Found Stories of Losing Memories

1. Dad’s not all there anymore
2. Bird in a Cage
3. Little Josephine: Memory in Pieces
4. Heavy Snow: My Father’s Disappearance into Alzheimer’s
5. At a Particular Age: Heavy Snow Revisited
6. Sea Sirens: A Trot & Cap’n Bill Adventure

Book Reviews by Kevin Wolf

The graphic medicine works reviewed here are often—and rightly so—from the caretaker’s perspective and the outward manifestations of the patient, but not the patient’s thoughts or first-person accounts. Some artists of these works use surrealistic imagery to guess at the patients’ inner life. The primary medical topic covered in these graphic works is Alzheimer’s and other dementia-related diseases. I listened to a talk on “Hallucinations and Delusions Associated with Dementia-Related Psychosis: Understanding the Prevalence, Neurobiology, and Consequences” sponsored by ACADIA Programs-More Than Cognition. The talk provided statistics (e.g. about 5.5 million Alzheimer’s disease patients in the U.S. (2017)) and neuropsychiatric symptoms before and after diagnosis (e.g. before: depression, social withdrawal, paranoia; and after:  agitation, wandering, hallucinations and delusions). I review six books here, which includes two fictional tales (Dad’s not all there anymore and Sea Sirens) and two that provide different versions of the same memoir (Heavy Snow and At a Particular Age). The last two are memoirs: one of a nurse treating a dementia patient (Little Josephine) and the other an award-winning granddaughter’s story of her grandmother (Bird in a Cage).  These stories are often poignant and represent some of what families and health providers go through caring for dementia-afflicted patients.

In the non-illustrated fascinating book Advice for Future Corpses (And Those Who Love Them): A Practical Perspective on Death and Dying, Sallie Tisdale explains that those who are dying often signal their impending demise. For example, they might talk to someone who has already died as if that person is still alive; or they might talk about taking a ride to somewhere new that their dying state seemingly wouldn’t allow; or they’re reliving some vivid event in their past. And those around the dying might not understand the meaning of what they’re being told. Perhaps only after the person has died will they make the connection to what they had said. Something similar occurs in some of the works reviewed here.

A person who’s losing their memories because of dementia or Alzheimer’s is going through a kind of dying, where the life they lived is disappearing from their grasp. This may lead to frustrations, as memories are lost; while other family members are trying to understand what’s going on and what to do next. Alternatively, it’s as if the end of life is the mirror image of what occurred in infancy/childhood. In infancy/childhood you start with a mostly empty—though already filled with genetics and predispositions—vessel, your brain, and slowly fill it with nurture and education. While at the end of life for those losing their memory it’s the slow undoing of knowledge, and perhaps the near-emptying of the vessel that was their memories, knowledge, skills, and so on. For their children it might include a role reversal of becoming “the parent” or difficulty leaving one’s parent at a memory-caring nursing home. In childhood the hope is in fulfilling one’s potential, while for Alzheimer’s and dementia patients the hope is in comfort, support, and perhaps a time to reflect upon their history; and rarely the ability to resolve long-standing relationship issues, which are now beyond the ken of the dementia patient though on the mind of their (often) child.

According to OECD (Organization for Economic Cooperation and Development; 36 countries), 2.3% of those age 65-69 and 42% of those age 90 or more have dementia. From the U.S. Department of Health & Human Services’ National Institute on Aging, Alzheimer’s disease is named after Dr. Alois Alzheimer, who found in 1906 an autopsy showed abnormal brain tissue (now called amyloid placques and neurofibrillary) of one woman who suffered memory loss, language difficulties and unexpected behavior. Other dementia-related diseases include Lewy Body dementia (see review of Dad’s not all there any more, below), vascular dementia, frontotemporal disorder, and mixed dementia. Dementia’s cause and cure are currently unknown.  Two books (Dad’s not all there anymore; and Little Josephine: Memory in Pieces) provide a few resources (given later) for their readers.

Here are the dementia-related book reviews.

Dad’s not all there any more

This mini-comic-like—stapled pamphlet with firmer cardboard cover—unpaginated pseudonymous tale tells the story of Peter afflicted with Lewy Body Dementia (LBD) as told by his son, John G., his wife, Sue G. and health care providers who can’t prevent Peter’s memory from slipping away from him. Through these characters that speak of their father and husband, Alex Demetris, the author of Dad’s not all there any more, provides Peter’s decline from initially having Parkinson’s disease and eventually LBD. I recommend this short work.

