Amy Bloom’s memoir In Love: A Memoir of Love and Loss traces Bloom and her husband’s, Brian Ameche, relationship after Brian is diagnosed with Alzheimer’s disease. Bloom’s first-person point of view lends the memoir a vulnerable, humorous, and emotional tone, but the memoir also shares many of the same narrative elements Bloom employs in her four novels (Love Invents Us, Away, Lucky Us, and White Houses), including imagery, symbolism, and a nonlinear structure. The memoir is broken into two sections, each of which contains brief titled chapters. Some of these chapters are set in the days immediately preceding Brian’s assisted suicide with the Swiss nonprofit organization Dignitas. Others feature scenes from Bloom and Brian’s early romance, their wedding, and their daily lives together. These formal choices reflect the memoir’s thematic explorations, including The Personal and Emotional Impact of Alzheimer’s, The Struggle for Autonomy and Dignity, and The Power of Love and Commitment in Challenging Times.

This guide refers to the 2023 Random House Trade paperback edition of the memoir.

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

Plot Summary

The memoir opens in Zurich, Switzerland, in January 2020. Four years after Amy Bloom and her husband, Brian Ameche, discover that Brian has Alzheimer’s, they travel overseas for Brian’s assisted suicide. Although some states have right-to-die laws, assisted suicide is difficult to pursue in America. Therefore, Bloom and Brian chose to work with a Swiss nonprofit organization called Dignitas.

In 2016, Bloom began to notice changes in Brian’s behavior. He became forgetful, distant, and distracted. Bloom and Brian attributed these changes to Brian’s recent hip surgery, guessing that the anesthesia used during the procedure had altered his memory. They pursued medical assistance, but the doctors dismissed Brian’s symptoms. Meanwhile, Brian’s condition declined. He grew moody and short-tempered. He was disoriented and confused. His work and social life deteriorated. Fearing the worst, Bloom began to research Brian’s symptoms online. Her research and observations suggested that Brian had early onset dementia.

Brian and Bloom scheduled an MRI. The MRI catalyzed another series of mental and psychological tests. The doctors concluded that Brian had Alzheimer’s and had most likely been living with the disease for several years.

Bloom felt her life changing. The man she married was no longer himself. In turn, Bloom no longer felt like herself. She had been married twice before Brian. However, her relationship with Brian was unique. They met in middle age and developed a deep and distinct bond. She couldn’t imagine a world or a future without Brian.

Bloom assumed the role of Brian’s caretaker. She had already begun to grieve him but did her best to care for and protect him. Then, Brian decided that he wanted to pursue assisted suicide. Bloom performed more research. She read books, blogs, forums, and articles. She met with friends, therapists, counselors, and seers. She didn’t want her husband to die, but she wanted to help Brian fulfill his wishes: Brian didn’t want to end his life either, but he also didn’t want to die a slow death while becoming an unrecognizable person.

Bloom and Brian found Dignitas and began to work with the organization. The process quickly proved arduous, but in spite of these medical and psychiatric roadblocks, Bloom didn’t abandon her mission. Dignitas soon appointed Brian a Dignitas associate who went by the alias “Heidi.” Heidi led the couple through the process over the phone.

The most difficult part of earning Dignitas’s approval for Brian’s assisted suicide was procuring an accurate assessment of his mental health. He and Bloom worried Dignitas would deny their application because Brian’s neurologist and his psychiatrist had deemed him depressed. Bloom met with her personal therapist, Wayne, about her and Brian’s journey. Wayne offered to examine Brian and write the assessment for him. The couple received the green light from Dignitas because of Wayne’s subsequent letter.

Bloom and Brian began to prepare for Brian’s death with Dignitas in January of 2020. The organization referred to the process as accompanied suicide. The couple spoke with Brian’s mother and siblings and wrote notes to their children and grandchildren about Brian’s condition, wishes, and impending death. They tried to share the truth while protecting their family.

As the date of Brian’s accompanied suicide approached, Bloom started to panic. She met with her tarot card reader, Susie Chang, desperate for answers and wondering if they should postpone Brian’s appointment. Susie urged Bloom not to change the date, warning that doing so could entail further difficulties. Susie’s predictions proved accurate, as COVID-19 broke out shortly after Bloom flew home from Switzerland.

In the days preceding Brian’s death, Bloom and Brian try to enjoy themselves in Zurich. However, the trip doesn’t resemble the other trips they’ve taken together. Brian has trouble engaging, and Bloom feels uneasy and weepy.

Before Brian’s appointment, Bloom and Brian meet with the Dignitas doctor, Dr. G, who interviews him several times to ensure that his accompanied suicide is his choice. Bloom notices how lucid Brian is during these conversations and again doubts what she and Brian are doing. However, Brian isn’t afraid and doesn’t change his mind.

On Thursday, January 30, 2020, Brian and Bloom report to the Dignitas facility. They settle into their appointed room, where Brian takes the prescribed doses of antiemetic and sodium pentobarbital. Bloom listens to him talk about his football memories, wishing he would remember their life together instead. However, she longs for his voice when Brian grows quiet and passes away.

Bloom returns to the US. Her children help her settle back into her home. In the weeks following Brian’s death, Bloom’s electricity and appliances start to malfunction. She wonders if Brian’s spirit is playing with her.

Bloom hosts a memorial service for Brian at the library across from her house. She is moved by Brian’s friends’ and family members’ memories. Shortly thereafter, Brian’s mother, Yvonne, hosts a second memorial in Philadelphia. When the mourners remember Brian in childhood and adolescence, Bloom realizes how little she knew of Brian’s early life. She’s thankful for the love and grief she can share with the mourners but wishes her husband were with her. She thinks about her and Brian’s wedding and remembers Brian’s vow to love her for the rest of his life.