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When her husband died at 36, Christina Frangou was a statistical outlier, a young widow. She soon discovered that there was a name for the phenomenon surrounding her devastating grief and the toll it takes on those left behind

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Calgary-based journalist Christina Frangou lost her husband, Spencer McLean, to cancer in 2013. He was 36 years old.CHRIS BOLIN/The Globe and Mail

I sit cross-legged on a white mat spread on the bathroom floor and examine the rows of medication lined up on the shelf of the vanity – neat piles of green-and-white boxes of blood thinners, a rainbow of pill bottles, painkillers worth thousands of dollars. I study the labels: Percocet, Zofran, Maxeran, dexamethasone. Take daily. Take twice daily. Take with food. Do not crush. Do not chew. Take as needed.

I wonder if a one-month supply of drugs intended to save a sick person's life is enough to end a healthy one's. It probably is if you consume them not as directed. Chew them, crush them, don't take with food. Take handfuls at the same time. But the order matters. You must swallow an anti-nausea pill first so you don't vomit up a $248 cancer pill. This, I know. I've watched someone take cancer medication when he was trying not to die.

I remember the day we brought these drugs home. On the afternoon of June 1, 2013, my 36-year-old husband, Spencer McLean, was discharged from Calgary's Tom Baker Cancer Centre. As he changed from his hospital gown to his jeans, he let out a sob; he'd grown so thin that his jeans kept sliding down even with his belt cinched as tight as it could go.

On our way out of the cancer centre, we stopped at the hospital pharmacy to fill his prescriptions. We picked up a one-month's supply that cost twice our monthly mortgage payment, despite our private insurance and government coverage of his $7,000-a-month cancer therapy. We sat as we waited nearly an hour for the medications to be prepared; Spencer was too tired to stand. When the pharmacist called us to the front, he handed us three white plastic bags filled with boxes and bottles.

We stepped into the foyer of our condo nervously. Our parents had come by to clean up the packaging and plastic needle covers the paramedics had tossed to the floor of our living room in a rush one week earlier before they whisked Spencer to emergency. Neither of us was comfortable being home. We knew a fair amount about medicine and cancer – he, a surgeon; me, a medical journalist. We knew Spencer's cancer was extraordinarily aggressive. In the three weeks after his diagnosis, cancer galloped through his body at a ruthless pace, laying claim to his kidneys, his lungs, his liver. In its wake, clots formed in his blood, threatening to block arteries and veins. One had already clogged the vessel carrying blood to his liver, causing the organ to swell so large it extended across his abdomen and hogged any space that rightfully belonged to food. Each day became a balancing act in blood consistency: too thin, his kidney bled profusely; too thick, clots threatened to meander into his lungs and kill him.

At home that evening, right on schedule at 7 o'clock, Spencer took his cancer medication, then vomited it up. By morning, he was peeing out blood clots and couldn't eat or drink. We reached our oncologist on his cellphone and he agreed we needed to return to hospital. We'd been home less than 24 hours.

Spencer and I lay down on our queen-size bed, on top of the white-and-beige duvet we'd received as a wedding present. On the other side of our open window, a bird tapped its beak on a metal vent. Spencer lay on his left side; his right ached too much to place pressure on it. I nuzzled in behind him and put my nose to his back, where I imagined his diseased kidney to be. We wept like that for half an hour. I inhaled deeply and pretended that I was drawing cancer out of his body and into mine. Then, Spencer said, "Let's go."

That was the last time we were home together. Three and a half weeks later, Spencer died of complications from renal-cell carcinoma – an agonizing 42 days after the day we sat holding hands and stunned on a hospital bed, as a nephrologist told us the diagnosis.

The widowhood effect

Now, our home is my home. Spencer left everything to me; he'd no time to be more deliberate in his will. He gave me his beloved bikes and skis, his damn pager that woke us up in the middle of the night, his collection of model leg bones and pelvises, and a bathroom full of drugs that were supposed to save his life.

The pile of medication in our bathroom – my bathroom, now – is a remnant of a life that no longer exists. I don't know whether to dispose of these drugs or keep them in case I need them to end my own life. At 36, I am a widow.

The widowed are two and a half times more likely to die by suicide in the first year of widowhood than the general population. We are, in fact, more likely to die of many causes: heart attacks, car accidents, cancer, many seemingly random afflictions that are not so random after all. There's a name for this in the scientific literature: the widowhood effect.

