The primary story line focuses on the four-year period over which Jake progresses from early Alzheimer’s dementia to oblivion. The novel, however, covers most of Jake’s life. Two narrations become apparent, both in the third person, but the narrator is not identified. One narration hews closely to Jake’s dementia experiences. The other widens the scope on Jake’s experiences to provide details on his upbringing, family, occupation, and dreams. This narration also corrects factual errors and solves some mysteries arising from Jake’s reporting. The two narrations roughly follow the structure of the novel. Jake’s dementia experience and its impacts comprise the first part of each chapter while the second part is a “story of” a broader aspect of his life and history.  

The author, Samantha Harvey, imagines what it could be like to experience Alzheimer’s dementia from its early stages to the time when there is nothing much left of memories or cognition. She also imagines what it could be like to perceive the onset and progression of one’s own dementia and to intellectualize it.  

In Harvey’s conception of the dementia experience, it’s not that memories and facts are just unavailable, but that they can come back as independent agents to cause confusion, disorientation, and fear. The very first line in the book sets out this idea: “In amongst a sea of events and names that have been forgotten, there are a number of episodes that float with striking buoyancy to the surface. There is no sensible order to them nor connection between them.” (p. 1) In another angle of this conceptualization, Harvey writes that for Jake, “reaching back into memory is like putting his hand into a box blindfolded, knowing there are objects but not knowing quite what they are.” (p. 342) She places this concept into scenes that render specific experiences such as the following example:

What frightens him is the way objects rush and trip over themselves to support his confusion. He looks around his car and tries to remember what make it is; he cannot. He opens the window to feel what month it is. It isn’t a month. There aren’t months. There are just happenings, a lack of signposts. (p. 29)  

Harvey takes us the next step past imagining what it could be like to experience dementia to what it could be like for a person to know he or she has dementia. Jake could sense dementia creeping up on him:  “Confusion passes across him, across his skin. He can feel it these days as a bodily sensation not unlike a rash. He wants to itch at it.” (p. 40). Being more specific at another time, he says, “I feel like all my wires are being unplugged one by one. No, not even in an order, just unplucked.” (p. 189)  

Harvey also imagines that people with dementia can retain enough cognitive ability to consider their dementia status into latter stages of the disease. Eleanor, Jake’s life-long friend and now caretaker, at one time says to him, “You’re gone, Jake. Gone.” He responds, “Going.” (p. 311) And, based on what he has been told by medical people and what he has sensed himself, he’s able to figure that “his demise is reassuringly predictable.” (p. 122)  

Though Harvey imagines the dementia experience as the loss of connection among memories and facts, she goes further to suggest that there can be structure to how someone with dementia thinks about it. She uses entropy as an explanatory structure for Jake’s predicament: “Order will be a dream he once had that has melted like glass, slowly and quite imperceptibly.” (p. 122) As an architect, Jake understands entropy. He compares entropy as it explains how a house eventually becomes a pile of bricks to entropy as it explains how a mind eventually becomes a pile of memories, facts, and instructions. His job as an architect was “making a pile of bricks a house,” and therefore his personal project was making a pile of memories, facts, and instructions a mind, even though he knew that the effort was “just to delay the moment of losing.” (p. 44)