Dementia and Alzheimer’s Disease are complex illnesses that are still not entirely understood. Ruth cites her frustration with this early in the text, saying that diagnosing Alzheimer’s disease is not so much a diagnosis as it is ruling out other potential causes of memory loss: “It’s only after the person is dead that you can cut his or her brain open and look for tell-tale plaques and tangles” (4). The nature of this illness complicates grief and loss processes, as family members often find themselves mourning the loss of their loved one while they are still alive. Throughout the text, Ruth and her family learn to let go of and grieve the person Howard was, made more complicated by his past mistakes, while continuing to love and support the person Howard is in the present.

One way Ruth learns to process her grief and loss is by becoming attuned to the present moment, as suggested by her father’s doctor. Her diary entries take on a different tone as she switches from longer ruminations to simple observations about daily life with her father. She writes “Here I am, in lieu of you, collecting the moments” (189). Much like her father’s own journal, in which he recorded memories of Ruth’s childhood, Ruth uses her diary to record memories with her father that he can no longer retain.