It's dated now but a 1986 paper in the British Medical Journal explored death after bereavement. It opens atypically for a scientific paper: "The broken heart is well established in poetry and prose, but is there any scientific basis for such romantic imagery?" Indeed, there is, according to the author. He found that a strong association exists between spousal bereavement and death.

Multiple studies in the last 40 years have confirmed these findings. A meta-analysis published in 2012 that looked at all published studies of the widowhood effect found widowhood is associated with 22-per-cent higher risk of death compared to the married population. The effect is most pronounced among younger widows and widowers, defined as those in their 40s and 50s. The widowed in their 30s, like me, also die at higher rates than our married counterparts but the difference is not statistically significant – not because it is insignificant but because there are too few in this age group to detect measurable differences.

We are too few and too young to be significant.

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DREW SHANNON/The Globe and Mail

A terrible first act for a widow

We were in a fourth-floor hospital room facing the parking lot. My husband lay in a bed; directly beside it, the cot I slept in each night. Ten people – me, his parents, my parents, our siblings, our nurse – settled in around him, rubbing his feet and hands, telling him that we loved him.

A palliative-care doctor once told me that we die cell by cell until enough cells succumb that we cross over a line. But if you are watching the person you love the most die, you track their breaths, not cells. When someone is dying, their breath slows. Ever-widening gaps form between the end of the exhale and the beginning of the next inhale. In that space, you, the watcher, wait to find out if the unimaginable has happened. You don't know if this breath is the last one, or if there is another to come. You only know it's the last breath when it's too late to go back and tell them you love them one final time.

When Spencer didn't inhale again, I waited and waited. I was overcome with fury when I felt my lungs expand to inhale while his remained still. He was now there, dead, and I remained here, alive. I put my head on our hands, still intertwined, and I whispered to him over and over, "You were supposed to stay with me." I kept my head on Spencer's bed; someone – one of my sisters, I think – kept a hand on my unwashed hair. The nurse, crying herself, started to lower the head of Spencer's bed.

In the next seconds, I committed a terrible first act for a widow, but I did not care. I wanted to delete the memory of what cancer had done to my husband. Once strong and so preternaturally warm that I’d put my cold feet on his stomach after a day of skiing, he’d grown so thin that his collarbones poked out from the neck of his hospital gown; his hands were cold, his fingers curled in like claws. Adding insult to injury, his belly had swelled on his skinny frame as his abdomen filled with a cancery fluid due to liver failure. Spencer said to me once, bitterly, in the middle of the night as we drank milk sitting on his bed, that cancer turned him into Humpty Dumpty. He’d raged at the changes in his body. I took up his cause.

"I don't want to see him like this any more."

I thought I shouted it. My sister would tell me later it was a mumble, indiscernible. Ten bodies, plus Spencer and our two beds, blocked the space to the door of his hospital room. I stood up and moved quickly, so quickly that I tripped over someone's legs, falling into their lap. I don't know whose. When I got to the door, I froze, knowing the hallway contained nurses and patients and our friends watching the door. They had seen the photograph of a white rose that a nurse taped to the door to indicate someone was dying in the room. When I walk out, they will know he is dead. My father followed me to the door.

"I don't know where to go," I told him.

In a shining moment of dad-wisdom, he responded, “We’ll just go forward.”

Scenes from our life before cancer

My first minutes as a widow launched an ongoing education in how ill-prepared I was for this role. The charge nurse asked me if arrangements had been made for his body. I answered her confidently; it was one thing I knew with certainty. "He wants to be cremated and hiked up to the top of Polar Peak."

She paused as she absorbed how far from the mark was my answer. "That's lovely," she said, after a moment. "Have you selected a funeral home?"

I never thought about how a body goes from a hospital bed to a funeral home to ashes scattered on top of a favourite mountain. My dearest girlfriend offered to call her dad, a funeral-home director in Saskatchewan, for his recommendation. A nurse asked me if I wanted to donate Spencer's corneas for transplant. I paused, then answered yes because Spencer had just graduated from surgical residency with a specialization in trauma. I was guided into the nurse's office and instructed to speak to a woman from the transplant centre on the phone. After I gave my consent, the woman on the phone told me in clear terms that she needed to put me on hold for a few minutes while she confirmed information on her end. I hung up because I misunderstood her instructions. Eventually, another nurse called her back and finalized the transplant.

