A world-renowned musician receives a devastating medical diagnosis. As his condition deteriorates his estranged ex-wife becomes his caretaker, and the two of them reflect on their relationship as everything comes to an end. Author Lisa Genova brings all her scientific knowledge to illuminate yet another mystifying disease in the informative yet unsatisfying novel Every Note Played.

Richard Evans knows how to enthrall a crowd. He’s done it for years, and the attention makes him preen. Piano fans all over the globe have listened to him play the most complicated pieces with flawlessness.

Of course, his personal life is far from flawless. After several years of resentment and neglect, his wife decides she’s had enough and they get a divorce. But that doesn’t really matter to Richard. Why does he need the attention of one woman when the entire world sits with bated breath at his feet?

Then comes the day when his fingers stop doing what he wants them to, and Richard goes to the doctor. He doesn’t have tendinitis or any other condition common to pianists. Richard has Lou Gehrig’s disease, known in the medical world as Amyotrophic Lateral Sclerosis‎, or ALS. Most research states he’ll die within five years.

Since the divorce, Karina has done what she can to live a normal life. She sits at a piano day after day trying to impart some love and appreciation for the instrument to kids who come for lessons. The majority of them plunk their way through those 30-minute sessions, torture for students and teacher both.

Karina despises Richard, no doubt about that. When she had the opportunity to take her own music career forward in a major way, he convinced her to move from New York City to Boston. The move benefitted Richard tenfold. It took Karina’s music away from her. It didn’t help that she started as a classical pianist like Richard and veered into the world of jazz, something Richard has sneered at time and again. No, she’s happy to have her space now that he’s gone.

Then she finds out about Richard’s diagnosis. Her initial attempts to offer her sympathy get rebuffed, but that doesn’t surprise her. What does surprise her is the day Richard calls, desperate after he falls and no one is around to help. Even though she would rather slam the cover of the piano keys over her own fingers repeatedly, Karina tells Richard he needs to move out of his Boston brownstone and back in with her.

As Richard’s disease progresses, the two find neutral ground. When Richard musters up the courage to tell Grace, their college-aged daughter, about his disease, Karina acts as mediator between the two. Whether she wants to forgive him or not for the utter carelessness he showed her during their marriage, Karina realizes she won’t have a choice. One way or the other, she will simply have to let Richard go.

Author Lisa Genova shows her command once again in tackling a neuroscientific disease. As with her other books, Genova takes the complicated issues surrounding the disease and presents them in laymen’s terms. If a person knows absolutely nothing about ALS before reading Every Note Played, they will be armed with a wealth of information by the end of the novel.

It’s truly a shame, then, that Genova’s detailed research and lively descriptions aren’t supported by characters worthy of either. Richard’s arrogance as a concert pianist may seem justified in the start of the book, but his arrogance never wavers. Even when he’s completely dependent on Karina for the simplest of tasks like wiping his chin, everything about his life revolves around what he thinks and wants.

As the wronged wife, Karina may deserve sympathy at first. At some point her willingness to let Richard push her around makes her character balance that fine edge between a dignified partner and a whiny victim. It’s hard to tell sometimes what role she wants to play.

Their daughter, Grace, figures into the book more as a placeholder. The story really revolves around Richard and Karina and their individual struggles. Even knowing they were previously married makes it difficult to imagine them as a unit. They don’t like one another at all, which may make it harder for readers to suspend their disbelief when Karina allows Richard to come back home for the duration of his life.

Fans of Genova’s work will definitely appreciate her careful detailing. For other readers, however, I suggest they Borrow Every Note Played.

Lisa Genova has become one of my favorite writers! Her writing is amazing and the stories are so much more than a normal story. I really feel like I get an education with each book that I read of hers. The emotional side of Lisa's books are also amazing. I truly feel attached to the characters.
Every Note Played deals with ALS, so be prepared to have your heart broken. The story of Richard and Karina is ........well there are really no words to describe the perfect imperfections of these two!
Every Note Played is a beautiful story that must be read! With the lesson to live and love you will surely be moved by this amazing story.
I can not wait until Lisa Genova releases another must read!

4.5 Stars!

This book is a short but powerful story.

Let me start off by saying, I didn't know much about ALS going into this book. I am fortunate that I haven't had any family or friends effected by this disease so I went in blind. After finishing this book I am now well educated on the effects (both phsyically, emotionally and mentally) this has on both the person who has ALS and people around them.

We meet Richard who is an accomplished Pianist. He travels all over the world and is one of the best out here. We then Meet Karina who is Richard's ex wife. They fell in love in college over music (they both play piano) and both have extreme talent. They have one daughter together, Grace, who is in college. Karina and Grace live on their own and Richard lives on his own. Unfortunately Richard was never close to either of them due to some past experiences in his own childhood.

