Lisa Genova - Still Alice

When Alice thought about it later, the irony was striking. Outwardly, at least, Anna appeared to be the strongest. She did most of the consoling. And yet, it didn't surprise her. Anna was the child who most mirrored their mother. She had Alice's hair, coloring, and temperament. And her mother's presenilin-1.

"I'm going to go ahead with the in vitro. I already talked with my doctor, and they're going to do a preimplantation genetic diagnosis on the embryos. They're going to test a single cell from each of the embryos for the mutation and only implant ones that are mutation-free. So we'll know for sure that my kids won't ever get this."

It was a solid piece of good news. But while everyone else continued to savor it, the taste turned slightly bitter for Alice. Despite her self-reproach, she envied Anna, that she could do what Alice couldn't--keep her children safe from harm. Anna would never have to sit opposite her daughter, her firstborn, and watch her struggle to comprehend the news that she would someday develop Alzheimer's. She wished that these kinds of advances in reproductive medicine had been available to her. But then the embryo that had developed into Anna would've been discarded.

According to Stephanie Aaron, Tom was okay, but he didn't look it. He looked pale, shaken, fragile. Alice had imagined that a negative result for any of them would be a relief, clean and simple. But they were a family, yoked by history and DNA and love. Anna was his older sister. She'd taught him how to snap and blow gum bubbles, and she always gave him her Halloween candy.

"Who's going to tell Lydia?" asked Tom.

"I will," said Anna.

MAY 2004

Alice first thought of peeking inside the week after she was diagnosed, but she didn't. Fortune cookies, horoscopes, tarot cards, and assisted living homes couldn't tempt her interest. Although closer to it every day, she was in no hurry to glimpse her future. Nothing in particular happened that morning to fuel her curiosity or the courage to go have a look inside the Mount Auburn Manor Nursing Center. But today, she did.

The lobby did nothing to intimidate her. An ocean scene watercolor hung on the wall, a faded Oriental carpet lay on the floor, and a woman with heavily made up eyes and short, licorice black hair sat behind a desk angled toward the front door. The lobby could almost be mistaken for that of a hotel, but the slight medicinal smell and the lack of luggage, concierge, and general coming and going weren't right. The people staying here were residents, not guests.

"Can I help you?" the woman asked.

"Um, yes. Do you care for Alzheimer's patients here?"

"Yes, we have a unit specifically dedicated to patients with Alzheimer's. Would you like to have a look at it?"

"Yes."

She followed the woman to the elevators.

"Are you looking for a parent?"

"I am," Alice lied.

They waited. Like most of the people they ferried, the elevators were old and slow to respond.

"That's a lovely necklace," said the woman.

"Thank you."

Alice placed her fingers on the top of her sternum and rubbed the blue paste stones on the wings of her mother's art nouveau butterfly necklace. Her mother used to wear it only on her anniversary and to weddings, and like her, Alice had reserved it exclusively for special occasions. But there weren't any formal affairs on her calendar, and she loved that necklace, so she'd tried it on one day last month while wearing a pair of jeans and a T-shirt. It had looked perfect.

Plus, she liked being reminded of butterflies. She remembered being six or seven and crying over the fates of the butterflies in her yard after learning that they lived for only a few days. Her mother had comforted her and told her not to be sad for the butterflies, that just because their lives were short didn't mean they were tragic. Watching them flying in the warm sun among the daisies in their garden, her mother had said to her, See, they have a beautiful life. Alice liked remembering that.

They exited onto the third floor and walked down a long, carpeted hallway through a set of unmarked double doors and stopped. The woman gestured back to the doors as they shut automatically behind them.

"The Alzheimer's Special Care Unit is locked, meaning you can't go beyond these doors without knowing the code."

Alice looked at the keypad on the wall next to the door. The numbers were arranged individually upside down and ordered backward from right to left.

"Why are the numbers like that?"

"Oh, that's to prevent the residents from learning and memorizing the code."

It seemed like an unnecessary precaution. If they could remember the code, they wouldn't need to be here, would they?

"I don't know if you've experienced this yet with your parent, but wandering and nighttime restlessness are very common behaviors with Alzheimer's. Our unit allows the residents to wander about at any time, but safely and without the risk of getting lost. We don't tranquilize them at night or restrict them to their rooms. We try to help them maintain as much freedom and independence as possible. It's something we know is important to them and to their families."

A small, white-haired woman in a pink and green floral housecoat confronted Alice.

"You're not my daughter."

"No, sorry, I'm not."

"Give me back my money!"

"She didn't take your money, Evelyn. Your money's in your room. Check your top dresser drawer, I think you put it there."

The woman eyed Alice with suspicion and disgust, but then followed the advice of authority and shuffled in her dirty white terry-cloth slippers back into her room.

"She has a twenty-dollar bill she keeps hiding because she's worried someone will steal it. Then, of course, she forgets where she put it and accuses everyone of taking it. We've tried to get her to spend it or put it in the bank, but she won't. At some point, she'll forget she owns it, and that'll be the end of it."

Safe from Evelyn's paranoid investigation, they proceeded unimpeded to a common room at the end of the hallway. The room was populated with elderly people eating lunch at round tables. Upon taking a closer look, Alice realized that the room was filled with elderly women.

"There are only three men?"

"Actually, only two out of the thirty-two residents are men. Harold comes every day to eat meals with his wife."

Perhaps reverting to the cootie rules of childhood, the two men with Alzheimer's disease sat together at their own table, apart from the women. Walkers crowded the spaces between the tables. Many of the women sat in wheelchairs. Most everyone had thinning white hair and sunken eyes magnified behind thick glasses, and they all ate in slow motion. There was no socializing, no conversation, not even between Harold and his wife. The only sounds other than the noises of eating came from a woman who sang while she ate, her internal needle skipping on the title line of "By the Light of the Silvery Moon" over and over. No one protested or applauded.

By the light of the silvery moon.

"As you might've guessed, this is our dining and activities room. Residents have breakfast, lunch, and dinner here at the same times every day. Predictable routines are important. Activities are here as well. There's bowling and beanbag toss, trivia, dancing and music, and crafts. They made these adorable birdhouses this morning. And we have someone read the newspaper to them every day to keep them up on current events."

By the light

"There's plenty of opportunity for our residents to keep their bodies and minds as engaged and enriched as possible."

of the silvery moon.

"And family members and friends are always welcome to come and participate in any of the activities and can join their loved one for any of the meals."