A Matter of Death and Life

Irvin D. Yalom, Marilyn Yalom


Every day I, Marilyn, lie on the sofa in our living room and look out through the floor-to- ceiling windows at the oaks and evergreens that live on our property. It is now springtime, and I have watched green leaves reappear on our magnificent valley oak. Earlier today I saw an owl perch on the spruce between the front of our house and Irv’s office. I can see a bit of the vegetable garden that our son Reid planted with tomatoes, green beans, cucumbers, and squash. He wants me to think about vegetables ripening in the summer, when I will presumably “be better.”

For the last few months, since I was diagnosed with multiple myeloma, placed on heavy medication, and hospitalized after a stroke, I have been mostly miserable. My weekly chemotherapy injections are followed relentlessly by days of nausea and other forms of bodily suffering, the description of which I shall spare my readers. I am exhausted most of the time—as if cotton is stuffed around my brain or a foggy veil exists between me and the rest of the world.

I’ve had several friends who have had breast cancer, and only now do I have some understanding of what they went through to combat their disease. Chemotherapy, radiation, surgery, support groups have all been part of their everyday lives as breast cancer patients. Twenty-five years ago, when I wrote A History of the Breast, breast cancer was still thought of as a “terminal” illness. Today doctors refer to it as a “chronic” disease that can be treated and arrested. I envy breast cancer patients because when they go into remission, they can stop chemotherapy. Multiple myeloma patients generally require continuation of treatment, though less frequently than the once-a- week injections I now endure. Again and again, I keep asking myself: Is it worth it?

I am 87 years old. Eighty-seven is a ripe time to die. When I look at the obituary columns in the San Francisco Chronicle and the New York Times, I note that most of the deaths occur to people in their eighties or younger. The average age of death in the United States is 79 years. Even in Japan, which has the best national record for longevity, the average age is 87.32 for women. After the very satisfying long life I have shared with Irv and the good health I have enjoyed for most of my life, why should I want to live now with daily misery and despair?

The simple answer is that there is no easy way to die. If I refuse the treatment, I shall die painfully of multiple myeloma sooner rather than later. In California, physician aid in dying is legal. I could, when I am nearing the end, request assisted suicide from a physician.

But there is another, more complicated answer to the question of whether I should stay alive. Throughout this excruciating period, I have become more aware of the extent to which my life is connected with the lives of others—not only with my husband and children, but also with the many friends who continue to support me in my time of need. These friends have written multiple messages of encouragement, they have brought food to the house and sent flowers and plants. An old friend from college sent me a soft, cuddly bathrobe, and another knitted me a woolen shawl. Over and over again I realize how blessed I am to have such friends, in addition to my family members. Ultimately, I have come to the understanding that one stays alive not only for oneself, but also for others. Though this insight may be self-evident, only now do I realize it fully.

Because of my Stanford affiliation with the Institute for Research on Women (which I officially administered between 1976 and 1987), I established a network of women scholars and supporters, many of whom have become my close friends. For fifteen years, from 2004 to 2019, I ran a literary salon at my home in Palo Alto and apartment in San Francisco for Bay Area women writers, which added considerably to my friendship circle. Moreover, as a former professor of French, I spent time in France and other European countries whenever I could. Yes, I’ve had an enviable position that provided the opportunities to establish such friendships. I am comforted by the thought that my life or death matters to friends around the world—in France, Cambridge, New York, Dallas, Hawaii, Greece, Switzerland, and in California.

Fortunately for us, our four children—Eve, Reid, Victor, and Ben—all live in California, three of them in the Bay Area and the fourth in San Diego. In these past few months, they have been very present in our lives, spending days and nights at the house, cooking meals, and lifting our spirits. Eve, a physician, has brought me medical marijuana gummies, and I take a half of one before dinner to counter the nausea and give me appetite. They seem to work better than any of the other meds and have no noticeable side effects.

Lenore, our granddaughter from Japan, has been living with us this year while working at a Silicon Valley biotech startup. At first, I was able to help her adjust to American life—now it is she who has been taking care of me. She helps us with computer and television issues, and adds Japanese cooking to our diet. We shall greatly miss her when she goes off to graduate school at Northwestern University in a few months.

But, most of all, it is Irv who sustains me. He has been the most loving of caretakers—patient, understanding, committed to lessening my misery. I’ve not driven our car for five months, and aside from the time our children visit, Irv does all the shopping for food and all the cooking. He drives me to and from medical appointments, and stays with me during my several-hour infusions. He figures out the television possibilities in the evening and sits through programs even when they are far from his first choice. I’m not writing this praise to flatter him or make him seem like a saint to my readers. This is the unadorned truth as I have experienced it.

Often I contrast my situation with that of patients who have no loving partner or friend and who are obliged to undergo treatment on their own. As I sat recently in the Stanford Infusion Center, waiting for my chemo injection, the woman next to me said she was alone in life but found support in her Christian faith. Even though she has to negotiate her medical visits without someone at her side, she feels the presence of God near her at all times. Though I am not a believer myself, I was glad for her. And similarly, I have been heartened by the friends who tell me they are praying for me. My Bahai friend, Vida, prays for me every day, and if there is a God, her fervent prayers must have been heard. Other friends—Catholic, Protestant, Jewish, and Muslim—have also written to say I am in their prayers. The writer Gail Sheehy moved me to tears when she wrote: “I will pray for you and I will imagine you being cupped in God’s hand. You are just tiny enough to fit.”

Irv and I, culturally Jewish, do not believe that we shall be conscious after death. And yet, the words of the Hebrew Bible sustain me: “Yeah, though I walk through the valley of the shadow of death, I will fear no evil” (Psalm 23). These words circulate in my mind, among others from religious and nonreligious sources that I committed to memory long ago.

