The battle began anew when they reached the clinic where Paul had to bribe and cajole his mother inside against her will. By the time they were seated in one of the exam rooms, Paul looked as exhausted as he did after a hard day of work.

“Where am I?” Marion asked in a small voice. Her gaze skipped right over Hope to focus on Paul. “George? Why are we here?”

“Doctor David wanted you to come by, remember?”

“Why? Am I sick?”

“No, Mom, you’re fine. Just a checkup.”

The conversation continued in circles until David knocked and entered the room. “Good morning. Hi there, Marion.”

She shrank from a man she saw almost every day, except for the last week when he’d been off island on vacation.

David was wonderful with her, answering Marion’s indignant questions over and over while somehow managing to examine her. His brows knitted as he assessed her.

Hope wondered if he saw what she did—Marion was declining rapidly. Despite the years of experience she had with dementia patients, it was no less heartbreaking to witness the relentless march of the awful disease.

“Anything new or different since I last saw you all?” he asked, encompassing both Paul and Hope in his kind gaze.

“There’s more of a shuffle to her walk in the last week or two,” Paul said.

“What time is Daddy coming to get me?” Marion asked Paul.

“Not until he’s done working,” Paul replied.

David asked if he could speak to Paul and Hope in private. His colleague, Victoria Stevens, came into the exam room to stay with Marion. As Hope left the room, she heard Marion asking Victoria to call her husband to come pick her up.

They followed David into his office. David, who’d grown up with Paul and Alex, shut the door and went around to sit behind his desk. He seemed to choose his words carefully. “I thought about your mother a lot when I was on vacation,” he said to Paul. “We’ve talked before about the seven stages of dementia. I believe your mother is well into the sixth stage. I’m actually surprised by the amount of decline in her physical condition since the last time I saw her.”

“I’ve noticed the contractures in her wrists and fingers,” Hope said. “I was going to mention it to you today.”

“What does that mean?” Paul asked. “Contractures?”

“It’s when rigidity sets in and causes the hands to curl in on themselves.” David demonstrated by bending his fingers. “I fear that your mother’s condition has reached the point where I don’t feel comfortable being the only doctor involved. I’d like to have her evaluated by someone who specializes in dementia and memory disorders, just to make sure we’re doing everything we can to keep her comfortable and safe.”

Paul glanced at Hope. “What do you think?”