Still Alice by Lisa Genova

From Barnes & Noble

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This may be one of the most frightening novels you'll ever read. It's certainly one of the most unforgettable. Genova's debut revolves around Alice Howland - Harvard professor, gifted researcher and lecturer, wife, and mother of three grown children. One day, Alice sets out for a run and soon realizes she has no idea how to find her way home. It's a route she has taken for years, but nothing looks familiar. She is utterly lost. Is her forgetfulness the result of menopausal symptoms? A ministroke? A neurological cancer? After a few doctors' appointments and medical tests, Alice has her diagnosis, and it's a shocker -- she has early-onset Alzheimer's disease.

What follows is the story of Alice's slow but inevitable loss of memory and connection with reality, told from her perspective. She gradually loses the ability to follow a conversational thread, the story line of a book, or to recall information she heard just moments before. To Genova's great credit, readers learn of the progression of Alice's disease through the reactions of others, as Alice does, so they feel what she feels -- a slowly building terror.

In Still Alice, Genova, who has a Ph.D. in neuroscience from Harvard, uniquely reveals the experience of living with Alzheimer's. Hers is an unusual book -- both a moving novel and an important read. (Spring 2009 Selection)

From the Publisher

Genova gives us a hauntingly accurate portrayal of a young woman's descent into Alzheimer's Disease from the prime of life and the loftiest of cerebral heights.

Publishers Weekly

Neuroscientist and debut novelist Genova mines years of experience in her field to craft a realistic portrait of early onset Alzheimer's disease. Alice Howland has a career not unlike Genova's-she's an esteemed psychology professor at Harvard, living a comfortable life in Cambridge with her husband, John, arguing about the usual (making quality time together, their daughter's move to L.A.) when the first symptoms of Alzheimer's begin to emerge. First, Alice can't find her Blackberry, then she becomes hopelessly disoriented in her own town. Alice is shocked to be diagnosed with early onset Alzheimer's (she had suspected a brain tumor or menopause), after which her life begins steadily to unravel. She loses track of rooms in her home, resigns from Harvard and eventually cannot recognize her own children. The brutal facts of Alzheimer's are heartbreaking, and it's impossible not to feel for Alice and her loved ones, but Genova's prose style is clumsy and her dialogue heavy-handed. This novel will appeal to those dealing with the disease and may prove helpful, but beyond the heartbreaking record of illness there's little here to remember. (Jan.)

Joanna M. Burkhardt - Library Journal

Fifty-year-old Alice Howland, a highly respected linguistics professor, suddenly begins feeling disoriented and confused. Her diagnosis-early-onset Alzheimer's-irrevocably changes her life as well as the lives of her husband and three grown children. First-time novelist Genova holds a Ph.D. in neuroscience from Harvard University and writes an online column for the National Alzheimer's Association. These qualifications help to make her story realistic and compelling. Genova reads her own work, conveying meaning through emphasis and inflection. Of interest to all listeners. [Audio clip available through www.simonandschuster.com.-Ed.]

Kirkus Reviews

First novel efficiently showcases the experience of developing early-onset Alzheimer's. In 24 months, 49-year-old Harvard psychology professor Alice Howland exchanges the role of high-achieving teacher, wife and mother of three for that of a disoriented, inarticulate, forgetful shell of her former self. Stricken much earlier than most by this progressive, degenerative disease for which there is no cure, Alice loses her profession, independence, clarity and contact with the world with shocking rapidity in a narrative that sometimes reads more like a dramatized documentary than three-dimensional fiction. Genova, an online columnist for the National Alzheimer's Association, has a brisk style and lays out the facts of the disease-statistics, tests, drugs, clinical trials-plainly, often rather technically. The responses to Alice of her three grown-up children, who are also at risk of the disease; the struggles of her equally high-flying husband, a Harvard biologist; and Alice's own emotional responses, including fear, suicidal thoughts, shame and panic, are offered in semi-educational fashion, sometimes movingly, sometimes mechanically. Alice's address to the Alzheimer's Association Annual Dementia Care Conference is an affecting final public statement before her descent into fog and the loving support of her children. Worthy, benign and readable, but not always lifelike. Agent: Vicky Bijur/Vicky Bijur Literary Agency

Product Details

• Reading Group Guide
• Forewords & Introductions
• Read an Excerpt

Reading Group Guide

1. When Alice becomes disoriented in Harvard Square, a place she's visited daily for twenty-five years, why doesn't she tell John? Is she too afraid to face a possible illness, worried about his possible reaction, or some other reason?

2. After first learning she has Alzheimer's disease, "the sound of her name penetrated her every cell and seemed to scatter her molecules beyond the boundaries of her own skin. She watched herself from the far corner of the room" (pg. 70). What do you think of Alice's reaction to the diagnosis? Why does she disassociate herself to the extent that she feels she's having an out-of-body experience?

3. Do you find irony in the fact that Alice, a Harvard professor and researcher, suffers from a disease that causes her brain to atrophy? Why do you think the author, Lisa Genova, chose this profession? How does her past academic success affect Alice's ability, and her family's, to cope with Alzheimer's?

4. "He refused to watch her take her medication. He could be mid-sentence, mid-conversation, but if she got out her plastic, days-of-the-week pill container, he left the room" (pg. 89). Is John's reaction understandable? What might be the significance of him frequently fiddling with his wedding ring when Alice's health is discussed?

5. When Alice's three children, Anna, Tom and Lydia, find out they can be tested for the genetic mutation that causes Alzheimer's, only Lydia decides she doesn't want to know. Why does she decline? Would you want to know if you had the gene?