We find out that Richard has been diagnosed with ALS, however since he alienated a lot of people in his life and chose Piano over them, he doesn't have anyone to go to. Karina learns of his diagnosis but has so much hate towards Richard that she has as tough time feeling sympathy. Grace is also feeling the same way after not having a relationship with her father.

This book had me all over the place with my emotions. At first I was thinking wow Richard is a real jerk and Karina really needs some help to get over their relationship. But then you start to see the rawness that plays out within the books events. The family has to find a way to come together over this horrible disease. It raises the questions of How do we find forgiveness? Is this my burden to bare? Can you hate someone but also love them? and ultimately, When will be too late?

Needless to say by the end of this book I was a crying mess. ALS is truly a devastating disease and I wish it on no one. The choices and things this family had to give up to support one another was incredible and I'm sure not everyone who has ALS gets that chance.

My hats off to the Author, Lisa Genova, for this powerful tale. I would recommend this to anyone. Just be ready to shed some tears.

Thank you to Netgalley and Gallery Books/Scout Press for an ARC of this book.

5 educational and emotionally resonant stars to Every Note Played, my first Lisa Genova novel! 🌟 🌟 🌟 🌟 🌟

I cannot imagine this book being anymore emotionally-engaging than it was! I was enthralled from the first chapter, and part of it may have been due to a small personal connection.

Richard is a famous concert pianist diagnosed with ALS. His ex-wife, Karina, teaches children piano lessons in his shadow. When Karina learns of Richard’s diagnosis, she walks through many different expected emotions, especially since their divorce was less than amicable.

As the heartbreaking effects of ALS ravage away Richard’s body and his ability to do what he loves most, he is forced to accept help, and eventually it comes from the most unexpected person, Karina. What follows is a captivating tale of redemption and sacrifice.

I learned a vast amount about ALS- its effects, how it progresses, but most importantly, how it might affect the emotions of the individual with the diagnosis, as well as the loved ones impacted.

On a personal note, my dad was diagnosed with Parkinson’s disease a few years ago. While it is not ALS, I felt an attachment because as Richard lost his ability to play piano, what he loved most in his life, I was repeatedly thinking of my dad who has lost his ability to sing due to Parkinson’s. My dad studied voice and music, and even though he’s self-conscious about singing now, he was able to sing a few words of Happy Birthday to me back in December. A memory I will treasure, as I will cherish the experience of reading this book. I couldn’t help but feel personally connected to Richard’s story.

Overall, Every Note Played is a book I highly recommend because it’s well-written, thoughtful, enlightening, and poignantly powerful.

Thank you to Lisa Genova, Gallery/Scout Press, and Netgalley for the copy.

I received this book for free from Netgalley. That did not influence my review.

Lisa Genova’s new release, Every Note Played, is a gritty, realistic, and yet beautiful novel following the physical decline and emotional growth of a man dying from ALS. This is the first book I’ve read by this author, but I can understand why she is so widely read.

Richard Evans is a brilliant classical pianist, whose career comes crashing to a halt when he is diagnosed with ALS. Cruelly, the disease has attacked his hands first, robbing him not only of his life’s work, but of the very core of his identity. A year earlier, his marriage ended and this crisis has made him aware of how very alone he is.

Karina is the wife who divorced him. An exceptionally talented pianist in her own right, she has sacrificed her career to support his, devoting her time to bringing up their daughter. She teaches piano to ungifted, uninterested suburban students. Still mired in resentment– Richard cheated on her repeatedly as well as tearing her away from her promising start as a jazz pianist–Karina thought she would be reborn after the divorce, but instead is stuck. Their daughter is now in college and her ex-husband has moved out. No one is holding her back anymore and she has nowhere to place blame for her dissatisfaction.

Both believe the love they once shared is dead and buried. Responsibility for the failed marriage falls to both parties, but neither can relinquish old grudges. This is emotionally entangling enough, even without the addition of the slowly progressive, deadly disease. But the disease is what the story hinges upon.

Richard becomes increasingly physically dependent and Karina takes him home to be his support person.

The plot revolves around the progression of the disease. The novel is well-researched and graphic in its medical details. It’s heartbreaking and painful to read. Realistically, there can be no happy ending. And yet, there is healing of a sort for these broken people. The reader journeys through the process with Richard and Karina, engrossed.

