A LIVING TESTAMENT — (The Miami Herald)

SSRI Ed note: Popular, successful psychotherapist takes Xanax, Prozac, Trazodone, other meds, is stressed, dies of heart failure, officially no explanation.

Original link no longer available

The Miami Herald, (FL)

December 10, 1995

Author: JOHN DORSCHNER Tropic Staff Writer

Her patients were stunned when they heard the news. To Danny Salzverg, a Miami businessman who has recovered from Hodgkin’s disease, “it just didn’t seem real.” To Alan Edelman, a St. Louis radiologist who has been battling pancreatic cancer, it seemed “virtually impossible.” Yet another patient, Lisa Boccard, began lighting a candle every night and asking herself: “Why did she die? Like we were supposed to die, not her. How can this be?”

At first, no one was sure. Psychotherapist Teri Amar had become renowned for offering hope to people who had no hope. She urged people whose bodies were racked by cancer to live to the fullest and to aid in their own treatment by visualizing tumors disappearing.  Two of her cancer patients showed such remarkable recoveries that they became major news stories: Lisa Boccard’s provocative photos of her battle against breast cancer became a Tropic cover story, and Alec Courtelis, the well-known developer and political fund-raiser, was featured in The Herald’s Living section last year, in an article in which he credited Teri Amar’s counseling for helping him overcome overwhelming odds in his fight against pancreatic cancer.

As reports about Amar’s successes spread, patients flocked to her, and she had to hire colleagues to assist her at her Institute for Mind-Body Health in Coral Gables. Then suddenly, on Aug. 24, two weeks after her 50th birthday, she was found dead in her bed. Her obituary listed cause of death as “respiratory failure” — meaning she had stopped breathing. But why? An autopsy was ordered.   Shocked patients began asking themselves: Was it possible to cling to hope when the woman who had offered so much hope was gone?

Stacey Goldstein, a lawyer and another former patient who has bounced back from cancer: “I am who I am because of her. . . . When I first heard about her death, I said, ‘Oh my God, how can I go on?’ ”

Beyond the Black Hole

All of my life I have been a seeker. I have looked for happiness and peace of mind everywhere. I have looked on the outside, hoping that love, money, drugs, or food could fill the emptiness that I felt inside. They never did. I have looked on the inside, hoping that psychotherapy could give me the formula for filling in the void. I found many answers, but still the black hole gaped inside of me. Along the way, I discovered that I had something to give to other seekers, if only my optimism, for I never gave up. . . . Even in my darkest moment, I knew that if I could quiet the storms that raged inside my mind, I could discover what the purpose was of my life, and I would be able to choose to live in the best way for me.   — Teri Amar in her 1994 book, Quiet Healing

Her mother, Sally Felkoff, had six miscarriages. Teri was an only child. Born in the Bronx, raised after the age of 5 in Westchester, she suffered from severe asthma as a child and was periodically hospitalized. Her father, Edward, sold electrical supplies. Her mother helped him in the business. They were loving and demanding parents.

From Quiet Healing: “Whenever I accomplished anything, whether it was a good grade or a part in the school play, they would first praise me and then compare me to a cousin or to the child of a friend who had done even better. . . . If I was praised by someone else, I waited for the ax of comparison to fall.”   She went to the University of Florida, graduating with a bachelor’s in communications. It was the ’60s, and she drifted: a flight attendant for National Airlines; a reporter for an alternative newspaper; a student at a cosmetology school, flirting with the idea of being a hairdresser; a student of interior design.   Her cousin, Sandi Guttman, says that for a while Teri worked for an office-furniture store in Manhattan, and even tried telemarketing. For a lark, she had a butterfly tattooed on her behind. She married — and quickly divorced — twice.

“I think one lasted 3 1/2 hours,” jokes her mom. “Teri was the kind that jumped in with both feet. If she made a mistake, she made a mistake, but she was always there. I guess she grew up late.”   Herm Amar, who later became her third husband: “She was a hippie. I know she spent a lot of time living in Coconut Grove in those days, and did a lot of moving around. I used to kid her   because every time we drove through the Grove, she’d say, ‘I’ve lived there.’ And a few blocks later, ‘I lived there.’ She was very much into that scene.”