6. Why is her mother's butterfly necklace so important to Alice? Is it only because she misses her mother? Does Alice feel a connection tobutterflies beyond the necklace?

7. Alice decides she wants to spend her remaining time with her family and her books. Considering her devotion and passion for her work, why doesn't her research make the list of priorities? Does Alice most identify herself as a mother, wife, or scholar?

8. Were you surprised at Alice's plan to overdose on sleeping pills once her disease progressed to an advanced stage? Is this decision in character? Why does she make this difficult choice? If they found out, would her family approve?

9. As the symptoms worsen, Alice begins to feel like she's living in one of Lydia's plays: "(Interior of Doctor's Office. The neurologist left the room. The husband spun his ring. The woman hoped for a cure.)" (pg. 141). Is this thought process a sign of the disease, or does pretending it's not happening to her make it easier for Alice to deal with reality?

10. Do Alice's relationships with her children differ? Why does she read Lydia's diary? And does Lydia decide to attend college only to honor her mother?

11. Alice's mother and sister died when she was only a freshman in college, and yet Alice has to keep reminding herself they're not about to walk through the door. As the symptoms worsen, why does Alice think more about her mother and sister? Is it because her older memories are more accessible, is she thinking of happier times, or is she worried about her own mortality?

12. Alice and the members of her support group, Mary, Cathy, and Dan, all discuss how their reputations suffered prior to their diagnoses because people thought they were being difficult or possibly had substance abuse problems. Is preserving their legacies one of the biggest obstacles to people suffering from Alzheimer's disease? What examples are there of people still respecting Alice's wishes, and at what times is she ignored?

13. "One last sabbatical year together. She wouldn't trade that in for anything. Apparently, he would" (pg. 223). Why does John decide to keep working? Is it fair for him to seek the job in New York considering Alice probably won't know her whereabouts by the time they move? Is he correct when he tells the children she would not want him to sacrifice his work?

14. Why does Lisa Genova choose to end the novel with John reading that Amylix, the medicine that Alice was taking, failed to stabilize Alzheimer's patients? Why does this news cause John to cry?

15. Alice's doctor tells her, "You may not be the most reliable source of what's been going on" (pg. 54). Yet, Lisa Genova chose to tell the story from Alice's point of view. As Alice's disease worsens, her perceptions indeed get less reliable. Why would the author choose to stay in Alice's perspective? What do we gain, and what do we lose?

Enhance Your Book Club:

1. If you'd like to learn more about Alzheimer's or help those suffering from the disease, please visit www.actionalz.org or www.alz.org.

2. The Harvard University setting plays an important role in Still Alice. If you live in the Cambridge area, hold your meeting in one of the Harvard Square caf?s. If not, you can take a virtual tour of the university at: http://www.hno.harvard.edu/tour/guide.html

3. In order to help her mother, Lydia makes a documentary of the Howlands' lives. Make one of your own family and then share the videos with the group.

4. To learn more about Still Alice or to get in touch with Lisa Genova, visit www.StillAlice.com.

Forewords & Introductions

Discussion Questions:

1. When Alice becomes disoriented in Harvard Square, a place she's visited daily for twenty-five years, why doesn't she tell John? Is she too afraid to face a possible illness, worried about his possible reaction, or some other reason?

2. After first learning she has Alzheimer's disease, "the sound of her name penetrated her every cell and seemed to scatter her molecules beyond the boundaries of her own skin. She watched herself from the far corner of the room" (pg. 70). What do you think of Alice's reaction to the diagnosis? Why does she disassociate herself to the extent that she feels she's having an out-of-body experience?

3. Do you find irony in the fact that Alice, a Harvard professor and researcher, suffers from a disease that causes her brain to atrophy? Why do you think the author, Lisa Genova, chose this profession? How does her past academic success affect Alice's ability, and her family's, to cope with Alzheimer's?

4. "He refused to watch her take her medication. He could be mid-sentence, mid-conversation, but if she got out her plastic, days-of-the-week pill container, he left the room" (pg. 89). Is John's reaction understandable? What might be the significance of him frequently fiddling with his wedding ring when Alice's health is discussed?

5. When Alice's three children, Anna, Tom and Lydia, find out they can be tested for the genetic mutation that causes Alzheimer's, only Lydia decides she doesn't want to know. Why does she decline? Would you want to know if you had the gene?

6. Why is her mother's butterfly necklace so important to Alice? Is it only because she misses her mother? Does Alice feel a connection tobutterflies beyond the necklace?

7. Alice decides she wants to spend her remaining time with her family and her books. Considering her devotion and passion for her work, why doesn't her research make the list of priorities? Does Alice most identify herself as a mother, wife, or scholar?

8. Were you surprised at Alice's plan to overdose on sleeping pills once her disease progressed to an advanced stage? Is this decision in character? Why does she make this difficult choice? If they found out, would her family approve?

9. As the symptoms worsen, Alice begins to feel like she's living in one of Lydia's plays: "(Interior of Doctor's Office. The neurologist left the room. The husband spun his ring. The woman hoped for a cure.)" (pg. 141). Is this thought process a sign of the disease, or does pretending it's not happening to her make it easier for Alice to deal with reality?

10. Do Alice's relationships with her children differ? Why does she read Lydia's diary? And does Lydia decide to attend college only to honor her mother?

11. Alice's mother and sister died when she was only a freshman in college, and yet Alice has to keep reminding herself they're not about to walk through the door. As the symptoms worsen, why does Alice think more about her mother and sister? Is it because her older memories are more accessible, is she thinking of happier times, or is she worried about her own mortality?

