Elisabeth is Missing

Posted in Book Reviews on 14th Aug 2015

ACNRJA15-21

Author: Emma Healey ISBN: 0241968186 Published by: Penguin Price: £4.99 Pages: 288 Reviewed by: 
Dr Tom Hughes, Consultant Neurologist, Cardiff, UK.

In the prologue to this book, Maud finds half a compact mirror that used to belong to her sister Sukey, who disappeared just after the war. The story describes how Maud, despite advancing dementia, leads her daughter Helen to crack the mystery of Sukey’s disappearance. The sleuthing is complicated by Maud’s growing conviction that Elisabeth, a friend in whose garden the mirror discovery was made, has also disappeared. The ensuing dramas unfold in parallel, but in chronologically opposite directions – the reader and protagonist, each experiencing their own versions of delirium, moving to and fro between the parting narrative furrows.

The author’s style is appealing, and vividly conveys Maud’s growing sense of visceral certainty that embodied within her is information that would explain Sukey’s disappearance. She is even more certain, however, of her decreasing facility to remember and to communicate any such information.

Maud’s house is littered with notes-to-self – paper plaques of remembrance designed to release her from the entanglements of her condition, which must be Alzheimer’s disease. The ignominy, the drudgery and the rage born of her enfeeblement are juxtaposed with the light comedy and social farce of a misfiring intellect. The author’s credentials shine the brightest as she describes the brutal reality of life as a carer, with no warning of, or respite from, the next bedroom or restaurant ransacking. The incremental ratcheting-up of dependence without gratitude reduces daughter Helen to tears of frustration and bereavement. She does have the support of her own daughter, Katie, who defuses and diffuses both the harrowing and hilarious alike. Her brother, by contrast, seems unencumbered by any awareness of what might be his responsibility or of the simmering tensions within the family, as he pops in to pass comment.

The tempo of Maud’s condition sets the rhythm of the book (try humming the ‘Jaws’ sound track, but start much earlier, and hum much more slowly). The nature of the condition is also a useful plot device whereby certain events become nail-biters, terrifying for Maud simply because of her inability to interpret: I will never again look at or listen to a slow-moving stair lift in the same way.

As a cognitive haze starts to form denser clouds over the islands of preserved memory, the race is on. Can Maud find and collect the dots, and join them, before debility supervenes? Increasingly, she lacks the ability to hold in her mind the information required for deduction and, with each page-turn, a satisfactory conclusion seems less likely. The silver lining, however, is that as her ability to retain new information diminishes (including important information about Elisabeth, presumably), more attention can be devoted to her relatively preserved long-term memory. Despite living in an increasingly confused present, she simultaneously re-lives her own long-term memories, often vividly and with life-affirming clarity. Her descriptions of the chaotic post-war years, of the close bond she had with her sister, and of her parents’ reaction to their daughter’s disappearance give this part of the tale a raw and gritty ‘kitchen-sink’ feel. The addition of a significant maniacal wandering woman and a brooding lodger provide the post-war plot with a necessary dollop of intrigue.

With its mysteries solved, it is this novel’s upgraded account of experiencing dementia as a patient and, in particular, as a carer that lives on in the memory. Do carers deserve to be given a diagnosis even more than the patients? Do we need the same approach to the diagnosis of early dementia as we do to early pregnancy, with the dementia equivalent of antenatal classes and briefings from the beginning about the varied experiences and the differing means of delivering care as the final date approaches?

The more the general public reads about the natural history of dementia and its effects on patients and on those closest to them, the better prepared society will be for the increasing prevalence of this affliction: this is a book for everyone.

ACNR 2015;15(3):21.  Online 30/07/2015

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