Eventually, Teri found a focus for her life in a job counseling troubled juveniles in the Boston area. “She absolutely loved that job,” says Sandi. Teri earned a master’s degree in psychology from Cambridge College, then moved back to Florida, becoming a psychotherapist at a South Dade psychiatric facility.   “When she turned her life around,” says Sandi, “she turned it around completely. This one time, we were shopping in a store, and she went up to the cash register. Teri pulled $5 from her purse and gave it the cashier, saying, ‘Many years ago, I wasn’t myself, and I stole something from this store. And this is to pay you back.’ ” In 1983, she met Herm Amar, a periodontist. His wife had died of cancer, and he himself had gone through two bouts of Hodgkin’s disease, which is cancer of the lymph nodes. Chemotherapy had eradicated his disease, but left him with an indelible sense that life was not something to be postponed. And so it was with his romance with Teri. “Our first date was July 4 weekend, and several weeks later she moved in with me.” They were married the following year.

Teri became stepmother to Herm’s two teenage children, Eric and Karen, and began a private practice with an emphasis on therapeutic hypnosis, which she’d learned in a course in California. At first, her fledgling practice did not occupy huge chunks of time, and she often palled around with Diane Schiller, an advertising executive.   “She was easygoing, playful, giving,” Diane recalls. “She had a crazy sense of humor.” But Teri’s fun-loving side was never the whole story. “She was a very powerful woman — when Teri was around, you always felt secure,” Diane says. “My husband had a (hypnosis) session with her, and in one week he lost 10 pounds. She taught me to meditate. She was a very tough taskmaster — and very stubborn.”

A New Focus

Teri would not focus for long on mundane problems like weight-loss and smoking cessation. Herm unintentionally led Teri to her life’s work by suggesting that a cancer patient he knew go to his wife for counseling. That first patient led to several others. Moved by the patients’ desperate need for guidance, Teri began studying the literature. She was particularly impressed by Lawrence LeShan, a New York therapist who had found that patients who lived zestfully, who had dreams they wanted to fulfill, tended to live longer than those who simply lay in bed and waited to die. What LeShan was preaching was really a prescription for living for everyone, not just cancer patients, but those facing the possibility of imminent death seemed most willing to act on it.

From the beginning, Herm says, Teri found working with cancer patients intensely rewarding: “Their agenda was to learn what they needed to learn to live. People were very receptive to everything she was giving them. So rather than being depressing, it was invigorating work.”   Teri met LeShan at a conference and asked him to serve as her mentor, supervising her cases by long distance. He agreed. Following his teaching, Teri began urging patients to get the most out of every moment, because they never knew how much time they had. Like LeShan, she taught meditation as a way of relieving stress, which she and like-minded therapists were convinced helped foster disease. But Amar took mind-over-matter even further: She instructed her patients in imaging techniques, telling them to visualize the cancerous cells in their bodies being destroyed — some patients imagined missiles blowing apart malignant cells, others thought of Pac Man-like creatures gobbling them up. She believed such mental exercises might help prompt the body to strengthen its natural healing abilities.

Though some medical doctors remain skeptical of these techniques, there is an increasing body of evidence that such activities of the mind may affect the body’s immune system.   But Teri and others believed that even if none of these techniques eradicated disease, at least they helped her patients feel they were doing something productive, and helped them enjoy the time they had left.   As she told Tropic last year: “Our goal is to ‘Live Juicy.’ It means rolling down a grassy hill . . . doing those things that bring out your best, most magic self. And when people do that, their immune system seems to perk up and say, ‘Hey! This person might be a passionate person worth saving.’ . . . I never make outlandish claims. I don’t think that we as human beings are powerful enough to give ourselves an illness, and I don’t know that we’re powerful enough with our mind to cure it. I believe in modern medicine. I believe this work is complementary.”

