Danielle Snyderman's fascination with the love lives of her elderly patients began after a woman in her late 80s suffered a series of falls.
It was clear that she could no longer live safely in an apartment with her husband of six decades. A broken hip would have been catastrophic for her. Snyderman, a geriatrician, recommended that the woman move to assisted living.
Her husband resisted fiercely, fighting against what seemed to be in his wife's best interest.
"Every morning, we wake up," he told Snyderman, "and we look at each other and we stick out our tongues. Now we can't do that anymore."
That's when she thought of love.
Love was, of course, what the husband was afraid to lose a moment before he had to. It was what had kept him at his wife's side as her mind failed and his stayed sharp, as his body deteriorated faster than hers. It was the doorway to everything that really mattered.
So, in her off hours in 2013, Snyderman began formally interviewing patients at the Hill at Whitemarsh, the upscale retirement community in Lafayette Hill, where her practice is based, about their love stories. Here was a stealth path into their values and the forces that had shaped them.
The couples were happy to tell her how and when they had met and what had made their relationships survive. Many struggled with her kicker question: "How do you anticipate a time without each other?"
Amid office hours, teaching at Thomas Jefferson University, and the needs of her own family, Snyderman has managed to interview just 14 couples and two widows, and wants to do a few more each year. Someday, she hopes, there will be a book.
The stories have brought her closer to her patients. She believes her willingness to listen has heightened their trust in her. As she had hoped, knowing her patients better has helped her help them when medical problems worsened.
She was able to reminisce with members of Milton Sanders' family as they sat vigil after a fall caused fatal bleeding in his brain. She made sure Mildred Demchick could comfortably hold her husband's hand as he died.
When Snyderman encountered another obstinate man who didn't want his wife in assisted living, she knew what to say.
"I know, from what you've shared with me, that every decision you make is rooted in your relationship together," she told him. "I'm trying to think of the best way to keep you guys together as long as possible and as healthy as possible."
The man went into assisted living early so that he could be with his wife.
As baby boomers age, the country needs more specialists who understand the elderly. Snyderman hopes the love stories can make her field more appealing to young medical students.
Two pharmacy students, Jennifer Greene Naples and Cibi Kandammalil, volunteered to transcribe interview tapes. Both are now specializing in geriatrics and say the project solidified their career choice.
Naples, 33, never imagined focusing on caring for older people when she entered pharmacy school. When she was 28, though, her husband got a life-threatening illness. He survived and is doing well now, but she gained an appreciation for the challenges the elderly face and gratitude for "day-to-day miracles" like being able to go out to dinner together.
In an essay about her love-story experience, Naples wrote that she had been prepared to hear from the patients about heartache and suffering. Instead, she heard stories of "a connection that transcended the mortal confines of heartbeats and breath. And even those stories colored by the raw, wrenching hollowness of recent loss were infused with a certainty that true love - not the kind we've come to expect from lighthearted romantic comedies, but the kind that anchors our souls to ourselves - is never extinguished."
Snyderman's project is a form of narrative medicine, which uses stories as a tool to strengthen empathy and relationships.
About a year ago, Rita Charon, a narrative-medicine expert from Columbia University, talked to residents at the Hill about how patients' stories have helped her understand their medical problems. She encourages doctors to start a visit by saying, "Tell me your story."
While Snyderman wraps the love stories in professional utility, it is also obvious that she loves them because they are great little stories packed with humor, history, wisdom, and grace. Who wouldn't feel better after bearing witness to love that has weathered child-rearing, war, poverty, financial success, and physical decline? To seeing an 85-year-old woman's face glow with love as she and her husband speak?
"There's definitely this part of me that really loves a good story," Snyderman says. The project helps "balance who you are at work with what really brings you passion in your life."
Unveiling that humanity in her patients is fuel for difficult work. "Understanding my patients for who they truly are," she said, "helps me to stay passionate about medicine and feel that I am staying above the systems challenges we, as doctors, face."
The interviews are just an hour each, but they contain remarkable little gems.
Snyderman learned that Gene-Ann Polk and Edwin Horne met at a pre-football-game party while she was in medical school and he was in dental school at the University of Pennsylvania. Horne asked a friend to introduce them. "She was at the party with a Rutgers football player," Horne told Snyderman, "and when I was talking to her, he was rolling his eyes at me. . . . I knew in the back of my head that he was long gone, and I was in."
Later, Horne wrote Polk to invite her to more games. "The reason I wrote instead of calling was because a letter cost about 3 cents and a phone call was 5 cents," he said.
"So what you're saying is, I'm not worth 5 cents," Polk, then being treated for pancreatic cancer, saucily interjected.
