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

“For the last twenty-two years, Dignitas has been the only place to go if you are an American citizen who wants to die and if you are not certifiably terminally ill with no more than six months to live.”

Shortly after Amy Bloom’s husband is diagnosed with Alzheimer’s, he decides to pursue an assisted suicide. Bloom’s ensuing research reveals that dying voluntarily in the US (and most places worldwide) is intentionally difficult. She and Brian choose Dignitas because the organization, as its name suggests, promotes dignity in life and death; in explaining this decision in the book’s first pages, Bloom establishes The Struggle for Autonomy and Dignity as a key theme.

“I kept crying because I loved him and his appetites and all the sensuality and good humor and heat-seeking that went with them.”

Bloom begins to grieve Brian even before he dies, partly because of the changes Alzheimer’s brings, but also because she has been anticipating Brian’s death ever since she and Brian began working with Dignitas. Her inability to quash her emotions in this scene illustrates her profound love for Brian and her deep sorrow over losing him.

“Basically, I just won’t deal with it, with ‘after.’”

Throughout Bloom and Brian’s time in Zurich, Bloom imagines her trip back to the US without her husband despite attempting to stave off these imaginings. Because Bloom’s future is defined by Brian’s absence, she fears meditating upon it. This suggests that Bloom is still in a state of denial even as Brian’s death approaches.