Aaron looked across the table at Alma, her undercut and black curls, her coffee eyes and the plunging neckline of her dress, and for a terrifying second, his memory flickered like a glitched projector and she was made unknown. 

           And then she was made Alma again: beautiful Alma, creasing the linen napkin before folding it in her lap, adjusting the curve of her hearing aid and its position on her mastoid. The Pasta Garage was nearly empty—it was Mardi Gras a few blocks from the Vegas Strip—and Alma glanced at the tables around them constantly. The silence bothered her, Aaron knew, but he couldn't imagine the white noise the hearing aids created from the blank signal as she described it: noise like steel wool, noise like popcorn kernels, noise like something incoming. Even though Aaron and Alma met at their ASL class, Aaron didn't have hearing loss, and he sometimes felt Alma realizing their prognoses diverging, angling out as Aaron got worse. He felt himself wanting to snip the intersection. 

           "What are you getting?" Alma asked. She was studying the menu even though they ate there once a month. 

           I think we should break up. "Probably the same," he said. 

           “Cacio e pepe?” 

           He nodded gratefully. He hadn’t remembered, and he loved her for being able to tell. He hated that Alma had never known him before he was a 29-year-old dementia patient who couldn’t remember his favorite pasta order, or his zip-code, or his nephews’ names. “You okay?” She looked up. 

           “Yeah,” he said. “Yeah, I—yeah.” 

           Her gaze ossified. “You sure?”

           His eyebrows flickered to a crease and back and he clenched his jaw. “Yeah.” He paused, gathering the words like marbles in his mouth, awkward and bulky. “How was your day?” “Good, good. Oh, did I tell you Joshua texted me about doing a show at his gallery? I’d headline it, I think. Las Vegas artists was the theme, he said, so I think I want to do a huge collage with, like, space and a bunch of images of Las Vegas in popular media, you know?” “Yeah, that’d be—good,” Aaron said. 

           “Yeah, and I think he’d put up that unsold portrait I have in the studio, the huge lavender one.” 

           Aaron couldn’t remember that one, but he could probably chalk that up to never having seen it rather than dementia. 

           “I think I’ll get the gnocchi. I think I liked that the last time I had it,” Alma decided. It was getting late, and Aaron could hear the Mardi Gras celebration outside. “And I’m getting the…” It was supposed to be easy. It was supposed to be easy, and instead, it felt like climbing up stairs and expecting one more step but finding only level ground: that split second where you couldn’t be sure how far your foot would fall. 

           “Cacio e pepe,” Alma said gently, because Alma was always gentle, because Alma was perfect, or nearly. “What do you want to do after dinner?” 

           I think we should break up. 

           The kitchen doors swung open, and Aaron turned. Alma followed his gaze and watched as an acne’d teen walked slowly from the kitchen to them. He was spinning a pen in his hands and looked bored beyond belief and, Aaron thought, sad, but then, Aaron thought everyone looked sad. The teen got closer and the sound of his smacking gum took shape.

           They ordered, and the waiter retreated. Aaron didn’t talk much, but then, Aaron never talked much lately. 

           “Aaron,” Alma said. You good? she signed, her fingers hitting her palm with a dull thud. “You’ve seemed really absent lately. Especially tonight.” 

           Aaron didn’t remember the food arriving, but he was picking at the pasta. “I’m fine, really,” he said. “I’m sorry.” 

           They were both silent for a moment. The sounds of the parade were closer now. “What’s this called again?” Aaron stabbed at his plate with his fork. 

           “Cacio e pepe,” Alma said. 

           “Oh.” Aaron scooped some into his mouth. “Ca-chow e pe-pay,” he said in an awful Italian accent. Alma smiled, and he loved her. “It’s good.” 

           “Yeah?” 

           “How’s yours?” 

           “The sauce is really good, but the gnocchi’s a little too mushy this time. I think their gnocchi soup’s better.” 

           “What’s the holiday again?” Aaron circled the T of his fist to sign Tuesday, Tuesday, Tuesday. 

           “Mardi Gras, Fat Tuesday.” 

           “After dinner, do you want to go watch the…thing? The Mardi Gras thing?” “The parade? Yeah, sure.” 

           Aaron twirled some pasta and thought, as he often did nowadays, about how much fine motor control the action took. How long would he be able to do it? Would he just switch to penne? How much would he have to lose?