In this short story metaphorical imagery abound. The cover of Dad’s not all there any more provides a metaphorical jigsaw puzzle overlaid on Peter’s head with one piece missing; that piece on his forehead behind which is the brain’s frontal lobe that controls our behavior, intelligence, movement and memory. And in its place is an image of one of Peter’s delusions: a young girl in pigtails. Since this is a fictional work, the author is able to show what Peter sees in his delusions. In the back-cover’s flap is the missing piece. The title page shows a hanging scale that gives equal weight to the brain and Peter (image below); with his Parkinson’s balance issues treated with medications. The author pictures the Lewy body protein as blobs of proteins metaphorically mucking up the old-timey phone operators trying to make connections in the brains.

Though written with pseudonyms, some specific timing of events is provided. Peter is diagnosed with Parkinson’s disease in 2003 after surgery for gall bladder removal; and in July 2007 he’s diagnosed with Lewy Body Dementia (LBD).  For Parkinson’s he was given an unnamed medication which allowed him to not stiffen up. The Lewy body proteins can only be found during an autopsy because it looks similar (brain atrophy or shrinkage) to Alzheimer’s on scans. There’s no cure; with subsequent hallucinations, confusion, and gradual loss of memory. There is a loss of ADLs (activities of daily living; e.g., eating, bathing, toileting). The author is from the United Kingdom (UK) and uses the phrase “carers” which would be called “caregivers” in the United States. John is upset when he helps his father with toileting and dressing. This tale shows the gradual deterioration of Peter; losing his independence and needing to move into a senior living facility, where he could be cared for by professionals and allow his wife and son to care for themselves.

Some of the pages from chapters two and four of Dad’s not all there anymore were posted at graphicmedicine.org. For more information about LBD, the author provides websites of two charities: Lewy Body Society www.lewybody.org in the United Kingdom and Lewy Body Dementia Association  www.lbda.org in the United States.

Alex co-authored Grandma’s Box of Memories: Helping Grandma to Remember.

Bird in a Cage

Bird in a Cage by Rebecca Roher, though includes several medical topics, it is primarily a memoir of family history centering around the author’s grandmother, Grandma Wylie. This story covers reminisces of several generations, events at a Canadian lake cottage, and Grandma Wylie’s health and end-of-life care. Grandma Wylie’s dementia was brought on after a tragic car accident, so could’ve been from a traumatic brain injury (I surmise, though I’m not a diagnostician). Bird in a Cage is a gentle story asking the reader to join the family (e.g. Rebecca writes “grandma” and not “my grandmother”). There are scenes in hospital and a senior living facility. It’s drawn in pencil, which gives a just-lived touch to the design. Some events are presented at length while others are left for the reader to fill in. I highly recommend Bird in a Cage.

Family history includes an adventurous life and sometimes finding difficulties growing up in Grandma Wylie’s house (e.g. she needed a break from the family for a time). There are summer outings to the family’s Silver Island in Muskoka Region of Toronto Canada to the north of Lake Huron. Family life was filled with music, socializing, natural surroundings, and simple living (e.g. no electricity); they created their family “sing-songs” on the island with adults and kids alike participating. Rebecca jumps in time and place between growing up, family history, and Grandma Wylie’s mental and physical difficulties.

The cover shows Mary (Grandma Wylie’s real name), in a cage, but no allusion to being caged is provided in this graphic work; perhaps it’s her memories locked away. She got the nickname Grandma Wylie from her dog, Wylie. Many of the stories remind me of my own grandmother; they both loved crossword puzzles, had signature food creations, and gave their grandkids hard candies (lemon drops for Rebecca; mine were coffee candy). There were birthday outings and sleepovers. Religion was flexible with the author growing up Jewish, decorating Christmas trees at Grandma Wylie’s and Grandma Wylie joining the Baha’i faith in adulthood (“It’s a religion based on the spiritual unity of all humanity, acknowledging divine messengers from other religions & focusing on peace [50]”) sometimes to the detriment of her children.