I have read all of Lisa Genova's books so I was happy to receive her new book as an ARC. This is much like many of her other books in that the main character has a disease or some sort of issue and the story shows how that is affecting the character, their life and their family. In this book, Richard is diagnosed with ALS. He is a concert pianist and is slow to believe what is happening to his body. Eventually he is forced to move back in with his ex-wife. They have all sorts of issues to work through while dealing with his new reality. Overall, I really enjoyed the book, however, somehow it seemed that the book dwelled more of the disease and I wished for a bit more story. I would give it a 3.5 stars but rounded it up to 4 stars.

Richard Evans is a man on top of the world. He is a concert pianist that plays with raw emotion and incredible technique. To Richard playing the piano is breathing, it's life. He gave up so much to live this life of fame but suddenly he is feeling regret. His playing is perfection but his heart is starting to not be in it. His mind drifts elsewhere instead of getting lost in the music that his fingers are producing. Something is wrong. Audiences jump to their feet after his solo performances at some of the top concert halls in the world. He is loved by his fans and yet loved by no one all at the same time.

His current tour is suddenly cancelled. His agent is telling everyone that Richard has tendonitis, a common ailment that most pianists battle at some point or another in their career. Richard is trying to tell himself that as well, hoping that if he avoids the truth that the truth will magically change. Richard has been diagnosed with ALS.

Other than his adoring fans he has no one. Him and his wife Karina have been divorced for three years and have a searing hatred for one another, and their daughter Grace, who is in college, refuses to speak to him, taking her mom's side on everything. He's only had one other serious relationship that ended right before his diagnosis, the rest were just meaningless flings. He is estranged from his dad and two older brothers, and his mother passed away right before Richard turned 19, his only ally in the family.

The doctor's tell him to get prepared, no one knowing just how rapidly Richard will deteriorate, but where does he turn? Who can help him? He holds out as long as he can, losing both of his arms to ALS and relying on home health aids before anyone knows the severity of what is going on. He is completely alone in his empty apartment with his thoughts, in mourning, losing the love of his life. Playing the piano was his air, his life, his love, his everything. Without his ability to play, what does he really have?

A chance phone call brings him and his ex-wife Karina back together and a choice is made that she will bring him home and take care of him for as long as it takes, her too having to battle the raw emotions of being an ALS caretaker as well as dealing with her feelings about her ex-husband and their past together.

Every Note Played is a beautifully heartbreaking story that will stick with you long after you read the final page. Told predominantly from Richard's perspective, you glimpse into the life of someone that has to endure this scary disease, and get into the mind of someone that has to deal with slowly losing their life, as well as glimpses from Karina's perspective, dealing with her ex-husband and the painful memories that go along with that, as well as being a caretaker to someone with ALS.

To imagine that so many people in our country have to brave this painful disease on a daily basis leaves me speechless. My prayers are with anyone that has been affected by this illness. Before reading Every Note Played I knew little about ALS but now I feel informed and am in awe of how Lisa Genova, being a neuroscientist herself, can paint such a vivid picture of ALS through the eyes of the diseased. You feel heartbreak not only for that person but everyone involved, see the cleansing of forgiveness, and personal freedom in several forms.

I truly believe that everyone should read Every Note Played. There is adult language as well as mild sexual content for those that are sensitive to those aspects but given the situation I believe it goes with the territory. We all need to be aware of this disease and do our part to help find a cure. Please to go ALSOne.org to find out how you can help find better treatment options or a cure for ALS.

Lisa Genova writes novels about severe illnesses as an attempt to raise awareness and funds for research of them. I read Inside the O'Briens, about Hungtington's, and have seen the film based on Still Alice, which is about early-onset Alzheimers (and consequently gave my husband and I both more nightmares than we have ever had from any horror movie.) I hadn't quite made the connection to her previous work when I requested a galley of this novel; I was more focused on the classical pianist angle.

Richard is an acclaimed pianist. He is also recently divorced, a messy one, after his infidelities and some other secrets that were hidden. His wife and daughter are not in his life, his daughter having chosen her mother over her father, who often chose piano or his flings over time with her.

But as he is preparing for a tour, his fingers stop responding the way he expects and he is diagnosed with ALS. Eventually he has to figure out who in his family can help him as he loses the ability to care for himself.

This is a timely read with the very recent passing of Stephen Hawking, who lived far longer with ALS than most people do. Most people have the sentence of 3-5 years once they are diagnosed, and much of those years depends on which kind of treatment they get, or more accurately, which kinds of treatment they can afford. Since this is set in the United States, and Richard is limited to the insurance he purchased himself as a fairly healthy self-employed pianist, his insurance doesn't cover his expensive wheelchair, and certainly not the 24/7 care he would have required if he had elected to have the surgery that would have ended up with machines breathing for him. He could have had that surgery, but the rest of his body would still have deteriorated. There is no cure for ALS.