           They walked south after dinner, and Aaron texted a friend from his dementia support group—a frail 73 year-old man with hair like Einstein who answered Aaron’s texts on a flip phone—to let them into his single-story building. Alma parsed a fire exit map and led them to the rooftop. Aaron sat on the edge, legs dangling and feeling both young and ancient, until Alma tugged him back a couple inches. 

           It was loud now, but it felt peaceful above the crowd, so distanced from it they might’ve been watching through a screen. Aaron pressed his ear to Alma’s shoulder and loved her, deeply and suddenly in the moment. Nothing else was real, but suddenly the two of them were. “Do you ever think about what you would have done without me?” 

           Alma laughed, quick and sharp. “In a what would I do without you way?” she said, mimicking a swoon. 

           “No, in a—” Aaron searched the skyline for letters. “In a—all the time you spend driving me to appointments, or whatever else, what could you have done with it?” Alma scooted away, and for once she was the one who couldn’t speak. 

           I think we should break up, Aaron signed, and he made to say it, but Alma’s face had already fallen. 

*** 

           Aaron’s diagnosis was startling and rare. He was twenty-five, and he had finished a Masters in library science the month before. Logopenic variant primary progressive aphasia. An early form of dementia that left him reaching for words and grasping at nothing. The first time it happened, or at least the first time he could look back and point to, it was just go to bed. He just wanted to say he was about to go to bed, and instead, he could only think of start the car. A new pair of dice. Heaven forbid. Random phrases he couldn’t sort through. Eventually, he had to struggle through every other sentence. Eventually, it would be every word. He bounced around from specialist to specialist until his diagnosis. There was a possibility the aphasia was caused by an undetectable cancer, so he got PET scans every three months in case it was suddenly detectable. He started speech therapy and occupational therapy and ASL classes, something he wasn’t sure about but was supposed to slow his language loss. He met Alma. 

*** 

           A twice-a-year angio pinned Aaron to Alma’s couch the November before Mardi Gras, vertigo tumbling the room like a wash cycle and folding it into itself. He stared at the ceiling at the end of the tunnel his vision had become, white noise rushing like the ocean in his ears. “I swear I don’t usually react to the dye this bad,” he slurred. 

           Alma was in the kitchen, putting up the groceries she got while he was at his appointment. “It’s fine, Aaron,” she said. “I mean, not fine, I’m sorry, but I don’t mind you being here. I mean, I was actually thinking about you moving in. Like officially.” 

           Aaron squeezed his eyes shut, and then he snapped them back open when the dark made everything—the nausea, the vertigo, the lightheadedness—worse. “What do you mean, move in?” 

           “What it sounds like. We should talk about this another time.” She was standing in the doorway between the living room and kitchen now. “But it’d be easier for me to take care of you, long-term, if we lived together.”

           Aaron imagined the stabbing pain of her words—the implication she would become Aaron’s caretaker as he became unable to take care of himself—to be physical. He wrenched himself up to look at her— 

           “Aaron, no—” 

           —and threw up into the trash can Alma had dragged in from the closet, and then he threw up again, and then he spat bile into the trash and dropped his head into his hands. Alma had materialized beside him, helplessly standing and watching as he turned himself inside out. 

           “I’m sorry,” he croaked into his knees. 

           “No, don’t be.” She scratched his back. 

           He felt more like her child than her boyfriend, and he hated himself. 

           Later, they sat at Alma's kitchen table, Aaron turning saltines in his hands and considering the cup of 7-Up in front of him. 

           "I didn't know you'd be so against this," Alma said. "We've been together for over two years. I have friends that get married after that long." 

           "Do you want to get married?" Aaron said. 

           "No. I mean, yes, but not because of this. I just don't understand why you don't want to move in. It’s not like I want to file taxes jointly or anything. It just makes sense. It’d be easier for me to drive you to speech therapy and OT, or your PET scans. It'd help with rent at the very least. Neither of us are getting any richer." Alma's hands were curled around a mug of chamomile.

           Aaron blanched at the explicit mention of how much work he was. Usually, they talked around it, a verbal game of hide and seek. Everything was a non-specific appointment or errand. "I didn't know you were into that. Marriage." 

           "Don't change the subject." 