12. Alice and the members of her support group, Mary, Cathy, and Dan, all discuss how their reputations suffered prior to their diagnoses because people thought they were being difficult or possibly had substance abuse problems. Is preserving their legacies one of the biggest obstacles to people suffering from Alzheimer's disease? What examples are there of people still respecting Alice's wishes, and at what times is she ignored?

13. "One last sabbatical year together. She wouldn't trade that in for anything. Apparently, he would" (pg. 223). Why does John decide to keep working? Is it fair for him to seek the job in New York considering Alice probably won't know her whereabouts by the time they move? Is he correct when he tells the children she would not want him to sacrifice his work?

14. Why does Lisa Genova choose to end the novel with John reading that Amylix, the medicine that Alice was taking, failed to stabilize Alzheimer's patients? Why does this news cause John to cry?

15. Alice's doctor tells her, "You may not be the most reliable source of what's been going on" (pg. 54). Yet, Lisa Genova chose to tell the story from Alice's point of view. As Alice's disease worsens, her perceptions indeed get less reliable. Why would the author choose to stay in Alice's perspective? What do we gain, and what do we lose?

Enhance Your Book Club:

1. If you'd like to learn more about Alzheimer's or help those suffering from the disease, please visit www.actionalz.org or www.alz.org.

2. The Harvard University setting plays an important role in Still Alice. If you live in the Cambridge area, hold your meeting in one of the Harvard Square caf?s. If not, you can take a virtual tour of the university at: http://www.hno.harvard.edu/tour/guide.html

3. In order to help her mother, Lydia makes a documentary of the Howlands' lives. Make one of your own family and then share the videos with the group.

4. To learn more about Still Alice or to get in touch with Lisa Genova, visit www.StillAlice.com.

Lisa Genova graduated valedictorian from Bates College with a degree in Biopsychology and holds a Ph.D. in Neuroscience from Harvard University. She is a member of the Dementia Advocacy, Support Network International and DementiaUSA and is an online columnist for the National Alzheimer's association. She lives with her husband and two children in Cape Cod. Still Alice is her first novel.

Read an Excerpt

SEPTEMBER 2003

Alice sat at her desk in their bedroom distracted by the sounds of John racing through each of the rooms on the first floor. She needed to finish her peer review of a paper submitted to the Journal of Cognitive Psychology before her flight, and she'd just read the same sentence three times without comprehending it. It was 7:30 according to their alarm clock, which she guessed was about ten minutes fast. She knew from the approximate time and the escalating volume of his racing that he was trying to leave, but he'd forgotten something and couldn't find it. She tapped her red pen on her bottom lip as she watched the digital numbers on the clock and listened for what she knew was coming.

"Ali?"

She tossed her pen onto the desk and sighed. Downstairs, she found him in the living room on his knees, feeling under the couch cushions.

"Keys?" she asked.

"Glasses. Please don't lecture me, I'm late."

She followed his frantic glance to the fireplace mantle where the antique Waltham clock, valued for its precision, declared 8:00. He should have known better than to trust it. The clocks in their home rarely knew the real time of day. Alice had been duped too often in the past by their seemingly honest faces and had learned long ago to rely on her watch. Sure enough, she lapsed back in time as she entered the kitchen, where the microwave insisted that it was only 6:52.

She looked across the smooth, uncluttered surface of the granite countertop, and there they were, next to the mushroom bowl heaping with unopened mail. Not under something, not behind something, not obstructed in any way from plain view. How could he, someone sosmart, a scientist, not see what was right in front of him?

Of course, many of her own things had taken to hiding in mischievous, little places as well. But she didn't admit this to him, and she didn't involve him in the hunt. Just the other day, John blissfully unaware, she'd spent a crazed morning looking first all over the house and then in her office for her Blackberry charger. Stumped, she'd surrendered, gone to the store, and bought a new one, only to discover it later that night plugged in the socket next to her side of the bed, where she should have known to look. She could probably chalk it all up for both of them to excessive multitasking and being way too busy. And to getting older.

He stood in the doorway, looking at the glasses in her hand, but not at her.

"Next time, try pretending you're a woman while you look," said Alice, smiling.

"I'll wear one of your skirts. Ali, please, I'm really late."

"The microwave says you have tons of time," she said, handing them to him.

"Thanks."

He grabbed them like a relay runner taking a baton in a race and headed for the front door.

"Will you be home when I get back on Saturday?" she asked his back as she followed him down the hallway.

"I don't know, I've got a huge day in lab on Saturday."

He collected his briefcase, phone, and keys from the hall table.

"Have a good trip, give Lydia a hug and kiss for me. And try not to battle with her," said John.

She caught their reflection in the hallway mirror — -a distinguished-looking, tall man with white-flecked brown hair and glasses, a petite, curly-haired woman, her arms crossed over her chest, each readying to leap into that same, bottomless argument. She gritted her teeth and swallowed, choosing not to jump.

"We haven't seen each other in a while, please try to be home?" she asked.

"I know, I'll try."

He kissed her, and although desperate to leave, he lingered in that kiss for an almost imperceptible moment. If she didn't know him better, she might've romanticized his kiss. She might've stood there, hopeful, thinking it said, I love you, I'll miss you. But as she watched him hustle down the street alone, she felt pretty certain he'd just told her, I love you, but please don't be pissed when I'm not home on Saturday.

