Attachment is suffering, attachment is love

After he dies, my husband wants me to not just survive, but thrive

My grandfather used to tell a story about the death of his brother, Noah, a few days before the liberation of Auschwitz: “Noah had typhus,” my grandfather would say. “He was like a skeleton. We were both like skeletons. He died in my arms. Three days later, the Americans came, and one handed me a whole chocolate bar as he walked past. My brother never got to taste chocolate again.”

As far as I can tell, my grandfather, Daniel, never let go of his brother long enough to really wrap his arms around anyone else. Daniel’s been dead for a decade now, so I can’t ask him, but he told other stories that made it obvious that the wholesale destruction of his old life at the hands of the Nazis meant he never fully engaged with the objectively bountiful life he built in America afterwards. He may have survived, but he never thrived. Daniel’s story reminds me of a documentary I just watched called The Zen Diaries of Gary Shandling (minus the Nazis):

The film begins with old home movies, painting a portrait of Shandling’s childhood as a happy one that turned tragic at age 10, when his older brother, Barry, died at 13 from cystic fibrosis. “I never had a conversation with him about it, but when I interviewed people, a few said, “When Garry’s brother died, they didn’t talk about him anymore,” says Apatow. “That was an approach some people took back in 1960…”

As work on the film progressed, “I found a diary entry where Garry was very upset that he was never allowed to go in and say goodbye to his brother, and that his mom didn’t want him to go to the funeral,” Apatow says… The director theorizes that Barry’s death became something like the organizing trauma of Shandling’s life and work… the emotional climax of the film centers on the discovery, tucked away in one of the journals, of a letter that Garry once wrote to Barry—an attempt at saying goodbye that they weren’t able to have as kids.

My grandfather, like Shandling, couldn’t process the grief of losing not just a brother, but an entire family. There was the person he was before, and the family he was connected to, and then there was the person he became after, and the family he never fully connected to. Even my grandmother, who Daniel met shortly after liberation at a displaced-persons camp, belonged to the “after.” Daniel always seemed detached from the life he was living and the people in it, confused by how to relate to the family he’d made, yet whose existence seemed to be a perpetual, and disorienting, surprise. His family, including me, were crowded out by too many ghosts, and most prominently the ghost of Noah.   

I first heard my grandfather’s stories when I was about six. So maybe it’s unsurprising that I became a tiny insomniac, ruminating over what would happen if I opened the bedroom door the following morning and discovered that my life had been shaken like an etch-a-sketch, as my grandparents’ lives had. Would I try relentlessly to build my future upon the ghostly outlines of a few remaining scrawls, or would I be willing to shake things up further and truly start over?

I imagined thousands of outlandishly gristly scenarios and how I might survive them, rising phoenix-like from the ashes. While I could fantasize about heroically overcoming unlikely scenarios, I had a much harder time imagining the prosaic losses most likely to happen in real life: the death of a parent, a sudden injury, a terminal illness. I’m a high-attachment person. How would I actually handle the death of someone I’m deeply attached to?

I’m about to find out.

My husband, Jake, is dying of metastatic squamous cell carcinoma of the tongue. Jake was first diagnosed in  September of 2022, and, after an initial partial glossectomy, radiation, and rapid recurrence, Jake had what’s called “salvage surgery,” which is as last-ditch an effort as it sounds. The salvage surgery on May 25  lasted 12 hours: Jake’s entire tongue and part of his larynx were removed. The “total glossectomy” wasn’t just the severing of his tongue, but the severing of his old life and so many of the things that constitute the human experience: speaking, kissing, swallowing, tasting. That’s the start of a solid list of things he’s attached to.

A few days after his surgery, I went home briefly to shower, get a change of clothes, and check the mail. On our doorstep was a chocolate-of-the-month box from Choc-o-sphere. Jake loves both coffee and dark chocolate. To his only semi-concealed disgust, I prefer milk chocolate, and can’t really appreciate the subtle differences between a Peruvian bar versus a Costa Rican one. Nobody’s perfect. I opened the box and put the bars in the wine cooler (Jake insists that fridges are too cold and wine coolers produce the ideal chocolate temperature), where they still sit. When I returned to the hospital, I squeezed my body next to Jake in his hospital bed, wrapped my arms around his emaciated six-foot-one, one-hundred-and-thirty-five pound body, and thought, “He’s never going to taste chocolate again.”

I’m terribly, completely attached to Jake. Jake and I have had our problems, but not the “lack of attachment” problem that often heralds breakup or divorce in other couples. We’re many things, but we’re not ambivalent. We’ve been together for 15 years, having met each other at 24. A human being’s frontal lobe supposedly doesn’t even fully develop until they’re 25, so, really, I’ve spent my entire developed adult life with Jake. We’ve shaped each other’s brains: we write together, think together, bounce ideas off each other, read together, laugh together, and likely brainwave entrain upon one another as we sleep.