           He also didn’t want her to see just how bad he was at functioning, at existing—at eating breakfast and remembering to get the mail or brush his teeth, at remembering when he had done laundry last or if he had already made that call to his insurance or not. "Well, don't—I don't want you to feel like I'm your responsibility, like you have to take care of me. You don't." 

           “Aaron.” Alma knitted her eyebrows together. “I don’t have to. And I already do, anyway.” 

           Aaron very suddenly and forcefully wanted to leave, not just the Alma’s apartment but also their relationship and in fact all of his relationships and maybe Las Vegas too, just for good measure. 

*** 

           After the diagnosis, Aaron sat at his kitchen table, staring at his cellphone. There were people he needed to tell, people he should tell, and nobody he wanted to tell. What he wanted to do: throw his phone across the living room, and so he did. 

           He didn't tell his mom for three days, and when he did, he texted her links to NIH and Mayo Clinic and Living with Dementia articles. She called him almost immediately, but he dropped his phone like the caller ID had burned him. The prospect of talking about it was terrifying, and he was exhausted. Everything was so tiring lately. He turned his phone on Do Not Disturb for two more days before picking up.

           She wanted him to move home, to Oregon. The rest of his family—two sisters, three nephews, and the brothers-in-law whose names he could never remember—lived outside of Portland. They would be able to take care of him, she said. She had read the articles, she said. She knew what he would need. 

           “I’m not leaving Las Vegas,” he said. He felt no particular attachment to this plastic imitation of a city, but it felt important to pretend to in that moment. 

           “You don’t even like Las Vegas.” 

           Damn. “Well,” he said. “Well.” He pivoted. “Mom, I’m fine. I could have—decades before I need help. There’s no way of knowing. And I like Las Vegas,” he said, voice lukewarm. “I like it more than having people hovering.” 

           “I don’t hover.” 

           Aaron sighed. On the other end, she did too. 

*** 

           Alma and Aaron never fought, except for when they did. They were always tired, and it was always about something else. And in the third year of their relationship, it was happening more and more. 

           The first time Alma brought up moving into together, they were driving back from one of her gallery showings. They were both exhausted—out of spoons, Aaron’s OT would say—and it was a terrible time to bring it up, but two of Alma’s friends were moving in together. The whole conversation was a mess: switching between speaking and signing even though Alma had one hand on the wheel and both eyes on the road, both of them bringing up long buried grievances with the other, both on the verge of tears of frustration and exhaustion. 

           I love you, Alma signed. Why can’t you believe that?

           “Alma, I love you, I love you, but I can’t even remember the difference between I love you and airplane half the time, and it’s only going to get worse.” Aaron laughed, a hysteric thing closer to a sob, clumsily signing at the same time. I don’t know the difference between I love you and airplane. It was funny, deliriously so. The same handshape, different motions his brain couldn’t remember. 

           “So?” Alma said. When would I not know what you meant? She swerved out of the adjacent lane and sped through a yellow light. 

           “I didn’t mean it literally, I just—I don’t want you, I wish, well—” Aaron sighed. Alma shook an open palm. What? 

           I don’t know, I don’t know. “I don’t want you to waste time on me.” 

           “You don’t get to tell me the value of my time, Aaron,” she said. She pulled into her apartment parking lot. “But you keep telling me you’re not worth it, why don’t you expect me to believe it?” She turned the keys, got out, and slammed the door. 

*** 

           Alma was diagnosed a few months after Aaron. A benign tumor had combined with Ménière’s disease to create a perfect storm of vertigo and hearing loss. A delicate cocktail of drugs with weird side effects—her skin was sensitive to the sun, and she wasn’t supposed to have too much calcium in her diet—tamped down the vertigo to manageable levels, but the hearing loss was unpreventable and worsening. 

           The audiologist gave her two lilac hearing aids and a list of ASL classes in the area, and then she met Aaron. 

***

           “Alma?” Aaron knocked on the open door to Alma’s studio, two angiograms before Mardi Gras “I think I’m gonna get groceries, do you need anything?” 

           Alma’s brush dropped from the canvas. The studio was a mess, as always: half-finished paintings lined against the wall, Tupperware palettes next to the sink. “Are you sure?” “We’re out of milk, and I wanted hot chocolate,” he said sheepishly. Two years into their relationship, Aaron had never offered to go grocery shopping. It stressed him out, and stress triggered his aphasia. But maybe the new combo of meds was working, and he needed to be able to go grocery shopping. 