Joyce Perry, herself a psychotherapist, started seeing Teri after Joyce was diagnosed with breast cancer: “She was very helpful in getting me focused. She had such a gift working with cancer patients. I’ve heard over and over again people say, ‘Teri had more of an impact on my life than anyone I’ve ever met.’ It was the hope she would instill, the love, the compassion.”   The concepts she was teaching were centuries-old — ideas and maxims that people could find in the self-help section of any bookstore. But most of us don’t seek higher meaning, or strive to follow paths to inner calmness, until we are given a huge “wake-up call,” which is what Teri called cancer.

Her patients say that her special ability was not in the words she used to convey the message, but her style, the aura she radiated that persuaded people she truly cared about them.   Stacey Goldstein says that when she first met Teri in an oncology ward, she felt herself walking into a “depressing place” and then being greeted by the “warmest, biggest smile.”   Lisa Boccard: “She was just so warm and loving, and she held my hand. I felt that I was going home.”

Her husband, Herm: “She exuded charisma. She had that ability to bond right away with people. For example, people show you family pictures and you pretend to find some interest in them. She was genuinely intersted in them, to the point where the next time she met you, she’d ask quesitons about the people. That was innate, and it was genuine.”   Reva Spawn, a massage therapist at the retreats: “When she was present with you, she was totally present. And that’s what most people need.”   Unlike most therapists, Teri didn’t hesitate to give direct advice. Lisa Boccard recalls, “She didn’t sit there and hold your hand and say, ‘It’s OK, Lisa.’ ” In fact, once Teri ordered Lisa to get out of a damaging relationship with a boyfriend. “If you don’t stop seeing him,” Teri warned, “you’re not going to live.”

Lisa, almost two decades younger than Teri, sometimes felt as if she was the psychotherapist’s daughter, and the two women became close friends. “When I went to her office, we did our work, but when we left the office, we’d go have dinner, and we were Teri and Lisa, not patient and therapist. And what we discussed in the office was never, ever brought up outside that room.”   Lisa was one of a group of patients invited to a New Year’s Eve Party at the Amars’ house. All of Teri’s patients had her home phone number.

Most psychotherapists would not cross the line from professional to personal like this with their patients, but Teri was in many ways untraditional. Although she earned a Ph.D. from an Idaho home-study institution called Kennedy-Western, putting in hundreds of hours of study and writing a thesis that would later become her book, Quiet Healing, Teri usually preferred to follow her instincts rather than any formal instructions.   “She had a very unorthodox approach,” acknowledges Herm, who earned a master’s degree in mental health counseling at St. Thomas University with the idea of helping Teri in her practice. “One of the things they teach you in every single class is: Don’t tell the patient what you think is right for them. Because at some point they’ll resent it and do whatever the hell they want to do anyhow. But I think she felt her patients needed to get themselves moving quickly. In some cases, she clobbered them over the head till they got the point. That was her approach, and it worked.”

Paul Blaney, a clinical psychologist and associate dean at the University of Miami, says that most therapists don’t step beyond the traditional lines “not because it’s automatically bad, but because it’s risky. But there are certainly contexts,” he adds, in which unusual measures are called for. “Especially when you’re talking about somebody who works with patients in crisis, it’s very hard to be critical of them.”   In 1993, Teri began offering exclusive retreats in the Keys, where a dozen or so cancer and AIDS patients could get six days of intensive therapy at oceanside settings, doing group sessions, getting one-on-one counseling, working with massage therapists and dietitians, taking quiet strolls on the beach or nighttime sails in a catamaran.

Teri amassed a first-rate staff from all over the country, including Debby Franke Ogg, a New York psychotherapist whose astounding recovery from cancer through meditation and other alternative treatments was featured in a 1988 television movie, A Question of Faith, starring Anne Archer.    Almost invariably patients who went to the retreat said they loved it. Danny Salzverg, who runs a string of downtown Miami sporting-goods stores: “That week in the Keys was my turning point. I went down there a wreck, and I came out realizing I was much more alive than dead. Teri told me, ‘Stop your mind from awfulizing. Start using the mind to your advantage.’ ” Still, at $3,000 a patient, few could afford the retreats, particularly since very few insurance programs pay for such intense psychological counseling in cancer cases. “She could have done it a lot cheaper in a Beach hotel, but she wanted everything exactly right,” says Herm.

