48 pages • 1 hour read
Lisa GenovaEvery Note Played
Fiction | Novel | Adult | Published in 2018A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 16-24Chapter Summaries & Analyses
Chapter 16 Summary
After the choking incident, Karina takes Richard to the ALS clinic, where his doctors determine that his ability to swallow has decreased significantly. The next day, he undergoes surgery to attach a feeding tube directly to his stomach. The doctors also provide him with a BiPAP, short for bilevel positive airway pressure, which is a machine with a mask attached that helps him breathe at night.
Three weeks pass, with Karina continuing to care for Richard, including administering food and medicine via the feeding tube. Richard fantasizes about his favorite foods, but this is dangerous since it increases his saliva production, which interferes with his breathing.
During the night, Richard’s BiPAP occasionally loses its seal, which sets off an alarm. As a result of waking up several times each night to adjust the BiPAP, Karina becomes increasingly tired.
As Karina places the BiPAP on Richard one night, he feels a desire to apologize to her for all the wrongs he committed throughout their marriage, including multiple affairs, instead of making excuses as he usually does. He says, “I’m sorry,” but his voice is too weak for her to hear over the sound of the BiPAP.
Chapter 17 Summary
A few days later, after Bill finishes his shift with Richard, he confronts Karina, concerned about the “tension” between her and Richard. He asks her whether she ever intends to talk openly with Richard about their fraught history and then encourages her to reconcile with Richard while she still can, in order to get “peace of mind and closure” (163). He points out that forgiving Richard is more for her benefit than his. He also encourages her to take some time for herself.
Chapter 18 Summary
About a month after Christmas, Grace returns home for a long weekend. She joins Grace and Elise on a morning walk. Grace and Elise encourage Karina to get more help caring for Richard, but she insists that she is fine. Elise invites Karina to join her and her students on a four-day trip to New Orleans in March, and Grace offers to care for Richard while Karina is gone. Karina reluctantly accepts their offer.
Karina returns home to find the BiPAP alarm ringing.
Chapter 19 Summary
Karina rushes to check on Richard, who is fine. He asks her to help him go to the bathroom, which is one of her least favorite parts of caring for him. Afterward, she cleans spilled urine from the floor.
Richard then asks Karina to attach his Head Mouse so that he can use his computer. She spots him working on a draft of a letter to his father. When she implies that he should ask his father for help, he responds that it is not necessary since he is only a minimal burden to Karina. Offended that he does not appreciate the extent to which he disrupts her life, she tells him to “go to hell” and briefly imagines letting him die the next time the BiPAP alarm goes off.
Chapter 20 Summary
During a piano lesson, Karina waits for a 13-year-old student, Dylan, to play the first note of a simple prelude by Johann Sebastian Bach. Rather than show him the note, as she usually does, she waits in silence, feeling increasingly upset and critical of him and of Richard, whom she can hear sputtering for air through a buildup of saliva. She daydreams of going into the next room and smothering Richard with a pillow. She starts when Dylan finally plays the first note, middle C.
Chapter 21 Summary
Possibly at Karina’s request, Grace sits for a few minutes in Richard’s room just before she is scheduled to go back to school. After an awkward silence, he assures her that her tuition money will not be impacted by his treatment. She asks if there are any new treatments for ALS on the horizon, and Richard explains that he is part of a clinical trial for a new drug. At best, however, drugs can only stop ALS from progressing, not reverse it.
Just as Richard is reflecting with regret on how much of Grace’s childhood he missed, Grace says that she feels like he “picked piano over [her]” throughout her childhood (190). Richard admits that he did so and realizes that he hardly knows his own daughter. Grace wipes away Richard’s tears, as well as her own, before departing, leaving Richard wishing that he could give a more comprehensive apology.
Chapter 22 Summary
Richard and Karina meet with Dr. George, an augmentative communications specialist. Richard explains that he is losing his ability to speak clearly and wants to know how to continue communicating. Among the services Dr. George offers is voice banking, or recording key words and phrases in a patient’s voice to be used when the patient can no longer speak; ideally, Richard, whose voice is already weakening, would have come in much sooner. Dr. George encourages Richard to take some time each day recording himself, focusing on personal phrases or even movie quotes.
Dr. George also gives Richard an alarm button he can push to call for help during emergencies, an alphabet board and accompanying flipcharts with common phrases he can use to communicate nonverbally, and a microphone that amplifies his voice.
Chapter 23 Summary
Richard continues to spend time each day revising drafts of a potential letter to his father, Walt, but he stops short of sending any of them. Since Walt rejected Richard for pursuing classical music, Richard doesn’t want to show any signs of vulnerability. Above all else, he fears that Walt would be indifferent to Richard’s plight instead of offering the apology that Richard craves. One of the nine drafts is a simple statement of the facts, while another emphasizes Richard’s illustrious career as a pianist. A third details various wrongs committed by Walt, including his use of anti-gay slurs against Richard and his threat to destroy Richard’s piano with a chainsaw. Richard imagines Grace writing a similar letter to him.
Karina enters, announcing a phone call from Richard’s brother, Tommy, who reveals that Walt died the night before. With Karina’s encouragement, Richard promises to attend the funeral in New Hampshire the following week.