All to say that this presents some difficult decisions, and harder because by the time they are past denial in dealing with the disease, he has already lost much of his ability to communicate. No cure, no insurance coverage - these facts sometimes force a decision that may not be the best, but the options are pretty limited.

This is not a cheery read! It reminds me in some ways of the cancer novels I used to read as a pre-teen although I do think the author has a nobler goal, in raising money. I feel like some of the ending was less realistic, with many of the relationships coming to resolution. Not everyone gets to do that, whether they understand they are dying or not.

Another book about ALS that I read in the last few years is Home is Burning by Dan Marshall. It is a memoir, from the perspective of the son of someone with ALS, as he moves home to help his father as his body starts to go downhill. This novel shows more of the internal emotional struggle (and external physical struggle) of the person with the diagnosis, which I felt made for a richer read.

Richard owns the world. He is a renowned pianist; booking sold old concerts all over the world. He’s a man-about-town, a most-wanted bachelor, and rarely sleeps alone after each of his outrageously perfect concerts. He’s divorced with one daughter, has a dad and brothers who always laughed at him for playing piano, and he works tirelessly to prevent that baggage from slowing him down in his ambitions and quests.
Without warning, Richard can’t control his hand. Richard has ALS and is terribly, sadly alone.
Karina had a great shot at jazz; she was a natural and in her element. Until her then-husband, Richard insisted they move in order to further his own career. She never found a jazz niche in New York. It simply didn’t exist. As their daughter, Grace grew; Karina’s career and desires fell by the wayside while Richard’s career took off. Karina, in her anger and determination to keep one personal desire to herself, the desire to have no more children, lies to Richard until they’re finally divorced and free of one another.
How do these two people, each with so much pride, guilt and deep-rooted anger, end up together three years after their divorce when Richard needs help so badly? These undertones of human error and forgiveness are overshadowed by the cruel, relentless and uncompassionate symptoms of ALS. Each day, each hour is a new loss, each remaining ability, simple motor skills, such as breathing, swallowing, talking, become a cherished function that is on its way out.
So sets the stage for Every Note Played. It’s a realistic glimpse into the lives of one family affected by the disease with no cure. As Richard’s health fails, Karin and Grace’s ability for compassion and forgiveness strengthens.
The author, Lisa Genova, is an amazingly accomplished person. I respect her tremendously and am always eager to read her works. Her personal history and education are so impressive, and her compassion that comes thru in her writing is sobering. She accomplished that with Still Alice and has opened my eyes to the slow, steady decline of ALS with this new novel.
Ms. Genova’s notes from the author at the end of the book really add such a personal touch to her writing. She is sincere. This comes thru so strongly in her characters. Although it is a sobering subject, I thoroughly enjoyed reading this book. It reveals so much about the disease, compassion, forgiveness and basic humanity.
(I received an advance copy of this book from NetGalley in exchange for an unbiased review. Thank you to Gallery / Scout Press and NetGalley for making it available.)

I am so very grateful for a copy of Every Note Played from Netgalley. Lisa Genova is one of my most favorite authors and this book was even better than the last. Every book I read from Genova is written on such a technical level but yet very approachable and understandable. I don't think that I have read many other authors that can portray the character's feelings like she does. This book takes you inside the life of an ALS patient. This is not the pretty picture of the ice bucket challenge. This is the very real and horrible disease of which there is still no cure. I have lately been a slow reader but this book was read in two days. Lisa Genova you are still one of my favorite authors of all time!

I love how Lisa Genova takes a serious medical condition, a condition that affects a lot of people, and humanizes it. After reading one her books, I come away with a better understanding of what their lives must be like and what they and their loved ones have to go through.

Richard was a very talented pianist when he got the diagnosis of ALS, which started by paralyzing his right arm. Of course, he was in denial for quite awhile but it ultimately ended his career. It was heartbreaking to watch him struggle to try to maintain as normal of a life as he can.

Karina, his ex-wife, steps up and becomes his caregiver, basically because he has no one else. As the two of them struggle to get through the days and nights and the changes in Richard's condition, they come to realize what's important. The decisions that had to be made are tough ones and make this story a very emotional read.

I truly appreciate the education and understanding that I get from reading one of Lisa's books. Once again, she has created a touching, beautiful story about another devastating disease that affects so many people.

Bestselling author of Oscar-winning, STILL ALICE and neuroscientist, Lisa Genova's  novels always make me cry. Her new one, EVERY SINGLE NOTE (ScoutPress), is not any different. This time, her novel is about regret, forgiveness, freedom and what it means to be alive. All of Lisa's novels tackle unique diseases and EVERY SINGLE NOTE incorporates ALS. For those of you who enjoyed STILL ALICE, you won't be let down.