At age 82 (~2003) Grandma Wylie was hit by a car, and suffered a brain injury. While unconscious for days, she was restrained from pulling out her oxygen (nose) and venous tubes. After reviving she hallucinated, thought her deceased husband was with her, that she was eighteen, and played nonsense words in Scrabble. Rebecca recalls her mother (Beth) arguing with an insurance company—since 1957 with revisions in 1966 and 1984, Canada has had a national health care system (called Canadian Medicare) with comprehensive coverage and some provincial variations; what might be covered with private insurance includes: prescription drugs, private hospital rooms, rehabilitation and ambulance services. Grandma Wylie moved into a senior living facility. An occupational therapist helped improve her memory. She’d sometimes wander away and visit her prior home and sit in its garden. She was diagnosed with early onset dementia. Family dynamics with Grandma Wylie’s daughter becoming the parent for Grandma Wylie’s child-like behavior are on display.

Later Grandma Wylie breaks her hip and remains wheelchair dependent. The author and her mother consult Grandma’s doctor, “How do you know if she’s in pain? Are they giving her any pain meds? How long do you think she has?” (43; 63-65) We learn stories of growing up with Grandma Wylie as a mother; about her allergies, about her father’s medical troubles, Grandma Wylie’s touching, familial end-of-life care, and posthumous revelations.

Medical issues for two other family members are presented. They’re for Rebecca’s Aunt Christine (not discussed here) and Grandma Wylie’s father. Her dad was on barbiturates through the end of his life after he was gassed in WWI. I tried to find the connection between being gassed in WWI and potential barbiturate use. A University of Kansas article indicates the weapons-of-war gases—which were violations of the 1899 Hague Convention—in WWI were tear gas (by France; either xylyl bromide or ethyl bromoacetate); symptoms resolve after 30 minutes), chlorine gas (by Germans; can lead to death or permanent lung damage; water soluble so water-soaked cloth over mouth is protective), phosgene or diphosgene (German; carbonyl dichloride or trichloromethane chloroformate, deadly from pulmonary edema (lung fluid)), and most commonly was ‘mustard gas’ (2-chloroethyl sulfide; chemical burns/blistering, respiratory problems, 2-3% died).   But I couldn’t find a connection to barbiturates as a curative to gas poisoning. I did find an article that connected barbiturate (first synthesized in 1860s) against some WWII combat neurosis (now called PTSD) victims.

Rebecca received her Masters of Fine Arts (MFA) in 2015 from the Center for Cartoon Studies (CCS) in White River Junction, Vermont. CCS organized the 2018 Graphic Medicine Conference. Bird in a Cage—as a 20-page comic book—won the Best English Comic in 2014 by the Expozine Alternative Press Jury.

Little Josephine: Memory in Pieces

Little Josephine: Memory in Pieces was first published in 2012. It’s a memoir by Valérie Villieu (visiting home health nurse), surrealistically drawn by Raphaël Sarfati, translated from French by Nanette McGuinness, and stars Josephine, a gentle mind-traveling dementia/Alzheimer’s patient. Villieu helps patients with memory problems and some activities of daily living (mobility, washing, providing medications, etc.) difficulties in order to delay their moving from home to institutional care. We learn the tasks nurses, caregivers, and conservators are supposed to do; and how much Villieu went beyond the norm for Josephine. Other issues occurring in Little Josephine include legal conservatorship, loneliness, building trust between patient and nurse, empathy, the benefits of informality over professionalism, and whether time has meaning any more. In this review, I will use the last names of the artist and nurse/writer, acting in their professional roles, and Josephine’s first name, as the one cared for or portrayed. I highly recommend Little Josephine.

Villieu alone often uses the pronoun “we,” in translation, when helping Josephine, as in “we stopped by…,” “we made her breakfast …” which could be her personal pronoun preference or a translation issue. Villieu would visit Josephine 2-3 times per day starting early to get her ready for the day—because the caregivers came by at noon to provide lunch—and again in late afternoon to get Josephine changed into her night clothes. A caregiver would come again in the evening to provide dinner. In the evening Villieu would chat with Josephine. This gave Josephine a pattern to her day. Villieu had some frustrations working with Josephine’s conservator—person or agency assigned by a court to take legal responsibility for Josephine’s care, shelter, finances, food, health, and so on—because they had 65 people to conserve and wasn’t very responsive to Villieu’s queries—demonstrating its bureaucracy by repeating the same overwhelming panel—even during a crisis! The in-home caregivers—drawn as walking dogs—were problematic too because they changed so often and their training to work with the elderly was deficient … until an excellent, patient, maternal caregiver (Sandra) is finally found. Caregivers are paid minimum wage often with little training so elder abuse for many occurs or the caregivers might feel exploited; the latter for Sandra. Racism might arise from the patient or their family. Josephine has bouts of paranoia, obsession (e.g. hiding things, scratching her forehead, collecting random papers and old photos), delirium and apathy with some coherence in between. Josephine’s fragility and vulnerability lead to many people watching over her.