I spent the first night at my parents' house. The next day, despite protests from my parents and Spencer's, I drove myself home, taking an unusual route because the city had flooded in the biggest storm in a century and my favourite road home was under water. I had heard the rain tinging off the ledge by our hospital room for four days straight – ting, ting, ting as Spencer lay dying. A nurse had told me that parts of the city close to our condo had been evacuated. As I drove home under a sunny sky, I saw the ordinarily blue waters of the Bow River had overflowed their banks. Water flowed through streets of the downtown and nearby communities. I absorbed this information without reaction; of course, the city is flooding, I thought.

Inside our house, Spencer's orthopedic surgery textbooks lay open on the dining-room table where he spent hours studying. A duffel bag half-packed with ski gear had been left on the floor of the closet, marked for our upcoming move to California. On our fridge, a page ripped from a magazine, a kitchen for our dream home. Scenes from our life before cancer, interrupted by the visuals of life after cancer. Lance Armstrong's autobiography folded open on the coffee table. A canary-yellow plastic bin held a few used needles in the bathroom. Our crumpled duvet bore the marks of two bodies that lay side by side that last afternoon at home. I was numb; stunned. I crawled under the covers and lay there without tears.

I needed to shower. I got out of bed, undressed, turned on the water and stepped in. I spotted Spencer's green bar of Irish Spring soap, resting, partially used, on the edge of the bathtub; its letters had rubbed off weeks ago against his body. I lifted it to my nose. As soon as the scent reached me, I crumpled to the floor of the shower, the smell triggering a flood of memories. That is the smell of our intimacy, of my head on his chest. I curled up with the bar of soap and cried. Then, the dilemma began and I will spend months thinking about this: I have to lather the soap to get that smell. The more I lather, the less soap remains. I hid the soap at the back of the tub, protected from water, and pulled it out on the worst sorts of days. It bubbled into smaller and smaller pieces until, some time in year two, it disappeared down the drain.

Spencer smiled like a little kid

We met skiing at Lake Louise in 2007 when Spencer was a medical student. He was skiing with a friend who knew the man I was dating at the time. The four of us converged midway down a powdery run on a bluebird day that sparkled in the aftermath of a massive snowfall. We were introduced again several months later when we happened to be seated next to each other at a restaurant. By the end of that night, we knew we could make the other laugh in an extraordinary way. Later in the fall, when we were both single, Spencer invited me for coffee. From that first date, we forged speedily onward. Within two months, as we drove from Calgary to his hometown of Fernie, B.C., Spencer shyly suggested that we get married one day at a back-country ski lodge not far from his home. Three years later, we did.

He smiled like a little kid, employing every muscle in his face to express maximum delight. He loved camping, cycling, the Vancouver Canucks and buffalo mozzarella. He relished the cold of winter, and griped against two-faced politicians and ski hills that charge too much. He used to whip his nephews around in a speedy game of airplane that made me wince. He was razor-sharp, mischievous and observant. He once sent me a text message at a restaurant while seated beside me. "The girl across from us has OCD. She keeps straightening everything. I'm going to make our table crooked. Hee hee!"

He swore he'd never buy me a Valentine's gift, but proposed an idea in lieu. For a year, he'd find a new way to tell me he loved me every day. I'd discover "I love you" written on Post-it notes stuck to the fridge, documents left open on my computer, texts sent to me late at night. I still find notes at the bottom of old grocery lists in my iPhone: "I love you. SM."

We married as Spencer started his third year of his orthopedic-surgery residency. He regularly worked 90 hours or more a week and went long stretches without a day off. He left our bed for the hospital so often in the middle of the night that he claimed I could say goodbye in my sleep without realizing he'd gone. He missed ski trips, Saturday-morning sleep-ins, family dinners. He was working in Lethbridge, Alta., on my birthday; volunteering in Haiti for his.

We once enjoyed the short bliss of a pregnancy followed by the devastation of an early miscarriage. I cried frequently during the second year of our marriage. I tried to hide my heartache by weeping in the bathtub. I wanted to try fertility treatment; he didn't. He worried our problems with infertility initiated at his kidneys, malformed from birth due to a spontaneous mutation – a freak accident in his genes, a small blip in the assembly line during DNA replication that resulted in one tiny, atrophic kidney and another large kidney smothered in cysts. He didn't look as though he had anything wrong with him, blazing his way down a mountain in one ski-chattering rip. But his kidneys were concerning enough that we'd been turned down for life insurance. Spence feared his kidney problems could be passed onto our children. We decided we would adopt some time after residency.