Richard is an accomplished pianist. He's received standing ovations from audiences all over the world in awe of his rare combination of emotional resonance and flawless technique. Every finger of his hands was a finely calibrated instrument, dancing across the keys and striking each note with exacting precision. That was eight months ago.

"The first bubble breaks the surface, a pop in his left calf. It vibrates there for a few seconds, the opening act, then jumps to his right quadriceps, just above the knee. Then the pad at the base of his right thumb flickers. Over and over, and over."

Richard has ALS, and his entire right arm is paralyzed. His fingers are impotent, still, devoid of possibility. The loss of his hand feels like a death, a loss of true love, a divorce—his divorce.

Three years ago, Karina removed their framed wedding picture from the living room wall and hung a mirror there instead. But she still hasn’t moved on. Karina is paralyzed by excuses and fear, afraid to pursue the path she abandoned as a young woman, blaming Richard and their failed marriage for all of it.

When Richard becomes increasingly paralyzed and is no longer able to live on his own, Karina becomes his reluctant caretaker. As Richard’s muscles, voice, and breath fade, both he and Karina try to reconcile their past before it’s too late.

EVERY NOTE PLAYED is a powerful novel. I understand ALS much better after reading Lisa's book. I felt as if I could feel what Richard was going through at times, and the ending will absolutely bring understanding and inevitable tears. Lisa has a unique talent for bringing understanding of diseases to readers and helping us understand their power, but the ultimate overwhelming lesson is love conquers all.

*****



Acclaimed as the Oliver Sacks of fiction and the Michael Crichton of brain science, Lisa Genova is the New York Times bestselling author of Still Alice, Left Neglected, Love Anthony, and Inside the O’Briens. Still Alice was adapted into an Oscar-winning film starring Julianne Moore, Alec Baldwin, and Kristen Stewart. Lisa graduated valedictorian from Bates College with a degree in biopsychology and holds a PhD in neuroscience from Harvard University. She travels worldwide speaking about the neurological diseases she writes about and has appeared on The Dr. Oz Show, Today, PBS NewsHour, CNN, and NPR. Her TED talk, What You Can Do To Prevent Alzheimer's, has been viewed over 2 million times.

**A NOTE FROM LISA:

In May 2017, about the same time that I finished the final draft of this book, the FDA approved a new drug for the treatment of ALS. Radicava became available by prescription to patients in August 2017; intravenous infusions in twenty-eight cycles and costs $1,000 per infusion. In a trial in Japan, Radicava slowed the decline in physical symptoms by 33 percent. There is hope.

If you would like to to get involved or/and make a donation, ALS ONE is an extraordinary organization:

www.ALSONE.org

 *****

Thanks to Scout Press, we have one copy to giveaway. Just tell us what you know about Lisa Genova and her novels. I know, all her books make me cry.

We'll choose a winner soon. Good luck.

Richard Evans hasn’t exactly been the best husband and father. He sacrificed his wife and daughter for his art. In their place, the piano became his lover and his child. There is no room for imperfection and regrets. Until now.
When he first was diagnosed with ALS, he refused to believe that fate could be so cruel. He’s far too young to lose both his music and his life. Now all he can hope for is that he can finally gain absolution from those he so carelessly cast aside.

“He sits back at his bench, readying to play it again. He positions his left hand on the keys, but instead of hearing the orchestra begin in his mind’s ear, he hears only the oppressive silence of his empty apartment and a voice in his head, an arrogant naysayer stealing his confidence, talking him out of this pathetic plan.
Richard lifts his left arm straight out in front of him. It begins to tremor just below shoulder height. He tries to will it higher, recruiting every muscle fiber he can conjure to the job, but his arm won’t budge any farther. Exhausted, he lowers his hand back onto the piano keys.
Instead of beginning his solo, in opposition to the overbearing silence and the voice in his head, he plays a single note, D, with his pinkie. He holds the key and the foot pedal down, listening to the singular sound, bold and three-dimensional at first, then drifting, dispersing, fragile, decaying. He inhales. The smell of coffee lingers. He listens. The note is gone.
Every note played is a life and death.
Maybe the disease will stay in his shoulder. The voice in his head knows better and insists on another peek down the rabbit hole. No hands.
Richard leaves the piano. He retreats to his bedroom, undresses, and crawls back into bed. He does not call his agent. He lies on his back, staring at the ceiling, wishing he could stop time, hiding from his future, knowing without any doubt or hope that someday soon he won’t simply be peeking down that rabbit hole.
He’s going to live and die in there.”

Karina left her native Poland because she wanted so much more from life than just being a wife and a mother. She wanted to explore music and find her own path. But that is exactly what she became when she fell in love with Richard.

