Lisa Genova - Still Alice

"Is everyone in your party here now?" she asked, smiling pleasantly, but a little too long to be sincere.

"No. We're still waiting for one," said Anna.

"I'm here!" said Tom, entering behind them. "Happy birthday, Mom."

Alice hugged and kissed him and then realized that he'd come in alone.

"Do we need to wait for...?"

"Jill? No, Mom, we broke up last month."

"You go through so many girlfriends, we're having a hard time keeping track of their names," said Anna. "Is there a new one we should be saving a seat for?"

"Not yet," said Tom to Anna, and "We're all here," to the woman in black.

The period of time that Tom was between girlfriends came with a regular frequency of about six to nine months but never lasted long. He was smart, intense, the spitting image of his father, in his third year at Harvard Medical School, and planning on a career as a cardiothoracic surgeon. He looked like he could use a good meal. He admitted, with irony, that every medical student and surgeon he knew ate like shit and on the fly--donuts, bags of chips, vending machine and hospital cafeteria food. None of them had the time to exercise, unless they counted taking the stairs instead of the elevator. He joked that at least they'd be qualified to treat each other for heart disease in a few years.

Once they were all settled in a semicircular booth with drinks and appetizers, the topic of conversation turned to the missing family member.

"When was the last time Lydia came to one of the birthday dinners?" asked Anna.

"She was here for my twenty-first," said Tom.

"That was almost five years ago! Was that the last one?" Anna asked.

"No, it couldn't be," said John, without offering anything more specific.

"I'm pretty sure it was," Tom insisted.

"It wasn't. She was here for your father's fiftieth on the Cape, three years ago," said Alice.

"How's she doing, Mom?" asked Anna.

Anna took transparent pleasure in the fact that Lydia didn't go to college; Lydia's abbreviated education somehow secured Anna's position as the smartest, most successful Howland daughter. The oldest, Anna had been the first to demonstrate her intelligence to her delighted parents, the first to hold the status of being their brilliant daughter. Although Tom was also very bright, Anna had never paid much attention to him, maybe because he was a boy. Then, Lydia came along. Both girls were smart, but Anna suffered to get straight A's, whereas Lydia's unblemished report cards came with little noticeable effort. Anna paid attention to that. They were both competitive and fiercely independent, but Anna wasn't a risk taker. She tended to pursue goals that were safe and conventional, and that were sure to be accompanied by tangible accolades.

"She's good," said Alice.

"I can't believe she's still out there. Has she been in anything yet?" Anna asked.

"She was fantastic in that play last year," said John.

"She's taking classes," said Alice.

Only as the words left her mouth did she remember that John had been bankrolling Lydia's nondegree curriculum behind her back. How could she have forgotten to talk to him about that? She shot him an outraged look. It landed squarely on his face, and he felt the impact. He shook his head subtly and rubbed her back. Now wasn't the time or place. She'd get into it with him later. If she could remember.

"Well, at least she's doing something," said Anna, seemingly satisfied that everyone was aware of the current Howland daughter standing.

"So Dad, how'd that tagging experiment go?" asked Tom.

John leaned in and launched into the specifics of his latest study. Alice watched her husband and son, both biologists, absorbed in analytical conversation, each trying to impress the other with what he knew. The branches of laugh lines growing out from the corners of John's eyes, visible even when he was in the most serious of moods, became deep and lively when he talked about his research, and his hands joined in like puppets on a stage.

She loved to watch him like this. He didn't talk to her about his research with such detail and enthusiasm. He used to. She still always knew enough about what he was working on to give a decent cocktail party summary, but nothing beyond the barest skeleton. She recognized these meaty conversations he used to have with her when they spent time with Tom or John's colleagues. He used to tell her everything, and she used to listen in rapt attention. She wondered when that had changed and who'd lost interest first, he in the telling or she in the listening.

The calamari, the Maine crab-crusted oysters, the arugula salad, and the pumpkin ravioli were all impeccable. After dinner, everyone sang "Happy Birthday" loudly and off-key, attracting generous and amused applause from patrons at other tables. Alice blew out the single candle in her slice of warm chocolate cake. As everyone held their flutes of Veuve Clicquot, John raised his a bit higher.

"Happy birthday to my beautiful and brilliant wife. To your next fifty years!"

They all clinked glasses and drank.

In the ladies' room, Alice studied her image in the mirror. The reflected older woman's face didn't quite match the picture that she had of herself in her mind's eye. Her golden brown eyes appeared tired even though she was fully rested, and the texture of her skin appeared duller, looser. She was clearly older than forty, but she wouldn't say she looked old. She didn't feel old, although she knew that she was aging. Her recent entry into an older demographic announced itself regularly with the unwelcome intrusion of menopausal forgetting. Otherwise, she felt young, strong, and healthy.

She thought about her mother. They looked alike. Her memory of her mother's face, serious and intent, freckles sprinkled on her nose and cheekbones, didn't contain a single sag or wrinkle. She hadn't lived long enough to earn them. Alice's mother had died when she was forty-one. Alice's sister, Anne, would've been forty-eight now. Alice tried to visualize what Anne might look like, sitting in the booth with them tonight, with her own husband and children, but couldn't imagine her.

As she sat to pee, she saw the blood. Her period. Of course, she understood that menstruation at the beginning of menopause was often irregular, that it didn't always disappear all at once. But the possibility that she wasn't actually in menopause snuck in, grabbed on tight, and wouldn't let go.

Her resolve, softened by the champagne and blood, caved in on her completely. She started crying, hard. She was having trouble taking in enough air. She was fifty years old, and she felt like she might be losing her mind.

Someone knocked on the door.

"Mom?" asked Anna. "Are you okay?"

NOVEMBER 2003

Dr. Tamara Moyer's office was located on the third floor of a five-story professional office building a few blocks west of Harvard Square, not far from where Alice had momentarily lost herself. The waiting and examining rooms, still decorated with framed Ansel Adams prints and pharmaceutical advertisement posters on the high-school-locker-gray walls, held no negative associations for her. In the twenty-two years that Dr. Moyer had been Alice's physician, she'd only ever been to see her for preventative checkups--physical exams, immunization boosters, and more recently, mammograms.

"What brings you here today, Alice?" asked Dr. Moyer.

"I'm having a lot of memory problems lately that I've been attributing to symptoms of menopause. I stopped getting my period about six months ago, but it came back last month, so maybe I'm not in menopause, and then, well, I thought I should come in and see you."

"What are the specific kinds of things that you're forgetting?" Dr. Moyer asked while writing and without looking up.