remember this woman not because of her life, exactly, but because of how it ended. After she was found wandering in the woods, unmoored,

“Sue decided that she strongly wished not to descend into dementia under indefinite institutional care,” [her son] Brian Hubbell said by email. “So, on the morning of Sunday, Sept. 9, she ate her last grapefruit and informed her friends and doctor that she intended to stop eating and drinking. She stuck to her plan and died 34 days later, increasingly lucid through the last few days.”

My mother texted me the link: “I love this woman,” she wrote. The right to die sits at the center of my family, sending electric shudders outward like the branches of a star. When does a person have the will, the ability, and the consent of the world around them to end their life? What is a good death, and can one choose it? Do we have the right to know which grapefruit is our last? My mother has been sporadically and acutely suicidal through most of her adulthood, alongside long periods of joy and stability, and my father died last year of a degenerative disease that took seventeen years to kill him, in the slowest, most brutal way possible—early-onset Alzheimer’s, which he developed around the age of sixty. I remember first wanting to die when I was five years old.

We have each had to grapple with the legal, ethical, and intimate consequences of these questions, their pragmatic challenges and their vast profundities. So it did not surprise me when my mother clipped out the story of Sue Hubbell and stuck it on the crowded fridge, our nexus of domestic detritus and sought-after optimism. It was a graying prayer flag, a newsprint Polaris. Let our last days be only increasing in their lucidity. Let us be eighty-three, with a plan to stick to. The obituary closes on a note of stubborn ascendance: “In her final conversations with [Brian Hubbell], he added, she said she considered the ending to her life that she had orchestrated ‘a triumph.’” I believe this is the only time a suicide has ever been described as such in the paper of record. I also believe “the ending to her life that she had orchestrated” is the most obscure possible way to say that a woman starved herself to death.

A year and one month later, Marilyn Yalom’s New York Times obituary was titled “Marilyn Yalom, Feminist Author and Historian, Is Dead at 87.” The specifics of her death aren’t mentioned, except for a diagnosis, multiple myeloma. In her later years, she devoted herself to death as a subject of study, pinning it down as it tunneled toward her. It’s like drawing a map of where you’re going while already on the highway. This survey was done in tandem with her husband, the psychiatrist and writer Irvin D. Yalom; they both started writing books about dying as they aged, culminating in their cowritten memoir A Matter of Death and Life, which follows their relationship in the final months of Marilyn’s life. Although this is the only book they wrote together, it seems they did most other things in step, two lives looped and rhythmic.

They met in 1946 when he climbed into her house through a window. She was having a party, and it was too crowded to get in through the door. She was fourteen, he was fifteen. Within ten years they were married, and they stayed married until her death. Four kids, buckets of grandchildren, sixty-five years of marriage, with extra added on for the teen romance. She wrote twelve books. He wrote nearly twenty. For me, it’s the kind of relationship trajectory that has the flickering crackle of a record player or the bright warning of a typewriter bell; it sounds warm, and obsolete. An heirloom marriage, durational in the way past technologies often seem—the promise of a different, longer encounter with time.

In her forty-seventh year of marriage, Marilyn Yalom published one of her best-known books, A History of the Wife (2001). It’s like she transcribed a couple thousand years of herself. The book is a thick, friendly cultural history of Western marriage, low on analysis and high on anecdote, both comprehensive and detailed. Beginning with the ancient world and going all the way up to the most recent century, the history of the wife is also a history of money, medicine, religion, war, and many other things most actual wives did not have authority over until recently. Divorce is there, at the very start, as are contraception and abortion, old and hallowed strategies. Unlike many feminists of her generation, who rejected the heterosexual family wholesale, Yalom earnestly wishes for a better kind of wife, and by tracking the changing shape of marriage, she demonstrates that it can change further. She writes:

Ironically, we may come to think of marriage as a vocation requiring the kind of devotion that was once expected only of celibate monks and nuns. To be a wife today when there are few prescriptions or proscriptions is a truly creative endeavor.