In June, 2013, we were supposed to be celebrating the end of residency over a bottle of wine. We were supposed to give our condo keys to a young Australian surgeon named Kate, who’d already wired us several thousand dollars in down payment for a year’s accommodation. We were supposed to pack our most important belongings into our 2005 Toyota Rav 4 and drive off to California where Spencer was starting a fellowship. We were supposed to cross the border into the United States on July 2, as per our visas from the U.S. government. Our visa categorized Spencer as “resident alien physician,” and me, in the dehumanized lingo of the U.S. Citizenship and Immigration Service, his “complete dependent.” I’d been furious when the lawyer first showed us. We were supposed to get that sorted.

But nothing is as it's supposed to be.

The right suit, the wrong box

"Which casket do you want, Chris?"

We stood in a room of empty, open caskets. My friends, my siblings, Spencer's brother looked at me, waiting on an answer. I wanted to say, "I don't want a casket. I just want Spencer to come home." But things were hard enough. I didn't need to add difficulty to the day.

I couldn't think coherently to make decisions so I grabbed answers at random. I chose a cherry wood casket with a white satin lining. I'd promised Spencer that I'd hike his ashes 1,052 metres up a mountain so windy and pebbly at the top that hiking poles are a must. The urn I selected was a heavy wooden box, 25 centimetres wide and almost as tall, which needed to be dismantled in order to access the ashes.

I returned home to pick a suit for Spencer to wear at his funeral. I stood in our closet and considered the two options: the suit he wore at our wedding or the suit he was supposed to wear to the exam he missed because he almost died in our living room. On that night, as we'd watched television, he suddenly couldn't inhale without pain ripping up his side. He'd put his head on my shoulder and his hands on my thighs while I sat on a coffee table in front of him, my legs on either side of his, shouting to a 911 operator on the phone.

"My husband can't breathe," I told her. "He is 36 and was diagnosed two weeks ago with metastatic kidney cancer. He can't breathe."

To him, I kept saying, "Spencer, are you still with me? Squeeze my leg." And he would.

By the following morning, we knew Spencer was dying faster than we'd understood. We had barely grown accustomed to the phrase "a life-limiting disease" and now we were dealing with a life-ending disease. His survival would be measured in weeks, rather than years.

He wore his navy blue exam suit to his funeral. I sprayed it with a perfume of mine that he loved, because I wanted something of me with his body that day. I added a pair of dress socks from the company Happy Socks and the fellowship tie the Royal College of Physicians and Surgeons had given him a week before he died. I put his dress shoes inside our front door to remember them the next morning when I carried his suit to the funeral home. That afternoon, I returned home after a run and saw his shoes there, just like he'd kicked them off after a day of work. I indulged the fantasy for a few seconds.

"Hey babe, I'm home," I called out.

I revelled in that split-second where I could pretend that he was around the corner, out of sight, studying at the dining-room table. But the silence that met my call destroyed me. I lay on the floor and cried there for a long time, an ugly, snotty, gasping cry. On the other side of the door, I heard the elevator ding, followed by the sound of my next-door neighbour pulling out her keys. She stopped at her door, less than a metre from mine. I covered my mouth to quiet the sobs and remained still. She waited; I waited. Then she put her key in the lock and carried on. After that day, on the worst nights, I would take Spencer's pillow, the one he died on, and a blanket from our bed, and curl up on the hallway floor. I'd whimper there until sleep or morning came. I did this as many as 70 times over the ensuing three years.

The day of Spencer's funeral arrived sunny and record-breakingly hot. Seven hundred sweaty people crammed into a church. The heat caused the fire alarm to buzz, briefly, thrice during the funeral. This made me laugh out loud. Spencer would have relished it, these ridiculous blasts shattering the solemnity of his memorial. After, we toasted Spencer in a pub while our nephews flew remote-control helicopters on the patio.

Late in the evening, one of his friends said to me: "It's a shame you never had kids. You love your wife but, boy, you really love your kids."

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DREW SHANNON/The Globe and Mail

Days filled with ‘widow tasks’

I longed for traditions for mourning to give my private grief a public face. But there are no traditions for how a North American woman in the 21st century mourns her partner. For the grief-stricken, we've no identifying adornment to alert the world – no sad equivalent of a wedding ring. My closest reference as a widow is my Greek grandmother, my Yiayia, widowed for the last quarter-century of her 100-year life. She wore a black dress with black stockings on her bowlegs and, sometimes, a black kerchief around her hair. Unintentionally, I drifted to ensembles of black, grey and beige. I carried Spencer's wedding ring on a chain around my neck, and I wore his shirts with the sleeves rolled up. I blurted out my plight in conversations with strangers – the person beside me on a plane, a source I was interviewing for a story. I felt a need to justify my thinness, my red eyes, my habit of staring straight ahead without seeing. A plea to the world: Go gentle with me, please. I am not entirely here.