This work is in color. Symbolic of disappeared memories, there is a persistent image of a clean slate by showing a lone blank central panel or multiple blank panels that’s left to the reader to fill. We with Villieu slowly learn Josephine’s life story including her relationship with her father. Sarfati, the artist, sometimes uses the panel border as a ledge for Villieu to talk her off of resulting in a trusting relationship.

The cover art is a throwback to Winsor McCay’s Little Nemo in Slumberland by showing Josephine whimsically reading and enjoying papers and a butterfly flying by as her bed with flowing long legs walks over Paris. In the early 1900s, while sleeping (McCay’s) Little Nemo had fanciful, surreal, amazingly drawn colorful—with racially ignorant stereotypes—nightly travels often ending with his parents finding him with scattered bedding fallen on the floor wondering if his dreams were real. Josephine is living in her own disorganized, mysteriously imagined (by Sarfati) diurnal world, sending her on travels only meaningful to her.

The graphic work includes a few photographs of Josephine’s clothes. Josephine had a stuffed dog and bear for companions joining her for meals, on walks, and at bedtime. Carrying a doll or stuffed animal for comfort by dementia patients is common. For example, a friend’s mother had carried around and cradled a baby doll after losing most of her memories. Other imagery by Sarfati symbolizing Alzheimer patient’s inner struggles includes missing puzzle pieces, Josephine floating on a disk, and multi-panels superimposed over the x-ray of a skull. When Josephine eats in a café, she’s drawn in the middle of circa 1950s photographs.

The writer tells us early on, “The city [Paris], changing family structure, and increasing number of people with neurodegenerative diseases … make people more vulnerable and the visiting nurse’s role has expanded beyond healthcare. … We have to take responsibility for overall care, like you would with a parent [unpaginated, so I can’t give quote’s page number].”

When first meeting a patient, Villieu always has the same question: will they accept help? At times home caregivers either didn’t pay attention to Josephine’s lack of eating or willfully fabricated that she was eating in the care logs kept. The reader gets to feel frustrations of living under conservatorship when Josephine leaves her apartment after Villieu finally gets permission from the conservator to buy new glasses, whose lens had cracked six months before. Josephine wasn’t willing to go out without being able to adequately see.

Villieu visits Josephine for more than three years. Little Josephine’s end is medically sad … Villieu closes with an essay, including, “[Josephine] was funny and amazingly alive … Josephine made me question what was important and helped me think better of my work, keeping me from losing myself in passivity and indifference.” Villieu explains Alzheimer’s disease and provides www.alz.org (the Alzheimer’s Association) for more information.

Heavy Snow

Sallie Tisdale writes (ibid, 144), “When I watch falling snow, I see transformation of the world into a smooth plane where differences disappear. The snow falls in fragments so delicate that a mere breath can destroy them—the way moments fall; the way life passes by.” In the introduction of the first edition of Heavy Snow: My Father’s Disappearance into Alzheimer’s by John Haugse; John writes, “One winter morning, I was walking with my father outside his nursing home. It was snowing heavily. I glanced back to look at our trail and noticed that his tracks had almost vanished, while mine were still well defined. … [his dad said], ‘I’m not surprised. I often feel like I’m disappearing [page ix; and almost wordlessly drawn on 91-92].’” His father remains unnamed throughout Heavy Snow. In the end, there’s only a hint of his name provided (page 130, 136); but before long before then we learn his father’s story, especially as it relates to his Alzheimer’s, John’s strained relationship with his father, and both their struggles with his father’s memory loss over almost a decade. The timing of events isn’t provided in this edition, but is in the revised version of Heavy Snow, called At a Particular Age: Heavy Snow Revisited which was published in July 2020. I highly recommend either of these tales. Page numbers in bold is for 2020 edition At a Particular Age.

I’ll discuss the original version of Heavy Snow here. There’s touching humor (e.g. his father was still driving and while running an errand got “lost” and drove by his own home). Fights between father & son occur with unresolved generational issues (e.g., father, who’s a pastor, belittles John for being an artist). And after Alzheimer’s sets in can father/son sour relations ever be resolved? His dad’s memory is sound with respect to his chess skills (he keeps beating John). His father has some of the typical delusional thinking of dementia patients, like misplaced or not currently visible things he thinks were stolen.

