Every Note Played

“Unsparing in her depiction of the disease’s harrowing effects, neuroscientist Genova also celebrates humanity.” —People

“Sometimes it’s easier to tell truth in fiction…And she tells it with heart and hope.” NPR

“Her juxtaposition of scientific detail with compassionate, heartfelt storytelling is unparalleled.” Bookreporter

Every Note Played will grip and gut you.”The Boston Globe

From neuroscientist and New York Times bestselling author of Still Alice comes a powerful exploration of regret, forgiveness, freedom, and what it means to be alive.

An accomplished concert pianist, Richard received standing ovations from audiences all over the world in awe of his rare combination of emotional resonance and flawless technique. Every finger of his hands was a finely calibrated instrument, dancing across the keys and striking each note with exacting precision. That was eight months ago.

Richard now has ALS, and his entire right arm is paralyzed. His fingers are impotent, still, devoid of possibility. The loss of his hand feels like a death, a loss of true love, a divorce—his divorce.

He knows his left arm will go next.

Three years ago, Karina removed their framed wedding picture from the living room wall and hung a mirror there instead. But she still hasn’t moved on. Karina is paralyzed by excuses and fear, stuck in an unfulfilling life as a piano teacher, afraid to pursue the path she abandoned as a young woman, blaming Richard and their failed marriage for all of it.

When Richard becomes increasingly paralyzed and is no longer able to live on his own, Karina becomes his reluctant caretaker. As Richard’s muscles, voice, and breath fade, both he and Karina try to reconcile their past before it’s too late.

Poignant and powerful, Every Note Played is a masterful exploration of redemption and what it means to find peace inside of forgiveness.

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Published Jan 29, 2019

336 pages

Average rating: 7.67

51 RATINGS

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Community Reviews

Mary Pat Holt
Feb 05, 2026
10/10 stars
One of the best books I’ve read so far this year. This is not a happy read. It was sad & depressing. It is the story of Richard, an accomplished concert pianist who is stricken with ALS. The disease quickly takes over his body, first his fingers (no more piano playing), then his arms & legs & eventually his voice. It was hard for me to like Richard. He choose piano over his wife & daughter. He loved them but he loved the piano more. This is one of the reasons why his marriage fell apart. As his disease progressed, his ex-wife, Karina becomes his reluctant caregiver. He had 3 different home health aides but this disease doesn’t slow down & eventually Richard needs 24-7 care. Karina has her own faults for their divorce. They both are angry & resentful about the past. Can they find peace & forgiveness before it’s too late?

I have read all of Lisa Geneva’s books & this is my favorite. Lisa has a degree in bio psychology & is a neuroscientist so she knows her stuff. Whatever I thought I knew about ALS, it’s not much. Of course I’ve heard of Stephen Hawking & I’ve watched The Theory of Everything more than once, but this story is eye opening. Lisa writes so beautifully. We see all the bad & ugly things that happen because of ALS. Nothing is sugar coated but is also doesn’t read like a text book case of ALS. This disease is so awful. Think about everything you are able to do that you just do automatically & take for granted (turn on the tv, open the refrigerator, get into bed, tie your shoes, enjoy a piece of your favorite cake, swallow, breathe) and then slowly your body betrays you & you are paralyzed limb by limb until you need care 24-7. This story was heart wrenching many times & I found myself crying before it was even over. I grew to like Richard (we all have flaws & no one deserves this shitty disease). Karina was amazing stepping up & caring for her ex husband like she did. How do you put someone else’s needs above your own? She was definitely paralyzed by her own fear. I think I loved Bill the most, the am caregiver who helped with all Richard’s morning routines. He was amazing.

I finished this book last night. I know these characters will stay with me for awhile & I hope I have gained more understanding about ALS by reading this book. Thank you Lisa Genova.
Harrietaspy
May 04, 2025
10/10 stars
I love Lisa Genova's books. Her ability to get to the messy truth of being sick or around someone who is... She does a fabulous job with the science as well. Thoroughly enjoyed
JHSiess
Feb 03, 2024
8/10 stars
Lisa Genova crafts an exquisite, profound, and moving story of Richard, a concert pianist who is diagnosed with ALS (Lou Gehrig's Disease) at the age of 45. Cruelly, the disease claims his right hand first, then his left, ending his career. Estranged from his father and brothers, he is left with few choices as the incurable, swiftly progressive, and unspeakably cruel disease advances. His daughter, Grace, is away at college and he will not disrupt her life (or raid her college fund). His ex-wife, Karina, also an accomplished pianist who gave up her own budding career in jazz to raise Grace while Richard toured, convinces him to move back into the family residence so that she can care for him. Thus, each of them must confront the long-held anger, resentments, and justifications for their respective role in the disintegration of their marriage. Karina, in particular, finds forgiveness difficult until, with the help of one of Richard's experienced caregivers, she comes to understand that forgiving Richard has nothing to do with him and everything to do with her own well-being and need to move forward following Richard's inevitable death. Every word of Every Note Played resonates, as Genova, a neuroscientist, details Richard's physical decline and the associated psychological toll it takes on him and everyone around him. The predictability of the story does not detract from its power. Rather, because of Genova's straight-forward, unflinchingly -- indeed, sometimes brutally -- honest approach to the subject matter, Every Note Played is an unforgettable reminder that "every note played is like a life and a death."
Thanks to NetGalley for an Advanced Readers' Copy of the book.

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