This is a difficult book to read, but it is a painfully honest and accurate look at daily life in an alzheimer's unit of a nursing home. I was a volunteer "friendly visitor" for nearly four years at a skilled nursing facility, where there were some alzheimer's patients mixed in with the other patients, so I recognized much of what Dyer describes of the behavior and physical failings of her mother and other patients at Tanglewood. This is not a very long book - I read it in just one day - but I found I had to keep getting up and taking short breaks from it, because I kept catching myself physically clenching and wincing as Dyer described in detail, in short, broken sequences, examples of patients in the unit (yes, including her own mother) who had lost control of their bodily functions and would often wet themselves and/or play with and fling their own feces. But perhaps the most heartbreaking loss of all in these victims of this terrible disease is the loss of words, and even of speech itself. Dyer's mother was also profoundly deaf, which exacerbated the problem of communication even more.

Perhaps one of the most telling lines in this short book is a comment often voiced by one of the patients, who enjoys repeating a favorite phrase, a "joke": "Death must be OK ... because nobody has ever come back from it!" And for the patients far gone in the clutches of this devastating dementia, perhaps death would be okay.

As hard as alzheimer's is on its victims, it can be equally hard on the victims' families, on their closest caregivers and visitors - spouses, parents, children. When her mother finally succumbs to the disease, Dyer comments, "I don't plan to recover from what I've seen over the last nine years. My friends look at me with sorrow and urge me to take a good long vacation ... The Florida sun or a Bahamas breeze will not help me forget any of this. And why would the daughter of a woman who forgot everything find comfort in forgetfulness? ... I don't want to forget a single thing."

In a Tangled Wood is Dyer's testament that she has not forgotten a single thing. Most of all she has not forgotten her mother. Painful at the writing must have been, this book stands as a tribute to her mother, and also to the people who helped to care for Annabelle Coyne during those last difficult years. This is the third memoir by Dyer that I have read. All three are excellent. Joyce's mother and father would be proud. ( )