This graphic version has serif font narration, hand lettering word balloons, and is drawn in pencil with brief chapters of comic-strip-like stories. John shows his father finding a drawing that appears to his father as one of John’s childish pictures of a female; his father crumples it up and tosses it on the floor; while John’s mom unfolds it & puts it on the frig and it’s actually a finely rendered drawing of his mom. (19-20, 29-30).  Blank pages are a common occurrence which reinforces the “snow” theme or the wiping away of memories leaving whiteness. Baseball as metaphor arises a few times (e.g. placing John on deck to take care of his father when his mom dies after breaking her hip).

It’s written mostly in captioned first-person narration form with some word balloons reinforcing the narration. In the later version, some pages were removed (e.g. page 69 nursing home scene) from Heavy Snow and others added.

His father in his late 70s—before the Alzheimer’s diagnosis—blamed his memory loss to a heart attack two years before. The author found his father couldn’t remember recent conversations or even names of bench tools. His father’s residence has to relocate several times, which leads to the author’s and his siblings’ frustrations.

Before he moves out of his house, his dad mentions his memory loss on only one occasion, calling it “old-timer’s disease” which John corrects to “Alzheimer’s disease (50-51, 54-55).” When his memories were clearly failing and he needed better care with his living arrangement, his father was only willing to see his cardiologist, who misdiagnosed him as only needing patience, because that’s what his father wanted to hear (65-67, 67-70). It took several visits to different doctors to get the proper dementia diagnosis. John sees his father’s regression and fears he’ll inherit it; and perhaps be placed, Kafkaesque fashion, into a nursing home.

His father loses a lot of weight because he refused to eat and couldn’t explain why. A dentist found he had a badly impacted molar though he never said he was in pain; once the molar was pulled, he regained his weight. An only-because-they-both-have-dementia relationship occurs between the author’s father and a female (Susan) resident. Toward the end his father has a bout at a VA psychiatric ward, because of his aggression toward other seniors. His deterioration progresses to eventually being wheelchair bound. “He had lived in the nursing home for six years.” (129, 135)

At a Particular Age: Heavy Snow Revisited

Suppose you’re an award-winning animator and wrote a graphic medicine work when you were in your fifties about your father’s Alzheimer’s disease at the end of his life; and you’ve reached a particular age when his Alzheimer’s had started. The father was diagnosed in his early eighties, but the memory loss began in his seventies. What if your farther is long-dead but you still have unresolved issues with him? Would you revisit that earlier story and if you did would you bring it up to date with new information, fill in holes that you left out in the first version, better place yourself in that story and resolve your long brewing issues? When I did the review for the Heavy Snow—published in 1999—I researched its author and found he rewrote, revised, and recently published (July 2020) with his fresh, elderly eyes that earlier work and renamed it At a Particular Age: Heavy Snow Revisited. Based on its new title, I would expect it to be the original story and any wisdom gained since Heavy Snow was published. John Haugse’s father had died in 1998. There’s almost all of the original work and very little added wisdom. Since both books overlap but are distinctive, I decided to review them both. Since I’ve already reviewed Heavy Snow, I’ll here discuss some of the changes and additions the author made in the revisited version. I highly recommend reading either version.

At a Particular Age is inked (therefore redrawn) with color, while Heavy Snow was in black pencil. The dedication page has a third person description: “Through the illustrated-vignette style of the book, the author portrays with poignancy and humor the tragedy of Alzheimer’s and the terrible strain it puts on the caregiver … it is also the story of how an estranged father and son are brought together by illness. …  By caring for his father, the son hopes to resolve their bitter difficulties and find peace before the disease makes it impossible.” The chapter titles remain the same except for adding a foreword, renaming the first chapter from “Starting Out” to “And So the Story Begins,” and combining two chapters (discussed shortly). Again, page numbers for At a Particular Age are bolded to distinguish them from Heavy Snow’s page numbers.

The author brings some wording into the present (e.g. generational battles over the son’s anti-Vietnam War view and arguments over newspaper articles went from “Liberal Press” (8) in Heavy Snow to “Fake news from the liberal press” (19) in At a Particular Age). There are some factual additions (e.g. timing of his father’s Alzheimer’s diagnosis, rather than his son recognizing his father’s failing memory). Most of the chapter opening images have been revised (e.g. the author’s angelically winged mother with glasses on (21) becomes sporty in baseball cap and glasses around neck (31)).