Her career and aspirations always took a backseat to his and after the birth of their daughter Grace, she completely forgot who she was. Their divorce was a strange mercy, but with a tragic blow from destiny, they are forced to come face to face with the frailties of love and healing power of forgiveness.

“And she could blame Richard and his affairs for holding her back. He was wrong and bad, and she was right and good, and she could resent him for her unfulfilled dreams of playing jazz, and this was the perfect excuse, the brilliant smoke screen deflecting anyone who might inspect the situation for the truth. The truth is, she was terrified of failing, of not making it, of never being as recognized and loved as an artist as Richard is.
But then she got divorced and Grace went to college, her excuses literally out the door. With seemingly no one left to blame, she pointed her finger at the hands of time. Too much had passed. Her chance had passed. It was too late.”

I thought I knew what I was in for when I started reading Every Note Played, but I never expected how beautifully Lisa Genova could make me ache with only words.

With characters that are both flawed and at times, needlessly cruel, she skillfully makes their longing and regret so tangible that I found myself experiencing all of the emotions right along with them.

It’s heartbreaking in its honesty about all of the things taken for granted, clinical in its design and desperate in its search for mercy. And it will open your eyes to the fragile power of love…

What I loved most about this book was the dynamics between Richard and his family. While I was saddened by Richard’s physical decline my heart was warmed by Richard’s desire to put his relationships in order before he looses the chance.

This book was very good. I read it in 2 days. Love the Author. Only gets better. Run...to buy this book. Highly recommend!!!

"Some nights the music is well played and applauded, and other nights, the music is transcendent. He lives for those transcendent nights."

ALS (amyotrophic lateral sclerosis), or more commonly known as Lou Gehrig's disease, is a terrible, awful waste of human life. And author Lisa Genova writes this gut wrenching story about one man that has it.

Richard Evans is a world renowned concert pianist. He has devoted his entire life to his piano playing, letting it be all consuming and ruining his marriage and his relationship with his daughter.

So what happens when he can't play any more?

"The keys want to be caressed, the relationship ready and available to him, but he can’t respond, and this is suddenly the cruelest moment of his life. He stares in horror at his dead hand on the beautiful keys."

This book is written from mostly Richard's point of view, allowing the reader glimpses into his life as this disease steals pieces of him away, a bit at a time. There are no punches pulled in this book. Every heartbreak and indignity is shown on the pages of this story.

This is also written from his ex-wife's point of view as she takes over caregiving for him. It is a story of regret and forgiveness along with details of the disease.

I read Genova's book STILL ALICE not long after it was released and can still remember the tears I shed as I read about Alice's losing battle with Alzheimer's disease. It was gut wrenching too (I've had quite a few family members with Alzheimer's) but I think ALS might even be worse. With Alzheimer's the patient eventually doesn't realize what's happening to them. It's still horrible for caregivers but the patient is oblivious.

With ALS the patient's mind is clear up to the very end, knowing everything that happens to them.

Both diseases are horrible and Genova writes brilliantly. If you want to read a true "horror" book, read this or STILL ALICE.

I received this book from Gallery Books through Net Galley in the hopes that I would read it and leave an unbiased review.

I finished Lisa Genova's newest novel Every Note Played with tears rolling down my cheeks, but I've found that is par for the course after reading three of her previous novels: Still Alice, Left Neglected, and Love Anthony. Genova's novels are gut-wrenchingly sad as she eloquently, brilliantly, and touchingly puts the reader in the mind of the person suffering from the disease, and she does such a stupendous job writing such amazing characters, crafting the plot, and weaving the story that while reading the book, you feel the character's pain,  emotions, and suffering, and you walk away forever changed by what you have learned about the horrific disease and its effects on the person and their family.

In Every Note Played, Genova puts the reader inside the mind...and the body...of Richard, a brilliant and world-renowned concert pianist, who has just been diagnosed with ALS after experiencing muscle control issues in his right hand. But it doesn't stop in that hand but quickly moves to the left and he is now a pianist without the use of his hands, which I thought such a devastating loss. ALS is a brutal and cruel disease, and Genova doesn't spare the reader as she details how Richard begins experiencing irretrievable loss one limb at a time as the neurons in his brain and spinal cord die off eventually leading to full paralysis. This leaves him completely locked in with only his brain able to function. And Richard's decline is rapid and even though he has wonderful daytime care, he can no longer be without 24-hour  round the clock care. 