Richard deletes the folder containing the drafted letters.
Chapter 24 Summary
Following Walt’s funeral, Richard, Karina, and Grace join his extended family at the family home where Richard grew up. Richard learns that the piano he once played has been moved to Tommy’s house, where Richard’s nieces are learning to play. Looking around the house, Richard misses his mother, Sandy, who supported his efforts to play piano and even blocked Walt from cutting the piano with a chainsaw during an angry fit. Sandy died when Richard was 18. Though his mother never met Karina, Richard imagines she would have liked Karina, unlike Walt, who was prejudiced against her since she is a lapsed Catholic and a Polish immigrant.
When Richard’s brother Mikey offers him a sandwich, Richard and Karina explain that he only consumes through his feeding tube. Mikey encourages Richard to “fight” ALS, citing the viral ice bucket challenge as well as the 2016 documentary Gleason about a football player who was diagnosed with ALS. Richard appreciates Mikey’s good intentions but considers his advice ridiculous.
Mikey and Tommy reveal that Walt left his house to the two of them, but they plan to give Richard an equal share of the proceeds from selling it. They apologize for Walt’s meanness and compliment Richard for his piano playing, citing him as an example to their music-minded children; Richard is deeply touched. Before Richard, Karina, and Grace leave, Mikey offers a toast to Walt.
Chapters 16-24 Analysis
These chapters see the novel’s plot continue to move toward climax through rising action. Specifically, Richard’s worsening symptoms necessitate a new, higher level of daily care. This impacts Karina, who feels exhausted and underappreciated, fueling additional resentment toward Richard. As their conflict intensifies, so does Richard’s quest to get closure with his father, who, in an ironic twist, dies just as Richard is composing letters to him. As this subplot reaches its climax in this section, all that remains to be resolved in the final section, at least in personal terms, are Richard’s key relationships with Karina and Grace.
Much of the conflict between Richard and Karina can be seen in terms of Blame, Guilt, and Reconciliation. Due to lack of clear communication from Richard, Karina comes to feel that her ever-increasing level of self-sacrifice is going unappreciated. In some ways, this represents a new low for her as a character. Perhaps never before during their marriage was Karina asked to give up so much and receive so little in return. As her resentment toward Richard grows, her desire for reconciliation fades, at least temporarily, as she envisions inflicting harm on Richard. This highlights the reality of caregiver burnout as well as the importance of expressing gratitude; Karina’s pain might have been significantly lessened if Richard expressed his appreciation sooner and more frequently. However, Genova does not assign all the responsibility for Karina’s frame of mind to Richard. As Bill points out, Karina has just as much opportunity to communicate clearly, or not, as Richard does, and learning to forgive would be to her benefit. Even as Richard’s relationship with Karina remains as fraught as ever in this section, Richard goes through a process of reconciliation and healing within his family, as his two brothers apologize for their father’s poor treatment of Richard. Their words demonstrate the healing power of apology to Richard, setting the stage for him to offer a similar gift to Karina.
Building on this same theme, this section also sees Grace and Richard drawing closer together despite lingering guilt on his part and blame on hers. Grace remains something of a mystery to Richard and, by extension, to readers. Certainly, she has conflicted feelings about Richard and is more loyal to Karina than she is to him. Her abrupt accusation that Richard did not sufficiently prioritize spending time with her throughout her childhood prompts an honest confession from Richard. As this moment shows, perhaps more than her parents, Grace has a knack for communicating honestly. Only by bringing her concerns out into the open can she and Richard acknowledge and begin to address them.
This section also deepens Genova’s theme of Confronting Mortality. As Richard begins to lose the ability to perform certain fundamental, life-sustaining activities, such as breathing and eating on his own, this raises questions about the nature and value of life. Like the long, slowly fading note he played on his piano, Richard’s life appears to be gradually slipping away, one function at a time. Notably, none of Richard’s appetites fade; he still longs for the food he cannot eat, just as he longs to play the piano. As each of these and other avenues of expression or satisfaction is taken from Richard, he is left to consider what it means for him to be alive, as well as what constitutes his essential identity as an individual. In this context, he finds that his personal relationships loom larger than ever.
In terms of The Transformative Power of Music, this section sees a few small but critical developments. This includes Karina’s decision, at long last, to attend a musical event in New Orleans with Elise. That Karina makes this decision only under pressure from Grace and Elise demonstrates the need to support not only those who are diagnosed with terminal illness but also those who are directly impacted as a result. Karina’s openness to musical exploration coincides with a new low point in her career as a music teacher, with her disastrous lesson with Dylan culminating in the playing of a simple middle C. Like other forms of art, music can be immensely fulfilling, but it risks becoming the opposite when it is forced upon the unwilling. However, there is a sense that because this trip will focus on jazz music, Karina’s under-nurtured passion, it will be especially transformative by helping her re-explore a genre she previously gave up for Richard.
Richard is also reminded of The Transformative Power of Music when he goes to his father’s funeral and learns that the same piano he used to play as a boy is now being played by his nieces. He realizes that his passion for music, though not appreciated by his father nor inherited by his daughter, will live on in his brother’s children, even after his death.
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By Lisa Genova