From Heavy Snow                                            From At a Particular Age

Two chapters (“Losing Ground” (57-76) & “Settling In” (77-98)) become one chapter (61-107) with the former’s name. There’s an added confusing sequence (83-91) that jumps from the Heavy Snow version of John and his sister, Ruth—drawn younger—disposing of their father’s papers to them—drawn older—finding the sketchbooks John had made of their father’s memory deterioration. And since the siblings appear to be drawn older, I expect this story to be closer to present day; but the language puts it in the past and not present. Here’s when the author wanted some acknowledgment from his father for his artistic career and to better connect to his father; but his father wouldn’t even look at the drawings. His sister asks a stereotypical question of comic artists/writers with respect to mixing medicine and comics, “Do you think it’s appropriate for such a serious subject?” and the author answers with a non-sequitur “I only made notes on exactly what happened” (83). This sequence is also about more recent wisdom gained when the author recognizes his and his father’s “reality … had taken different paths … and that was going to have to be okay (87).” This whole sequence makes me think his sister had never seen the original Heavy Snow. One drawing of his father giving communion at the senior home leads to John unable to recall if that communion had even occurred. Only eight pages after the “serious subject” conversation it happens again—making it appear that memory issues might be arising in John or at least better editing would be desired in this revised version. Ruth asks again “…Will people accept a ‘comic book’ about such a serious subject as Alzheimer’s disease?” And the author responds, “Good question: I haven’t a clue” (91). Like I wrote, it’s a confusing added sequence for me. Regarding Ruth’s last question: I would have answered a resounding yes; after all Art Spiegelman‘s Maus I: A Survivor’s Tale and Maus II: And Here My Troubles Began about Art’s father, his relationship with him, and the serious subject of the holocaust were published to much acclaim in 1986 and 1992, respectively; and there had been at least a few dozen graphic medicine works published before 1999 (e.g. Our Cancer Year by Harvey Pekar Joyce Brabner and Frank Stack (illustrator) in 1994), let alone hundreds of graphic medicine works by 2020, when this sequence was added.

The reason for the title Heavy Snow is moved to within the graphic work (100-101) rather than explained in the introduction (ix) and shown in the interior ((91-92)

The new cover shows the son covered with color splotches, holding his paintbrushes, bending down to scrutinize his very small dad who’s packed for his end-of-life travels. Much of the imagery remains the same, but the narrations are more over-arching and not panel-by-panel. New drawings show a greater maturity for storytelling. The author reviewed his sketchbooks and used some different images, or rescanned some images because they’re much sharper in At a Particular Age than in Heavy Snow which may have lost some of the looseness in the penciled originals. Wording is often changed which sometimes introduces typos and may be for artistic reasons and not corrected recollections (e.g. Heavy Snow has his father’s accountant says “One day he [author’s father] agrees to sell the house, the next minute he says NO! (38)” while in At a Particular Age he says, “One day he agrees to sell the houses the next day he says, ‘No’. (44)” (my emphasis in the typo/changes; his father owned only one house)). Another story is given that his dad meets another Alzheimer’s resident, Susan, and they both think they’re married to each other; but in Heavy Snow the meeting occurs “several months after entering the home” (101) while in At a Particular Age it’s “several years after …” (108). He did live in the senior home for six years.

The font used for captions is better than the type used in the original tale, but since the newest version uses the same font for narrator captions and most word balloons—original had hand-lettered word balloons—some of its real-life connection to the reader is lost. Had I not had both versions of this book, I wouldn’t have been as critical of the revised version or known of wording changes made.

The poignant moments remain strong, when the author tries to connect over their role reversal with his disconnected father. There are voyeuristic scenes for the reader seeing the son upset by the father’s incontinence and the love they speak of (128-129). There are no self-revelatory concluding remarks of At a Particular Age; rather the closing is, in part, about his sister’s Alzheimer’s diagnosis. I highly recommend either version; though favor the original.

