Ugh... The Letter. Writing a concerned letter to a loved one is akin to saying "I can't talk to you, so this is the only way to tell you how I feel." I'm not saying that it isn't appropriate, just that it sends a very specific message. Of course the message attached to failing to read the letter is that he doesn't want to hear her concerns, regardless of the medium.
Suffice it to say, if my wife wrote me a letter to address some issue she had with me, enormous red warning lights would be flashing. If I was in such a state that I refused to read it, I would be pretty sure that things were degraded to a point where repairs were unlikely.
Maybe she needs to sit him down, tell him to be silent and listen without interruption, open the letter, and read it aloud to him. It lets her share her carefully worded thoughts, and gives him a chance to respond.
Of course I'm slightly drunk at the moment (hence the slurring), so keep that in mind as you consider heeding my advice.
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