After 65 years of marriage, two life-partners face the prospect of final separation, as one of them develops multiple myeloma. This is the crisis that led Irvin Yalom, eminent psychiatrist, novelist, and pioneer of existential psychotherapy, and his wife Marilyn, acclaimed feminist author and historian, to collaborate in writing the story of their journey through Marilyn’s final months of life. In the resulting book, Irvin and Marilyn write alternating chapters until Marilyn becomes unable to write. After her death, Irvin continues with the story of his bereavement.  

Marilyn’s chapters include reflections on love and illness, ranging from Emily Dickinson and Henry James to Paul the Apostle. She frequently expresses her gratitude: “I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home.” (p. 20) Most of all, she is thankful for her husband, “the most loving of caretakers.” (p. 15) Yet, as her disease progresses, she comes “to the understanding that I would never be the same again—that I would pass through days of unspeakable misery while my body would decline and weaken.” (p. 76) She decides to pursue the option of physician-assisted suicide, which is legal in California, when her suffering becomes overwhelming.  

In his chapters, Irvin resists this decision, maintaining hope for additional “good” life, despite all evidence to the contrary. Near the end, Marilyn’s pain and other symptoms become so severe that she cries out, “It’s time, Irv. It’s time. No more, please. No more.” (p. 139) Her physician arrives, confirms her intention, and surrounded by her whole family, Marilyn sucks the liquid through a straw and quietly passes away.


I’ve rarely read a book so candid about living and dying in the embrace of a such loving relationship. A Matter of Death and Life is a must-read for anyone weighing the difficult moral issues of physician-aided death,whether assisted suicide or euthanasia. The book is full of practical wisdom about communication, compromise, caregiving, support, and love during the experience of terminal illness. Irvin Yalom concludes the book with a sentence from Vladimir Nabokov’s autobiography, “‘The cradle rocks above an abyss, and common sense tells us that our existence is but a brief crack of light between two eternities of darkness.’ This image both staggers and calms. I lean back in my chair, close my eyes, and take comfort.”  


Stanford University Press

Place Published

Palo Alto, CA



Page Count