Yalom’s experience as a wife, if we take wifehood as a kind of experience rather than a kind of identity, isn’t present in the book explicitly—autobiography is not her primary mode, although the material of her life always surfaces. In her earlier books, her sons and their wives posed for demonstrative photographs of historical change, a placid couple with a BabyBjörn strapped to the man’s chest; she quotes her own husband as a psychoanalytic authority in Maternity, Mortality, and the Literature of Madness, her groundbreaking survey of women writers whose accounts of insanity were, she posits, catalyzed by the trauma of pregnancy and birth. But it isn’t until A Matter of Death and Life that Irvin appears fully formed in her intellectual landscape, like a whisper of a cloud that suddenly starts to rain. It is only as she dies that the short history of the husband, as an experience, emerges.

A Matter of Death and Life presents the closing scenes of a long marriage, with the tone of both an informal diary and an instructive text. The chapters switch back and forth in perspective, sometimes returning to the same dilemma or situation, as Marilyn prepares to die and Irvin prepares for life to continue without her. At the time of writing, she is eighty-seven and he is eighty-eight. Their account is overly conscious of its potential utility; in fact, they frequently reiterate that a sturdy way to cope with dying is to think of yourself as a pedagogue, modeling dignity for those around you, which the book itself does. Those who can’t live, teach.

The memoir is clearly the ending to a big love story, albeit one where nothing seems to have happened except for the startling outcome that heterosexual monogamy worked as promised: no plot, all twist. The Yaloms are still very much in love, and that is both bizarre and dull, alienating and encouraging to read about. But what interests me is not how to stay with the same person for seven decades (I’d rather keep bees), but, again, that starry uncertainty, silver and hot: How do we choose to die? Unmentioned in the obituary, but central to the book, is the process of Marilyn’s physician-assisted suicide after an ineffective and unbearable cancer treatment, and the conflicts this choice opens up inside her marriage. It’s a tale as old as time: she wants to go but he doesn’t want her to leave.

Irvin’s resistance to the idea of scheduling his wife’s death is deeply understandable—it is an a priori emotion, a relational given. We all want more time, even those who’ve had the most. Marilyn’s candid wish not to exist any longer feels so out of bounds that when she first brings it up he is almost impressed. She is being brave and absurd. He writes:

But over and over, Marilyn speaks about physician-assisted suicide. You just can’t request physician-assisted suicide when there are effective treatments available, I think, but do not want to hammer her with reality. She will learn this for herself. I keep reminding her of all the precious moments she is still experiencing.

The Yaloms lived in California, which in 2016 became the fifth state to legalize physician-assisted suicide; it is currently available in only ten states—the entire West Coast plus Colorado, New Mexico, Maine, New Jersey, Vermont, Hawaii, and Montana—and the District of Columbia. To qualify in California, Marilyn needed to be an adult with a terminal illness that two doctors had determined would cause her death within six months, have “the capacity to make medical decisions” on her own, and be able to administer the lethal drugs to herself. No one could give them to her or help her get them down. Care slips into murder as a hand lifts a glass. This sounds mostly reasonable to the young and healthy, a handful of pills, but grasping, sipping, and swallowing are not always easy. Sometimes that is how you know that death is happening to a person: they need in a way they have only needed once before, a return to a familiar vulnerability that none remember.

Suicide makes more sense to the state if it’s presented as a swifter route to an inevitable outcome, only a few months of citizenry thrown away. In one chapter, Irvin jokes about being institutionalized for suicidal ideation at the age of eighty-eight—asylums full of the acceptance of fate. But he believes his wife is not going to die in the next six months; there are medicines, meanings, ways out or through, making her ineligible and her inquiries null. This is magical thinking, but if you get any doctor comfortable, they’ll admit that telling a person “how long they have” is always a kind of murky divination dressed in a lab coat. Over dinner, Marilyn tells her friends, another couple, that if this stage of treatment doesn’t work, she will choose assisted suicide. The husband, David, swiftly responds, “Your body has only one vote.” Marilyn observes, curtly, “It occurs to me, as it has many times this year, that my death is not mine alone.”

If her death is a democracy, who else are the constituents of Marilyn’s remaining days? It surprised me that her friends felt so entitled to her body and its fate, but I guess the alternate response would also be unsettling—you could tell your friends you plan to die in a few months, and they could say, “Okay.” I know someone who attempted suicide by overdose, and afterward rather endearingly joked, “I was just making sure everyone wanted me to,” a lopsided pause, “not do that.” At the heights of despair or illness, I have described my own body as not not alive.