We share a mind—no alien parasite out of a science fiction novel needed. As Jake might say, we’re doubling the processing power by being together. As the end of Jake gets closer—recurrent and metastatic head and neck squamous cell carcinomas are, at current levels of technology, essentially always fatal—and the tragic reality of detaching my day-to-day reality from his existence nears, I’ve been trying to understand how, or if, I can update my software to run without his constant input (I ping him for everything, including things in which my expertise far outweighs his) and what that means for me, insofar as the “me” I’ve known with Jake will exist after he dies.     

Especially since moving out of our home in New York City and relocating to Arizona in 2020, in response to the COVID pandemic, we’ve been as enmeshed as two people can be. We like it that way. When we first got together, people sometimes said we seemed unalike. And, still, in many ways we are unalike, having different but complementary skill sets: I’m more open to novel experiences. He’s more technical, with the capacity to focus on a project for long, uninterrupted swaths of time, a skill I’m also honing thanks to his help. Jake told me that a friend once said, “You two are really well suited to each other,” in a way that didn’t exactly sound like a compliment. But we are well-suited to each other, even if that friend was identifying some of the stranger, off-putting or more niche features of us as human beings—like being cranks about the depredations of zoning and parking minimums—that we share. Look, parking minimums raise the cost of housing in a way that burdens the budgets of poor and rich alike, making us all materially worse off than we should be. Asking whether we each started off as having too many peculiar interests, or shaped each other into being well-suited for each other, is unimportant. We’re here now and we like it.

This is the end of Jake’s time as he knows it on earth, but also, it’s the end of my time as I know it. There’s the who I was before, and who I was connected to, and then there will be the who I am after Jake dies. Who will that be? Who will I be connected to? Jake says he wants me to go on to live a “generative life” and to find love again. But when I try to peer into that future, I see static, as if aliens have taken out human communication infrastructure, instead of the heroic resilience I fantasized about as a child. Maybe I have aliens on the mind from watching a TV show called Invasion. My whole life feels alien right now.   

I love Jake. I like being attached to Jake. I want Jake. I want a future with Jake. But the universe doesn’t care what I want, like it didn’t care what my grandfather wanted. I’m not special. While the Buddhists are probably right, and attachment is the source of great suffering, that is because attachment, at least for me, has been a source of great love and meaning.

I’m not a Buddhist; I’m an anxious, secular Jew, which means my religious inheritance is mostly an easily upset stomach, existential dread, and stories, like my grandfather’s, of displacement and loss. Impermanence, and the suffering that comes from attachments—to my own life, to the lives of the people I love—aren’t new concepts to me. Maybe being high-attachment is part of my genetic inheritance, too, and my grandfather’s brain was built the same way.

It’s apparently possible for grief to become “pathologic,” within the brain, which sounds bad in my medical opinion, like an infection turning gangrenous. I don’t remember how I found it, but I recently read a book, Wired for Love, that touches on the work of a grief researcher named Mary Frances O’Connor (she may sound like a nun out of 1950s Ireland who plays a pennywhistle in a seisún at McConnell’s pub, but she’s actually a psychiatrist at UCLA). Dr. O’Connor uses fMRI to explore the way normal grief can become “pathologic,” or, alternately, “complicated:”

“She and her colleagues performed a study which showed people who were suffering from uncomplicated or complicated grief photos of their deceased loved ones while scanning their brains. She found that part of the brain’s dopamine driven reward system—the nucleus accumbens—was activated for people with complicated grief but not for people with ordinary grief….A healthy kind of grief means that when you see a photograph of your lost love, you understand that it does not represent a “living reward” but rather the memory of someone who is gone. For whatever reason, complicated grievers can’t wrap their brain around this fact. They are not coming to terms with the death of their beloved. On a deep level, their brain is still expecting to see them, to feel them again. Though the nucleus accumbens is located in that brain’s so called reward circuit, its hyperactivity is not a sign that good things are happening—quite the contrary. Complicated grief, if not treated, can be so harmful that some researchers have likened it to traumatic brain injury.”

Books meant for therapists and psychiatrists describe treatments for complicated grief. Repeating the details of your loved one’s death until you truly believe that it happened, for one—exposure therapy for loss. Maybe I’ll spend years with the deep structures of my brain expecting Jake to walk into the room and hold me, though my logical mind knows that isn’t possible. Or, maybe I’ll carry him with me everywhere, a part of me, and he’ll walk into every room with me, as much a part of the architecture of my mind as he is now. I don’t know. Him being a metaphysical part of me sounds romantic, but it isn’t as satisfying as him being physically there. Probably, there’ll always be rooms I will want Jake to enter. There will be conversations I imagine with him, conversations in which I’ll expect him to answer, though he can’t, and my brain just won’t understand or accept why he doesn’t.  

