It was a premonition that proved true.  She came to learn this as she sat in Elizabeth Fairborough’s office a week following the Trout Point incident.  Alberta had undergone a series of tests at her physician’s request, and now looked at her friend as she delivered the results.

“For a woman of 81, you are in remarkably good health, Bertie, but the brain is another matter. Alzheimer’s is a progressive disease. Over a period of many years, symptoms will slowly become more severe, and a person’s overall condition will worsen. Each person experiences a different progression of symptoms over a different stretch of time, though many will experience slow-moving Alzheimer’s that takes years to progress. For some, it may seem that symptoms are progressing rapidly, and that’s what’s happening in your case.”

She paused, knowing this wouldn’t be easy.  “It doesn’t happen very often but, occasionally, the disease can jump light years ahead of the normal deterioration rate.  In your case, it is aggravated by some thyroid difficulty.  I think we can control that with medication, but, still, it is happening faster than I expected.”

Alberta listened, somewhat detached.  “I know … I’ve sensed it,” she said, confirming her friend’s diagnosis.  It’s not what I expected, but I need to be prepared, for the sake of the kids.”

Elizabeth rose and came around to sit in the chair beside her old friend.  “This is where it will start to turn difficult, Bertie.  The episode in the valley that you told me about was unusual in that it seemed to last for hours.  That’s unusual for someone as early into the process as you have been.  It means something else is going on.  The MRI results have helped a bit, but we have no way of knowing if we can slow down the deterioration.”

Alberta rose and walked to the window.  “This is what I hoped for, you know – a merciful demise.  I’ve done enough studying in the last few weeks to see how much it can take out of the caregivers, and I’ve dreaded that happening to Robin and Jennifer.”

“I understand that,” Elizabeth responded, sympathy clearly in her tone.  “The problem is that the decline can be so sudden that they may feel incapable of keeping up, of providing the care you require.”

“What are you suggesting?”

“Nothing – at least not yet. If things keep going at this pace, it’s likely you will end up in some facility that can provide the care you require, and at the level you require.  It would be the best for both of them.”

“Oh, Lizzie, I don’t want to leave our home – the place Sandy and I designed with such love.”  To Elizabeth’s surprise, the tears flowed rapidly. This wasn’t like her friend, who was usually so staid and polished.  Clearly, she was aware of the consequences.

“Okay, okay – I understand. Let me see what I can do about homecare. It’s a lot more common than it used to be, mostly to save hospital costs.  The important thing now is that I need to see you every week, Bertie.  I’ll come to you and guide you through it, but be prepared for more lengthy bouts of forgetfulness as the days wear on.  There are lots of little disciplines for you to undertake to keep it from declining quicker.  I will have to change your medications somewhat…

“And so it begins,” Alberta whispered, while facing out the window.

“Bertie, it’s probably been ‘beginning’ for years, we just didn’t know it.”

Alberta stood, saying, “I understand.  It’s not as though I haven’t spent numerous hours looking back over the years to spot those little beginnings.   But I just mean that I’m now facing my point of embarkation.  From this point on, things become serious, and I have to handle this with great care, Lizzie – youhave to help me with that.  This is going to be so difficult for Robin and Jen and I don’t want to add to their suffering.  I need to be strong and as collected as I can be.  I’ll count on your honesty to help me with that.”

“That’s my Bertie – ever strong,” Fairborough said, with a forced smile.

“For them, Lizzie, for them.”

“I don’t fully accept that,” the physician said, causing her patient to look up sharply.

“Look, if you want me to be honest, let’s start right now.  For the entire time I’ve known you, you’ve been the most collected woman I can remember.  Your capacity to focus is legendary and I’ve rarely seen your emotions tip over the edge. You are from strong stock and it shows in your bearing – in your being.  I suspect that if anything terrifies you, it is the possibility of having others witness you losing that self-dignity in real time and with difficult consequences.”

Alberta drew in her breath and lifted her chin.  “Really, how could it be anything else?  It’s who I am Lizzie and how I was brought up.  I was a young girl during the Blitz and it was in everyone around me – an entire population just getting on with things.  Getting back to work, singing songs in the air raid shelters, protecting the children, praising Winston Churchill, and always, always, putting the tea on.”