They used to walk together over to Harvard Yard every morning. Of the many things she loved about working within a mile from home and at the same school, their shared commute was the thing she loved most. They always stopped at Jerri's—a black coffee for him, a tea with lemon for her, iced or hot, depending on the season—and continued on to Harvard Square, chatting about their research and classes, issues in their respective departments, their children, or plans for that evening. When they were first married, they even held hands. She savored the relaxed intimacy of these morning walks with him, before the daily demands of their jobs and ambitions rendered them each stressed and exhausted.

But for some time now, they'd been walking over to Harvard separately. Alice had been living out of her suitcase all summer, attending psychology conferences in Rome, New Orleans, and Miami, and serving on an exam committee for a thesis defense at Princeton. Back in the spring, John's cell cultures had needed some sort of rinsing attention at an obscene hour each morning, but he didn't trust any of his students to consistently show up. So he did. She couldn't remember the reasons that predated spring, but she knew that each time they'd seemed reasonable and only temporary.

She returned to the paper at her desk, still distracted, now by a craving for that fight she didn't have with John about their youngest daughter, Lydia. Would it kill him to stand behind her for once? She gave the rest of the paper a cursory effort, not her typical standard of excellence, but it would have to do, given her fragmented state of mind and lack of time. Her comments and suggestions for revision finished, she packaged and sealed the envelope, guiltily aware that she might've missed an error in the study's design or interpretation, cursing John for compromising the integrity of her work.

She repacked her suitcase, not even emptied yet from her last trip. She looked forward to traveling less in the coming months. There were only a handful of invited lectures penciled in her fall semester calendar, and she scheduled most of those on Fridays, a day she didn't teach. Like tomorrow. Tomorrow she would be the guest speaker to kick off Stanford's cognitive psychology fall colloquium series. And afterward, she'd see Lydia. She'd try not to battle with her, but she wasn't making any promises.

Alice found her way easily to Stanford's Cordura Hall on the corner of Campus Drive West and Panama Drive. Its concrete, white stucco exterior, terra cotta roof, and lush landscaping looked to her East Coast eyes more like a Caribbean beach resort than an academic building. She arrived quite early but ventured inside anyway, figuring she could use the extra time to sit in the quiet auditorium and look over her talk.

Much to her surprise, she walked into an already packed room. A zealous crowd surrounded and circled a buffet table, aggressively diving in for food like seagulls at a city beach. Before she could sneak in unnoticed, she noticed Josh, a former Harvard classmate and respected egomaniac, standing in her path, his legs planted firmly and a little too wide, like he was ready to dive at her.

"All this, for me?" asked Alice, smiling playfully.

"What, we eat like this every day. It's for one of our developmental psychologists, he was tenured yesterday. So how's Harvard treating you?"

"Good."

"I can't believe you're still there after all these years. You ever get too bored over there, you should consider coming here."

"I'll let you know. How are things with you?"

"Fantastic. You should come by my office after the talk, see our latest modeling data. It'll really knock your socks off."

"Sorry, I can't, I have to catch a flight to LA right after this," she said, grateful to have a ready excuse.

"Oh, too bad. Last time I saw you I think was last year at the Psychonomic Conference. I unfortunately missed your presentation."

"Well, you'll get to hear a good portion of it today."

"Recycling your talks these days, huh?"

Before she could answer, Gordon Miller, head of the department and her new superhero, swooped in and saved her by asking Josh to help pass out the champagne. Like at Harvard, a champagne toast was a tradition in the psychology department at Stanford for all faculty who reached the coveted career milestone of tenure. There weren't many trumpets that heralded the advancement from point to point in the career of a professor, but tenure was a big one, loud and clear.

When everyone was holding a cup, Gordon stood at the podium and tapped the microphone.

"Can I have everyone's attention for a moment?"

Josh's excessively loud, punctated laugh reverberated alone throughout the auditorium just before Gordon continued.

"Today, we congratulate Mark on receiving tenure. I'm sure he's thrilled to have this particular accomplishment behind him. Here's to the many exciting accomplishments still ahead. To Mark!"

"To Mark!"

Alice tapped her cup with her neighbors, and everyone quickly resumed the business of drinking, eating, and discussing. When all of the food had been claimed from the serving trays and the last drops of champagne emptied from the last bottle, Gordon took the floor once again.

"If everyone would take a seat, we can begin today's talk."

He waited a few moments for the crowd of about seventy-five to settle and quiet down.

"Today, I have the honor of introducing you to our first colloquium speaker of the year. Dr. Alice Howland is the eminent William James Professor of Psychology at Harvard University. Over the last twenty-five years, her distinguished career has produced many of the flagship touchstones in psycholinguistics. She pioneered and continues to lead an interdisciplinary and integrated approach to the study of the mechanisms of language. We are privileged to have her here today to talk to us about the Conceptual and Neural Organization of Language."

Alice switched places with Gordon and looked out at her audience looking at her. As she waited for the applause to subside, she thought of the statistic that said that people feared public speaking more than they feared death. She loved it. She enjoyed all of the concatenated moments of presenting in front of a listening audience—-teaching, performing, telling a story, teeing up a heated debate. She also loved the adrenaline rush. The bigger the stakes, the more sophisticated or hostile the audience, the more the whole experience thrilled her. John was an excellent speaker, but it often pained and terrified him, and he marveled at Alice's verve for it. He probably didn't prefer death, but spiders and snakes, sure.

"Thank you, Gordon. Today, I'm going to talk about some of the mental processes that underlie the acquisition, organization, and use of language."

