Lately, I keep hearing and reading about Alzheimer’s. A friend recently brought up a story she’d heard about an elderly couple; one of them was diagnosed with Alzheimer’s, and the in-home care costs became unbearable. Then there was the news of a 39-year-old woman with Alzheimer’s fighting for her right to an advance directive for euthanasia, sparking legal and ethical debates. And in Nobel laureate Han Kang’s novel, We Do Not Part, I read about the mother of the protagonist’s friend and her struggle with the disease.

I remembered Still Alice, a novel that once brought me to tears. It was the first English book I ever finished in one sitting. When one day all the things you’re proud of slip away, and even the memory of that pride fades—does joy or sadness still hold meaning?

My prior understanding of Alzheimer’s was limited to the idea of an “elderly disease.” My former neighbor’s mother, a highly educated woman who had worked in scientific research, was among China’s first post-revolution generation of intellectuals. In her late 60s, she developed what we then called “senile dementia.” Her symptoms mostly revolved around memory loss; she might wander and get lost, as I often heard in news stories about older adults.

But Alice was in her 40s—my age.

Though early-onset Alzheimer’s is rare, it’s not unheard of, as that news report about the 39-year-old reminded me. Suddenly, this disease didn’t feel so distant.

For Alice, a brilliant Harvard professor with a family full of medical professionals, Alzheimer’s must have seemed a remote possibility. But when it struck, it crept in unnoticed, catching her completely unprepared. The author pulls healthy readers into the disjointed world of an Alzheimer’s patient, a fractured mirror that leaves you questioning whether what you see is close or far, real or illusion, past or present. Every piece feels familiar, yet impossible to connect into a whole.

In Still Alice, she loses her way even in her own home, walking endlessly through the maze of her mind until she wets herself. Time skews; she mistakes midnight for noon and strides out of the house dressed for work. She enters a neighbor’s kitchen, desperately trying to remember where the coffee is stored, just to make herself a cup. During a student’s thesis defense, she repeats her feedback word for word, leaving her diligent students puzzled and increasingly frustrated. Some of them, who once revered her, begin calling her a fraud in their reviews, accusing her of wasting their time.

Alice doesn’t cry. She holds onto her composure, partly due to her pride but more because as the disease progresses, her awareness of her own changes becomes increasingly foggy. She’s left confused, afraid, and powerless during moments of fleeting clarity, struggling to comprehend why the life she once tried to control so carefully has slipped beyond her grasp.

For the Alzheimer’s patient, there may come a point where sadness and joy become as elusive as the past they can no longer recall. But for their loved ones, the pain is relentless, sharp, and searing. I can’t imagine if given the choice, whether I’d want to be Alice or her family—perhaps it’s harder to be the ones left watching.

To watch someone who once cared for you regress to an infant-like state, dependent in ways far more profound than a child ever could be, feels unbearable. A child, at least, holds the promise of growth. But the loved one lost within the maze of their mind can only slip further away. Babies may be voiceless, but at least they communicate through cries. An Alzheimer’s patient, however, might fall silent entirely. Babies can be left safely in a crib; an adult with Alzheimer’s has the strength and will to move, leaving trails of accidents or getting lost. Every life plan, career, and academic pursuit may come crashing down under the weight of the patient’s care. And for most, the financial burden is crushing.

Alice was “lucky” in that she had three bright, loving children and a husband able to shoulder the costs. But not every real-life case has this “luck.”

Alzheimer’s is profoundly heartbreaking, not just for the logistical and financial strain it brings, but because it negates the very concept of “self” by dismantling the brain’s capacity for self-awareness. Without memory, is life simply a blank slate? Without self-recognition, does the body become an empty shell? In that case, what is the meaning of “I”? And what is the purpose of simply staying alive?

Perhaps it’s this bleak prospect that drives some Alzheimer’s patients to wish for the right to choose euthanasia, to spare themselves and their loved ones before the disease erodes all dignity and meaning in “life.” But asking a person to set a future date to die before they reach the point of “no return” is an ethical paradox. By the time they reach a state of “unbearable,” they may have already lost the ability to choose. What a heartbreaking dilemma.

Even with all the advances in medicine and technology, Alzheimer’s remains an enigma. Apart from genetic inheritance, no definitive cause or prevention has been found. It feels almost cruel. No one knows who Alzheimer’s will “choose” next.

Alice’s story reaches a climax when, as a public advocate for Alzheimer’s awareness, she gives a speech, emphasizing the importance of understanding and acceptance. She explains that Alzheimer’s patients are not fools or madmen. Even as their minds dim, they can be insightful, compassionate, and full of life. They know how to love, even when they forget who they love.

In the end, the novel concludes quietly, like the calm surface of a summer pond: Alice has lost her grasp of language, even simple words, yet she does understand the context conveyed in her daughter’s silent gestures on stage - Love.

May all good people live in peace. Health and peace are the greatest blessings.