In fact, he adds, the Keys retreat was always a money loser. “She had a big heart, and was always inviting people who couldn’t afford to pay the full fare.” Lisa Boccard, UM drama instructor Katherine Lenel and former Florida Atlantic University administrator Stan Andrews all say that they were invited to retreats even though they could pay very little of the fee.

Last year, Teri started seeing her most famous patient: Alec Courtelis, a South Florida developer and Republican activist who had raised $8 million for George Bush’s campaigns. At age 67, Courtelis was told that he had pancreatic cancer and would probably be dead within 90 days. Courtelis went through a punishing new type of chemotherapy and began seeing Teri, who taught him to visualize his cancer cells disappearing and encouraged him to pursue his dreams. Courtelis did: He bought a waterfront dream house on Key Biscayne, where he relaxed and meditated on the magnificent view.   After four months of medical treatment and psychotherapy, a CAT scan showed no cancer in his pancreas. He was not pronounced cured, but he had made a remarkable comeback. Says Alec: “There’s no question that Teri had a major role to play in my recovery.”

No Piece of Cake

On Nov. 20, 1994, Sandra Jacobs, The Herald’s health writer, wrote a story about how Alec had “beaten amazing odds.” She quoted Alec’s son, Pan, about the positive role Teri had played: “After one visit with Amar, Dad had that old Cheshire- cat smile.”   Herm: “Before Alec, she was already busy as hell. But when that article broke, we started getting 50, 60 calls a day. It was bananas. She had no room to fit these people in. So she recruited some of her disciples to come in and help out.”

Listening to the troubles of desperately ill patients at all hours began consuming her life. Friends worried about her.   Diane Schiller: “Can you imagine dealing day in and day out with people who are dying? And you’re their only hope? She had a lot of love in her heart, but she had no time for herself. I spoke to her five minutes here and there. She’d say, ‘Hello, I love you, I can’t talk to you now. I’m going to the hospital to see a patient.’ I’d ask her, ‘What do you draw from inside of yourself?’ I really was worried there was nothing else to draw.”

In July, one of her patients, Rodrigo Martin, a 28-year-old airport employee, died of cancer. He was a particularly upbeat, outgoing person, and friends say Teri took his death hard.   Psychotherapist Debby Ogg, who has also devoted her life to counseling patients, says that such mourning goes with the territory: “I cry for a patient every time one dies.”   But Debby says she was worried that her colleague was stretching herself too thin. “I urged her to take time off. I believe Teri knew she was working way too hard, but I think she was in the middle of something she couldn’t stop.

[The autopsy was later to reveal that] Quietly, Teri was taking prescription psychotropic drugs: Xanax, a tranquilizer, and Prozac and Trazodone, anti- depressants that are also being used to treat a variety of problems, including panic attacks, anxiety disorders, pain, insomnia and chronic fatigue syndrome.   Teri’s friend Diane was surprised when a Tropic writer told her about her drug usage. “She always preached ‘meditate, not medicate,’ ” says Diane.

Was the psychotherapist still feeling some of the turmoil from her earlier years, remnants of the “black hole” she had felt as a youth? Or was the daunting task of listening each day to the desperate fears of seriously ill patients finally taking its toll?   The best person to answer those questions, of course, is no longer able to. Her husband says Teri was stressed, but not depressed. The use of Prozac and the other drugs was not inconsistent with her beliefs, he says. Her methods were meant to aid medicine, not replace it.   “Yes, she was overstressed. And it’s well documented that stress affects the immune system, but if anyone could deal with the stress, she could,” says Herm. “She was a hearty and strong person. She meditated daily. She worked out like crazy. She was in great shape to handle stress.”

Still, Herm acknowledges, the demands of pursuing her dream were consuming her: “She was enormously committed to her work. I would say obsessed. I always thought the institute was the child Teri never had. She wanted everything right. She had a tendency not to delegate work, out of fear it wouldn’t come up to her standards.”  For whatever reason, last summer Teri began suffering from flu-like symptoms and headaches. Her sinuses seemed constantly clogged, but there was so much to do, she didn’t have time to be sick.