American mental health discourse often emphasizes that we shouldn’t live for other people, that contentment needs to be self-producing, unentangled. Conventional therapy looks for a well of inner sufficiency, tapping the ground of habits and intentions. These methods echo the language of addiction recovery—you can’t get sober simply because your mother begs you to—but the substance we are trying to quit is suffering. Contemporary sanity is offered as a discipline that abstains from unhappiness. If we work hard enough, we will achieve the desired double negative: to not be not happy. But death (inconveniently, desirably) cancels our efforts out. There’s a lot of chatter about how we all die alone, stranded, waving white flags, but sometimes death can seem like a very crowded experience—an archipelago rather than an island. Maybe death is when we are the most porous, unable to hold up any flimsy borders of the individual, ocean streaming in on all sides. Maybe I’m wrong. I mean, there’s only one way to know.

I don’t want to elide the difference between choosing to die because of the pain involved in living and choosing to die because of the pain involved in dying. Or the difference between psychic misery and physical agony, and their respective infinities, although in the thick of either, they blur. I feel certain that there are many forms of aliveness that are far worse than death, but when I was actually confronted with a dear person’s wish to die, my first thought was, “You can’t do that to me”—grabby, devoted. If you were gone, it would destroy my life, and we don’t destroy each other like that. They nodded. Okay. Entanglement saves—I have edged away from plenty of harm, harm I really wanted, because my mother exists.

And while it’s clear that you can’t be completely obligated into sobriety—or joy, for that matter—the most effective routes to either are often found in communion, not for others but undeniably with them, friendship as a disturbance in the field. But sometimes togetherness wanes, like the body. Marilyn Yalom writes, “How much longer must I live before I am allowed to die?” Do we owe one another our existence, extended to its farthest point? Do we owe one another the humility to welcome death in, the grace to let our love out?

In Miriam Toews’s transcendent novel All My Puny Sorrows (2014), what care requires of us is always unreachable. (And yet we reach, we reach!) The book follows our narrator, Yoli, a single mom and writer, as she negotiates the ins and outs of her elder sister Elf’s ardent wish to die, a wish that is so all-consuming that their entire family is pulled into its orbit, a wish like the sun. No one can look at it directly. Elf’s depression is crystalized in its intentions, almost clear-headed, absolutely sure of the solution to its problems. Dying would make the pain stop, and the pain must stop.

Elf is a virtuosic pianist, laconic, hilarious, wry in her love, winking from the threshold, one foot out the door. Her character is so full, brimming from the hospital bed, that the reader’s position is complicated: we want her to survive, happy ending, and we want her to get what she wants, happy ending. Paradox unfurls like Hollywood cursive on a title card. The novel does not have a happy or a sad ending; it has only the ending of sadness. As her failed suicide attempts pile up, and the merry-go-round of hospitalizations continues, Elf decides she doesn’t want to go alone or in pain, and she asks her sister to take her to Switzerland.

Currently, Switzerland has the most liberal physician-assisted suicide laws of any nation, and it is the only one to allow the participation of nonresidents, causing a stream of what is referred to, cynically, correctly, as “suicide tourism.” It is also the only place that allows people with severe, long-term mental illness to choose physician-assisted suicide. This expands the definition of illness: Is constant, unebbing suicidality a terminal disease? Elf begs for refuge from her own selfhood, and she seeks it in the mountains, high cliffs of snow.

Considering her sister’s request, Yoli remembers something she read in Al Alvarez’s book on suicide, The Savage God:

It had to do with some of the writers and artists who lived, and killed themselves, under Russia’s totalitarian regime: “And, as we bow in homage to their gifts and to their bright memory, we should bow compassionately before their suffering.”

As she drives away from the hospital, Yoli thinks:

It sounded naive to me now and selfish and fearful to say you must live, you must want to live, you have to live. That’s your one imperative, the single rule of the universe. Our family had once been one of those with normal crises like a baby (okay, two babies) born out of wedlock. Our family had once been one of those typical ones that only thinks about killing each other in the abstract.

