I knew that this book was about a woman who slowly descends into Alzheimer's disease, but I wasn't expecting it to be so profound about the meaning of life. Alice Howland discovers she has early on-set Alzheimer's disease shortly after her 50th birthday, when she is in the prime of her career. Her children have recently moved on into adulthood and she and her husband John are empty-nesters, with prestigious careers at Harvard University. The diagnosis shakes her to her core, and John is firmly in denial throughout most of the book.

While I really enjoyed a lot of the story that centered around an understanding of what it may feel like to have Alzheimer's (because we really won't ever know), I think part of the story that really captivated me was the reaction from her family. Her relationships at the beginning of the book are so different from the end. Her two eldest children, Anna and Tom, are closer to Alice than Lydia, the "wayward" youngest, who has defied her mother's expectations for her and moved to Los Angeles in order to begin a career as an actress. Alice has spent most of her life deep into higher education, and she places high importance on it. It seemed to be a personal slight to her that Lydia dismisses it out of hand. But, as Alice loses more and more of her memory and "self", Lydia is the one that seems to deeply understand her, or at least is interested in meeting her where she is.

Alice's relationship with John is probably the saddest part of the entire novel. At first, he rejects the diagnosis outright. He wants to meet with the doctor himself, and argues over and over. When Alice has a DNA test done and it reveals that she has a genetic mutation found in many Alzheimer's patients, John is on a new mission to find some kind of cure or treatment. He begins researching it with as much fervor as he does with his Harvard laboratory experiments. But as Alice descends farther and farther into her disease, John retreats from her more and more. He clearly feels like her handicap is slowing him down. He can't stand to be around her. He won't watch her take her medications. And near the end, when she can't remember the names of her family, or even that she is related to these people, he moves to New York City for a new job and leaves Alice behind.

One of the plot threads that runs throughout is Alice's plan to take her own life once her symptoms become out of hand. She sets an alarm on her Blackberry to ask her every morning to answer 5 basic questions: What month is it, Where is my office, Where do I live, How many children do I have, and When is Anna's birthday. The document instructs her to find a bottle of sleeping pills and take them all when she can no longer answer the questions. The Blackberry unfortunately meets an untimely demise in the freezer, but while poking around on her computer some time later, she happens upon the document, entitled Butterfly (an allusion to her mother's prized necklace that she has taken to wearing). She tries to carry out the instructions in the document, but her forgetfulness (and possibly John's removal of the pills) prevents her from completing the task.

This book is important, I think, for families that have a member who is suffering from Alzheimer's, or even someone in the early stages of diagnosis. There is an empathy that comes from reading about this experience, even if it can never be verified that this is actually how it feels.

I checked off the box for something that scares me, because the idea of one day having Alzheimer's, or caring for someone that does, is really frightening. It does run in my family, although I don't think I'll be having my DNA tested. (Like Lydia, I'd rather not know.) But somehow, this book has tempered the fear. It would still be not the most awesome outcome, but maybe it wouldn't be that terrible.