On Aug. 10, Teri spent her 50th birthday with patients and staff during a scheduled retreat in the Keys. To help Teri celebrate, her patient-friend Lisa Boccard stopped by with flowers. They chatted a bit, then Teri said she didn’t feel very well and needed to lie down.   Back in Miami, Diane Schiller took her out for a belated birthday dinner at a deli. Diane had arranged for a cake to come at the end of the meal, but Teri said she had to get to a book signing and did not have time to stay. Diane insisted, and Teri remained just long enough to blow out the candles, then raced out the door.

The Short Goodbye

After two months of antibiotics, Teri was still suffering severe sinus headaches. Her doctor recommended a relatively simple surgery, called a “septoplasty,” to clean the clogged sinuses. At 7 p.m., Tuesday, Aug. 22, she was wheeled into an operating room at Baptist Hospital. At 8:30, the surgeon, Frank Kronberg, came out and told Herm that everything had gone well. When Teri gained consciousness in the room, she complained of pain, and a nurse gave her a shot. Five-inch strips of gauze were to remain in her nostrils for two days.

The following morning, Cathy Blum, the program director at the Institute for Mind-Body Health, drove her home: “She was great, cheerful. I was amazed. I had surgery on my nose once, and I remember the pain. She insisted on giving me a full tour of the house — it was the first time I’d been there — showing me the dogs and everything, and finally I said, ‘Teri, you have to go to bed.’ ”   Teri may have been putting up a brave front. When Herm called her that afternoon, she said she was “in a lot of pain.” When he arrived home that evening, she was still hurting. Throughout the evening she dozed, occasionally taking a painkiller that the doctor had prescribed.

On Thursday, Aug. 24, the pain persisted. When Herm left for work about 8:30, she said she was going back to bed. A couple of hours later, he called the house; she was still feeling awful.  Herm: “I called her about 12:30. I woke her up. I said, ‘How you doing?’ ‘I’m still in a lot of pain.’ She didn’t have much to say, and I hung up.” Teri had a 2:30 p.m. appointment to have the packing removed from her nose. “I called her about 3:30, assuming she’d be home. The machine picked up. I figured she just got delayed over at the doctor’s office.”  About 5:15, when Herm was at St. Thomas registering for fall semester classes, he was beeped by the office of Dr. Kronberg.

“They said, ‘Where’s Teri?’ I said, ‘What do you mean?’ ‘She never came for her appointment.’   “At that point, I got frightened. My son lives 10 minutes away from our house. I called him and asked him to drop by and check.” Herm started racing home.   Eric Amar: “She was slouched over on the bed. Her feet were hanging over the side.” He called 911 from the bedroom, then dialed his dad’s cell phone.   Herm: “I asked, ‘Are the medics there?’ And he said, ‘Yes, everybody’s here.’ I said, ‘By everybody, do you mean the police?’ And he said yes, and at that point, I knew she was dead.”

He arrived to be greeted by two uniformed cops. They expressed sympathy, but said they had to treat the area as a crime scene. Herm insisted on seeing her. He was told: “The best we can do is take you to the door. You can look in.”    Herm: “I saw her lying across the bed at a diagonal, like she had dozed off. . . . I couldn’t really see her face. . . . We waited almost an hour for the homicide detectives. They came. They interrogated me. They interrogated my kids. They went back over to the bedroom area. I could see the flashbulbs going off. This took two hours.”   Detectives found her dressed in blue jeans and a T-shirt. Apparently, at some point during the day, she had felt well enough to get dressed for her doctor’s appointment. Her head was resting on a 1991 edition of the Physicians’ Desk Reference, open to the section on amoxicillin, a penicillin she was taking to fight infection. It appeared that she was starting to feel bad and searching for possible drug side effects.   Before Teri’s body was sent off to the medical examiner for autopsy, the officers gave Herm a few minutes alone to say goodbye to his wife.