Alice had given the guts of this particular talk innumerable times, but she wouldn't call it recycling. The crux of the talk did focus on the main tenets of linguistics, many of which she'd discovered, and she'd been using a number of the same slides for years. But she felt proud, and not ashamed or lazy, that this part of her talk, these discoveries of hers, continued to hold true, withstanding the test of time. Her contributions mattered and propelled future discovery. Plus, she certainly included those future discoveries.

She talked without needing to look down at her notes, relaxed and animated, the words effortless. Then, about forty minutes into the fifty-minute presentation, she became suddenly stuck.

"The data reveal that irregular verbs require access to the mental..."

She simply couldn't find the word. She had a loose sense for what she wanted to say, but the word itself eluded her. Gone. She didn't know the first letter or what the word sounded like or how many syllables it had. It wasn't on the tip of her tongue.

Maybe it was the champagne. She normally didn't drink any alcohol before speaking. Even if she knew the talk cold, even in the most casual setting, she always wanted to be as mentally sharp as possible, especially for the question and answer session at the end, which could be confrontational and full of rich, unscripted debate. But she didn't wanted to offend anyone, and she drank a little more than she probably should have when she became trapped again in passive aggressive conversation with Josh.

Maybe it was jet lag. As her mind scoured its corners for the word and a rational reason as to why she lost it, her heart pounded and her face grew hot. She'd never lost a word in front of an audience before. But she'd also never panicked in front of an audience either, and she'd stood before many far larger and more intimidating than this. She told herself to breath, forget about it, and move on.

She replaced the still blocked word with a vague and inappropriate 'thing,' abandoned whatever point she'd been in the middle of making, and continued on to the next slide. The pause had seemed like an obvious and awkward eternity to her, but as she checked the faces in the audience to see if anyone had noticed her mental hiccup, no one appeared alarmed, embarrassed, or ruffled in any way. Then, she saw Josh whispering to the woman next to him, his eyebrows furrowed and a slight smile on his face.

She was on the plane, descending into LAX, when it finally came to her.

Lexicon.

Lydia had been living in Los Angeles for three years now. If she'd gone to college right after high school, she would've graduated this past spring. Alice would've been so proud. Lydia was probably smarter than both of her older siblings, and they had gone to college. And law school. And medical school.

Instead of college, Lydia first went to Europe. Alice had hoped she'd come home with a clearer sense of what she wanted to study and what kind of school she wanted to go to. Instead, upon her return, she told her parents that she'd done a little acting while in Dublin and had fallen in love. She was moving to Los Angeles immediately.

Alice nearly lost her mind. Much to her own maddening frustration, she recognized her own contribution to this problem. Because Lydia was the youngest of three, the daughter of parents who worked a lot and traveled regularly, and had always been a good student, Alice and John ignored her to a large extent. They granted her a lot of room to run in her world, free to think for herself and from the kind of micromanagement placed on a lot of children her age. Her parents' professional lives served as shining examples of what could be gained from setting lofty and individually unique goals and pursuing them with passion and hard work. Lydia understood her mother's advice about the importance of getting a college education, but she had the confidence and audacity to reject it.

Plus, she didn't stand entirely alone. The most explosive fight Alice ever had with John followed his two cents on the subject— I think it's wonderful, she can always go to college later, if she decides she even wants to.

Alice checked her Blackberry for the address, rang the doorbell to apartment number seven, and waited. She was just about to press it again when Lydia opened the door.

"Mom, you're early," said Lydia.

Alice checked her watch.

"I'm right on time."

"You said your flight was coming in at eight."

"I said five."

"I have eight o'clock written down in my book."

"Lydia, it's 5:45, I'm here."

Lydia looked indecisive and panicky, like a squirrel caught facing an oncoming car in the road.

"Sorry, come in."

They each hesitated before they hugged, as if they were about to practice a newly learned dance and weren't quite confident of the first step or who should lead. Or it was an old dance, but they hadn't performed it together in so long that they each felt unsure of the choreography.

Alice could feel the contours of Lydia's spine and ribs through her shirt. She looked too skinny, a good ten pounds lighter than Alice remembered. She hoped it was more a result of being busy than of conscious dieting. Blonde and five feet six, three inches taller than Alice, Lydia stood out among the predominance of short Italian and Asian women in Cambridge, but in Los Angeles, the waiting rooms at every audition were apparently full of women who looked just like her.

"I made reservations for nine. Wait here, I'll be right back."

Craning her neck, Alice inspected the kitchen and living room from the hallway. The furnishings, most likely yard sale finds and parent hand-me-downs, looked rather hip together—-an orange sectional couch, retro-inspired coffee table, Brady Bunch style kitchen table and chairs. The white walls were bare except for a poster of Marlon Brando taped above the couch. The air smelled strongly of Windex, as if Lydia had probably taken last second measures to clean the place before Alice's arrival.

In fact, it was a little too clean. No DVD's or CD's laying around, no books or magazines thrown on the coffee table, no pictures on the refrigerator, no hint of Lydia's interests or aesthetic anywhere. Anyone could be living here. Then, she noticed the pile of men's shoes on the floor to the left of the door behind her.

"Tell me about your roommates," said Alice, as Lydia returned from her room, cell phone in hand.

"They're at work."

"What kind of work?"

"One's bartending and the other delivers food."

"I thought they were both actors."

"They are."

"I see. What are their names again?"

"Doug and Malcolm."

It flashed only for a moment, but Alice saw it and Lydia saw her see it. Lydia's face flushed when she said Malcolm's name, and her eyes darted nervously away from her mother's.