           Twenty minutes later, Aaron pulled into a parking spot and couldn’t remember where he was until he looked up at the giant Kroger’s sign. Why was he there? 

           Aaron turned off the car. He checked his pockets. Wallet, phone. He checked his phone and his recent messages. Nothing helpful. He got out of the car. He shut the door. His hand lingered on the—handle. 

           A tide rose in his mind, and all the words he was so close to using became fuzzy, textured in a way that scratched and itched. Why was he here? Where was here? Kroger’s. Why was he here? 

           He searched his pockets again, close to tears. He felt so goddamn helpless. He swiped to the emergency contacts and called Alma. 

           “Aaron?” 

           “Alma, I—I can’t, I don’t know. I’m sorry, I just, I can’t. I don’t know why I’m here.” “Aaron, it’s okay.” Her voice was honeyed. Her voice was water. “Just come home. I’ll go with you later. Just come home.” 

***

           Before Alma had terrible luck with her ears, she had fantastic luck with her art. She worked in acrylics, mostly, but she took commissions for anything. She worked with the Meow Wolf exhibition when it first came to Las Vegas, and she did a few live wedding paintings before her balance issues got bad, and before she met Aaron at speech therapy. 

           She was incredible, but how much more could she have done if she wasn’t taking care of him? 

*** 

           Every morning Aaron swallowed fifty dollars in pastel pills, some powdery and some plasticky. Every morning, he thanked God he had insurance. 

           The only one he thought did anything was the Abilify, 10 milligrams. It leveled him out, made everything feel a bit more doable. He would have to go off it when the dementia gets worse. 

           Almost two years after meeting Alma, Aaron finally had a set of extra pills at Alma’s apartment, in a chic purple case she got him because it was her favorite color. Aaron stood in front of the mirror, pulling on a t-shirt and swallowing the pills. 

           “Are you ready?” Alma called from the bathroom. “I want to get out there before it gets hot.” 

           “I know,” Aaron said. “I remembered. I’m almost ready, anyway. Where’d I put my hiking boots?” He ran his fingers through his hair, persuading it out of its morning faux-hawk. “Probably by the door, right?” 

           Aaron leaned around the bathroom door. “Nope.” 

           “Well then, I don’t know.”

           They went hiking in the canyons outside Las Vegas every few weeks. To Aaron, it feltlike a gross indulgence, spewing carbon into the air on the drive just to walk around for a few hours, but to Alma it felt like a necessary one. Once they were there, Aaron would be able to breathe, and he would agree. 

           Alma pulled her Rav4 off the road and into the dust. Already, Aaron felt himself being mutated by the beauty of the desert and its strange splendor. It twisted inside him, pressing in on his diaphragm. 

           “You okay?” Alma said, holding a hand out. 

           “Yeah.” What? 

           Alma hit her palm on the C of her right hand. Camera. 

           “Oh,” Aaron said. “Right. You got the water right?” 

           “And all my painting stuff, which you might have to carry.” Alma opened the door and waited for Aaron to open his so she could click the locks. 

           “Painting stuff?” 

           “I was gonna do the live painting, remember? And you brought a book?” 

           “Oh.” Aaron shut the door. “Well.” 

           They hiked for nearly an hour before Alma stopped and dropped her bag. Aaron dropped his and sat down in the dust while Alma set up her easel. 

           “I don’t even like reading anymore,” Aaron said. 

           “You’re a librarian.” 

           “I know.” Aaron hummed a song with words he’d forgotten. 

           “That’s the only one that’s actually ironic.” 

           “What?” Aaron looked up. He was sitting cross-legged, arms balanced on his knees.

           “The song. Isn’t it ironic?” 

           Aaron blinked. 

           She shrugged, tipping the Tupperware palette in her hand. “You made granola last night. It’s in your bag.” 

           Aaron dug into his bag for the granola, gave up, and opened his book instead. Reading had become his homework in the last few weeks. He muddled through a few pages a night, writing down the unfamiliar words letter by letter in his OT notebook like they were hieroglyphs: shapes he couldn’t parse. They sparked nothing in his brain. “What’s this about? Did I tell you?” 