For now, I’m making sure that Jake and I inhabit the same room as much as possible. I’ve been following Jake around our apartment like an imprinted duckling. We wake up together. He gets up and goes to jot down an idea in the office and I’m right behind him, settling into the second desk we set up specifically because I don’t want to be stuck writing in the common room while Jake is in the office. There’s an entire wall between the common room and office—an unacceptable distance right now.

I tag along when Jake takes a walk or nap, although mimicking Jake’s sleep habits isn’t new. I’m a bad sleeper, and I sleep better with Jake. He finds it amusing that I can be awake and productive, but the second he says he’s ready for bed I’m under the covers and ready for a cuddle before he can even get his pants off. When Jake sits on the couch to read, I read from one cushion over. If I can have one of my limbs draped onto him, or one of his draped onto me, that’s better. When friends or family offer to come over to hang out with Jake to give me “respite time” (respite from what, exactly?), I find the offer to be the opposite of what I need, which is more Jake. I experience no diminishing marginal returns from being with Jake.  

Some books on grief suggest that many people start to disconnect from each other upon news of a terminal diagnosis, sort of like teenagers rebelling against parents, in preparation for going out into the world on their own. If the posts from some of my Facebook support groups are indicative, disconnection is a common response to terminal illness for a lot of couples. That’s not us.

Jake and I have been calling the period between May 25 and today our “bonus time,” a time when he was supposed to be dead, but he’s not. He’s still in the room with me. We’re still talking. He’s still editing me. And if I can walk into a room and not only expect to see him there, but know that he’ll actually be there, then why wouldn’t I, now, while I still have the chance?

Chaplain Kate Braestrup—chaplains are kind of in the grief business, right? They get most of their work from birth, marriage and death—wrote: “Grief is just love squaring up to its oldest enemy, and after all these mortal human years love is up to the challenge.” I want my attachments, to Jake. Right now, they’re a source of happiness, of connection, of humanity.  But I want those attachments to become an invitation to more connection, and not a block to it, the way it was for my grandfather or Gary Shandling. Is it possible to remain attached to a dying man after he’s dead, but in a way that doesn’t tangle me in a web of unfulfillable yearning? Jake has been wondering about that too. We’ve been trying to approach the problem the way we have always approached problems—together. That’s part of what I know what happens to me after I die, but what about those left behind?” is about:  

I hope, too, that we’ve said everything there is to say between us, because Bess and I have a deal, a rule, an agreement: to leave nothing unsaid. Whatever it is we want to say, we say. This may not be a common way to face death. Bess is in a bunch of doctor-related Facebook groups, including some about relationships and some about terminal illness, she reports that a lot of couples don’t seem to have relationships in which they can say what they most deeply feel and believe. Instead, they seem not to like each other much, or to focus on quotidian aspects of their lives up to the very end. How must that feel to the person left behind?

Trying to avoid regrets and what-ifs will, I think, help the grief process. Wishing for someone to return because of unfinished business sounds much worse than wishing for someone to return because you want to share new, exciting news with them. Although, to someone like me, who feels the urge to share even the details of my day with Jake as a way of making them feel more real, maybe it’s not.

Jake’s been trying to help me think about the future without him. Planning a future with someone who won’t be in it is a strange but somehow comforting activity. Looking with Jake at my post-Jake life helps me: who will I let comfort me? (Jake and I have ideas.) Who will I stay with? (My parents, some friends in Rhode Island and New York.) What books will I read? (Lord of the Rings, and anything Jake loved and marked with his notes.) It feels good to know that Jake approves of the plans.

Considering the future also helps with the details that’ll be too much to handle in the moment, when my grief is raw. Jake is preparing for the future by taking care of it—and me —now. We’ve worked out some of the practicalities that loom large: He’ll be cremated. I’ll have the number to call. I know what he wants at his wake (an open bar, among other things that celebrate life). I’ll get him a memorial bench in Manhattan’s Stuyvesant Park, on 2^nd Avenue and 16^th Street, in the NYC neighborhood that’s our spiritual home.  

Look, I know myself. Jake soothes my anxieties and I feel the real-time calming of my nervous system when he holds me. No matter how helpful the future planning is, I know that the only person who will be able to make me feel better about Jake’s death will be the one person who won’t—who can’t—be there.

Before Jake’s diagnosis, I’d once believed we could make some rough sketches of the life we want, work for it, and have it happen. No one undergoes the delayed gratification of a medical education if they don’t believe they’ll be around 12 years after starting, to enjoy what passes for the fruits of all that labor. Even with a lifetime of stories of others’ losses, like my grandfather’s loss of his brother, and the intellectual understanding that huge ruptures come for us all, there’s a certain sense of safety most of us hold onto until we truly meet the concept of impermanence. The grim reaper is the ultimate in impermanence. I’ve been really lucky until recently. I’ve lost family members, but both my parents are alive, and Jake was, until October, healthy. While I’ve had physical struggles, I’ve not had to yet face the terminal one.