 Now Richard is forced to examine his life since he is tragically alone. Instead of being a devoted husband when he had the chance, he spent years devoting everything to playing classical music, his piano, and cheating on his now ex-wife Karina, a piano teacher, who is honestly a more talented pianist than he is, but she had to give up her dreams and has never forgiven Richard for that. He also neglected their daughter Grace when she was little, and she is now in college and has little contact with her dad.

It is at this point that Genova lets us experience ALS through the eyes of Karina, who even though she is bitter, makes the choice to become his carer since there is no one else.  While there might have been some resentment on her part at first and plenty of exhaustion, she never wavers in her care of her ex-husband. As Richard loses his ability to talk, the two are able to communicate without words and explore their mutual feelings of betrayal, dislike, hurt, and more. More than being a story about a devastating disease, Genova has written a tragically beautiful story about family, responsibility, love, friendship, forgiveness, and second chances. 

 I admit before reading Every Note Played that I did not realize what a merciless disease ALS is although I was familiar with it of course, especially because of people like Lou Gehrig (for which the disease is named) and Stephen Hawking having had the disease. However,  I now have an understanding of how this disease affects the person diagnosed, the family, and the caregivers. Genova's skill, besides her excellent writing chops, is how she uses her background as a neuroscientist to give the reader not just every minute detail about the disease, from the day to day grueling and agonizing experiences of the sufferer and the carer, but also to give actual facts--how it is diagnosed, progresses, treated, the psychological impact, and the life expectancy rate, which is on average only 3 years and how the lifespan of Stephen Hawking was almost unheard of with the disease. Actually, she mentions him in the book, but I also read a wonderful article/tribute she wrote after his death explaining why Dr. Hawking probably lived as long as he did. Genova also made a point in her novel to point out there is NO cure for ALS and only one drug on the market approved for treatment; however, the ALS foundation's goal is to have a cure by 2020. My sincerest wish is they achieve their goal so no one will ever have to suffer from this horrible disease.

Every Note Played was one of my most anticipated books for spring, and it more than delivered! It is a must read, and Genova is a phenomenal author who never disappoints her readers!

**Thank you Netgalley, and Lisa Genova for an ARC in exchange for my fair and honest review.**

I was at first reluctant to even read Every Note Played, because I knew it was going to be heart-wrenching. But something made me request it from Net Galley and I’m so glad I did. Yes, at times it is difficult to digest, as we watch a gifted and world renowned concert pianist lose his ability to play because of the onset of ALS. Eventually he loses his ability to do anything with his body, and is now dependent on his former spouse for his care. It is a remarkable journey through heartbreak and forgiveness, and yes, it made me cry, but it also made me grateful to have read it. It ends on a truly uplifting note as two people who once loved each other are given the chance to heal and let go.

Lisa Genova’s compelling and poignant new novel Every Note Played gives her readers an intimate and in-depth look at how a debilitating disease can impact not just the one who is suffering from the disease but also the family and caregivers as well. For those who are familiar with Genova’s writings, she takes readers on a similar journey in Still Alice with Alzheimer’s Disease as her subject matter. In Every Note Played, she tackles ALS (or Lou Gehrig’s Disease as it is sometimes called).

For those unfamiliar with ALS, it is a devastating disease in which a person’s neurons start to die off, basically paralyzing the person a little at a time until they can’t walk, can’t use their arms, can’t chew and swallow food without choking, and eventually cannot even speak and must communicate through the blinking of their eyes. By this point, an ALS patient is typically also struggling to even breathe on their own and usually have to have breathing assistance machines.

As horrific as all of that is, perhaps the cruelest part of the disease, however, is that while the person’s body is rapidly failing them and becoming a prison, the disease doesn’t impact their mind at all. So they are fully aware that they are trapped and dependent on those around them for even the most basic of needs. As of my writing this review, scientists haven’t figured out a definitive cause or cure, and have developed very few options for treatment, so ALS is unfortunately a death sentence. In rare cases there are people like Stephen Hawking who successfully lived with the disease for decades, but the typical lifespan is about 3 years after diagnosis, sometimes even less. (Sorry for going overboard on the medical details of ALS, but I lost a family member to this disease and so this book hit me really hard on quite a few levels).

Every Note Played follows Richard Evans, a gifted and world-renowned pianist who suddenly loses the use of his right hand and is subsequently diagnosed with ALS. Richard, whose entire life has revolved around playing the piano – to the detriment of both his marriage and his relationship with his now grown daughter – cannot fathom what kind of life he can possibly have if he can no longer do the one and only thing he loves to do, play music. As the disease progresses and takes away so much more than just his ability to play the piano, Richard starts to reflect more and more about his life and all that he has thrown away for the sake of his career. He knows he’s going to die and starts to wonder if there’s time to make amends and make peace with those he has forsaken for most of his life.

