Review: Counting Backwards - Binnie Kirshenbaum

Genre: Contemporary Fiction

Published: Soho Press, March 2025 My Rating: 1/5 stars

"You look at him, puppy-eyed. At this man who looks like Leo, but isn’t Leo and want to say “my husband always kept pens in his pocket too. I miss you already.”

I thought long and hard on how to rate this novel. What I eventually ended up with was the longest review I've ever written, and a rating of a single star. Although it has a bunch of redeeming qualities, which I will address below, I ultimately reserve my 1-star reviews for books that I feel are potentially harmful or downright piss me off. Both applied here.

Before we get into the Good-Bad-and-Ugly-style disection, I want to address two points:

First: I am NOT attacking the author, or her personal experiences around this subject-matter. My review is about the book, not the individual.

Second: I’ve seen people be proper vile in the comments of critical reviews on this book – more so than usual -, or attempt to silence these reviewers based on “you don’t know what you’re talking about”. So let me state my (unfortunate) credentials on the subject, to nip those comments in the bud.

- 7 years of caregiving for my mother, until her passing of a terminal neurodegenerative illness.

- another round of palliative caregiving for my foster-mother a few years down the line

- I work professionally in (primarily) oncology and palliative care in the Netherlands. That final point becomes relevant in The Bad section.

I feel so passionate about this book because I do personally care and feel for this topic. That’s why I am expressing my opinion; to show a different inside-insight that might be helpful to others.

The Good:

I desperately wanted to love this book. Representation of neurodegenerative illness (specifically the rarer ones like Lewy Body dementia) from an own-voice patient- and caregiver-perspective is unfortunately far to rare in literature. Understandably so, because this is a hard topic to speak of, let alone write about. I want to commend the author for doing it anyway and providing many readers with a story that they found recognition or even comfort in.

Although she mentions in multiple reviews that this book is not autobiographical, her experiences of losing her husband to Lewy Body dementia put an undeniable layer of authenticity into the story.

The power is in the smallest moments here. The every-day losses of a trivial task no longer being possible, a once-shared memory suddenly being yours alone, or that flash of realization that – in that moment - the person you once loved more than anything is suddenly unrecognizable to you (and vice versa). These small moments may seem featherlight on a day-to-day basis, until their cumulative weight sneaks up to you in crushing heartbreak. Kirshenbaum understands that, and portrays it in an understated manner, befitting of the experience.

I also really appreciate the choice of second person narrative for this story. This again, is not an easy choice, but it puts you as the reader straight into the shoes of our protagonist and forces you to engage in the question: what if this was me?

The ending paragraph ties the choice of second-person narrative into a neat bow, hitting me with a sudden rush of sadness when I realized what it was doing.

The Bad: (dislikes from a factual and professional point)

Because representation of this topic is so rare, your voice is going to ring extra-loud once you dó speak up. Any one-sided- or factually incorrect information is amplified as a result too. Here’s where I have a problem with this book.

1. There are factual inaccuracies in the story. Some of them are small, like the nurses being the ones prescribing medication to Leo, without a doctor ever being present or signing off on it. (Nurses cannot legally prescribe medication, this is a task reserved for doctors). Some of them are bigger, like the portrayal of the doctors wait-and-see-policy as being “negligence” and his final diagnosis of LBD being made by a mental-health professional.

When Leo first presents with symptoms, he sees a neurologist for an MRI. This neurologist sends him home without a definitive diagnosis and recommends him a re-scan 6 months later. This is presented as him dismissing Leo’s concerns and being negligent and incompetent. In truth, this is medically the correct policy when suspecting LBD. Part of the diagnostic process is the progression of symptoms and scans in time. This time is necessary to rule out other illnesses that can mimic LBD, and diagnosing a patient with a terminal neurodegenerative illness without a cure based on 1 consult, is premature and potentially harmful.

This book presents the neurologists careful consideration of a serious diagnosis as “lazy/tardy caregiving” and dismissal. This is a far too prevalent misunderstanding in medicine already, and its perpetuation is harmful. A speedy but wrongful diagnosis can be far more harmful than a correct and thorough diagnosis with 6 months later.

