56 pages • 1 hour read
Still Alice
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January 2004-April 2004Chapter Summaries & Analyses
Chapter 5 Summary: “January 2004”
On January 19th, Alice meets again with Dr. Davis. We learn that she has tried to move her appointment from the 19th; her students are taking her final exam that day, but more importantly, her mother and sister had died on that date thirty-two years prior, so she views it as an unlucky date. However, the next available appointment isn’t for another four weeks, so she is forced to take it.
As she goes through her own set of tests with Dr. Davis, she considers the similarity between her own current position and that of her students in the exam and the various times she had served as a control subject in similar tests with her graduate students, recognizing that her role has shifted from that of the control to that of “the subject being tested” (68). Upon completing the tests, Dr. Davis chastises her for not bringing someone with her, as previously requested, a reprimand that evaporates any “solid relief and confidence generated from her self-evaluated competence in the neuropsychological exams” (69).
After rattling off a list of all the things Alice doesn’t have, he informs her that, considering what has been ruled out in conjunction with her symptoms, it is likely that she has early-onset Alzheimer’s disease. For a moment, Alice is comforted by his use of “probable” until he explains they only use that term because “the only definitive diagnosis for Alzheimer’s…requires either an autopsy or a biopsy” (70). Because it is early-onset, it is likely that it is genetic, which leads her to think about her children. He then writes her prescriptions for medications, but reminds her that while they may slow her decline, the meds will not stop it or reverse it, and that she will need to inform her family of her condition.
Later, in her office, she reviews an Activities of Daily Living questionnaire given to her that is to be filled out by John because she may become an unreliable source regarding her own activities. The list of the most severe impairments is “humiliating” (73), but Alice finds the worst ones to be in the section on communication, as she will have “No more language” (73). Looking around her office, she realizes that “[e]verything she did and loved, everything she was, required language” (74).
John comes to her office to take her to the cemetery to visit her mother, sister, and father, the latter of whom has only recently died and been buried with them. This irritates Alice, as it “had always been a private visit between her and her mother and sister,” and she feels he “didn’t deserve to be” there with them (75). As they stand over the graves, Alice wonders first what John thinks about while they’re there, then reflects upon her father’s alcoholism. We learn that her father was responsible for the crash that killed her mother and sister, following which he continued drinking just as heavily, so when he became belligerent and nonsensical in his later years, she had assumed it was a result of his alcoholism; now, however, she realizes that he likely had Alzheimer’s, which would mean he also passed it on to her. She begins to cry; John asks her if she is okay, but she is unable to tell him about her diagnosis, thinking that she’d “rather die than tell him” (78).
Alice begins to have suicidal thoughts but realizes that she still wants to live. So, ten days later, she tells John, who stubbornly insists that the diagnosis was incorrect and that there is nothing wrong with her. She finds herself building “a surprisingly solid case against herself” in order to convince John (80). John remains unconvinced until he remembers the incident with Dan’s wife at Eric’s holiday party, at which point he excuses himself to do his own research into the disease.
Chapter 6 Summary: “February 2004”
Alice and John see Stephanie Aaron, the genetic counselor at Mass General Hospital’s Memory Disorders Unit, in order to be screened for several genetic mutations associated with Alzheimer’s based on John’s research. Stephanie is hesitant, informing them that the results are only conclusive if they are positive, which would mean that she does have Alzheimer’s; if they are negative, on the other hand, the results won’t tell them anything, as 50% of people with early-onset Alzheimer’s don’t show a mutation. John counters, however, that that number is only 10% for people Alice’s age. Alice understands that, more than anything, this is a way for John to maintain hope that their “lives aren’t ruined” (84).
As they drive home, John maintains hope that the results of the blood work will be negative; Alice reminds him that a negative result still doesn’t mean she’s fine. John is insistent, telling her she “jumped the gun going to see a neurologist” because the neurologist is not impartial and will read the symptoms in a way that may be inaccurate and biased (86).
Alice is somewhat convinced by John’s insistence, but when they return for the results of the blood work, Stephanie informs them that Alice is positive for the PS1 mutation, eliminating any doubt that she has Alzheimer’s. John continues to question the results, asking about the lab’s false positive rate, to which Stephanie replies that the lab’s accuracy level is 99%. Alice, on the other hand, has accepted the results, and she and Stephanie discuss what this means for her children. On the way home, John is silent, but cries the entire way.
Chapter 7 Summary: “March 2004”
John now avoids Alice whenever she takes her medications and refuses to ask for her assistance finding things. She wonders “about the source of this newfound stubborn independence” (91), and whether it is out of concern for her or embarrassment for himself.
They have resumed walking to Harvard together at her insistence, although she hides from him that she “simply wanted that time back with him, to rekindle their former morning tradition” (92), even if they do not talk on the way. They stop in at a coffee shop, Jerri’s, where Alice orders a coffee, as John does, despite John’s insistent reminder that she doesn’t like coffee. She drinks the coffee to spite him while secretly looking forward to being able to throw it out once she reaches her office.