"Why don't we get going? They said they can take us early," said Lydia.

"Okay, I just need to use the bathroom first."

As Alice washed her hands, she looked over the products sitting on the table next to the sink—Neutrogena facial cleanser and moisturizer, Tom's of Maine mint toothpaste, men's deodorant, a box of Playtex tampons. She thought for a moment. She hadn't had her period all summer. Did she have it in May? She'd be turning fifty next month, so she wasn't alarmed. She hadn't yet experienced any hot flashes or night sweats, but not all menopausal women did. That would be just fine with her.

As she dried her hands, she noticed the box of Trojan condoms behind Lydia's hair styling products. She was going to have to find out more about these roommates. Malcolm, in particular.

They sat at a table outside on the patio at Ivy, a trendy restaurant in downtown Los Angeles, and ordered two drinks, an espresso martini for Lydia and a merlot for Alice.

"So how's Dad's Science paper coming?" asked Lydia.

She must've talked recently with her father. Alice hadn't heard from her since a phone call on Mother's Day.

"It's done. He's very proud of it."

"How's Anna and Tom?"

"Good, busy, working hard. So how did you meet Doug and Malcolm?"

"They came into Starbucks one night while I was working."

The waiter appeared, and they each ordered dinner and another drink. Alice hoped the alcohol would dilute the tension between them, which felt heavy and thick and just beneath the tracing-paper-thin conversation.

"So how did you meet Doug and Malcolm?" asked Alice.

"I just told you. Why don't you ever listen to anything I say? They came into Starbucks one night talking about looking for a roommate while I was working."

"I thought you were waitressing at a restaurant."

"I am. I work at Starbucks during the week and waitress on Saturday nights."

"Doesn't sound like that leaves a lot of time for acting."

"I'm not cast in anything right now, but I'm taking workshop classes, and I'm auditioning a lot."

"What kind of classes?"

"Meisner technique."

"And what've you been auditioning for?"

"Television and print."

Alice swirled her wine, drank the last, big gulp, and licked her lips.

"Lydia, what exactly is your plan here?"

"I'm not planning on stopping, if that's what you're asking."

The drinks were taking effect, but not in the direction Alice had hoped for. Instead, they served as the fuel that burned that little piece of tracing paper, leaving the tension between them fully exposed and at the helm of a dangerously familiar conversation.

"You can't live like this forever. Are you still going to work at Starbucks when you're thirty?"

"That's eight years away! Do you know what you'll be doing in eight years?"

"Yes, I do. At some point, you need to be responsible, you need to able to afford things like health insurance, a mortgage, savings for retirement—"

"I have health insurance. And I might make it as an actor. There are people who do, you know. And they make a hell of a lot more money than you and Dad combined."

"This isn't just about money."

"Then what? That I didn't become you?"

"Lower your voice."

"Don't tell me what to do."

"I don't want you to become me, Lydia. I just don't want you to limit your choices."

"You want to make my choices."

"No."

"This is who I am, this is what I want to do."

"What, serving up venti lattes? You should be in college. You should be spending this time in your life learning something."

"I am learning something! I'm just not sitting in a Harvard classroom killing myself trying to get an A in political science. I'm in a serious acting class for fifteen hours a week. How many hours of class a week do your students take, twelve?"

"It's not the same thing."

"Well, Dad thinks it is. He's paying for it."

Alice clenched the sides of her skirt and pressed her lips together. What she wanted to say next wasn't meant for Lydia.

"You've never even seen me act."

John had. He flew out alone last winter to see her perform in a play. Swamped with too many urgent things at the time, Alice couldn't free up to go. As she looked at Lydia's pained eyes, she couldn't remember now what those urgent things had been. She didn't have anything against an acting career itself, but she believed Lydia's singular pursuit of it, without an education, bordered reckless. If she didn't go to college now, acquire a knowledge base or formal training in some field, if she didn't get a degree, what would she do if acting didn't pan out?

She thought about those condoms in the bathroom. What if Lydia got pregnant? Alice worried that Lydia might find herself someday trapped in a life that was unfulfilled, full of regret. She looked at her daughter and saw so much wasted potential, so much wasted time.

"You're not getting any younger, Lydia. Life goes by too fast."

"I agree."

The food came, but neither of them picked up a fork. Lydia dabbed her eyes with her hand-embroidered linen napkin. They always fell into the same battle, and it felt to Alice like trying to knock down a concrete wall with their heads. It was never going to be productive and only resulted in hurting them, causing lasting damage. She wished Lydia could see the love and wisdom in what she wanted for her. She wished she could just reach across the table and hug her, but there were too many dishes, glasses, and years of distance between them.

A sudden flurry of activity a few tables away pulled their attention away from themselves. Several camera flashes popped and a small crowd of patrons and wait staff gathered, all focused on a woman who looked a bit like Lydia.

"Who's that?" asked Alice.

"Mom," said Lydia in a tone both embarrassed and superior, perfected at the age of thirteen. "That's Jennifer Aniston."

They ate their dinner and talked only of safe things, like the food and the weather. Alice wanted to discover more about Lydia's relationship with Malcolm, but the embers of Lydia's emotions still glowed hot, and Alice feared igniting another fight. She paid the bill, and they left the restaurant, full but dissatisfied.

"Excuse me, ma'am!"

Their waiter caught up to them on the sidewalk.

"You left this."

Alice paused, trying to comprehend how their waiter might come to possess her Blackberry. She hadn't checked her email or calendar there. She felt inside her bag. No Blackberry. She must've removed it when she fished her wallet out to pay.