           Alma looked up from the blocking she was doing on the canvas. “I don’t remember. Read the back.” 

           Aaron did. “I feel like such a child doing nothing when you’re always doing…something.” 

           “I’m just painting, I’m not, like, doing surgery or something.” 

           Aaron laughed. “Still.” 

           “You cook for us both most of the time.” 

           “Fair enough.” Aaron laid back onto the ground and stared up at the clear sky, the cliff’s at the edge of the horizon. He could look at them and feel like he was falling.

*** 

           Aaron didn’t want to move home to Oregon, but he still visited after his diagnosis. He took his sisters out for hipster coffee that he couldn’t afford to tell them about the diagnosis, and they stared at him blankly, the significance lost on them for the first second of knowing. 

           “I have dementia,” Aaron repeated, enunciating so forcefully it felt like he was still trying to convince himself. He was.

           “But you’re younger than both of us,” Melanie said. 

           “Yes,” Aaron agreed. 

           For the rest of his trip home, everybody treated him as though he were glass, or a train wreck they couldn’t turn away from. He was mostly left with babysitting his sisters’ sons. They were the only ones who were normal around him, giggling and shrieking as he lifted them skywards and spun them onto the bed, their small soft bodies writhing as he tickled them or wrestled them into pjs. They were so happy, and he was so sad. 

*** 

           Admittedly, before his diagnosis, Aaron didn’t know how dementia could be fatal. How did forgetting things cause death? He was too embarrassed by the not-knowing to ask his doctor, so he Googled it: he would grow old, forgetting all the time he had survived. Then he would fall, and then he would fall again. He would break his brittle bones. He would break them again. He would aspirate food he tried to swallow, and all the foreign matter in his lungs would cause infections. He would get pneumonia. He would get it again, and again, and his scarred lungs would eventually give in to all that food he hadn’t managed to swallow down the right pipe. And then he would look up from his hospital bed, where he would be hooked up to ventilators and IVs and oximeters, and Alma would be there. He couldn’t do that to her. 

*** 

           A year and a half after meeting Alma, Aaron’s doctor started him on a cocktail of drugs that turned his stomach into something foreign and angry. It flipped inside of him, repulsed by anything Aaron tried to eat or drink, and two days in, Aaron took Sprite into his bathroom, and, exhausted, lay on the bathroom floor. He couldn’t think. He felt like his thoughts were moving through a thick swamp, or tar. He was sinking. He was floating. He was dry heaving into his toilet. He was groaning. He was listening to a knock on the door and wondering if it was death. “Aaron?” Alma was standing over him. 

           He closed his eyes, opened them, and stared at the grout. 

           “Aaron, come on, let’s get you to the bedroom.” 

           Aaron groaned. “I don’t, just—” He held up a hand. “Please,” he choked. “Leave.” Alma blinked. “Aaron. I—” 

           “Please.” 

           She hesitated, and then she turned around and walked away. 

           Aaron looked at his hand. His middle and ring fingers were curled down. I love you. 

*** 

           Early on in their relationship, one lazy morning in bed, Alma had asked him what he wanted to be when he grew up, like he was a child, and Aaron had laughed. “No, I’m serious,” she insisted. “Answer it like it’s serious.” 

           Aaron’s head was on her stomach, one hand loosely holding hers. The pale morning light drooled across the both of them, beautiful and, like everything else, bittersweet. “Well,” he said. It was just starting to be his filler word, then, one he could always land on. He didn’t know how to answer Alma with anything but vague sentiment. He wanted to be the kind of person who took a walk at the same time every day, the kind of person who knew their neighbors’ dogs. He wanted to not feel so sad when confronted with beauty. “I don’t know. You first.” 

           “I wanted to be a firefighter for a while. I don’t know; I kinda think I’d like your job. Libraries are nice. I could have a second act as a chef. A TV chef. You never know.”

           “I wanted to be a writer, you know, before.” He had never told anyone the bitter irony of it, a writer, but Alma knew him better than anyone. Better than he knew himself. “And now?” She ran her thumb in a circle on his palm. 

           “I don’t know, Alma. I want to be the kind of person who calls to ask how the weather is where you are. I want to be happy.” 

           “Aren’t you?” 