Marriage, or its absence, is the standard fault line of a family, trembling, latent until the ground splits open. I hesitate to add that in the novel Elf has a husband, a loyal, wounded companion who loves her, as if his presence will make her suicidality seem untrustworthy somehow. Maybe because her commitment to him was chosen, whereas her sisterhood was not. Maybe because even I sometimes consider the married woman inherently lucky, despite all the married women I know.

In All My Puny Sorrows, Switzerland is a metonym for a good death, a chosen one. Hands are held. The sisters are left with what a chosen love is, what goodness means when survival is not the goal anymore. Death and love circle each other, high above, like hawks. The sisters squint into the sky. Yoli points out that no matter what, Elf will get what she wants: “So why don’t you just wait for it to happen. Exercise some patience and all your dreams will come true. Guaranteed.” What is the difference between dying now and dying then, dying in Switzerland or dying in Manitoba? Yoli insists that she is in a more painful position because she is waiting for the impossible: true love, which is neither here nor there. It exists only in hopefulness. Elf responds:

You’re contradicting yourself. You are quite certain that your dream of true love, whatever that is, will never come true but on the off chance that it might come true you will stick around to find out. I know that my so-called dream of death will come true so therefore, according to your own argument, I should be free to leave. There’s nothing to find out. No big surprises in the wings and nothing to hope for.

Of course, both are wrong. Death is always a surprise, and true love is only ever here, now, or it is not at all. Yoli imagines loving Elf to her fullest capacity:

My sister finally getting her wish, Nic, my mother (my father too, even though he’s dead, because this was a fantasy and I could have dead people in it if I wanted), me, my kids, holding her, touching her, smiling, kissing, saying goodbye, saying Elfie, you, you have made an incredible difference to our lives, you have filled us up with joy and kept our secrets and made us laugh so hard and we will miss you terribly, adios, CIAO! saying it properly, together, and Elf drifting off so peacefully on a soft cloud of eternal love.

Maybe a good death is a very true impossibility; it exists only in hopefulness. In the end, Elf steps in front of a train.

A Matter of Death and Life transcribes Marilyn’s death in the present tense from the perspective of Irvin. She has decided to go through with physician-assisted suicide, but it’s unclear what day, what hour. Her pain grows, and her ability withers. Here’s another paradox: the more pain you have, the more it makes sense to die, but the more pain you have, the less you are able to make decisions, especially irrevocable ones. Marilyn is given a dose of morphine every hour; days are spent in sleep. The “lethal drug mixture” is waiting “in the back of a small closet in our bathroom in a bag with large warning signs on it.” (If only all deaths were so clearly labeled!) Finally, she speaks and says it’s time. The doctor arrives, but he concludes that Marilyn’s mental state is too debilitated “from the morphine to voluntarily swallow the life-ending drugs, as California law requires.”

The system curls in on itself: the doctor orders that they limit Marilyn’s morphine over the next twenty-four hours, so that she is awake and suffering, so that she can make her choice. Is that what agency is? Is pain the price of entry? Or, forgive me, the price of exit? She wakes up the next morning, begging. I would imagine that being in agony is, perhaps, a more compromised state than being under the drowsy cloud of opiates, but maybe that is how the law insists on measuring objective reality: it hurts. She is real because she is awake; she is entitled to death because she begs. The children surround her. Her husband watches: “Dr. P. leans close to Marilyn and asks in her ear, ‘What would you like?’” She answers, “No life. No more.”

The negative reigns. She goes, with Irvin’s head against hers. I am moved by the use of “like” in this moment. Not what do you want, what do you need, not are you ready to die, is it time, should we do it, but in the final minutes, What would you like? As if it was laid out on a plate of biscuits. I would like no more pain, please, I would like Switzerland, thank you. I would like to consider myself a triumph. I would like you to hold my hand. In the last flare of language, they move toward likeness and liking, the soft little wants of childhood and conversations in the mid-afternoon. I am reminded of how kids describe puppy love, “like-like,” doubling attachment, sidling up to the idea of desire. We find alternate routes to our destination, new words and ways to the indescribable. Sometimes it is too crowded to open the door, so we climb through the window.