Robin had arrived in the morning, having taken the train directly from Paris to London.  Fully briefed by Jenny on what was transpiring with their mother, he cut his trip short by two days and arrived in time to prepare lunch for all three of them.  As the aroma of vegetarian quiche wafted through the house, Jennifer and her mom set the dishes on the small round ceramic tabletop in the alcove overlooking the garden.

The air was rife with pleasantries, all attempting to stifle the tension.  Elizabeth Fairborough had called only an hour before to say she was waiting for one final test result that would come in over the noon hour, and that she would be immediately by for a late lunch.  Nothing in her voice had given anything away, since it was Jenny who answered the call while Alberta was out in her garden.  The moment Jenny told her mom that her doctor would be by in a couple of hours, any sense of ease or familial happiness was replaced by a kind of rigid silence as they cleaned up and prepared for their visitor and the news.

It was 2:30 before Fairborough had been able to break free and take the short drive to join them in Clerkenwell.  The moment Alberta spotted her friend entering the doorway and saw her features, she sighed.  The look in her old friend’s eyes said only one thing: this is serious.  She pretended not to notice as she hugged Fairborough and guided her through to the alcove.  Fittingly, the sun quietly disappeared behind the clouds.

A short time later, with the quiche plates cleared and a decanter of coffee in the centre of the table, the doctor looked down at her hands.  “Go ahead, Lizzie – we might as well hear it.”

Alberta’s stoicism helped Faribrough proceed with the thankless task.

“It’s Alzheimer’s, and it seems fairly aggressive – though in your daily life it hasn’t been all that obvious,” she said, placing her hand over Bertie’s.  

“Are there different kinds of the disease?” Robin asked, his hands resting under his chin.

“It varies from person to person, it seems,” she responded.  “There has been suspicion for a lot of years that Alzheimer’s represents more than one illness and, in fact, exists in three distinct subtypes – inflammatory, noninflammatory, and cortical.  Yours is inflammatory and the most unpredictable.  Some people contract the disease through genetics, but your tests and background reveal that no one in your immediate past from your family suffered with it.  It likely means that you have late-onset Alzheimer’s and science still hasn’t been able to tell why some people get it and others don’t.”

The doctor paused momentarily to look around the table.  Jennifer’s face looked chalky, as she attempted to deal with her shock. Robin’s countenance was a map of confusion, anxiety, sympathy, and a certain element of hopelessness.  But when she turned to look at her friend of decades, she received her own shock – Alberta was smiling at her with a warmth and tenderness that was almost overwhelming to Fairborough.

“I’m glad you’re here,” Alberta said, reaching out to take her hand.  “I guess I’m not surprised, given that I’m 81.  Still, having someone nearby as equipped as you are, Lizzie, gives me strength.”

She turned then to face her adult children.  The tears had only recently coursed their way down her son’s cheeks, but Jenny was clearly distraught.  “The important thing now is that we go through this together.  We all know that I have fewer years ahead of me than behind me anyway, so we’ll just prepare a little differently.  It isn’t necessary that we be strong, but we have to be open as to how to handle it.  I know what’s coming, as you likely do, and I presume there will come a time when I won’t be able to recognize you, but that doesn’t mean you won’t be front and centre in my heart, even though my brain might be confused.”

Fairborough looked on in deepening respect.  This was Alberta just as she had always known her, and it was a marvellous thing to observe.

“So, what now?” asked Robin, his voice like some kind of haunting whisper.  It was clear that the answer was directed to the only doctor around the table.

“This much we know,” she began.  “Nearly everyone with Alzheimer’s will eventually have the same symptoms.”

“Such as?” Jenny pushed.

“Memory loss, confusion, trouble with tasks that used to be so easy, and a growing difficulty in making decisions.  It’s a complicated thing, actually.  What we know is that the disease destroys the nerve connections in the brain, making it progressively more difficult to do ordinary things like walking around the house or swallowing and feeding yourself.”

When the next words were uttered, they came from a place of deep reserve: “But the end is always the same, right, Lizzie – death?”

Alberta’s tone suddenly filled the room with tension.  No one dared look at her for fear of falling apart.

“Look, we all know how this ends.  It can be tragic and ugly, remorseful and infused with anger.  But that is now up to all of us.  This isn’t just your journey, Bertie.  For a while, at least, it is ours as well.  We can’t change the outcome of what you will endure, but by all being together, we can alter the journey.”

The profound nature of these words had the effect of calming their emotions.  They realized that Fairborough was right – this was their path to trod.  They all looked at Alberta, who in turn looked directly at her old friend.