           Aaron tilted his head back so he could see her face. She was propped up on lavender pillows, one hearing aid on and the other on the nightstand. Her walls were covered in leftover unsold paintings. Thunder rumbled distantly in the desert. Everything was beautiful. “Yes,” he said, and it was true. 

*** 

           “So turn to your partner, and practice those few signs,” Eric said, enunciating slowly and limply signing the words at the same time. He spoke more clearly than anyone Aaron had ever known, and that might have been his only qualification for teaching the ASL class Aaron’s occupational therapist had recommended. 

           Aaron rolled his eyes as he turned in the child’s desk, banging his knee on a crossbar. The class was held in a high school in the evening, and he could tell every time he saw a dick carved into any carvable surface. Hi, Aaron signed, turning it into a near salute with his dramatic bitterness. My name is A-a-r-o-n, and I’m an alcoholic. 

           His partner barked out a surprised laugh. Aaron was grateful she had read ahead, too. My name is A-l-m-a, Alma signed. She ran her fingers across the rough hair of her new undercut. She was smiling, and Aaron smiled too.

           Aaron and Alma were both too old for the pizza place they went to after class. It was filled with punk teenagers, something Aaron thought Google Maps really should have warned him of. 

           “I feel like it’s the eighties,” Alma said, the words still clumsy with her new hearing loss. “All these mohawks.” 

           “And leather,” Aaron agreed. Neither of them had lived in the eighties, but they had also never felt as old as they did surrounded by teenagers wearing clothes they just didn’t understand. When they got to the counter to order, Aaron stared at the menu blankly. What kind of pizza did he like? Fucking hell. 

           Curiosity flashed in Alma’s eyes and she furrowed her eyebrows, reaching out and grazing his elbow. “Supreme, maybe?” 

           “Sure,” Aaron said, relieved. 

           “What kind of hearing loss do you have?” Alma called over the busy crowd as they waited at the end of the counter. 

           “Oh,” Aaron said. “Well. I don’t. Have hearing loss, I mean. I have aphasia—like I forget words—and so my, my neurologist thought I should try ASL classes. Good for the brain.” “Yeah I guess so. Learning another language couldn’t be bad for the brain, right?” “No, I guess not.” 

           The pizza was good and they ate slowly, clumsily practicing their new signs between bites. 

           I’m from O-r-e-g-o-n. I have two sisters. Teacher and lawyer. 

           I’m from—Alma gestured to the pizza place. “Here,” she said. “My parents were both in hospitality.”

           Aaron covered his mouth. “What place?” 

           “The Venetian, actually.” She folded another pizza slice. 

           “You do a lot of gambling, then?” 

           “No, actually. I’ve never actually been.” She took a sip of her Coke. 

           “What?” Aaron shook a bent-b handshape. He had been in the class for weeks, and it had become reflex. “How the hell—you live in Las Vegas and you’ve never been gambling?” “I just never got around to it.” 

           “We should go,” Aaron said seriously. “We’re adults, we’re diseased, we need to go gambling. We’re due for some good luck.” 

           “Okay, are you free after this?” 

           “Tonight?” Aaron said. “It’s nearly nine.” He looked at his watch. Someone from his dementia support group had recommended it. It had multiple alarms, which would apparently be important later. 

           “Yeah, nine, come on, it’ll be fun. We’re due for some fun.” 

           “Okay, let’s do it.” 

           Gambling was awful, and the casinos all smelled the same, so they left and walked down the Strip, laughing at their quick exit from Caesars Palace. 

           Alma bumped into him, and Aaron looked down at her. 

           “Balance issues, ‘member?” 

           “Oh, yeah, sure, balance issues.” 

           Alma brushed the back of his hand with hers and then threaded their fingertips together. “Balance issues?”

           “Balance issues.” Her voice was small and breathy. When they passed the Bellagio fountains, Aaron stopped as the water burst into the air. “Isn’t it ironic?” was blasting from a speaker on a corner, and showgirls wearing red and white were stopping passers-by. Alma reached up and pulled his head down to hers, and she kissed him. 

           He closed his eyes, but her face burned into his retinas, and he knew he would never forget her. Her hand slipped into his pocket and squeezed his ass, and someone clapped, and then the sidewalk erupted into applause. He couldn’t catch his breath. His head spun. They pulled away from each other and grinned. 

           How could he not fall back in love?