The first month, my days were filled with what I called "widow tasks." I left the house every morning with a copy of his will and his death certificate tucked into my purse. I grew accustomed to being called the executrix, a term not nearly as powerful as it sounds. I visited the bank to discuss what to do with $160,000 in student loans. The woman at the bank was stunned at Spencer's age; her husband, too, died at 36, many years before, she told me. I cancelled his credit cards and his membership in the Canadian Medical Association, and started his taxes. I was interviewed by a woman at the organ-transplant centre who asked me how many sexual partners Spencer had had. As I looked through his e-mails for taxable receipts, I found the password for a lock he bought for his laptop: ilovemywife.

After a few hours of widow tasks, I sat, dumb, in front of the television. The Tour de France began a few days before his funeral. Spencer had bought me a road bike as a wedding present. We watched the tour together the year before he died. He explained to me how the peloton and domestiques and crosswinds worked. After he died, I watched each day's stage once in the morning before I left our condo and the replay that night when I got home. Eventually, I brought my bike into the living room and practised clipping my feet in and out of the pedals in front of the television. I'd never been on my road bike without him. The summer after he died, I refused to take it out of the house.

People asked, "How are you?" and I'd stumble over a response. One night, my sister and I came up with a warped but useful method of answering this question. Every day, sometimes several times a day, I'd give her a number on a scale of 0 to 100, 100 being as happy as I'd ever been; below seven possibly suicidal. Several times, I croaked out sevens or lower, and she'd come over.

I read a statistic that, on average, a widow loses 75 per cent of her support base after the loss of a spouse, including loss of support from family and friends. Many friends disappeared as grief set in. On the day of Spencer's funeral, I said a teary goodbye to eight of my closest friends who, like Spencer, had just finished residency and were moving around the world for fellowships. Of those who stayed, many drifted away – some immediately, others more slowly.

But, while I cried from loneliness, I found consolation in isolation. This seems incongruent, I know. But home, alone, in our condo, I didn’t have to pretend to anyone that I was okay. I didn’t have to listen to anyone say time heals everything or that I am still young and other inanities. On my own, I could wear Spencer’s dirty T-shirts around our house. That was a genuine solace. It still is.

There is a term used in bereavement literature for a young death: an “off-time” death. I find it graceful and apt. When your spouse dies an off-time death, you, too, fall out of time. You drop out of sync with your contemporaries. In the same summer I bought a casket, my sister, who is pregnant with twins, bought two cribs. I scrolled through my Facebook stream of people getting married, having babies, watching their kids ski their first black-diamond runs until I could no longer look. New parents grumbled about sleepless nights with crying babies. I wrote imaginary responses in my head: I’m exhausted, too. I also woke up to someone crying loudly in my bedroom. But it was me, dreaming Spencer had sent me a letter saying he was never coming back.

A friend in Montreal, a mother of two, posted a Washington Post story about a study published in the journal Demography. The story was titled, “It turns out parenthood is worse than divorce, unemployment – even the death of a partner.” I fumed over the post for days. I found the original study; I read their methods, reviewed their conclusions. I needed to confirm that this story had it all wrong. I am right. The investigators looked at why birth rates are low in Germany, why some people don’t have a second child after a first. Parents who are unhappy after a first child generally do not have a second. Happiness levels drop for some parents – sometimes significantly – after the birth of their first child, but the dip is usually temporary.

Parenthood is nothing like the devastation of having your spouse die young.

Those of us who have lost a spouse endure a particularly gutting kind of stress that eats away at our protective barriers. In 1949, two psychiatrists at the University of Washington set out to study stressful life events and the ways they contribute to illness. For 15 years, the duo studied 5,000 patients. At the end of the study period, death of a spouse topped their list of cataclysmic life events. The authors assigned it a value of 100. Far behind in second place, with 73 points, was divorce. Nearly 50 years have passed since they published that study, and the results still stand. The stress of losing a spouse permeates every part of one's body, affecting each cell and manifesting tremendous physiological changes. Cortisol levels rise, and sleep is disrupted. Heart rate and blood pressure increases. Your neutrophils – a white blood cell that fights infection – become less effective, particularly in the elderly. Your cells begin to falter in their responsibilities, your immune system weakens, and you fall prey to countless illnesses that, under normal circumstances, would be held at bay.

