Oxygen: A Novel [Hardcover]

The protagonist of Carol Cassella's "Oxygen" is thirty-seven year old anesthesiologist Dr. Marie Heaton, a dedicated and conscientious physician. After introducing herself to her patients and reassuring them that they are in good hands, she administers drugs that bring about "a temporary loss of sensation, an absence of pain during ... otherwise painful procedure[s]." Marie loves her job, "its precision and focus, its balance of technical skill and judgment." For the past seven years, her excellent performance has earned her the respect of her colleagues at First Lutheran Hospital in Seattle, Washington. Although she is single and childless, Marie is too busy to dwell on her ticking biological clock and her anemic social life. She once had a fling with a fellow anesthesiologist, Joe Hillary. However, they decided to settle for a platonic friendship and are now best buddies rather than lovers.

Marie's life comes to a screeching halt when she administers anesthesia to an eight-year old girl named Jolene Jansen. For some inexplicable reason, Jolene's heart rate plummets and her blood loses its oxygen supply. Although Dr. Heaton tries every technique at her disposal to bring the child back, she fails. This devastating tragedy leads to sleepless nights during which Marie second-guesses herself, wondering what she could have done differently. She is also on tenterhooks waiting for the inevitable malpractice suit to be filed. Marie is raked over the coals by lawyers and members of the hospital board, but she is more concerned with Jolene's mother, Bobbie, who is disconsolate over her daughter's death.

This is a touching book about a courageous and compassionate woman who is nearly brought to her knees by a series of calamities. Cassella's descriptive writing is beautifully crafted and she thoughtfully explores the ways in which people either support or undermine one another. The events in this novel demonstrate how selfish and callous individuals bring untold misery to their friends, family, and coworkers. The author, who is an anesthesiologist, provides an insider's look into the political, legal, and human sides of modern hospital care. She also imbues the story with an added dimension by shedding light on Marie's personal life. Although she has deep affection for her younger sister, Lori, and her adolescent niece, Elsa, Marie has no idea how to cope with her seventy-nine year old father. He is a former history professor who is steadily losing his eyesight and his ability to function independently.

"Oxygen" is suspenseful and engrossing; it builds in intensity until it reaches its electrifying conclusion. Marie, the first person narrator, tells her account in the present tense with an intimacy that draws us in and keeps us invested in the outcome. The title is an elegant metaphor: Just as oxygen makes physical existence possible, so do productive work and love provide the psychological and spiritual sustenance that bring meaning and fulfillment to our lives.

This is the uncommon kind of novel. Smart, poignant, reflective and layered. The mystery component is planted so gently, it makes for a wonderful, seamless narration. The characters' foibles and flaws give depth and reality to the the story. I really, realy enjoy writing that gives the reader credit for some smarts-- too many novels spoon feed everything to the reader-- but Oxygen is the rarer gift, a more complicated and developed story that knows we can figure things out. There were so many phrases or turns of language that were especially loaded and compact, I lost track-- although at the time I savored them, then I'd get lost in the story again. A special look at a special world. Highly recommended.

Dr. Marie Heaton takes great pride and pleasure in guiding her patients into the land of Nod so they can have their gallbladder out, their knee replaced or their baby delivered without pain and often even without awareness. She loves her job until the unbearable happens --- an eight-year-old girl under her care dies in surgery, despite all her best efforts. The crisis leads her to question not only her professional competence but also her personal relationships. And yet, even as she carefully documents each methodical step she took and each drug she administered, she is haunted by inconsistencies.

This first-person narrative works on many levels --- as a mystery, as an exposé of the sometimes brutal juncture of the medical and legal professions, as a family drama, and as a romance of sorts. Marie has never found time for a husband. "I never meant to dam myself off from those. I just knew they would require careful scheduling." In the aftermath of the child's death she feels more alone than ever. Taking a painful leave of absence from her duties while the investigation proceeds, Marie faces a different sort of challenge --- her aging father's demise, and the realization that if she is ever going to mend her relationship with him, now is the time. Meanwhile, new knowledge comes to light through the child's autopsy that seems to implicate Marie even further. The hospital begins to back away from her, and there is the specter of criminal charges being filed against her, on top of the malpractice suit.

Through this difficult time, Marie takes some comfort in the rejuvenation of a former love affair with Joe, another anesthesiologist on the hospital staff. As their relationship heats up, more clues trickle in about the real cause of the child's death. Marie must uncover and face some unpleasant truths to clear her name.

This novel is written with a clear, even hand, and the reader feels like a part of the heady world of high-stakes surgery. Carol Cassella, a practicing anesthesiologist herself, shows skill in giving us enough medical detail to understand the nuances of the case without overwhelming us. Marie's guilt and her desire for the mother's forgiveness are well-drawn without being overdone. It would have been easy to get maudlin here, and I applaud the author for not doing so. (I think she's a much better writer than Jodi Picoult, with whom she is compared on the cover flap.) There are some great lines here, such as "It is our job to rage against the dying of the light."

Marie is an appealing character --- smart but compassionate, needy but not blinded by her needs. In the end she saves herself with some timely medical sleuthing, although the answers come at a high personal price. All in all, OXYGEN is a great read with some juicy surprises.

--- Reviewed by Eileen Zimmerman Nicol

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