They both smiled at this, understanding that all this was part of English lore – a defining moment in the history and reputation of the nation.

“I can give you a lift home, if you can wait for half an hour,” Fairborugh suggested.

“No, but thank you, Lizzie. The kids are meeting me down the street at La Porchetta for lunch.  They’ll want me to fill them in on what we discussed.  It’s interesting about the newer generation, isn’t it?  They want to talk through everything, completely and unequivocally.  It’s all so different to the way we are, but they deserve to know what’s going on, since the caregiving will now largely be up to them.”

“I’ll be in touch about the live-in caregiver, but, until then, plan on seeing me every week.”

Their mother found Jen and Robin already tucked away in a corner booth, their car parked almost directly in front of the windows.

“Well, you two are here early,” she noted, seating herself at the edge of the booth.

“We thought we’d beat the crowd and grab a more private spot,” Robin noted.  “Why don’t we order and then you can let us know what Elizabeth had to say?”

Once they had decided on their meals, Alberta told them, in full, what her physician’s advice had been, and that her decline would become more precipitous in the coming months. “Elizabeth says there remains some professional disagreement on the stages of the disease, though she tends towards the opinion that there are seven altogether.”

“And they are?”

Their mother was suddenly flummoxed and did her best to mask it.  When she came up blank, Jen asked, “Did she give you some material that could help us, Mom?  I’ve been keeping a file.”

“My, that sounds important,” Alberta said, in an attempt at levity.

“It is important, Mom. We need to know best how to proceed, especially if you’re unable to tell us.”

Her son’s counsel caused her to feel somewhat ashamed of herself – both for forgetting and for treating things so lightly when it would be these two that would be with her on most occasions.

To make the uncomfortable situation worse, when the waitress came with the food and asked who ordered the Bruschetta di Montagna, Alberta replied, “Oh, that must be your order, Jenny.” When her daughter reminded her that she had made the selection for herself only minutes previously, she fell into an embarrassed silence.

“Mom, it’s okay. These are good things for us to go through and to learn from.”

All three were silent for some time before Alberta said, “I’m sorry, you two, and you’re right – it was nothing significant.  She reached out and grasped both their hands, smiling.  “Thank you for being so understanding.  I love you both.”

Over coffee, the conversation became more instructive and things settled down.  With things more relaxed, Alberta recalled the various stages her daughter had asked about.

“It seems that people with the illness follow something of a similar trajectory – no impairment, very mild decline, mild decline, moderate decline, moderately severe decline, severe, and then very severe decline.  For some reason, I have progressed through the early stages quickly, and what the event at Trout Point revealed is that I’m likely entering the moderate decline phase earlier than expected.  And yet I’m having an easier time conversing than many would have in this stage, so that’s a good thing.”

Robin put his cup down and asked, “Can you tell us about this ‘moderate’ phase?”

“I think so,” she responded. “Short-term memory begins to fail – little things, like forgetting where I left my boots or what I ordered for lunch today.”  This was said in a way that produced smiles all around.  And we’ve all seen that I can’t really manage my budget, or even money, lately, which I presume is why you’ve taken that job on, Robin.”

“And what comes after this stage?” Jennifer inquired.

“The scary stuff, I think. Difficulty dressing or doing basic functions like cooking or perhaps climbing stairs.  After that, I’ll eventually need help going to the bathroom – something that will likely embarrass me more than anything.” The last few words were uttered while she looked at Jenny with what appeared to be a mild shame on her features.

“Mom, not to worry. We’ll manage.”

Robin wanted to ask about the last two stages – severe and very severe – but opted to remain silent. The time had been difficult enough for his mother.  They would cover it another day.

“I think that what matters right now is that the early stages have developed quicker than we thought and we don’t know how that will skew the rest of the timeline.”

In the back seat on the way back to Clerkenwell, Alberta looked at the familiar landmarks and then some of those she had forgotten in recent weeks.  She had to address the possibility that her demise – her death – seemed to be nearer than she was anticipating.  More than anything she must keep her wits about her as long as she could.  And stronger than that was her desire to maintain her self-respect – perhaps a difficult and overpowering task, considering that she might not even know herself.