My body began a revolt the moment we heard the words "suspicious for cancer." That day, I vomited so many times in the hospital bathroom that Spencer's physician asked me if I was okay. I couldn't keep food down. My menstrual cycle became erratic, arriving every few weeks and lasting for four to 17 days. Nearly a year after Spencer died, my family doctor suggested I take birth-control pills to control my period – a recommendation hard for her to make and for me to hear after years of doctors' visits to improve our fertility. Even my blood cells, now strangely large and low in number, showed the effects of missing Spencer. An ultrasound revealed a small benign tumour on my right kidney – same as his. My wee, asymptomatic, I-miss-you tumour.

I am still keen to speak with Spencer about all this. I suspect he would say things like, "These tumours are common"; "It's no big deal." I've needed to speak with him about many things in the last three years. I didn't know the password to our computer backup system. One of his colleagues called me to say, hesitantly, that the department of surgery needed his pager for the incoming batch of residents. I couldn't find it. My right Achilles tendon often aches from too much running and I know he'd say the same thing he said the last time this happened – "rest is the most undervalued aspect of training" – but I'd like to hear him say it anyway. I want to tell him our accountant, who has been very good to me, has Asperger's syndrome. I want to talk to Spencer about the medications in the bathroom, and how I have felt like I am dying too slowly from unhappiness and I don't know what to do. I would like to point out to him that, based on my family history, I am probably going to survive another 65 years, barring an unnatural death, and that is very long time to be unhappy. He'd wrinkle up his face at that last one; he hated histrionics. More than that, he hated to see me unhappy.

Mostly, I need to speak with him about the day he died. For the 42 days he had cancer, we were inseparable. We walked laps around the hospital floor, the nurses calling out, "Hey, lovebirds" every time we passed their station. When he couldn't walk any more, I sat beside him in a chair during the day and slept on a stretcher at his feet at night. We had what we called "milk picnics" in the middle of the night when we couldn't sleep. I'd get us two small cartons of milk from the hospital kitchen and I'd sit cross-legged on his bed while we talked. We dissected every step of our cancer adventure: that time a nephrologist made us stand in a hospital hallway to read on a computer screen the report confirming that cancer had scattered like polka dots through Spencer's lungs; whether it would be better for one of us to have Stage 4 cancer or both of us to have Stage 2 cancer; the time I stole an adult diaper off a nurse's cart and Spencer dressed up in it to make the nurses laugh. I yearn for a milk picnic to ask Spencer what he felt and heard when he was dying. The combination of medications, disease and exhaustion eroded his ability to think coherently in the last days. My husband, who had helped save the lives of patients in the same hospital where he lay dying, was confused by the remote control to operate his bed. Sometimes, he'd reach up and rub his head in thought, look up at me with complete trust, only to ask something bizarre: "Chris, do I have somewhere to go today?"

The worst, in a panic: "Chris, I have my passport but I can't find yours."

He kept pressing the button on his morphine pump. The doctors believed it was delirium rather than pain, but I will always agonize over whether he was hurting. In the last hours, when he could no longer speak, I kept telling him that I loved him, that he was very brave. I want to know if he could hear me and if it was annoying to hear the same things repeatedly. I want to know if he knows that I was the first to leave after he stopped breathing.

The desire to talk to your spouse after they've died is a recurring theme in studies in scientific journals and online support groups for the grief-stricken. I understand why: My brain has not yet caught up with the reality of my life. I am accustomed to reflecting on the world through the language of Chris and Spencer – what we find funny, sad, interesting. Now that he's gone, I'm the only one left who speaks our language.

Our third wedding anniversary arrived while I was alone at my family's summer home on the Mediterranean island of Cyprus. That morning, I listened to a voice message Spencer recorded three days before he died, speaking into the voice-memo app on my phone. Steroids have eroded his voice. He is so tired that he pauses in the middle of sentences to catch his breath.

He starts out by saying, "You are my favourite," because we always used to say that. He pauses a long time. There is a crack as he inhales. "You are the most beautiful woman I've ever met." He pauses again. "Indubitably." Then, he asks me to look after his wife. "You are the only person she will listen to. Please make sure she is happy."

"I will miss you and I will love you forever."

He signs off as if it is a letter. "Love, Spencer."

