In the beginning, she was my big sister: three years older, a head taller, and—I knew even then—not like the rest of us. As I grew up, she became my little sister, whom I protected from mean boys, the neighbor's heartless crow, and the word "retard." She became literally littler, too: Today the fluffy top of her head barely grazes my shoulder, and I'm no giant myself.

When people ask about Betty's "mental age," I never know what to say. We're in our 50s now, shaped by the slings and arrows of fortune both outrageous and ordinary. The gap in our physical age broadens as her teeth loosen and her bones crumble; but the intellectual chasm that divides us, once so obvious and immutable, widens and narrows in startling ways. Betty can't write a grocery list or read a thermometer, but she can take the temperature of a room better than anyone I know. She can't reliably feed a cat or lock a door, but if you tell her a secret she'll keep it for a hundred years.

Betty calls her best friend, Laura, by her full name, a vaguely Victorian quirk that Laura mimics, because in certain tight circles Betty is the last word on etiquette and all else. Weekdays at 3 sharp, the phone rings.

"Hi, Betty Wood."

"Hi, Laura Ellis."

"What did you have for snack, Betty Wood?"

"Twinkie, Laura Ellis. You?"

"Twinkie, Betty Wood."

This is the After Work Call, following their shift at a sheltered workshop they refer to as "the shop." They've been at it for 30 years, pleasant hours sanding blocks, potting seedlings, or sorting secondhand clothes. Side by side they work, Laura with her telltale Down-syndrome silhouette: soft as a snow-muffled shrub, her round tongue resting on her lower lip like a winter berry. Betty, by contrast, is composed of points and angles, like a bird in a children's book: You could draw a decent likeness in a few sharp strokes. They chat and jabber from first bell to last, because the shop, like any workplace, teems with intrigue. Stolen boyfriends, hoarded candy, shifting alliances and dibs on lunch seats, the occasional dustup or medical crisis, the full operatic range of human striving.

Betty is the watcher, her pale eyes seeming to take in every contingency at once. If there's peace to be made, she will make it. If not, she's quick to step out of the way. "I'm a good lady," she tells whoever will listen, and I doubt that anyone to date has disagreed.

Because Betty thrives on routine, her week recycles the same highlight reel. Saturday morning infomercials, Tuesday lunch out, Thursday paycheck ($3); but the jewel in the crown is Friday night, when she beelines to Laura's house to laugh it up with Ron, Laura's adored and adorable old father. Because we lost our parents young, and then our beloved aunt and uncle, Betty has perfected the art of choosing surrogates. Ron—whom Betty calls "Fella"—makes their weekly lemon pie, a sacrosanct step-by-step that Betty hawkishly supervises, setting out utensils that her pushover host allows her to store according to her own unknowable logic. In a whip-quick sleight of hand, she plucks a measuring cup from a toy chest, and there ensues a great cloud of flour and much pan-rattling and conventional disaster—the dog gulps up half the filling on a good day, all of it on a great one—but somehow a pie results, a foamy treasure they can crow over.

Then Ron falls ill, and the trappings of piemaking give way to the trappings of something else. Pill bottles lining the counter. Apron strings wrapped twice around his ebbing waist. And finally no more pie, instead a hospital bed hogging the parlor, a sobering meringue of fluffed pillows and daisy-yellow sheets.

"Does she get it?" people ask. Which leaves me speechless.

Betty gets hospital bed. She gets soup by the thimbleful. She gets syringe in the fridge. She can spot, sooner than most, the signposts on that one-way road.

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