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The pair had known each other for more than 70 years and had been married for 66. Perhaps it was fitting that their health was failing in tandem.

After Mr. McLean, 93, died of congestive heart failure around 6:40 a.m. on March 7, the couple's children told their mother. Pneumonia made her too weak to speak, but her breathing slowed and her limp body twitched.

"You could tell that she probably knew," son Robert said in an interview.

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Just six hours later, at about 12:40 p.m., Mrs. McLean, 89, took her last breath.

Her son believes that she simply lost the will to live. "I think the fact that they knew each other was dying just made them die together," he said. "I think they were kind of fighting for each other as long as they could."

It may sound like the stuff of romance novels, but people can indeed die of a broken heart. Doctors' files are full of cases where husbands and wives passed away within short order of each other. Sometimes it happens on the same day, sometimes their deaths are separated by weeks or months. Some bereaved spouses simply lose the will to live, others become deeply depressed and some become vulnerable to illness.

"I believe in dying of a broken heart. I think that it does happen," said Howard Dombrower, a doctor at Toronto's Baycrest Centre for Geriatric Care.

And sometimes people's hearts literally fail. "You definitely can die from grief and from shock and sudden surprise," said Ilan Wittstein, a cardiologist and professor at Johns Hopkins University School of Medicine.

A 2000 Denver, Colo., news report describes the case of a couple who had been married for nearly 25 years. Minutes after police officers told Jerry Siens of the sudden death of his wife, Mary, in a car accident, he collapsed and died of a heart attack. And in Merseyside, England, in 1997, Muriel Bradbury died of a heart attack after she was told that her husband of 46 years had died, also of a heart attack.

While some people in similar circumstances experience classic heart attacks, doctors have discovered a form of heart failure -- known as broken heart syndrome -- that is triggered by sudden emotional trauma, such as news of an unexpected death, an armed robbery or a surprise party.

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People who experience devastating emotional anxiety release large amounts of stress hormones, including adrenalin and noradrenalin, that are temporarily toxic to the heart and effectively stun the muscle, producing symptoms consistent with a heart attack, including chest pain and shortness of breath.

"It's kind of swarming the heart and overwhelming the heart muscle," said Dr. Wittstein, who has studied the syndrome, which is called stress cardiomyopathy.

Though the condition is reversible and most patients have complete recoveries within two weeks, it can be fatal for those who do not reach a hospital. The prevalence of the syndrome is unknown, but Dr. Wittstein believes that it occurs much more frequently than doctors realize and that patients are often misdiagnosed and over-treated with needless medication and invasive surgery.

Once they go through the initial period of losing a spouse, husbands and wives still face a host of risk factors for death. Research has found, for example, that single men do not live as long as married men.

Like anybody who experiences the death of a loved one, bereaved husbands and wives may have trouble sleeping, fail to eat and get little exercise, which weakens their immune systems and leaves them susceptible to the flu or pneumonia, which can be fatal among the frail.

Teresa Jones, a funeral director at Leyden's Funeral Home in Calgary, which recently handled arrangements for two couples who died one after the other, said staff make a point of addressing the importance of staying healthy to the newly widowed. "When we're giving advice to surviving spouses, that's one of the first things that you say -- make sure you're eating and sleeping," she said.

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Dr. Dombrower, who is a geriatrician, often sees "rapid deterioration" among older patients who have lost a spouse. He tells the story of a man who died of a heart attack about a year ago. His wife, who was relatively healthy, then descended into depression and lost the ability to look after herself. She contracted pneumonia and died within six months of her husband.

"I think there is a giving-up. It's not hard to understand that," he said.

The mind is "very powerful," he said. If a person fixates on something, it may just happen. Just as unwittingly popping a sugar pill increases one's chances of recovery, a loss of interest in life can have serious physical consequences.

Elderly people who have been married for several decades may find unthinkable the prospect of living without their partner.

If bereaved spouses are religious, they may want nothing more than to join their husbands or wives.

Depression is also very common among widows and widowers. A recent study found that elderly people who suffered from both depression and feelings of loneliness had a higher risk of death.

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"You live for each other in some ways, so if one passes, the other one often gives out and depression sets in," Dr. Dombrower said.

Indeed, many older couples become co-dependent. One can act as the muscle, the other the brains. A couple may cope well, for instance, where the wife has physical ailments and the husband has dementia. She will remind him to take his pills and he will do the vacuuming.

After an elderly patient dies, Dr. Dombrower sometimes hears from the children that the surviving parent has declined rapidly.

But under his questioning, the children are often surprised to realize their late parent was compensating for the other's worsening health.

There is also a darker side to a life alone. Seniors have the highest risk of suicide, and sometimes physicians and their families are left questioning the cause of death in cases such as when a senior walks out in front of a car. "It does happen and we wonder," Dr. Dombrower said.

But in many cases for the families left behind, the consecutive deaths of spouses can be bittersweet. Robert McLean, the son of Mary and James McLean, called the way his parents died "a blessing."

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"I thought it was a great [testament]to their relationship," he said. "They were like two peas in a pod."

British poet Martin Seymour-Smith, whose wife, Janet, died two months after he passed away in 1998, wrote about the phenomenon in his last book, Wilderness, in an uncanny poem entitled To My Wife in Hospital.

Two people who were very old

Once loved each other so much

That a god decreed

That they should die at the same time

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And become one tree.

Jill Mahoney reports on social trends for The Globe and Mail.

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