I’m not a stranger to death and debility. As an ER physician, my job is death and debility. Chaplains handle the spiritual sides of birth, death, and debility, but I handle many of the practical sides, like trying to prevent a man from experiencing permanent damage after putting a bolt—one from a hardware store—around his penis, and then being surprised when said penis didn’t deflate properly (incidentally, this can become gangrenous, and would be considered pathologic). I often preside over the worst day of a person’s life: I tell families their loved one has died. I give news: a terminal diagnosis, I can’t stop the bleeding, the CPR didn’t work, the patient’s lifestyle choices caught up with him.

I know all these horrible things happen to people with chilling arbitrariness. I bear witness to their humanity, and shared in it, in a way. But then I found myself on the receiving end of the horrible news, and life changed, staring straight down the barrel of the human condition. A condition I didn’t fully experience before and now can never unknow.

Tragedy is the human condition.

Maybe that deep, abiding attachment is also part of the universal human experience. Maybe it doesn’t have to be or become pathologic at all.

One strange, unexpected mental side effect of Jake’s condition and experience: the anxiety attacks I’ve had when thinking about death and dying since I was a child have almost fully resolved. The magical thinking that insulated me from personal loss, that made anxiety a luxury, is gone. Here is the monster under the bed. Here it is in bed. There’s no hiding. I don’t have to picture the future, it will just show itself.

And it will hurt. Here is Wired for Love again:

“I was shocked by how much John’s death hurt, not just psychologically, but physically. My heart literally burned for weeks. I could barely eat. I lost twenty pounds in a month...This explains why surviving spouses suffer so many serious medical events during the bereavement period. Your resting heart rate increases, as does your blood pressure. Your body is flooded with the stress hormone cortisol, and your immune system is depressed. In rare cases, the news that your loved one has died can itself be lethal. In the twenty four hour period after a loss, a person has between a twenty one to twenty eight times higher risk than normal of suffering a heart attack, depending on how close you are to your loved one.”

I once saw a patient in the ER who was suffering from Taketsubo’s, or broken heart syndrome. The catchecholamine storm that came from the stress of finding out her husband had died that morning caused her heart to, in essence, forget how to beat properly. Instead of the ventricles and atria squeezing in their well-practiced way, her heart squeezed erratically, mimicking the shape of  a swimming octopus, which is where the syndrome gets its name. Incidentally, once an octopus mates, it dies, so maybe the point is that loving can produce real, physical damage. That doesn’t mean I want to love any less, though it may mean that I—that we all—suffer the cost.

The other night in bed, I read aloud to Jake a meditation by Thich Nhat Hanh on coping with death by attaching less to the loved one’s usual physical form, and seeing the way they exist in new forms:

Visualize a cloud in the sky. Maybe one part of the cloud has become rain;half of the cloud remains in the same form and half has taken a different one. And you cannot say that the rain is less beautifulthan the cloud, or the cloud is less beautiful than the rain. They can both be beautiful. 

When you live with your beloved one, be aware tha the or she is a kind of cloud. You are also a kind of cloud and are not entirely here in this body, because every day you produce thoughts, speech, and action which continue independently of you.

So we are like a cloud in the sky: every day it can produce rain or snow or hail. We can see the continuation of the cloud, even if it is still there in the sky.

So when you look at the rain or the tea, if you recognize your cloud there, your sorrow will vanish.

“That sounds nice and all, but we’re not clouds,” Jake replied. “We’re human beings. And you can’t be held by a cup of tea.” Which is why Jake has also told me that he wants me to find love again.

Initially, I feel resistance to the idea of one day loving again. Who, apart from committed polyamorists, wants to look at the person they promised to love forever and also promise that they’ll love someone else? But Jake wants me to live a full life, and life is lived within our connections to others. It’s not going to be enough to just feel connected to him after he’s gone. Remaining attached to him is, I think, both inevitable and okay. But if holding onto our attachment precludes the development of new ones, then the grief becomes damaging. Our love becomes damaging. And Jake would never want to hurt me like that.

Instead, if I can transform the love between us into the expectation of more love, then his love isn’t something I am losing: it’s something that’s teaching me how to open my heart more widely. Jake’s love—at least the foundation of it, if not the fruits of it—will guide me towards love again. I bet my grandfather’s brother, Noah, wanted my grandfather to live a full life, just as Gary Shandling’s brother would have wanted Gary to.  Jake has told me many times that he doesn’t merely want me to technically survive after he is gone—he wants me to thrive. My grandfather never figured out how to wrap his arms around anyone new. Jake reassures me that my learning to won’t mean that I will hold him any less tightly. There’s room.

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