"No," her husband said. "That's not what I'm saying. I'm saying I only had 3 cents."
Two years later, they sneaked off to get married. He became a football player at Ole Miss. They had two children when the Eagles drafted him in 1951 to play center. "Right at signing, I received $5,000, which was amazing. This was more than we could imagine at the time." Even so, he left football to start a roofing company.
The Farraguts were in a nursing home with rooms across from each other when Snyderman interviewed them.
After 65 "perfect" years together, Ken Farragut said, he had not thought of a time without Jane. "I cannot really think about it, but I do know that, no matter what, we will be reunited after death."
Al Goldman, an 89-year-old psychologist, told Snyderman why he and his wife, Adele, a sociologist, hold hands. "I think everyone should walk around holding hands with their loved one. Adele says it completes our circuit. It's our affective energy we are sharing. This sense of sharing is especially important as we age, because we acknowledge that the horizon is no longer that far away."
The interviews made Snyderman view her own marriage differently. Young couples, she said, tend to be selfish. "Is he loving me enough vs. am I doing enough to love him?" she said. "I think more that way now. . . . I'll stop now in a fight. Am I just arguing for me or am I arguing for us?"
The stories she is collecting are bittersweet. They are adorable and touching and profound. And almost over. Of the 30 patients Snyderman has interviewed, six have already died, including Gene-Ann Polk at 88 and both Farraguts. He was 85, and she was 86.
Hard as these deaths are for Snyderman and her students, Snyderman thinks these richer, deeper relationships have helped her face the deaths more authentically.
"It's more meaningful, and I think that in the end gives me energy," Snyderman said. "I perhaps feel the loss more intimately, but I think I can handle that in healthy ways. It just feels more real."
Marv kept calling, though, and the other guy's bragging started to annoy her. After about two months, Mildred let Marv come over. They talked for hours.
He had dimples. "That was simply the deciding factor," she said.
Marv would take the trolley to her school in Logan every day. While he waited, other girls would tell him their problems. He'd carry Mildred's books as he walked her home. After about a year, he bought her a "little gold ring with a tiny diamond." They were 17. He joined the Army. Just before they sent him to Europe two years later, they had a quick wedding. An aunt bought Mildred a powder-blue dress and matching hat. They had a two-day honeymoon in Atlantic City.
He came home, wounded, after a plane exploded near his jeep. He'd lost so much weight she barely recognized him. "But, of course, I found him because of his dimples," she said.
He became a CPA and eventually ran an insurance company.
He helped her get better at communicating. "One time I cried, and I couldn't explain to him what was wrong," Mildred said. "So he would sit there and wait for me to open up. He was very patient with me."
Marv liked to help people who were struggling. He got good at turning around struggling companies as well. He always told Mildred, "I love you."
There were few fights. He won most of them. "After arguing for a while, I guess I decided he was right."
His goal was to live one minute longer than his wife, but bladder cancer took him April 13, 2012. They had been married 67 years. Geriatrician Danielle Snyderman arranged for a reclining chair to be set alongside Marv's bed so Mildred could lie next to him and hold his hand.
"I loved holding his hand," Mildred said. "That was something I looked forward to every night, and . . . I miss that terribly. I really do."
He always refused to take off his wedding ring. He wanted to be buried with it, but this time, Mildred decided she was right. She uses her own ring now to hold his bigger ring on her finger.
"I had to take it off his finger, and it's part of me now," she said. "I have him here with me all the time."
Mildred, who has friends and nearby family, is helping Snyderman understand the loneliness that so many elders face. Now 91, Mildred describes herself as "healthy but miserable."
She "fell apart" when Marv died. "I started losing my sight very quickly after that, and I was under a great deal of stress."
She forced herself to eat. Nothing tasted good. Her hearing got worse. She couldn't sleep. "When he was here, he always held my hand at night before I went to bed, and that kind of lulled me to sleep, and for some reason I never got up during the night when he was with me."
She brightens at the memories. Especially when she talks about his dimples.
Snyderman says there's no medicine that can ease Demchick's grief. But maybe listening can help.
It was love at first sight for Frieda and Milton Sanders, even though she didn't think he was handsome.
They were both working for the government in Washington in 1941.
He took his meals at the boardinghouse where she lived. He had just finished breakfast when she appeared. He introduced himself and asked her name. "OK, Frieda, I will see you at dinner," he said.
"That was it," she said.
When geriatrician Danielle Snyderman interviewed them, they were approaching their 70th anniversary.
Frieda, the live wire, had a question of her own for her husband.
"Do you love me?"
"Yes," Milton, the quiet one, answered.