“Oh death, where is thy sting?” (1 Corinthians)

“The worst is death, and death will have his day.” (Shakespeare, Richard II)

And there is “The Bustle in a House,” a lovely verse by Emily Dickinson:

The sweeping up the Heart
And putting love away
We shall not want to use again
Until Eternity—

All of these familiar poetic phrases take on new meaning in my present situation, as I lie on the sofa and reflect. Certainly I cannot follow the advice of Dylan Thomas: “Rage, rage against the dying of the light.” There is not enough life force left in me for that. I feel more in touch with some of the prosaic inscriptions that my son Reid and I found when we photographed cemetery tombstones for our 2008 book, The American Resting Place. One is fresh in my mind: “To live in hearts we leave behind is not to die.” To live in the hearts we leave behind—or, as Irv so often puts it, to “ripple” into the lives of those who have known us personally or through our writing, or to follow the counsel of Saint Paul when he wrote: “though I have faith, so that I could remove mountains, and have not charity, I am nothing” (1 Corinthians 13).

Paul’s take on the primacy of charity is always worth rereading, for it reminds us that love, meaning kindness to others and compassion for their suffering, trumps all the other virtues. (The feminist in me is always taken aback when I read what follows in Corinthians: that women should “keep silence in the churches, for it is not permitted unto them to speak” and that “if they will learn anything, let them ask their husbands at home; for it is a shame for women to speak in the church.” When I read this, I chuckle to myself remembering Reverend Jane Shaw’s many magnificent sermons in the Stanford Chapel.)

Henry James has revised Paul’s words on charity into a clever formula:

Three things in human life are important. The first is to be kind. The second is to be kind. And the third is to be kind.

I hope to adhere to this dictum even as I anguish over my personal situation.


I know many women who bravely faced their deaths or the death of their spouses. In February 1954, when I returned from Wellesley College to Washington, DC, for my father’s funeral, my grieving mother’s first words to me were “You have to be very brave.” Always a model of kindness, her concern for her daughters was paramount as she buried her husband of twenty-seven years. Dad was only 54 and had died suddenly of a heart attack while deep-sea fishing in Florida.

Several years later, my mother married again. And she ultimately ended up marrying and burying four husbands! She lived to know her grandchildren and even some of her great-grandchildren After a move to California to be nearer to us, she died peacefully at the age of 92 1/2. I always assumed that I would die at her age—but now I know I will not make it into the nineties.

A close friend, Susan Bell, almost reached ninety. Susan had escaped death more than once in her life: she had fled the Nazi invasion of Czechoslovakia in 1939 accompanying her mother to London and leaving behind a father who died in the Terezin Concentration Camp. She and her parents had all been baptized as Lutherans, but the Nazis looked to Susan’s four Jewish grandparents as reason to threaten her life and kill her father.

A few weeks before she died Susan gave me a precious gift—her nineteenth-century English silver teapot. Tea from that pot had kept us alert years earlier as she and I worked on our 1990 book, Revealing Lives, an edited collection of articles on autobiography, biography, and gender. Susan had been a pioneer in developing the field of women’s history and continued that work as an affiliated scholar at the Stanford Clayman Institute until the end of her life. She died suddenly in July 2015, in the swimming pool at the age of 89 1/2.

But perhaps more that anyone, it is Diane Middlebrook who is my role model of how I would like to behave in the months to come. Stanford professor of English and acclaimed biographer of poets Anne Sexton, Sylvia Plath, and Ted Hughes, Diane became a close friend for over twenty-five years until her untimely death from cancer in 2007. When I saw her in the hospital shortly before her death, she received Irv and me with grace, communicated her love for us, and kissed us each good-bye. I noticed how respectfully she addressed the nurses as they came in and out of the room. Diane was only 68 years old when she left us.

There is one more person whose decline and death has greatly affected me: the noted French scholar Ren. Girard. Ren. had been my dissertation director in the late fifties and early sixties at Johns Hopkins, but I really didn’t get to know him as a close colleague and friend until he came to Stanford decades later. Then, with his wife Martha, I felt a new connection that lasted until his death in 2015.

That connection was oddly the strongest during his last years when he was unable to speak due to a series of strokes. Instead of talking, I would sit next to him, hold his hand, and look into his eyes. He always seemed to enjoy the jars of homemade apricot jam I brought to him.

The last time we were together, he saw a jack rabbit running outside past the window and exclaimed in French: “Un lapin!” Somehow those words emerged in spite of the brain damage that had blocked all speech. When I had a stroke and for a few minutes lost the ability to speak, I immediately thought of Ren. It was such an odd experience to have thoughts in your brain that you simply cannot turn into speech.

I am so grateful I quickly recovered my speech without obvious residual effects. I can’t remember a time when I did not enjoy talking. When I was four or five, my mother took me to elocution lessons, where we curtsied to Miss Betty and recited poems for an audience of other children and their proud mothers. Since then, throughout my life I have taken pleasure in public speaking, in addition to private conversations.

But today, I am exhausted by lengthy conversation. I limit myself to a half an hour with friends who drop by. Even an extended phone call tires me out.

When I despair of my condition, I try to remember all the reasons why I should still be grateful. I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home. There is hope that the chemotherapy treatments will be reduced in dosage and frequency, and that I shall be able to live a semi-normal life again, though right now I don’t believe that shall ever be the case. I am trying to resign myself to the life of an invalid, or at least the life of a convalescent, as one referred politely to people like me in the past.

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