Quiet Healing

The service at the Van Orsdel Funeral Chapel in West Kendall was packed. All the chairs were filled, as was the standing room on the sides and in back. Danny Salzverg arrived four minutes late and found himself in the corridor, unable to see or hear.  Inside, friends and patients were reading eulogies. One woman talked about how Teri had saved her from suicide. Others talked about how she had brought them back from cancer.   Joyce Perry, the therapist: “When I was diagnosed with breast cancer, I was plunged into the depths of a huge black hole. Teri lovingly and tenaciously led me out of the darkness.”   At Lakeside Memorial Park, it was drizzling. The rabbi held a brief ceremony, with the family seated under an awning. As people were leaving, the staff from the Keys retreat lit sage, set up a boombox and began playing two songs: I Release the Past and Precious Child of God.

These were the songs Teri had played on the last night of the retreats in her re-creation of an old American Indian ritual. A campfire was lit on the beach, and one by one the patients were asked to symbolically throw into the flames all the garbage and fears of their lives — to get rid of them once and forever.   As the music played, the drizzle turned to a downpour. Herm began crying. Teri was gone forever.

But a question remained. Why did Teri die? Patients and friends speculated that the post-operative packing in her nose had caused breathing problems. Or could it be that she had accidentally taken too many pain pills? For three weeks, the autopsy report remained uncompleted. But whatever the official findings would be, Teri’s patients and friends had to make their own adjustments. In her own writings, Teri had often referred to Viktor Frankl, the Austrian psychiatrist who, in surviving the Nazi concentration camps, had written about the caprices of fate, the miseries of human existence, the inevitability of death: “How is it possible to say yes to life in spite of all that?”

Viktor Frankl’s answer — and Teri Amar’s, too — was that we have no choice but to be hopeful. Millions died in the Nazi gas chambers, regardless of their attitudes. But among the people who were not immediately executed, those who had a dream of life beyond the barbed wire of the camps had a better chance of making it than those who did not.

In looking for ways to cope with her death, some patients turned to Teri’s book, Quiet Healing, in which she quoted Frankl: “The last human freedom (is) to choose one’s attitude in any given set of circumstances.” She saw Frankl’s concentration camp survivors as people who “were able to use their suffering as a vehicle to change and to grow.”   And so Teri’s colleagues hoped that her patients would similarly adjust. The other therapists at the Institute for Mind-Body Health vowed to keep her work going. They counseled her patients, and Joyce Perry took over Teri’s weekly group sessions. The patients were struggling to understand: “People want answers, and I don’t think there are any,” Joyce says. “They’re expressing a lot of fear. People are afraid to go on without her. ‘How can I survive?’ they’re asking.”

Alan Edelman, a radiologist with pancreatic cancer who had attended Teri’s last retreat in the Keys, came back from a vacation to find 20 messages on his answering machine about Teri’s death — and a message from Teri. “It was the spookiest thing. She sounded terrible, but she wanted to know how we were, and what we thought of the course. . . .

“I’m having a hard time with her death. Here I am fighting and doing all these things, and hopefully my body is responding, and she had something very benign and she died. It’s very strange. It’s a random occurrence. All you can do is fight it and try to heal yourself.”    For some, Teri’s death confirms the message she preached during her life. “It does emphasize the uncertainty and the preciousness of life,” says Ellen Anderson, an Alabama oncologist who is fighting cancer herself. “You better not waste today. It’s all you have.”    Danny Salzverg: “Anything can happen to anyone at anytime. You just have to keep going. Prior to my illness I was really concerned with the fear of death. Now I have more a fear of not living than dying . . . of wasting time. She taught about living in the moment. . . . I can’t do meditation every day, but I drive up U.S. 1 and now I see the sky is beautiful, and I can sit in traffic and just look at the sky. It used to drive me crazy. But I’ve learned to enjoy today, now.”

Danny was speaking by phone from his office in late afternoon, and at the end of the interview he said: “Before, I would have sat here at my desk and worked. Now, I’m going to watch my kids play chess at their chess club.”   Alec Courtelis, who continues his battle with cancer 18 months after doctors guessed he’d be dead: “We have no answer, other than it was God’s will for it to happen. All you can do is go on.”   Herm Amar was so shaken by his wife’s death that for several weeks he postponed meeting a journalist to talk about her. Finally, he agreed to an interview. He had decided, he said, that “with all the things I’ve been through in life — the Hodgkin’s, my first wife, my second wife — I no longer make long-range plans. . . . I have accepted this unpredictability factor of life, which most people are oblivious to.