"Thank you."

Lydia looked at her quizzically, as if she wanted to say something about something other than food or weather, but then didn't. They walked back to her apartment in silence.

"John?"

Alice waited, suspended in the front hallway, holding the handle of her suitcase. Harvard Magazine lay on the top of a pile of unclaimed mail strewn on the floor in front of her. The clock in the living room ticked and the refrigerator hummed. A warm, sunny late afternoon at her back, the air inside felt chilly, dim, and stale. Uninhabited.

She picked up the mail and walked into the kitchen, her suitcase on wheels accompanying her like a loyal pet. Her flight had been delayed, and she was late getting in, even according to the microwave. He'd had a whole day, a whole Saturday, to work.

The red voicemail light on their answering machine stared her down, unblinking. She checked the refrigerator. No note on the door. Nothing.

Still clutching the handle of her suitcase, she stood in the dark kitchen and watched several minutes advance on the microwave. The disappointed but forgiving voice in her head faded to a whisper as the volume of a more primal one began to build and spread out. She thought about calling him, but the expanding voice rejected the suggestion outright and refused all excuses. She thought about deciding not to care, but the voice, now seeping down into her body, echoing in her belly, vibrating in each of her fingertips, was too powerful and pervasive to ignore.

Why did it bother her so much? He was in the middle of an experiment and couldn't leave it to come home. She'd certainly been in his shoes innumerable times. This was what they did. This was who they were. The voice called her a stupid fool.

She spotted her running shoes on the floor next to the back door. A run would make her feel better. That was what she needed.

Ideally, she ran every day. For many years now, she treated running like eating or sleeping, as a vital daily necessity, and she'd been known to squeeze in a jog at midnight or in the middle of a blinding snowstorm. But she'd neglected this basic need over the last several months. She'd been so busy. As she laced her shoes, she told herself she hadn't bothered bringing them with her to California because she'd known she wouldn't have the time. In truth, she'd simply forgotten to pack them.

When starting from her house on Poplar Street, she invariably followed the same route—down Massachusetts Avenue, through Harvard Square to Memorial Drive, along the Charles River to the Harvard Bridge over by MIT, and back—a little over five miles, a forty-five minute round trip. She had long been attracted to the idea of running in the Boston Marathon but each year decided that she realistically didn't have the time to train for that kind of distance. Maybe some day she would. In excellent physical condition for a woman her age, she imagined running strong well into her sixties.

Clustered pedestrian traffic on the sidewalks and intermittent negotiations with car traffic in street intersections littered the first part of her run down Massachusetts Avenue and through Harvard Square. It was crowded and ripe with anticipation at that time of day on a Saturday, with crowds forming and milling around on street corners waiting for walk signals, outside restaurants waiting for tables, in movie theater lines waiting for tickets, and in double-parked cars, waiting for an unlikely opening in a metered space. The first ten minutes of her run required a good deal of conscious external concentration to navigate through it all, but once she crossed Memorial Drive to the Charles River, she was free to run in full stride and completely in the zone.

A comfortable and cloudless evening invited a lot of activity along the Charles, yet it felt less congested than the streets of Cambridge. Despite a steady stream of joggers, dogs and their owners, walkers, rollerbladers, cyclists, and women pushing babies in jogger strollers, like an experienced driver on a regularly traveled stretch of road, Alice only retained a vague sense for what went on around her now. As she ran along the river, she became mindful of nothing but the sounds of her Nikes hitting the pavement in syncopated rhythm with the pace of her breath. She didn't replay her argument with Lydia. She didn't acknowledge her growling stomach. She didn't think about John. She just ran.

As was her routine, she stopped running once she made it back to the John Fitzgerald Kennedy Park, a pocket of manicured lawns abutting Memorial Drive. Her head cleared, her body relaxed and rejuvenated, she began walking home. The JFK Park funneled into Harvard Square through a pleasant, bench-lined corridor between the Charles Hotel and the Kennedy School of Government.

Through the corridor, she stood at the intersection of Eliot Street and Brattle, ready to cross, when a woman grabbed her forearm with startling force and said, "Have you thought about heaven today?"

The woman fixed Alice with a penetrating, unwavering stare. She had long hair the color and texture of a teased Brillo pad and wore a hand-made placard hung over her chest that read AMERICA REPENT, TURN TO JESUS FROM SIN. There was always someone selling God in Harvard Square, but Alice had never been singled out so directly and intimately before.

"Sorry," said Alice, and, noticing a break in the flow of traffic, she escaped to the other side of the street.

She wanted to continue walking but stood frozen instead. She didn't know where she was. She looked back across the street. The Brillo-haired woman pursued another sinner down the corridor. The corridor, the hotel, the stores, the illogically meandering streets. She knew she was in Harvard Square, but she didn't know which way was home.

She tried again, more specifically. The Harvard Hotel, Eastern Mountain Sports, Dickson Brothers Hardware, Mount Auburn Street. She knew all of these places—this square had been her stomping ground for over twenty-five years—but they somehow didn't fit into a mental map that told her where she lived relative to them. A black and white circular "T" sign directly in front of her marked an entrance to the Red Line trains and buses underground, but there were four such entrances in Harvard Square, and she couldn't piece together which one of the four this one was.

Her heart began to race. She started sweating. She told herself that an accelerated heart rate and perspiration were part of an orchestrated and appropriate response to running. But standing still on the sidewalk, it felt like panic.