How grief changes you

No one warned me about the cognitive impairment that comes with grief. Tears, heartache, depression – these are expected, but the sustained diminishment of my thinking skills astonishes me. I lost my husband, and then I kept losing things: credit cards, a favourite running shoe, my way home as I was driving a road I'd driven a hundred times before. I regularly forget the keys in the front door of the condo. I woke up one morning to discover that I'd left it wide open through the night. More than once, I bought groceries and forgot them in the trunk of the car. I often think about older widows whose spouses die after many years of marriage. How lost they must be. That's borne out in studies of elderly widows, which suggest bereavement can be a factor in the development and progression of Alzheimer's disease. In my 36-year-old brain, I find myself unable to access the most rudimentary information. I no longer instinctively know the year with certainty; I do a mental check by calculating how long he's been gone.

I couldn't read novels for many months after Spencer died. My interest in the fantasies of someone else's imagination plummeted to nil. This, to me, indicated that I was truly broken. I felt some comfort when I read an interview with the poet Edward Hirsch. Hirsch, who lost his son in 2011 to a drug-related accident, said he couldn't read in the aftermath of his son's death. "To be left with myself and being unable to read meant I was unrecognizable to myself," he said.

I read Buddhism and found its concepts on death quite lovely, but I was too addled to embrace them. I read Marcus Aurelius's Meditations and came to rely on the pep talks from this old Roman emperor. Look well into thyself: There is a source of strength which will always spring up if thou will always look. But sometimes I lose patience with Aurelius's stoicism. Easy for you to say, dude, I'd tell him. You've got your wife, kids, an army and all the wealth of the Roman empire.

I read the poet Rebecca Lindenberg, whose partner, the poet Craig Arnold, disappeared while hiking on a volcano in Japan in 2009. He was 41. Her lines stuck in my head, none more this:

FRAGMENT, I am a fragment of us.

I am a fragment composed of fragments.

In the first fall after Spencer's death, I was invited on a date, the first time I was asked out as a widow. We met the day before during a press conference. I asked him several questions; each time he answered, he opened his response by addressing me by my first name. He was handsome and dark-haired, charming and smart. He asked if I was married; and I told him that my husband had died 107 days earlier. I have zero game when it comes to dating. He put a hand on my arm and told me he was sorry. I looked down at his hand, back up at him, and down at my arm again. It was an uncomfortable thing. He asked me to dinner. I told him I had work to do that evening and hid out in my hotel room for the rest of the night.

In my third year of being a widow, I ran into a man I'd known a decade earlier. As we caught up, we found out that we'd each lost a spouse to cancer in the same summer. "Are you still as fucked up as I am?" he asked me.

"Probably," I told him. "Maybe more."

Even in this space of deep sadness, there are things to be cherished and things to be envied. How envious I am to hear that someone has died after a one-, two-, 10-year survival with cancer, that they had time for bucket-list trips or an appetite for dinner in a favourite restaurant. On the other hand, there are people who believe I'm lucky. My husband and I enjoyed a rock-solid marriage. We had 42 days to say goodbye. This has buoyed me through the worst. To lose a partner without warning seems to me the cruellest thing. I met a woman once who told me that her husband died in a car accident after they'd had a fight. How beautiful and smooth my story seemed next to hers.

The hike to Polar Peak

Spencer's ashes rested on my nightstand for more than a year, where the weight of the box imprinted its shape permanently into the wood. I moved it onto my desk in the spare room during year two.

In the third year after Spencer's death, I told his family that I was finally ready to take his ashes home. Spencer's brother and wife organized a trip so we could carry out my promise to hike his ashes to the top of Polar Peak, the highest mountain looking out over the town where he grew up. We started out in the early-morning light. Spencer's brother, his wife, my sister's husband and I hiked from the base of the ski hill. Spencer's brother carried the urn in his backpack. As teenagers, he and Spencer used to hike up with their skis in the winter. After an hour and a half of climbing, we arrived at the top of a chairlift where we met my mother and Spencer's parents. We switched backpacks; now I carried the urn.

The terrain was loose scree, the incline steep. We watched our parents carefully as they picked their steps up the mountain. I carried on a secret conversation with Spencer in my head, chiding him for choosing this spot; we would have a major orthopedic disaster on our hands if anyone slipped at this elevation. The sky started to drizzle and broke into a freezing, sideways rain as we arrived at the top. We hid out in a ski-patrol hut. We sat on rolled-up snow fences and ate bagels. A sign at the back of the shed bore the warning: Welcome to Polar Peak!! Extreme terrain with big exposure over large cliffs. You must fight to self-arrest if you fall! I thought: He'd get a kick out of that.

