The narrative follows the Leary family across decades as they navigate the slow, devastating erosion of their stability caused by a husband's early-onset Alzheimer's disease. Eileen Leary, driven by a fierce desire for social mobility and a secure middle-class existence, finds her aspirations complicated by her husband Ed's quiet, academic nature and his eventual cognitive decline. The story unfolds through a multi-generational lens, examining the tension between individual ambition and the crushing weight of familial duty. As the disease progresses, the family must reconcile their past expectations with the harsh, unpredictable reality of their changing circumstances.

This novel received significant critical attention upon its release, with reviewers frequently highlighting the author's ability to balance intimate domestic drama with a broader historical scope. Critics often pointed to the emotional weight of the narrative, noting how the prose captures the slow, painful disintegration of a family unit under the pressure of illness. Readers have engaged with the book as a poignant study of the American experience, particularly regarding the intersection of personal ambition and the realities of aging. The work is widely regarded as a substantial contribution to contemporary family sagas, praised for its patience and its refusal to offer easy resolutions to the characters' struggles.