In fact,such a tremendous effort for someone who is approaching dementia. As a lecturer, a researcher and live among educational institutions, that make her able to write her experiences. Unfortunately, I just read it halfway when the white ants got it first. Definitely going to replace it. ( )

William F. Buckley once said that ninety-nine people out of one hundred are interesting, and the one hundredth is interesting because they aren't. This awkward book, a memoir issued under the guise of being an account of the progress of the author's dementia, gives that formulation a good hard wobble. An odd combination of quasi-academic disquisitions on neurophysiology, a field in which she adduces no qualifications, psychobabble about the nature of individuality, extended accounts of how she likes to wear her hair, color combinations in her clothes, memoirs of her girlhood on the high veldt of South Africa, and 'ask me about my grandbaby', I pity the fool who ends up next to her on a train.

All of which is unfortunate, as she begins the book promisingly by saying she's setting out to answer two big questions, viz., why she can still write effectively, if laboriously, and whether her short-term memory problems have extended to her long-term memory. Unfortunately, the first path leads us down the neurophysiology path, and the second finds her asking her siblings if their memory of a repellent incident from her youth matches her own. Her siblings are no masters of expository prose, for the resulting torrent of Twitterings left me wondering about said sibs ability to formulate a coherent sentence in English, and no wiser about her long-term memory. And as for the rest of her memoir, her life in apartheid-era South Africa was sporadically interesting, as were her encounters with the United States (I was particularly interested by her year as an exchange student at the rural Iowa high school where my father used to teach, albeit a decade before she attended). But all this navel-gazing about her fashion sense and hairdo preferences was tedious enough when she was going on about herself, but when she started in on what her grandkids like, it was all too much. On topic, she can be mildly interesting, mostly in some interstitial bits called "Dementia Field Notes", though not all of them are actually about her, and a digest she includes of excerpts from others' accounts of dementia, notably John Bayly's memoir of his wife, novelist Iris Murdoch, and her dementia, which reads like the book I wanted to read, and which I'm off to find a copy of. ( )

In this memoir, Saunders delves deep into her experiences with dementia and the effect its progression has on her loved ones, on her memory, on her daily activities, and on her sense of self. Combining personal recollections from her life (and examples of how she's attempted to resolve her own uncertainty about the veracity of these memories),"field notes" about her daily experiences with the symptoms of dementia, and detailed information about the brain anatomy and physiology as they relate to learning and memory, Saunders brings us along on her journey.

For the most part, it's a journey I enjoyed traveling with her, and not just because I enjoy reading about Salt Lake City, a place I love and once, for a short time, called home. There were a couple of sections that I found tedious, like the email back-and-forth with her siblings, but that might have been the result of the format of that particular section not translating well into audio. Similarly, I learned during the acknowledgements that there are photos and illustrations throughout the book that I missed listening to the audiobook. I'll have to pick up the hardcopy and see what I'm missing.
( )

Memory’s Last Breath is not exactly the book of field notes its subtitle suggests. Yes, it contains some qualitative written observations about Saunders’s decline in cognitive function as she goes about her daily life, and yes, these do assist the reader in understanding the lived phenomenon of the disease process. However, the author also includes a number of miniature essays on neuroscience topics, including brief bits about the discipline’s history, an overview of the lobes of the brain, some notes on how memory works (a more slippery, less reliable thing than many people know), trepanation (the ancients’ practice of drilling holes in the skull—some of them sizeable—apparently to relieve pressure and pain), and a number of other related brain-science matters. Saunders refers liberally to the work of Michael Gazziniga, a prominent neuroscientist and head of the SAGE Center for the Study of the Mind at UC Santa Barbara, so if you are familiar with his work or that of other popularizer of neuroscience findings, you won't find much new here. The author also makes frequent reference to John Bayley’s memoir(s) about his wife, philosopher and prolific novelist Iris Murdoch. Apparently, Murdoch’s last book, Jackson’s Dilemma, signalled her intellectual decline well before she was diagnosed with Alzheimer's Disease. Meticulous analysis revealed that the vocabulary in the last novel was less rich and varied.

The largest part of Saunders’s book consists of autobiographical material, which is presented in roughly chronological order. Beginning with her early life on her paternal Afrikaner grandparents’ farm in rural South Africa, Saunders also provides some details about her first year at boarding school, her time in Iowa as a high-school exchange student, a few tidbits about young men she briefly dated at university, and some information about how she met her husband, Peter, there. Early married life and parenthood are glossed over fairly quickly, but there are a few interesting anecdotes about the difficulties of life under Apartheid in South Africa. Saunders also includes a brief biographical sketch of her mother, an artistic social worker, Susanna Steenekamp, who, after a traumatic brain injury, developed dementia late in life.

Saunders says she writes memoir to flesh out her shrinking self with former selves and so that she “won't die of Truth”—by which I imagine she means the knowledge of the eventual erasure of her personal memory and identity. Strangely, the reader is provided with few details about relationships with siblings and school friends. As a result, I’m reluctant to call this writing “memoir” as there is minimal emotional resonance or “affect” to the material.

