A growing raft of scientific research is finding that being 'broken-hearted' is more than a turn of phrase. Photo / Getty Images
The place where five-year-old Beth Bowen lies buried is on the edge of a churchyard, just under a chestnut tree.
On the other side of the iron railings a few feet away, you can often hear the voices of children in the school playground where Beth herself once played as a pupil there.
But there's another reason Beth is never alone. Next to her is the grave of her father, Richard, a man of 31 who died, quite literally, of a broken heart 18 months after losing his little girl in what should have been a routine operation, the Daily Mail reports.
Beth's mother, and Richard's widow, Clare, says there's simply no other plausible explanation as to why he died so young.
"Richard had been healthy. There was no reason for his death other than the grief and stress he suffered from losing our child. When he died, it felt like we were putting them back together. He needed to be with her."
Until recently the idea of dying of a broken heart was considered a romantic notion - a desperate bid to find solace in the belief human love lasts beyond the grave. After all, it flies in the face of centuries of medical thinking that ruled the mind is separate from the body.
Now a growing raft of scientific research is finding that being 'broken-hearted' is more than a turn of phrase, and that the bereaved can be seriously physically damaged by the effects of grief.
The notion was thrown into sharp focus last December when news broke of the death of Hollywood star Debbie Reynolds from a stroke the day after her actress and writer daughter Carrie Fisher died from a heart attack.
Clare, a 41-year-old accountant from Cricklade, Wiltshire, says she felt an "instant stab of recognition."
"When I heard, I felt incredibly sad. I instantly understood Debbie couldn't live with the grief of losing her child. Some people can't." Indeed, scientists are finding that the shock of losing a loved one - whether a child, spouse or parent - can trigger a set of physical changes which can leave the people left behind at risk if they don't monitor their health.
For Clare, there is no doubt sorrow killed Richard, a design engineer, who had never smoked or shown signs of heart problems.
She believes his death was the direct result of a chain of events which started when doctors advised that Beth, who had a hereditary condition that caused severe anaemia, should have her spleen removed in July 2006.
The surgery was a standard treatment for Beth's illness. Her mother, younger brother and grandfather all underwent the same procedure, without complications. So as her parents kissed her as she was put to sleep for surgery, there was no reason to think she would not wake up in a few hours' time.
The operation should have lasted three hours. "After five, the surgical team came into the waiting room in blood-stained gowns," says Clare. "They told us: 'Something horrible's happened.'"
It transpired that Beth's aorta had been cut. She died from blood loss, followed by a heart attack.
In a haunting interview after her death, Richard repeatedly talked about being plagued by feelings that he had "let Beth down".
"Your only role as a parent is to protect your child and I didn't. I couldn't," he said.
To add to his grief, there were serious questions raised over the methods used during the operation.
An inquest the following year heard surgeons had made a controversial decision to use a new cutting drill, called a morcellator, which has been untried in paediatric surgery.
During a harrowing three-day hearing, Richard listened to the blow-by-blow account of his child's death. To understand what happened, he forced himself to look at autopsy pictures - something Clare couldn't bear to do.
Ultimately, it was ruled that no lessons could be learnt from the case. The inquest returned a narrative verdict, recording no more than the facts of the case, and apportioning no blame.
His feelings of powerlessness at not being able to get a resolution were so intense that Clare believes Richard suffered physical changes to his heart that he should not have experienced until he was twice his age.
The couple were unaware that he had been born with a genetic condition affecting his arteries, which made him more susceptible to the normal triggers of heart disease.
This should not have affected him until he was in his 60s, but the stress of Beth's death and ensuing inquest accelerated his condition.
"Effectively, he did 60 years of anger and stress in six months," says Clare. "The inquest was the tipping point. He didn't sleep or eat properly. Every time he closed his eyes, he saw autopsy pictures."
To try and ease the stress, Richard ran up to four times a week. Sometimes he came back complaining of unexpected breathlessness and stitches.
Then, on a jog up a steep hill one frosty morning in February 2008, he collapsed. Clare says: "I got a call from the ambulance crew. They told me they'd tried to save Richard but he'd died of a massive heart attack.
"I saw a consultant who talked me through Richard's autopsy report.
"He said from a risk factor point of view, there was nothing: Richard had low cholesterol, low blood pressure, didn't smoke, didn't drink and was fit. There was nothing other than his sadness over Beth's death."
After Richard's demise, Clare, who now has a new partner, qualified as a chartered accountant to support their two other children, William, now 13, and 11-year-old James.
So why are some people so overcome by grief that it kills them?
Scans by UCLA scientists have found that the part of the brain that deals with physical pain, the anterior cingulate cortex, also processes emotional pain.
But while the brain first registers grief, it's the heart that feels its effects, says Derek Connolly, consultant cardiologist at Birmingham City Hospital.
"The brain is most susceptible to the effects of emotion, but the heart controls the brain. All stress can present with chest pain."
Sian Harding, professor of cardiac pharmacology at the National Heart and Lung Institute, Imperial College, said in cases like Richard's, the huge surge of the stress hormone adrenaline when his daughter first died may have sparked changes in his heart.