Richard’s ex-wife Karina is paralyzed in her own way. She and Richard split up three years ago and yet she has refused to move on with her life. When they were first married, Karina, also a gifted pianist, gave up her dreams of becoming a jazz pianist to follow Richard to Boston so that he could become a classical pianist. Now that she and Richard have split, it would be easy enough for Karina to move back to New York and its jazz scene, but she chooses not to, always finding excuses and always blaming Richard and their failed marriage for every chance she refuses to take.

When Karina finds out about Richard’s condition, however, and knows there’s no way Richard can afford the ‘round the clock care he needs, she reluctantly offers to become Richard’s caregiver. Will Richard and Karina be able to put their differences aside and make peace with each other before it’s too late?

The complex characters and their even more complex relationships were what I found especially compelling about Every Note Played. In Richard Evans, Genova creates a man who, pre-ALS, was not an especially likable guy. In many ways, he was selfish, arrogant, and self-important. His career was the most important thing in his life, and nothing else mattered. His passion for the piano eclipsed everything else, including his relationship with his wife and daughter. After Karina and Richard divorce, in fact, his daughter rarely ever even bothers to try to communicate with him because he has done so little to ever cultivate any kind of a relationship with her. So yeah, the guy’s kind of an ass.

That said, however, Genova paints the portrait of what ALS does to a person so vividly and gut-wrenchingly that you can’t help but feel tremendous sympathy for Richard anyway. ALS is a disease you wouldn’t wish on your worst enemy. This is why his ex-wife Karina, even though she swears she hates Richard, can’t help but offer to take care of him once she realizes what this disease is going to do to him.

I love that Genova keeps it real here though. The dynamic of their relationship doesn’t magically change just because Karina feels sympathy for Richard and wants to help him. The hostility and resentment are still bubbling just below the surface. Karina still hates Richard and he doesn’t particularly care for her either so their interactions are often strained and awkward, as one would imagine a divorced couple would be around one another. They need to have some serious conversations if they are ever going to forgive each other and make peace, and those conversations aren’t the easiest to start. Then there’s the added pressure that they’re on the clock. Unless there is a miracle cure, Richard’s days are numbered…

In addition to this messy ex-couple and what they each bring to the table in this story, I also thought Genova did a tremendous job of teaching her readers a lot about ALS, especially about its progression and how it impacts both the patient and the patient’s family. She presents the story in alternating chapters from both Richard’s and Karina’s perspective so we are presented both with the details about how the disease is progressing as well as each of their thoughts about it.

As I mentioned above, I lost a family member to ALS and reading Richard’s journey brought back a lot of sad and painful memories because Genova’s depiction of the disease is so spot-on. I very much appreciated her attention to detail and really hope that people will read her book, learn more about the disease, and will want to donate money to help find a cure or at least some more viable treatments for ALS.

I could see some readers getting somewhat bored with the story if they don’t connect with Richard or don’t want to see a step-by-step progression of a debilitating disease. This was not an issue at all for me, but I just wanted to mention that so that people understand what they’re getting when they pick up this book.

Every Note Played is a powerful and poignant read that is sure to make you shed a few tears. Although it’s predominantly a story about how devastating ALS is, it also has its uplifting moments when it comes to family, forgiveness, and redemption. I would definitely recommend this to anyone who was a fan of Genova’s Still Alice but also to anyone who wants to know more about ALS.

Lisa Genova crafts an exquisite, profound, and moving story of Richard, a concert pianist who is diagnosed with ALS (Lou Gehrig's Disease) at the age of 45. Cruelly, the disease claims his right hand first, then his left, ending his career. Estranged from his father and brothers, he is left with few choices as the incurable, swiftly progressive, and unspeakably cruel disease advances. His daughter, Grace, is away at college and he will not disrupt her life (or raid her college fund). His ex-wife, Karina, also an accomplished pianist who gave up her own budding career in jazz to raise Grace while Richard toured, convinces him to move back into the family residence so that she can care for him. Thus, each of them must confront the long-held anger, resentments, and justifications for their respective role in the disintegration of their marriage. Karina, in particular, finds forgiveness difficult until, with the help of one of Richard's experienced caregivers, she comes to understand that forgiving Richard has nothing to do with him and everything to do with her own well-being and need to move forward following Richard's inevitable death. Every word of Every Note Played resonates, as Genova, a neuroscientist, details Richard's physical decline and the associated psychological toll it takes on him and everyone around him. The predictability of the story does not detract from its power. Rather, because of Genova's straight-forward, unflinchingly -- indeed, sometimes brutally -- honest approach to the subject matter, Every Note Played is an unforgettable reminder that "every note played is like a life and a death."