The novel portrays the challenges of early-onset Alzheimer’s disease (EOAD), a form of dementia diagnosed in individuals under the age of 65. While Alzheimer’s is most common in older adults, EOAD affects a significant number of people in their thirties, forties, and fifties, accounting for approximately 5% of all Alzheimer’s cases in the US (Mendez, Mario F. “Early-Onset Alzheimer Disease and Its Variants.” Continuum, vol. 25, no. 1, 2019, pp. 34-51). Symptoms demonstrated by one of the novel’s characters include memory lapses, confusion, and uncharacteristic flashes of anger, all aligning with the typical progression of the disease. Degenerative illnesses such as Alzheimer’s and dementia have been utilized in popular fiction to explore themes of identity, memory, and love, such as in Nicholas Sparks’s 1996 novel The Notebook and Lisa Genova’s 2007 novel Still Alice, both of which received movie adaptations.

The novel also addresses the genetic component of some forms of EOAD, which can be caused by mutations in specific genes. These genetic factors are explored through the central characters’ decisions about whether or not to undergo genetic testing after their father, Billy, is diagnosed with EOAD. Such tests, often for the APOE-e4 gene variant, can indicate an increased risk but don’t guarantee a diagnosis, presenting a difficult choice for those with a family history. Furthermore, the story touches upon the complex ethical debate surrounding end-of-life care for terminal patients. When Billy’s wife discovers that he has acquired pills for a potential assisted death, the narrative enters the real-world conversation around medical aid in dying (MAID). As of 2026, MAID is legal in over a dozen US jurisdictions, allowing mentally competent, terminally ill adults to request medication to end their lives. This form of healthcare offers agency to patients facing the loss of autonomy from a degenerative disease.