Not to mention that the final diagnosis is made by a mental-health professional, who hasn’t seen Leo himself and only goes off his wife’s story. This is irresponsible and incorrect in so many ways, and I can’t believe how this made it past editing.

2. In line with point 1, all doctors and professional caregivers/aids are portrayed as one-dimensionally incompetent, uncaring and useless. This is literally stated by Larissa on page, and isn’t challenged by a single instance. Again: such a one-sided portrayal of an entire profession is harmful to both the profession ánd potential readers who might distrust professional care because of it.

The caregiving that ís praised to high heavens in the book, ironically is far more questionable. I had a huge issue with the portrayal of Larissa. The (professional/personal??) relationship she has as Leo’s full-time aid is very codependent and the dynamic between her and our protagonist borders on abusive. Larissa – a person of color, with a family she’s supporting aboard - is clearly being underpaid, and has literally 0 time off. In addition, she dismisses all other caregivers as useless and actually puts Leo in danger by sending them away or ignoring their policies. At one point, she takes Leo off his prescribes medication, because “she feels it’s not right for him”. As a professional aid without medical training, you cannot do this. Patients can be seriously harmed and professionals (deservedly) lose their jobs over behaviour like this! None of this is ever called out in the book.

3. Then there is the entirety of Chapter 11 titled Mixed Messages, which almost made me throw the book across the room. In this chapter, out protagonist contemplates how “civilized countries like The Netherlands and Canada just euthanize people like Leo”. She even likens it to “medical tourism” regarding plastic surgery in Argentina and Mexico, and how these countries promote this, because its good for business.

As a Dutch physician, I cannot even begin to explain how dismissing, disrespectful and filled with misinformation this entire chapter is. First off, I’m not blaming the character for thinking these thoughts. In fact; I commend the author for putting them to paper, as I feel many caregivers will encounter them at some point in their journey.

However, I do blame the author for the way she portrays and oversimplifies it here. Euthanasia is an incredibly difficult and complex topic that should be handled with the most care. I could write an entire paragraph about all the ways this book misrepresents, underplays and oversimplifies this, but let me leave it at these 3 points:

- no, we don’t euthanize patients willy-nilly here in the Netherlands and you certainly cannot come for “medical tourism” to get this done. - comparing legal euthanasia to "putting down a dog" or a form of medical tourism is incredibly dismissive of the complexity of the issue and is an insult to relatives of patients who've passed in this manor ánd professionals who've been confronted with it.

- euthanasia is based on the explicit request from the patient, not the family. This makes euthanasia in cases of dementia so incredibly difficult, as the patient might not be able to express their wishes clearly anymore. The scenario that Addie fantasizes about (taking her husband to the Netherlands under false pretenses and having a doctor euthanize him, without his explicit and repeated consent is not euthanasia. It’s murder.

For a topic that is so sensitive and so misunderstood, misrepresentation like this is incredibly problematic and warrants my 1-star review on its own.

The Ugly: (dislikes from my personal perspective)

Here we get into my personal feelings towards the story. These are coloured by my experience of caregiving, and my own biases. They may not be “correct” and may downright be “ugly” in their own right. I’m aware of this, but they are a part of what made me dislike this book so strongly.

In short: I hated our protagonist and could not relate to how she chose to deal with the situation at hand. She chooses to ship her husband off to a separate apartment and hires a full-time live-in care-aid to completely delegate all care to. This couldn’t be further from my experience and choices in caregiving and the book did nothing to help me understand how Addie came to this point.

The moment of “rehoming my husband” comes very abrupt and the lead-up to this decision isn’t fleshed-out enough for the reader to reach that point with Addie. Because of that, her undoubtably complex grief comes across as disingenuous, and her decision to step away from her husband as selfish, callous and privileged. Again: I am not saying that delegating care for a sick loved-one is callous. I am saying that the way it was written here made it come across as such, and made it impossible for me to relate to our protagonists grief in the way I was supposed to.

If you made it to this point, I’m genuinely impressed and thankful for sticking with it. I’m well aware this was a monster of a review, but getting my thoughts on paper was therapeutic after this read. I’m glad this book seems to have struck the right note for so many other readers, but obviously it didn’t for me.

If you're still interested in reading this book for yourself, you can find it here on Goodreads.