In her office, she reads an email from Anna; when Lydia calls, she believes Lydia is Anna at first and tells her that she was about to reply, not understanding by Lydia’s confusion that she has the wrong daughter. Lydia is calling to invite Alice to see Lydia in a play in which Lydia was just cast. Alice has never seen Lydia act, and her hesitance to respond is interpreted as unwillingness; Alice is unable to tell Lydia that her hesitance is because she can no longer travel alone, and that “her attendance would be at the mercy of John’s availability” (95).
Later, Alice goes for a run, despite acknowledging that it does not clear her head the way it used to. She wonders how much longer she’ll be able to function in her daily duties before her deterioration will become noticeable. She considers that her position does not include clear metrics; she knows that she wants to leave before “the gossip and the pity” (96), but also realizes that she has no way of knowing when that will be. She wonders who she is if not a Harvard psychology professor (96). As she considers the fact that she may end up living for many years with the disease, she stops running and throws up her lunch.
On her way home, she stops in a church, recognizing that despite knowing where she is, she “[has] never felt more lost in her life” (97). She stays for a while to contemplate, then, “with complete and simple lucidity” (99), realizes that the answer is to talk to John. However, when she returns home, she finds that John is furious because they have missed a dinner with friends and he had no idea where she was. She tells him that she needs to be able to talk about things while she can, to which he replies, “I don’t know if I can” (100).
Chapter 8 Summary: “April 2004”
Alice and John get all their children together for Easter with the intent to tell them about Alice’s diagnosis. As Anna isn’t drinking, Alice is at first concerned that she has already managed to conceive; however, she has not yet. Once everyone is present, they break the news that Alice has early-onset Alzheimer’s, and additionally that she has the autosomal dominant P1 mutation. Anna and Lydia don’t understand at first, so Tom explains that that means they all have a 50% chance of carrying the mutation, as well, and that if they carry it, their children would likewise have a 50% chance of carrying it. They explain both the treatments that she is on and also that John is looking into more experimental treatments, as well. Anna and Tom are shocked, saying that she seems fine, but Lydia claims to have noticed something was wrong as far back as a year prior. Anna and Tom decide to get tested for the mutation, while Lydia decides she’d rather not know.
Later, Alice goes to her office to get some work done; she relishes the fact that William James Hall is oddly quiet, which allows her to work without interruption. It isn’t until she arrives back home that she realizes she had gone out in the middle of the night in only her nightgown.
Anna finds that her artificial insemination procedure didn’t work, so she is not pregnant, about which she and Charlie are relieved. The next day, they are told that Tom has avoided the mutation, but blood work has confirmed that Anna has it. She and Charlie have also decided to go ahead with in vitro fertilization, as they are capable of doing a preimplantation genetic diagnosis on the embryos to ensure that only the mutation-free embryos are implanted, which will in turn ensure that her children are free of the mutation. Alice feels jealous that Anna “could do what Alice couldn’t—keep her children safe from harm” (109).
“January 2004”-“April 2004” Analysis
Superstition and spirituality begin to play a larger role in the novel; this never becomes a novel about spiritualism or turning to religion, but there are subtle ways in which the cold logic of science is questioned in the face of terminal illness. In January, Alice tries to avoid receiving the news on the 19th, as she believes nothing good can happen on that day because it’s the same day her mother and sister were killed. This particular belief is upheld, but later, when Alice finds herself in a church, her epiphany that she needs to simply talk to her husband and all will be okay is undercut when John pushes her away emotionally.
The role and limits of science are further interrogated, as well. The diagnosis itself is a reminder that despite the steady march of progress, humans are still powerless in the face of a disease such as Alzheimer’s. There is an interesting juxtaposition between John’s own research and the way he deals with Alice’s diagnosis, as well: as a cancer cell biologist, John studies a disease that is nearly, but not entirely, without hope (but of course does so impartially), and loves his work, whereas the futility of Alice’s situation appears to leave him at his breaking point, unsure of how well he can cope.
Likewise, science plays an interesting, contradictory role in their conversation with their children. On the one hand, genetics means that Anna is certain to succumb to the disease, as well; they speak in hopeful terms that a cure may be found in the future, but this is nevertheless still just that. On the other hand, science allows Anna to ensure that her children will not carry the genetic mutation that has led to Alice’s disease and will eventually lead to her own; this is bittersweet for Alice, who is simultaneously relieved that her grandchildren won’t suffer and guilt-ridden because her child will.
We see another turn toward emotion in the contrast between Lydia and her siblings. Anna and Tom have always done what they were supposed to do; as a result, at the start of the novel, Alice appears to get along better with them than with Lydia. How humankind deals with the unknown and the unexpected, though, is a major theme in this novel. Anna and Tom are kind, but logical and calculating, and they react to the news in remarkably predictable ways: Tom immediately turns to medical jargon, while Anna bemoans her own poor luck as much as her mother’s. Lydia has always been more about passion and expectations, though; despite the tension between her and Alice and the fact that Alice feels furthest from Lydia, of all her children, Lydia appears to have noticed something was wrong long before anyone else—including John—and Lydia’s reaction is the only one purely focused on Alice and her well-being.
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