This made him vulnerable when he suffered the second major shock of the inquest.
Professor Harding, who is a British Heart Foundation funded researcher, says: "The heart is susceptible to adrenaline, which controls the fight and flight response.
"In evolutionary terms, it comes into play when you're under attack, but also when you have blood loss, because it closes down the vessels and stimulates your heart."
Certainly Ildiko Greenwood, 59, attributes the loss of her youngest son, former British snowboarding champion Jonathan Greenwood, at the age of 33, to the fact that some people are more physically affected by profound grief.
Ildiko's husband of 33 years, Alan, died of a heart attack in November 2010, aged 59.
"Alan, who worked as a commercial driver, had just pulled over in a layby and poured himself a cup of tea, when his heart stopped beating," she says. "The doctors said it was just like turning off a light.'
Although all her four children were distraught, Jonathan seemed to take it particularly hard.
"Alan and Jonathan used to have a special bond, the same sense of humour. We had a boat on the canal and they went there every weekend to work on it. They took every chance they could to be together."
After his father's death, Ildiko says Jonathan 'lost the will to live'.
"When he heard the news, he burst into tears and wouldn't leave the house for two weeks until the funeral. After that, he turned from this happy guy to being this person who didn't want to do anything. He stopped snowboarding. He lost his job and stopped having relationships. He'd say: 'I wish I was with Dad.'"
Every week or so, Ildiko would visit Jonathan's house two miles away in Bacup, Lancashire.
He went to see his GP but turned down the suggestion he try anti-depressants. On that last meeting, her son seemed unusually morbid.
She says: "We sat down to have a cup of tea and he started to cry. He said: 'I keep having this weird dream I'm going to die.'"
"I hugged him and said: 'Don't be so silly, you're not going to die. We all have strange dreams sometimes.'
"Sometimes when we were together I didn't want to talk about his dad dying because it upset me, but he would do so for hours if you let him. So I'd try to change the subject. But I wish I had heard him out more."
A week later, Jonathan's sister found him dead when she popped round to see him.
Ildiko adds: "He was lying on the living room floor with a duvet over him. It was just like he had gone to sleep."
A post mortem into his death in November 2014 proved inconclusive, but the family were told he died from natural causes.
Miles Behan, consultant cardiologist at Spire Edinburgh Hospitals, says depression may have a corrosive effect on the heart: "Their blood pressure may also be elevated. Stress can cause the heart to beat irregularly and the blood to clot more, so also plays a part."
Indeed, more and more research is finding a direct link between grief and heart health.
A 2012 Harvard study published in the journal Circulation found a person's risk of having a heart attack increased 21 times over in the day immediately following the death of a loved one and six times over in the following week.
Yet death from a broken heart is most commonly associated in our minds with elderly couples who die within a short time of each other. That is what happened to Marilyn Baines's parents, who died four days apart in 2009.
Marilyn, 63, an auditor, from Lichfield, in Staffordshire, remembers how her father, Raymond, 80, and mother Beryl, 76, were "very much in love."
When Raymond was being treated in hospital for a chest infection, Beryl took his illness and the separation very hard. 'When I took Mum to see Dad in hospital, she got dressed up to the nines, which was unusual. She said she wanted Dad to see her the way she was when they first met. She sat and held his hand.
Marilyn remembers how Beryl cried on the way home in the car.
"Mum didn't want to leave the hospital at the end. She said she couldn't live without her 'Bab', her name for him." That evening, Beryl died.
"I got a phone call from my daughter, who found her, to say Mum was dead on the settee. She had sat down with her best clothes on. She had a lovely smile on her face, like a contented look."
Doctors confirmed that Beryl died of ischaemia or lack of supply of blood to the heart.
Fearing what the news would do to their father, Marilyn and her sister decided they couldn't tell their father until he was stronger. Yet he already knew.
"When we arrived at the hospital, he said: "I've had an out-of-body experience. Your mum's gone. She's looked after me for 57 years and now she's sitting there waiting for me to join her."
"When we told him it was true, he cried and retreated into himself. He wouldn't get up. He had no willpower. Four days later, he died overnight in hospital.
"He didn't want to be in a world without his wife."
Pat Frankish, a psychologist with a special interest in bereavement, says deaths close together are more likely in co-dependent couples, where the loss of the partner shakes the survivor's sense of identity. "They find they are simply lost without that other person," she says.
That's how it for was for her parents, says Marilyn. "As she left him, Mum said to Dad: 'I loved you at the beginning, I love you now and I'll always love you.' That was the morning she died."
For Clare, the sole consolation of losing her daughter and husband so close together was that in death, they were also reunited.
She now knows how much she needs to look after her own health, so she stays well for the sake of Beth's two younger brothers.
"I struggle to go to Beth and Richard's graves. I can't stand between them because I can't bear to put my back to either of them," says Clare. "So I deal with one at a time because the grief of losing your husband, the father of your children, your future plans and dreams, is different from losing your child.
"Don't underestimate the physical effects of bereavement. The consequences can be devastating."
New York Times: These charismatic cooks are a counter to harder-edge chefs.