She willed herself to walk another block and then another, her rubbery legs feeling like they might give way with each bewildered step. The Coop, Cardullo's, the magazines on the corner, the Cambridge Visitor Center across the street, and Harvard Yard beyond that. She told herself she could still read and recognize. None of it helped. It all lacked a context.

People, cars, buses, and all kinds of unbearable noise rushed and wove around and past her. She closed her eyes. She listened to her own blood whoosh and pulse behind her ears.

"Please stop this," she whispered.

She opened her eyes. Just as suddenly as it had left her, the landscape snapped snugly back into place. The Coop, Cardullo's, Nini's Corner, Harvard Yard. She automatically understood that she should turn left at the corner and head west on Mass Ave. She began to breathe easier, no longer bizarrely lost within a mile of home. But she'd just been bizarrely lost within a mile of home. She walked as fast as she could without running.

She turned onto her street, a quiet, tree-lined, residential road a couple of blocks removed from Mass Ave. With both feet on her road and her house in sight, she felt much safer, but not yet safe. She kept her eyes on her front door and her legs moving and promised herself that the sea of anxiety swelling furiously inside her would drain when she walked in the front hallway and saw John. If he was home.

"John?"

He appeared in the threshold of the kitchen, unshaven, his glasses sitting on top of his mad scientist hair, sucking on a red popsicle and sporting his lucky gray T-shirt. He'd been up all night. As she'd promised herself, her anxiety began to drain. But her energy and bravery seemed to leak out with it, leaving her fragile and wanting to collapse into his arms.

"Hey, I was wondering where you were, just about to leave you a note on the fridge. How'd it go?" he asked.

"What?"

"Stanford."

"Oh, good."

"And how's Lydia?"

The betrayal and hurt over Lydia, over him not being home when she got there, exorcised by the run and displaced by her terror over being inexplicably lost, reclaimed its priority in the pecking order.

"You tell me," she said.

"You guys fought."

"You're paying for her acting classes?" she accused.

"Oh," he said, sucking the last of the popsicle into his red stained mouth. "Look, can we talk about this later? I don't have time to get into it right now."

"Make the time, John. You're keeping her afloat out there without telling me, and you're not here when I get home, and—-"

"And you weren't here when I got home. How was your run?"

She heard the simple reasoning in his veiled question. If she had waited for him, if she had called, if she hadn't done exactly what she'd wanted and gone for a run, she could've spent the last hour with him. She had to agree.

"Fine."

"I'm sorry, I waited as long as I could, but I've really got to get back to the lab. I had an incredible day so far, gorgeous results, but we're not done, and I've got to analyze the numbers before we get started again in the morning. I only came home to see you."

"I need to talk about this with you now."

"This really isn't new information, Ali. We disagree about Lydia. Can't it wait until I get back?"

"No."

"You want to walk over with me, talk about it on the way?"

"I'm not going to the office, I need to be home."

"You need to talk now, you need to be home, you're awfully needy all of the sudden. Is something else going on?"

The word 'needy' smacked a vulnerable nerve. Needy equaled weak, dependent, pathological. Her father. She'd made a life-long point of never being like that, like him.

"I'm just exhausted."

"You look it, you need to slow down."

"That's not what I need."

He waited for her to elaborate, but she took too long.

"Look, the sooner I go, the sooner I'll be back. Get some rest, I'll be home later tonight."

He kissed her sweat-drenched head and walked out the door.

Standing in the hallway where he left her, with no one to confess to or confide in, the full emotional impact of what she'd just experienced in Harvard Square flooded over her. She sat down on the floor and leaned against the cool wall, watching her hands shake in her lap as if they couldn't be hers. She tried to focus on steadying her breath as she did when she ran.

After minutes of breathing in and breathing out, she was finally calm enough to try to assemble some sense out of what had just happened. She thought about the missing word during her talk at Stanford and her missing period. She got up, turned on her laptop, and Googled MENOPAUSE SYMPTOMS.

An appalling list filled the screen—hot flashes, night sweats, insomnia, crashing fatigue, anxiety, dizziness, irregular heart beat, depression, irritability, mood swings, disorientation, mental confusion, memory lapses.

Disorientation, mental confusion, memory lapses. Check, check, and check. She leaned back in her chair and raked her fingers back and forth through her curly, black hair. She looked over at the pictures displayed on the shelves of the floor-to-ceiling bookcase—her Harvard graduation day, she and John dancing on their wedding day, family portraits from when the kids were little, a family portrait from Anna's wedding. She returned to the list on her computer screen. This was just the natural, next phase in her life as a woman. Millions of women coped with it every day. Nothing life-threatening. Nothing abnormal.

She wrote herself a note to make an appointment with her doctor for a checkup. Maybe she should go on estrogen replacement therapy. She read through the list of symptoms one last time. Irritability. Mood swings. Her recent shrinking fuse with John. It all added up. Satisfied, she shut down her computer.

She sat in the darkening study a while longer, listening to her quiet house and the sounds of neighborhood barbeques. She inhaled the smell of hamburger grilling. For some reason, she wasn't hungry anymore. She took a multivitamin with water, unpacked, read several articles from The Journal of Cognition, and went to bed.

Some time after midnight, John finally came home. His weight in their bed woke her, but only slightly. She remained still and pretended to stay asleep. He had to be exhausted from being up all night and working all day. They could talk about Lydia in the morning. And she'd apologize for being so sensitive and moody lately. His warm hand on her hip brought her into the curve of his body. With his breath on her neck, she fell into a deep sleep, convinced that she was safe.

Copyright © 2007, 2009 by Lisa Genova