“When I got my diagnosis of cancer, I was 27 years old. You know, 27-year-olds think they’re indestructible. And so I’ve been through a series of these events, and I’ve learned that you can count on nothing. There’s this joke — tell God your plans if you want to make him laugh. It’s so true.   “Teri used to call cancer the big wake-up call. Maybe you just have to have enough of these wake-up calls, like I’ve had, to know what life is about. It’s nothing you ever planned it to be. So I just keep going. . . . I know what keeps me going now — I have a desire to continue Teri’s work. I really feel a calling. I promised that to her, before they led her away.”

Tough Luck,  The autopsy

Wilson A. Broussard performed the autopsy. He found two five-inch strips of yellow-stained gauze in Teri’s nostrils — the packing that the surgeon was going to remove — but there was nothing in the nose or sinuses to indicate the surgery or packing had caused her death.  Investigators collected 23 prescription medications she had at the house. Her stomach contained large chunks of food, indicating she had felt well enough to eat shortly before her death.

The autopsy found a single oddity: Mild inflammation of the myocardium — the heart muscle. A microscopic examination revealed further damage. It was enough to be fatal. Official cause of death: Acute viral myocarditis.

Joe Davis, the Dade medical examiner, explains: “It’s a very common virus. In most people, nothing happens. In some people, it inflames the heart muscle, but you don’t find out about the damage until years later. In a few, it brings death.”

In those cases, Davis says, the patient may have a few days of flu-like symptoms, but that’s all. Suddenly, the heart goes into a rhythmic disturbance, and the person dies. “This had no relation to the surgery,” Davis says. “It’s just plain luck.”

And so she was struck down by a stealth killer. No amount of positive imaging could do away with an attacking virus that she didn’t even know was gnawing away at her heart.

Just plain luck. Is that possible? Many of us struggle to
deny the randomness of the universe. Teri’s friend Diane Schiller believes that the virus wouldn’t have felled her if she had been in better shape: “I believe, in my heart of hearts, she was worn to a frazzle, and that’s what did her in.”

Robert J. Myerburg, director of the division of cardiology at the University of Miami: “There is some evidence that stress alters the immune system. It is possible — but not medically proven — that a viral infection might be more severe if somebody were under stress. The key question is, would that mean that a virus would be more likely to focus on the heart? You can’t jump to that conclusion.”

Debby Ogg, the therapist and colleague who went through cancer: “We know exhaustion depletes the immune system. Worry and fear and concern — all of those things affect us.

“I think she was struggling to learn what she was trying to teach — which I think is true of all of us. I don’t believe she had learned it yet — but she was extremely passionate and devoted. . . . But to say she died because of stress? It smacks of blaming the patient who dies of cancer, that it was their fault. How do we know what God’s will is?”

Whatever her cause of death, Teri’s biggest legacy is shining through her patients: Urged by her to find a purpose, many chose assisting other cancer patients. Attorney Stacey Goldstein, whom Teri helped through a battle with Hodgkin’s disease, leads a major research fund-raising effort, Making Strides Against Cancer. Lisa Boccard speaks and shows her cancer photos to audiences as far away as New Orleans. Joyce Perry, psychotherapist, came back from breast cancer and decided to devote her life to helping other cancer patients. And developer Alec Courtelis raised $1 million to open the Courtelis Center for Psychosocial Oncology in Miami, to teach patients what Teri Amar taught him.

Clearly, Teri Amar’s life’s work has not stopped. As Debby Ogg puts it: “My goal and Teri’s goal was not to promise people their lives, but rather to make peace with death, so one could live their lives fully in the present. . . . Teri lived every minute of her life doing what she wanted to do. Everybody’s going to die, and one of the biggest parts of our culture is not admitting that. The point isn’t to bargain with the fates. The point is to live every moment fully now.”

JOHN DORSCHNER is a Tropic staff writer. His most recent story was on the Wolfsonian.