As a young woman, Saunders studied science at university. Though largely banal, some of the autobiographical details she provides underscore that her parents placed a high premium on intellectual endeavours and were proud of their eldest daughter’s academic accomplishments. A few years after Saunders, her husband, and young children left their troubled homeland for Utah in 1984, she embarked on a Ph.D. in English, ultimately landing a job as an administrator in the gender studies department at the local university. Memory’s Last Breath is laced with quotations from the likes of John Locke and snippets of poetry from Shakespeare, e.e. Cummings, and (perhaps not too surprisingly given her academic discipline) Adrienne Rich and Anne Sexton ( feminist cult figures), among others. I sometimes found these references and allusions rather forced--distracting and distancing--but it is understandable that an academic forced into early retirement by neurodegenerative disease would cling to some scholarly trappings to show that not everything has yet fallen away.

Saunders mentions in a footnote early in the book that several members of her family are on the high-functioning end of the autism spectrum. This explains the character of a rather tedious e-mail discussion between Saunders and her siblings that she includes in her book. It concerns what each of the grown children recalls about a memorable childhood encounter with a lethal puff adder and its 39 wriggling offspring. Each family member recalls different details: a slightly different “truth” about the experience. Maps are drawn, electronically forwarded, and dissected—all of this ultimately intended to prove how slippery memory can be. Memories, Saunders notes, are not formed and pristinely maintained; rather, they are formed and then rebuilt, often delicately transformed, every time they’re accessed. “Our family’s experience in comparing individual memories, “ she writes, “ is congruent to my finding that the brain refreshes the ‘truth’ every time you retell it.”

While the story of the puff adder illustrates an important point, some of the details Saunders includes in her field notes and biographical sections do not. A field note about laying out clothing and jewelry morphs into annoyingly long set of associations about a now-extinct subspecies of zebra. Sancho Panza, Eeyore, Einstein, Darwin, and a dice-throwing god also figure in the mix of associations. And don't get me started on Saunders’s wedding gown, which gets more play than the ceremony or the guests. Again, the “feel” of an important day in Saunders’s life is somehow lacking. It’s hard to know if the preoccupation with minutiae (that are of no great interest to the average reader) has always been part of Saunders’s (rather Asperger-y) personal cognitive style, if it is some odd manifestation of her incipient dementia, or if she includes the details because she is simply happy to still remember them. Whatever the case, I wish some of them had been edited out.

For me, one of the most interesting, new pieces of information about dementia gained from the book concerned some sufferers’ retention of higher-order abilities. In her research, the author discovers that “persons having spent a lifetime mastering particular knowledge structures and intellectual skills may retain access to this expertise even after becoming utterly dependent in daily activities.” Saunders marvels at her continued ability to write, for example, even as her abilities to negotiate aspects of day to day life (such as dressing, driving, and finding her way around a department store) decline.

I cannot say I was entirely engaged by Memory’s Last Breath. I was surprised at how tedious the autobiographical components often read, and more than once I considered abandoning the book. The field notes themselves, the observation and recording of the evidence of decline, and Saunders’s love for her husband, who will likely be burdened with her care, are the most affecting aspects of the book. The last section of Memory’s Last Breath is particularly notable for its description of Saunders’s and her husband’s clear-eyed and courageous preparation for her end-of-life care, which acknowledges the potential for euthanasia or doctor-assisted suicide.

The writing of any book is an accomplishment. That a vital woman afflicted with vascular dementia has been able to produce a readable, reasonably organized one that conveys something of the lived experience and heartbreak of identity-erasing condition is an achievement indeed. ( )

Read slowly to page 167 and stopped. Not bad, but not compelling: it's a mixture of neuroscience and personal experience, including a lot of childhood and family stories, with little momentum in the present.

Quotes

The discovery that "memories are not formed and then pristinely maintained," as neuroscientists used to think, but rather "formed and then rebuilt [reconsolidated] every time they're accessed" has far-reaching implications: every time we think about the past "we are delicately transforming its cellular representation in the brain, changing its underlying neural circuitry." So, a memory is changed every time it is remembered. (31)

"History is that certainty produced at the point where the imperfections of memory meet the inadequacies of documentation." -Julian Barnes, The Sense of an Ending (35)

...a narrative is true "as remembered and affirmed by the storyteller." (Moth Radio Hour's disclaimer) (37)

...early childhood impressions, particularly those laid down before the acquisition of language, are...impossible to erase. (75)

When we exit puberty, our brains will never again form new connections at the rate and to the extent they do while we are teenagers. Our transition to adulthood is heavily governed by the knowledge and skills the prepubescent child has already stored up and connected to related areas of control. (82)

Michael Gazzaniga points out that when we do not have enough cues to explain a situation, we very seldom say, "I don't know what is going on." Instead, "the human tendency to find order in chaos" causes our brains to fill in conspicuous gaps or loose ends so that "everything fits into a story and is put into a context." (144)

According to the Alzheimer's Association, "an older adult caring for another with dementia has a 60 percent chance of dying before the person they're taking care of because of the stress." (155)