"I make him say it," she said. "Every morning, I am the one who showers and gets ready first. Milton lays in bed and watches television. I say, 'Good morning, I love you,' and he says, 'I love you,' and I get a kiss."
Theirs was an easy relationship with few regrets. She wishes she had finished school sooner. He, with a physics degree from MIT, wished he had started his own optical fiber business earlier. She said one thing she wished she could take back.
"One year around Christmastime, when I was home with four children, Milton came home after an office party. He was a little high and he stretched out on the couch and asked me to get him a cover and I said, 'Yes, I can get you a shroud.' "
She still feels guilty. "That is the one thing I truly regret. We dealt with conflicts by talking everything out."
Sometimes Milton would ask her how she'd handle the finances if he died first, but she didn't take it terribly seriously. "We were going to live forever," she said.
Anyway, she already wrote all the checks. She picked out his clothes. She did all the cooking and cleaning up and changed every diaper.
It never bothered her.
"Milton never ever said no to me, no matter what."
Three months shy of their 70th anniversary in 2014, Milton died of a head injury. He was 94.
Snyderman sat with the family at the hospital after the prognosis was clear. They reminisced about an early date where Frieda and Milton kicked tiny pinecones through Rock Creek Park. Frieda still has them in a little box.
"We had a wonderful life. Wonderful friends," she said. "I can't complain."
She is 92 now, with a remarkably smooth face and the spunk to flirt with a much younger photographer. Her new friends are not as close as the ones she made in her youth, and it is tough to watch her neighbors move to canes and walkers, but she's playing bridge and having fun.
"We were both pretty strong people. We were independent and we knew one day one of us was going to go. This was our last stop," she said.
"I'm thankful that Milton didn't outlive me," she said. "He would have been lost. It would have been a tragic thing."
He laughed as he glanced at Adele, his wife of 63 years. "Should I tell them?" he asked playfully. "Maybe I better not." Slight pause. "Well, I'll tell you."
"Don't," she interjected, not playfully. "It was the first year we were married, and we didn't know how to conduct this affair of being married. . . . It's embarrassing."
Here it is, that dark moment from a marriage that he now calls "magical and mystical and marvelous":
She threw a green pepper at him. He threw it back at her.
"I think that was the time that defined the way we would relate to each other," said Adele, who became a sociologist after the kids were old enough. "We never did that again."
What they did instead was talk.
"One thing that does define our marriage is intellectual honesty," said Al, a psychologist who ran a marketing research firm. "Adele knows everything about me, including all of the things that I'm not happy about myself."
They met on a blind date when she was 19 and he was a World War II veteran in college. She thought he was arrogant. He thought she looked awfully young.
She was very pretty, though, and he asked her out again. On the second date, she wore a "gorgeous" gold dress, and he fell in love. But he had no money, so they waited three years to become engaged.
Over time, he chose to become more "selfless." He gave a little on his neat-freak need for order. If he sees something out of place now, he thinks: "For heavens sake, just do it yourself."
Adele also learned to stop herself. "When something really bothers me and I feel myself getting angry," she said, "I say, 'OK, Adele, save this till tomorrow and see how you feel about it,' and tomorrow, when I'm ready to assert my anger, it's not there anymore."
They have reached the stage of marriage called interdependence, Al said.
"When you're first wedded, there's a relationship that in some ways is driven by hormones," he said. "After we've known each other now 66 years, something develops that is closer to welded rather than wedded."
Adele said there's an element of luck to their love story. "We both kept changing," she said, "so we aren't the same people we were then. We just happened to like the way the other turned out."
He wishes he could help young people understand what they have to look forward to at the end of a long marriage. He is happier now than he was 20 years ago and said he was "crazy in love" with his wife, the only woman he has ever loved.
"There comes a point in life," Al said, "where you know the security of your relationship is rock solid, immovable, and enduring forever. That's a very good feeling because life provides an environment where there's constant change and constant threat."
He is convinced that the psychological comfort they bring each other is good for their immune systems.
Still, they're well aware the end is coming.
"It's inevitable," Adele said. "I'm 84 years old. He's 89. I wish it could go on forever, but it can't."
Al guesses - hopes, really - he'll go first. "For Adele to die first, it would be the most traumatic event of my life," he said. "I can't imagine anything worse."
After such a bond, either survivor will likely have a tough time. "When one of us dies . . . our closeness, our incredible closeness, may be more difficult for the survivor . . . ," he said, "but maybe that's the price one has to pay for all the wonderful things that happen when you are this close."
Nancy Kern was driving in Virginia on Valentine's weekend four years ago when her cellphone rang.
The connection was bad. Annoyed, she asked again: "Who is this?"
It was a man she first met back in 1947, the man who now sat next to her while Ayla, a 12-year-old black poodle, slept at their feet.