Sea Sirens: A Trot & Cap’n Bill Adventure

Sea Sirens: A Trot & Cap’n Bill Adventure by Amy Chu and Janet K. Lee is a fantastical middle school graphic novel that includes a character—the pseudo-memoirist’s grandfather born in Vietnam near the ocean—that has dementia. The fictional memoirist is Trot who has adventures with her cat, Cap’n Bill, who both enjoy surfing on the ocean. This is the first book in the series of their adventures. It’s inspired in part by a lesser known tale of L. Frank Baum’s—the beloved author of The Wonderful Wizard of Oz—called The Sea Fairies published in 1911 and illustrated by John R. Neill who also illustrated most of Baum’s Oz-series. The Sea Fairies’ main characters were a young girl named Trot and a peg-legged old sailor called Cap’n Bill. Sea Sirens doesn’t have much medical content; though the underwater scenes could be seen as the delusional imaginings of a dementia victim. But that is not how the authors present the tale. Rather, it’s a wonderful tale of a teenager’s undersea adventure to find her grandfather who wandered off. I recommend Sea Sirens, not for the medical aspects, but for its beautiful imagery and adventures.

Other themes in Sea Sirens include loss, humans upsetting the ecology of the ocean with their trash; the sea sirens’ power “is to understand all creatures (64);” that cats can talk (often with sarcasm) if we humans only knew how to listen; war among sea creatures; sea life long precedes land life; beautiful lighting underwater; and position reversals between Trot and Cap’n Bill or Trot and her grandfather. The loss theme includes: loss of memory by Trot’s grandfather (“Grandpa”)—who sometimes thinks he’s back in Vietnam—and of Grandpa himself being lost on land and sea. The phrase “scaredy cat,” is not P.C. in this context. And there’s a fun twist of events when war between the sirens and serpents seems likely.

 There are several new real things that I learned from Sea Sirens; they include a Vietnamese board game and the public announcement of a Silver alert.  The board game (Ô Ăn Quan; literally: “Mandarin Square Capturing”), played on a wood board; and is similar to mancala, with pebbles distributed over a dozen squares or shallow holes.  I learned and played mancala a lot in middle school. The Silver Alerts are—like Amber Alerts for missing children—the authorities putting out a general alert to be-on-the-lookout-for adults, especially senior citizens with dementia, Alzheimer’s disease or other mental disabilities. The Silver Alert is available in over 35 states in the U.S. and occurs early on in Sea Sirens. Unlike in the other books reviewed here, Grandpa’s dementia is used as a reason for him to wander off and forget things, not for health and caretaker issues being the primary concerns. Grandpa plays a fun, not a deteriorating role in Sea Sirens. Or as Queen Aquareine puts it, “This is all very trange [sic] (120)” and enjoyable.

 Capn’ Bill has a milky eye (Perhaps cataracts? Was the visual pun intended?) which doesn’t come up in the dialogue of Sea Sirens. There are lots of beautiful color and images—similar to John R. Neill’s color illustrations—especially under the sea. There are sirens—led by Princess Clia, and her mother Queen Aquareine—with tailed bodies, armed with tridents, and riding seahorses side-saddle (they are tailed after all). Sirens battle serpents. A wonderful mural history of the sirens and serpents covers the walls of their water home. Cats, because they generally don’t like water, haven’t been seen by the Sirens before. But Cap’n Bill likes water and especially seafood. The serpents “speak” with white slithering lettering in black word balloons. There’s a lot of humor in Sea Sirens.

Sea Sirens’ Book 2 is called Sky Island. The grandfather in Sky Island shows even less symptoms of dementia. I recommend Sea Sirens for its imagery and enjoyable storyline, not for its means-to-an-end medical content. The rest of the stories reviewed here cover Alzheimer’s and similar dementia-related diseases better than Sea Sirens from a medical perspective.

Amy Chu has written for Marvel, DC and others. Janet K. Lee with writer Jim McCann won the Eisner award for Best New Graphic Album in 2011 for Return of the Dapper Men.

Other Alzheimer’s/dementia books reviewed at graphicmedicine.org include: Aliceheimer’s: Alzheimer’s Through the Looking Glass by Dana Walrath;  Keeper of the Clouds written by Liza Futerman and illustrated by Evi Tampold; Roses in December: a story of love and Alzheimer’s and Safe Return Home: An Inspirational Book for Caregivers of Alzheimer’s by Tom Batiuk & Chuck Ayers; Tangles: A Story of Alzheimer’s, My Mother, and Me by Sarah Leavitt; and Wrinkles by Paco Roca. A recently reviewed book (The Brain by Tory Woollcott (writer) & Alex Graudins (illustrator)) can provide further background on how the brain works.