When the storm eased, we walked out to the mountaintop, still encircled by clouds of black and indigo. Spencer's brother unscrewed the screws on the bottom of the wooden box. My sister-in-law had researched how to spread ashes and cautioned that we might see bits of bone along with ashes inside the box. My teeth chattered and I shivered. We passed around the bag of ashes and each of us spread some over the mountain. I went last. I sobbed and sobbed and sobbed, and was astonished at how much ash there was to spread.

Home as a Christmas-free zone

Our last Christmas together, Spencer worked late on Christmas Eve. He met me at my parents' house after most of the household had gone to bed. We flopped side by side on the couch. He yawned and I put my head on his shoulder. We made a pact to spend our next Christmas on the beach in California.

The next day, he woke with a crippling stomach ache. He joined my family for coffee and breakfast, which he picked at, then disappeared back to bed, whispering to me, "Tell your family that I'm tired."

We worried; my mom kept asking me, "Is Spencer okay?" I'd go check and bring him apple juice. The following day, Spence drove to Edmonton to write an exam he needed for accreditation to practise medicine in the United States. He texted me when he finished, frustrated that there was too much about the kidney. I passed the info onto my brother, who was also prepping for the test. I signed it, "The exam widow."

Between work and study, it took us weeks to take down our Christmas tree. Its branches were covered in ornaments we'd bought over the last seven years: a gaudy sparkling streetcar from a trip to San Francisco, a dainty wooden fairy from an adventure in Berlin where he accidentally got on a train without me, a bear in a white coat from the year he graduated from medical school.

When we packed everything up, we tucked the tree and our box of ornaments into a space at the back of my parents' basement. We told them we didn't know when we'd be back for them.

Four Christmases later, the tree and the box remain in my parents' basement, unopened and unmentioned. My home is a Christmas-free zone, a refuge from the merriment of the season. This is a survival tactic. In a season that celebrates togetherness, I need one place where it's comfortable to be alone.

If I charted my emotional state over the last three and a half years, you would see what researchers call a lot of noise. Dots spread chaotically over a time plot, no discernible pattern to their location. The five famous stages of grieving would be represented: denial, anger, bargaining, depression, acceptance. But they are less stages and more viewpoints that I revisit time and again.

One winter day that first year he was gone, I packed up his medications and took them to a drug store to dispose of them. The pharmacist wouldn't take them; something about how the blood thinners needed to be ejected first. I didn't understand. So home we went again, me and my bags of medications. I restocked them in the vanity.

Some time in year two, I gave the drugs to my parents and asked them to get rid of them. I renovated the bathroom; the old vanity doesn't exist any more.

This is where I am supposed to tell you how I have moved on. We like pretty endings for young widows. Jackie Kennedy married Aristotle Onassis; Lady Mary found a handsome new groom on Downton Abbey. Loneliness is averted, parity restored. Studies show remarriage negates the widowhood effect, neutralizing any negative influence on mortality. But I don't believe you can replace one person with another, or that young widowhood is simply a time gap between a funeral and a remarriage. I think it's about withstanding a blow that fundamentally changes your architecture. Some days, you are wobbly; other days, less so.

I've come across little things of Spencer's in the last three years, a ghostly version of the way he used to leave me notes around the house. One day, I delighted to find a stick of Chapstick in his ski jacket. I smeared it on my lips and stored the tube separate from all the other tubes of Chapstick in the house so it could never be confused. I discovered a piece of paper he kept folded in his sock drawer with a typed-out protocol for Achilles-tendon recovery on one side and my initials scribbled on the other. I wonder if he stored it there the first time I hurt my Achilles tendon, or after he was diagnosed because he knew that I was likely to run myself into injury from grief.

I still have days where I lie on the floor and miss him so terribly that I keep repeating, “I want you to come home.” It does not happen as frequently as in year one or year two but it slays me just the same. I got a rambunctious puppy called Ajax, named for the character in The Odyssey who misses his best friend, Achilles, so much that he dies from grief. Like Spencer, Ajax hates to see me cry. She begs to be let up on my lap so she can lick my tears away. It’s nearly impossible to derive therapeutic benefit from tears when a puppy’s tongue pokes into your eyeball, putting you at risk of some kind of zoonotic conjunctivitis. She refuses to let me sleep on the floor of the foyer. This, I suppose, is progress. I’ve even taken many of Spencer’s clothes to Goodwill, minus a collection of my favourites – soft-flannel shirts, ski sweaters, a jacket. They hang in the closet beside my own.

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