The Sister Pact

Three women confronting a family history of dementia make an unusual promise to one another. Will they have the nerve to see it through? 

By Lee Woodruff
illustration of sisters
Photograph: Illustration by Brian Cronin

My two sisters and I are driving to a family reunion when he calls. It’s serendipitous. We’d been trading phone messages for two weeks, and now, at the moment he finally catches up with me, we are all three of us in the car.

“This is a theoretical conversation, right?” my physician friend says over the speakerphone. “You are doing research for a novel?”

“Yes,” I reply. And my sisters and I nod knowingly to one another. The subject is taboo, fraught with tension. None of us wants to leave fingerprints. We don’t want to explore websites, write away for information or hold discussions in a doctor’s office. Now, to be extra careful, I am lying to my friend. I’m not researching a novel. I’m gathering information, planning for a disaster that could befall any or all of us.

We three sisters have made a pact, and we are one another’s best shot at carrying it out. In our case, blood is thicker than other ties, or at least more committed. Blood will ensure it gets done right.

Sibling relationships come in all forms of function and dysfunction, and in that regard I am extremely lucky. For me, my sisters are my bones, my best friends and confidantes. We have the kind of rapport that enables us to finish one another’s sentences and speak in a shorthand that goes back to childhood. I know when one of them is lying or being brave for my benefit, and I can detect the whisper of a hesitation in a tone over the phone. With just a look or a stray expression, we can parse a hidden meaning or savor an inside joke.

But right now we aren’t laughing. For the past several years, the three of us have joined forces on our most daunting task yet: navigating our parents’ end-of-life issues. As witnesses to our father’s advancing Alzheimer’s and the weight of that burden on our mother’s fragile health, we’ve put our heads together in endless conversations. We’ve combined wisdom, divvied up duties. And while watching it all go down before our eyes like a slow-motion car accident, we’ve decided to formulate our own exit strategy.

Like the witches around the cauldron in Macbeth, my sisters and I plan to accomplish what our other loved ones may ultimately find impossible to do for us. If we are robbed of dignity, comfort and the will to live, we aim to deliver one another from a prolonged and tortured ending. This is a deed that will most likely be too weighty for our children, too clouded by love and nostalgic memories for our husbands. So we have vowed to be there for one another. We just hope we will have the fortitude, the wisdom and the benevolence to see it through.

If existence should someday become unbearable, how can we end our own, or our sister’s, suffering? The man on the phone is about to tell us.

As girls and then young women, Nancy, Megan and I spent long, lazy hours on our family’s Adirondack dock each summer, dipping our legs into the lake as we talked. We’d huddle over every subject, the way sisters do: boyfriends, crushes, the utter cluelessness of our parents, a friend’s little slight, the bigger heartbreaks. Now we talk about our menopausal selves and our husbands’ habits; celebrity scandals; and our semi-adult children. We trade stories on how to set limits with our teens, find second careers and deal with empty nests. The  topic we return to most often, picking it over like the carcass of a rotisserie chicken, is our elderly mother and father.

Like most families, ours has a lot of skeletons in its genetic closet. Cancer, heart disease, depression. But most frightening by far is that my sisters and I are the fourth generation standing in line to lose our minds. Alzheimer’s, dementia, senility . . . whatever the exact diagnosis, the result is the same: the slow ebbing, the agonizing erasure of a human being.

Originally published in the February 2013 issue.

Share Your Thoughts!



I nursed my father and mother through Alzheimer's and Lewy-body dementia respectively. If I had someone who could help me bow out gracefully should I not realize that I'd gone past the point where I could recognize the danger, I would be grateful. Sadly, I do not.
If you've not seen this happen to a loved one, you can't begin to know the horror of wondering what your last years will be like.

Laura E. Kelly02.02.2013

I was glad to see this article. The boomers, who so avidly did leg lifts with Jane Fonda, will soon be in this sad situation in droves. We need more open conversation and legal options for dealing with this imminent health crisis, not political debate that gets cut off when someone says the words "death panels."
As for preparing for your own end, I always think of the vivid scene in Lisa Genova's book Still Alice where the ailing Alice writes herself a note designed to test her future cognition, with instructions on what to do if she fails the test. When she eventually fails, she goes to carry out the wishes of her formerly well self, but forgets what she's doing along the way. And ends up lost, as feared, since her family can't/won't help her (despite pacts). A haunting scenario.

Dorothy Walsh01.30.2013

Thank you for this beautiful essay. My sister and I have had this same conversation after our mother was diagnosed with Alzheimer's about 7 years ago. It has been a strange and desparately sad journey as she has lost more of herself every year. My mother, if she had any cognition, would be mortified to know that this was the way she was spending her last years on earth. The one thing she loved more than anything were her kids, grandkids and great grandkids. She will never know the ones who have yet to be born. My mother was a very even tempered woman but being robbed of the chance to be with the kids would have pissed her off. My fear, of course, is that I will get this disease but I also fear that if I did it would rob me of the ability to decide to drink that cocktail.

Katie 01.30.2013

If she were serious about this pact, she wouldn't have written this article. If one of the sisters commits suicide, the other two will be in jail because here's the plan, laid out completely. It's just a ploy to sell more books by being so bold.

rie LeMer01.29.2013

Thank you More for this brave article. I continue to admire Lee for the life she crafts, for her resilience, smarts and boldness. I appreciate this glimpse of the deep abiding love of siblings and their crucial role in all things joyous and difficult.

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