“How much time will I have before the disease takes me?” she asked quietly, bracing herself for what might be said next.

“Bertie, that’s not quite how it works.  It plays havoc with the brain but it doesn’t kill you.  A host of other ailments will strike in consequence of Alzheimer’s, and they represent the real threat.”

“Such as?” asked Jennifer.

“The most probable is pneumonia.  That’s because, as swallowing becomes more difficult, food or liquids can go down the windpipe instead of the esophagus, causing damage or infection in the lungs. Then dehydration and malnutrition become serious problems.”  She paused for a minute, looked directly at Alberta, and added, “We know the end, Bertie; we just don’t know the path that you will take there.”

That evening, after everyone had gone home, save Robin who retired to his bedroom, Alberta wandered the house, deep in thought.  She fired up her laptop and visited numerous sites regarding what she was facing, learning as she went.  Some key points struck her as relevant. 

61 percent of those with Alzheimer’s at age 70 are expected to die before the age of 80. Thirty percent of people age 70 without Alzheimer’s would be expected to die by age 80. 

  • Alzheimer’s is the only disease among the top 10 causes of death that cannot be prevented, cured or even slowed.
  • By mid-century, if a cure is not found, someone in the United Kingdom would develop the disease every 33 seconds.
  • In 2015, 15.9 million family members and friends provided 18.1 billion hours of unpaid care to those with Alzheimer’s and other dementias. That care had an estimated economic value of $221.3 billion.
  • Approximately two-thirds of Alzheimer’s and dementia caregivers are women. Thirty-four percent are age 65 or older.
  • In 2013, Alzheimer’s care cost $203 billion in Britain. Costs could surpass the $1 trillion mark by 2050.

She was saddened by the sense that such information carried an air of hopelessness.  She realized how difficult any cure must be to find when so many millions of people were claimed by Alzheimer’s.  On the other hand, there was some built-in encouragement concerning just how much research was being applied to the problem.

Her eyes tired from scanning the screen for over an hour, so she journeyed out to the garden, now bathed in the milk tones of a bright moon.  She had donned her Scottish wool sweater and gathered herself up in one of the upholstered chairs.  Looking around, she focused on all those things she had come to cherish – the birdfeeder for the swallows she loved so much, the faint sound of the small waterfall that Sandy had built for her, the large Alder Buckhorn trees that offered such scrumptious and full berries, and always, at the top of the hour, came the ringing of the bells from the ancient church tower.

Alberta found herself slipping into a state of sentimentality that filled her with warmth. She put off until another day the preparations she would have to arrange before she grew incapable of even the most basic tasks.  Instead, she drifted in and out of the past and the present – seamlessly, and with a sense of love.  Her life, she acknowledged, had been a good one – better than most – and she withdrew into those stages of her past that now filled her with a sense of accomplishment. Her degree from Eton, a successful writing career, her move into an editing position, and then, eventually, her esteemed role at Society. It had all been good, despite the challenges, giving her a sense of identity and dignity.

Her active mind roamed back even further to her childhood, the warm, cozy embrace of her parents and sister, and the sense that the world was full of wonder and mystery – just the enticing place for a young girl eager for life.  Curiously, Alberta realized she had been spending hours thinking about her childhood and her upbringing in recent months.  Have I already begun my journey into my past?she asked herself, having read enough about her disease to understand that the journey back was merely an essential component of its reach.  She thought of her weekly visit to her parents’ graves, which were situated only a few blocks distant, in the church yard. She felt a comfort in it, as if she were now closer to them than she had been in decades.

As an encroaching chill reminded her that it was getting late, her final thoughts ran to Robin and Jenny.  What good kids they had become, and honouring to their parents and upbringing.  She smiled, understanding that she would now have their companionship more than ever, whether or not she would realize it.

Her last thought before rising was of her husband – what they had built, what they had brought into the world, how her hand always seemed to be in his.  How they had loved!  Alberta was sure she felt her heart grow physically larger at just the thought of him … and them together.

“Well, Sandy, my dear, won’t be long now,” she said out loud, almost like a prayer.  “We’ve been apart long enough.  Be patient, my dear – I’m coming.”

With tears building in her eyes, her hand lifted the key from the chain around her neck and she kissed it gently.  She knelt down to reorganize the small stones in the special arrangement she had designed on the day of her husband’s funeral.  Her hands passed tenderly over their smooth surfaces, and she thought of the face she had seen in the elevator the day before.  Was it a sign?she asked herself. Of course, it was,she reasoned, and my task now is to heed it.

Alberta Alexander stood fully erect, as she always did, smiled at the stones, and moved quietly into the house as the church bells rang out their plaintive tones.