I didn't know what to expect from this book. A book about Buffalo, NY (a depressed town) wasn't very promising. But I tried to keep an open mind. This novel is about a young man in his late twenties named James whose mother is in the grips of ever worsening dementia. James finds himself struggling with both the physical and mental decline that accompanies the disease - his mother is in a nursing home where she receives 24 hour medical care and hygiene care. He is keenly aware of the irony of the situation - his mother was a nurse who not only dealt with and cared for people with dementia and Alzheimer's Disease but also advocated for the right of the patient to make all of end of life cares including when to kill themselves. He also worries about his father, who now lives alone in a big house in Buffalo, visiting his wife everyday and getting older everyday without he (because James lives in NYC) or his sites (who is in the Pacific Northwest) around to help.
I didn't really like James all that much but I didn't think that I was supposed to. On some level, I empathized with him. He drinks way too much and is unsuccessful by conventional definitions - while he longs to write the Great American novel, his employment in this novel involves him wiring smarmy one liners for a greeting card company. His one seemingly redeeming quality, was his dedication to his mother - he constantly agonizes over what she would want to see happen to herself now with the disease, he carefully flosses her teeth after the meals he attends with there and once, when she has to be changed after going in her adult diapers, he attempts to convince the nurses that he should be allowed to help them change and clean her.
I felt that this book was one way of poignantly presenting a side of the physician assisted suicide debate by blending what the life of someone suffering from a terminal and degenerative disease like Alzheimer's or dementia with a little bit of the science (in the voice of James' mother ironically, who wrote frequently about P.A.S. before she became ill). He doesn't offer a specific answer as to whether it is right or wrong, but I got the sense that he was sympathetic to the cause if you will. It was a wonderful novel and I hope that he writes more soon!