EVERY NOTE PLAYED

“Demoralized, pathetic, emasculated, dying”—such is the state of a classical pianist afflicted by a fast-moving, incurable disease. But it’s not the end of the story, rather the beginning of a parallel journey, in neuroscientist Genova’s (Inside the O’Briens, 2015, etc.) fifth work of fiction.

Having made her reputation with novels about Huntington’s disease, autism, and, most famously, Alzheimer’s—Still Alice (2009), which was turned into a movie with Julianne Moore—Genova now turns to the merciless degenerative disease amyotrophic lateral sclerosis. The unsuspecting sufferer is Richard Evans, a renowned musician for whom the irretrievable loss of muscle control begins with paralysis in his arms, denying him both the joy and life’s purpose of playing music. But as important as Richard’s career is, it’s his emotional life to which the larger part of the book is devoted, specifically his failed marriage to Polish immigrant (and equally talented pianist) Karina, his distant relationship with his daughter, Grace, and his unresolved feelings toward his father, who never valued Richard’s gift. While charting Richard’s physical decline with her customary and precise mustering of medical symptoms, facts, treatments, and equipment, Genova appears equally interested in exploring the psychological ramifications of Richard’s prognosis. In the limited time remaining to him, Richard and Karina need to find a way to apologize and forgive each other for their individual failings in the marriage; Grace needs to understand her father’s regrets about his inadequate parenting; and Richard must come to terms with the damage his own father inflicted. Thus the novel has contrapuntal themes—the body’s decline matched with a different struggle, toward psychic reconciliation for Richard, and Karina too.

While undeniably formulaic, Genova’s latest is one of her strongest—more internalized, sometimes slow, but an eloquent and touching imagining of how a peaceful terminal place might be reached.