The Swimmers

Part 4’s narrator takes on the voice of Belavista, a long-term, for-profit memory residence, using second-person point of view to address Alice directly. Alice learns she has been sent to live there, like every other resident, because she failed cognitive and memory skills tests and because caring for her became too challenging for her family. She is urged to accept the fact that her condition—frontotemporal dementia—can’t be stemmed or reversed. It will only get worse. All the countermeasures people take to try to slow the disease’s progression have failed, and her experience won’t be the exception.

Dementia, Alice is told, can happen to anyone. It doesn’t respect wealth, intelligence, or any other qualifier. Nor is there a higher purpose to her getting this disease, as many people try to convince themselves. It won’t make her a better or more compassionate person, or change her priorities from the petty to the profound. Any hope Alice nurtures that she’ll be cured and able to return home is discouraged. In all likelihood, she will remain at Belavista until she dies, though how long that will be is anyone’s guess. Plenty of research into a cure for dementia has been attempted, but the lack of progress offers little cause for optimism.

The staff at Belavista sugarcoat residents’ conditions and symptoms with euphemistic phrases. For example, when they increase medication doses—perhaps to further sedate a difficult resident—they’ll merely say, “Let’s pursue this to the next level” (122). In contrast to this, Alice is told the Belavista staff won’t use that fake cheery voice others in the community often adopt with dementia patients. She is also told she will no longer have to deal with sticky note reminders all over the place, because, at Belavista, she doesn’t need to remember anything. The staff takes care of and controls every detail of her life. Alice will also benefit from being in a place where every resident has memory loss. She can stop pretending and hoping people don’t realize her memory is failing.

The fear Alice’s dementia caused in her life before Belavista won’t go away. She’ll continue to have anxiety, even panic, about all the things that might go wrong outside Belavista. Her fears will range from minor anxieties to existential crises. She’ll worry her husband will forget to defrost dinner and starve, the laundromat will lose her sweater, or her daughter will need new shoes. She’ll worry that her family will forget her. Worries about things inside Belavista will plague her too; the prospect of her roommate dying, falling asleep in the wrong room, or being in the wrong life.

Alice is warned not to fall victim to the false hope triggered by occasional days of lucidity. These days or moments of reprieve from her mental fog will be temporary. Before long, more and more of the memories that defined Alice’s life and identity will be lost to her disease. With each part of her that fades, she will become lighter until she’s completely empty. This will make her free at last, Belavista tells her. When she asks the staff why she’s here, unable to remember herself, they’ll placate her with euphemisms that don’t quite disguise her failure and lack of value to society.

GPS trackers will show Alice’s location to Belavista staff at all times. Her sleep will be monitored by electronic sensors. The pressure-sensitive mats on her floor will notify staff if she gets out of bed. Her alarm clock is also a surveillance camera, and the thermostat in her room has a hidden microphone. Everything is presented as safe and innocuous, but nothing is quite what it seems. Every aspect of Alice’s day-to-day life at Belavista is controlled, either with rules or drugs.

Her fellow residents were once bus drivers, professors, governors, actresses, and more, but now, like Alice, they’ve left who they were behind. Belavista staff favors patients who are docile and quiet and who have wealthy families that make large donations. Alice doesn’t have the same luxury as the favorites. If she feels the need, she can request a different roommate after one month, but after three such requests, she’ll be labeled nonadaptive.

On her first day at Belavista, Alice is encouraged not to think of herself as discarded or wonder if there’s anything she could have done differently to avoid being sent here. Rather, she should embrace her new life and take advantage of the (modest) amenities Belavista has to offer.

Objects that had meaning to Alice in her old life will not be needed, she is told. Her favorite clothes, artwork, and wedding ring are now mere relics of the past. She shouldn’t bring religious emblems either, as Belavista is an “icon-free institution” (113). Alice’s options for passing the time at Belavista are limited to the most mundane, meaningless group activities, like kindergarten-level crafts. From now on, her life will amount to passing time. Calming and sedating activities are encouraged. No matter what Alice is doing, all her time will be spent waiting; for visitors, the smallest tokens of joy or affection, and ultimately, death.

Alice’s television must always remain on during the day, even if she doesn’t want it on and no matter how upsetting the content may be. The reason, Alice is told, is that the TVs aren’t for residents’ entertainment but the staff’s. Current residents aren’t allowed in Belavista’s lobby, where potential residents and their families are presented with a lovely, false image of the facility. The actual experience for residents is characterized by alienation and neglect, which will speed along the process of Alice’s mind and body falling apart.

As a for-profit facility, Belavista charges extra fees for every service beyond the bare minimum. Alice will have to pay extra for a decent view from her window rather than a freeway overpass. She can pay even more to get a virtual window with images of trees or a personalized view. Participation in halfway decent activities or treatments, like music therapy, also costs extra. Products to help her sleep, like eye masks or weighted blankets, are available to purchase from an a la carte menu.

Alice will also have to pay more to get an experienced doctor instead of a trainee. Even then, she’ll only see her doctor for three minutes at a time, once a month, during which time it will be abundantly clear that the doctor doesn’t care about her. Belavista’s director, who makes $400,000 a year, doesn’t care about Alice either. Her focus is solely on metrics and shareholders. Residents are commodities. Their families often sacrifice all their savings just to afford the basic cost of their loved one’s stay. Some low-income residents’ stays are funded by government stipends. Belavista staff look down on these residents.

Belavista recognizes that Alice, like most residents, will experience resistance to coming here and some form of denial that this is permanent. She will brood over all the things she wishes she’d done with her life or done differently, but it’s too late now. Getting visitors will always leave her disappointed, as they return all too soon to their meaningful lives. At times, she will feel an overwhelming urge to go home, not realizing this is her home now—her last home before she dies.

At the end of the section, Belavista informs Alice that by signing her intake form, she agrees to be bound by all these conditions.