They had met briefly, through her brother, while she was a freshman at Mount Holyoke College in Massachusetts, and Jack Roberts was at Yale University in Connecticut. She felt a connection instantly, but did not realize he'd felt it too until a letter with his return address arrived three months later. "The guy who'd never spoken to me. How could he know what's in my mind?" she said, her teary eyes full of love as she looked at her husband. "It's been symbolic of everything that's happened."
They dated through her sophomore year. She even endured a meeting with Iggy, his medical-school cadaver.
He visited her that summer on Cape Cod, where she and other theater students were staying. He gave her his picture. As they sat in a car looking at waving sea grass, he opened up for the first time, telling her of "caring and deep, deep loss."
"I didn't move a muscle. I didn't want to break the bubble," she said.
"I remember most of all that, when we got out, he wouldn't hold my hand and he didn't kiss me good night and I knew that he was gone."
She was right. She never heard from him again.
She wouldn't know it for many years, but he had almost asked her to marry him that night. The future surgeon facing years of training didn't have room for a wife yet, though. Eventually, she, too, realized it wouldn't have worked.
They married other people. His wife died. So did the long-term girlfriend after her. After having two children, Nancy, who became a computer consultant, divorced. She later turned down two marriage proposals.
She had tried to find him more than once, but John Roberts was too common a name. He found her through her brother.
She cried as she told of hearing - bad as the phone connection was - the voice she thought she'd never hear again.
"Is that my darling Jack Roberts?" she blurted out.
What did he think when she said that?
"I thought I had a chance," he answered drolly.
She "angsted like I was 19 again" after they agreed to meet, but all went well at the little French restaurant near her house.
"Sixty years just slipped away, didn't they?" she said with another adoring glance.
By the end of the year, they were married.
Jack Roberts, 89, uses a cane and recently had shoulder reconstruction. He said Nancy, 85, has been a big help to him. She credits him with encouraging her to get a colonoscopy - it went well - and with keeping her emotionally grounded.
He says he doesn't think much about mortality. "You never know what's going to happen," he said. "I don't particularly worry about the future."
Nancy Kern Roberts does think about it.
"If he leaves first, I'm going to be really angry, because I have a great fear of death and, as long as I know he's there, I can handle that unhandleable moment," she said. "But I also know that I don't want to leave him alone."
She said she learned from her mother, who traveled to Europe at 101, to always think about the future - in a positive way. "My mother never ever said, 'I can't buy another coat.' She never said . . . 'I can't do that. I'm too old.' " That attitude helped carry her nearly to 105.
Nancy and Jack squabble occasionally, but she always stops and thinks about how short their time together may be.
"We can't do this," she tells herself. "We're all we have."
Is marriage good for you?
According to Kenneth Covelman, a psychologist who chairs the department of family and couples therapy at Thomas Jefferson University, science says yes.
Marriage, he said, is good for emotional, physical and financial health.
Researchers have shown that married people have fewer chronic and acute illnesses and spend fewer days on disability, he said. Married people are less likely than unmarried peers to die of heart disease, stroke, pneumonia, many kinds of cancer, cirrhosis of the liver, auto accidents, homicide or suicide.
The health benefits are greater for men than women, he said, but, on average, marriage is good for women, too.
"The quality of the relationship matters," Covelman said. "Marriages characterized by unequal decision-making, high levels of criticism and lack of emotional support lead to demoralization in both men and women and high levels of depression. High levels of depression put people at risk for more health-related problems."
Several factors may be responsible.
One is that there is a "strong correlation between psychological well being and physical health." Something about the commitment and caring that go with marriage is more psychologically beneficial even than living with a partner.
Covelman said the evidence is mixed on whether people who are able to sustain long marriages were more emotionally healthy even before they got married.
Once married, people tend to cut back on risky behaviors. They're more likely to quit smoking, eat healthy food and drink more moderately.
Spouses may encourage their partners to see doctors when they have symptoms and then encourage them to stick with the treatment plan. Covelman said there's evidence that women with breast cancer do better when they have highly supportive husbands. Spouses provide a lot of caregiving.
Marriage tends to put people on better financial footing. Economic health is strongly correlated with emotional well being, Covelman said.
Not everything about marriage is good. Couples tend to gain weight and exercise less after they tie the knot.
Not surprisingly, losing a spouse, particularly after decades of marriage, is "quite devastating," Covelman said.
The effects are worse in the first few months, but widows and widowers face higher long-term risks for health problems and death than married peers. The risks go down with remarriage.
Covelman said the surviving spouse can maintain better health by seeking treatment for persistent depression, maintaining or forming a strong social network and taking control of their lives rather than being passive.