Oxygen by Carol Cassella
2008 Simon & Schuster
Finished on 12/7/13
Rating: 4.5/5 (Terrific!)
Jodi Picoult meets Atul Gawande.
In this riveting new novel by a real-life anesthesiologist, an intimate story of relationships and family collides with a high-stakes medical drama.
Dr. Marie Heaton is an anesthesiologist at the height of her profession. She has worked, lived and breathed her career since medical school, and she now practices at a top Seattle hospital. Marie has carefully constructed and constricted her life according to empirical truths, to the science and art of medicine. But when her tried-and-true formula suddenly deserts her during a routine surgery, she must explain the nightmarish operating room disaster and face the resulting malpractice suit. Marie’s best friend, colleague and former love, Dr. Joe Hillary, becomes her closest confidant as she twists through depositions, accusations and a remorseful preoccupation with the mother of the patient in question. As she struggles to salvage her career and reputation, Marie must face hard truths about the path she’s chosen, the bridges she’s burned and the colleagues and superiors she may have mistaken for friends.
A quieter crisis is simultaneously unfolding within Marie’s family. Her aging father is losing his sight and approaching an awkward dependency on Marie and her sister, Lori. But Lori has taken a more traditional path than Marie and is busy raising a family. Although Marie has been estranged from her Texas roots for decades, the ultimate responsibility for their father’s care is falling on her.
As her carefully structured life begins to collapse, Marie confronts questions of love and betrayal, family bonds and the price of her own choices. Set against the natural splendor of Seattle, and inside the closed vaults of hospital operating rooms, Oxygen climaxes in a final twist that is as heartrending as it is redeeming.
I’ve always been fascinated by medical dramas. Over the past four decades, I’ve watched countless episodes of Emergency!, Chicago Hope, E.R., Grey’s Anatomy, and House. I’m intrigued by the specific details of medical care, whether I’m watching a TV show, reading a novel, or hearing about someone’s recent surgery. I’m probably one of those annoying patients (or the spouse of a patient) who asks far too many questions about a specific procedure. ;)
Anesthesia has always been somewhat of a mystery to me. I can never quite shake that strange feeling upon awakening from surgery. One minute you’re awake, waiting to drift off to sleep, and in the blink of an eye a nurse is gently waking you and you feel like you just missed out on a big chunk of your life.
Anesthesia was the antithesis of the complete, personally involved physician I had idealized to myself and my parents for all the years I studied chemistry and physics and biology alongside music and literature. It came as an unexpected, almost uncomfortable surprise to me when I discovered the immediate gratification of my specialty—injecting a local anesthetic at the precise nerve plexus to relieve the unrelenting pain of strained backs or injured limbs; calming a terrified obstetrical patient rushed into an emergency cesarean section, keeping her pain-free and hopeful, so her infant could make the miraculous transition from fetus to newborn uninjured; pulling the sleeping heart bypass patient back to consciousness and the inexpressible relief that they are still among the living. All of this, I discovered, was in contrast to general medicine, which could often do little more than shift the incessant, declining slope of mortality that begins the day we are born.I understood the general concept of anesthesia (well, as much as a layman can understand something so complex), but until I read Carol Cassella’s compelling drama, Oxygen, I failed to appreciate the incredible talent of an anesthesiologist. It is not simply the job of an anesthesiologist to keep a patient sedated, but it is also his or her responsibility to anticipate the patient’s pain in response to the various stages of the surgery, adjusting or adding the various drugs to maintain the patient’s comfort. Of course, now that makes sense, but it’s not something to which I’d ever given any thought until reading this novel.
People feel so strong, so durable. I anesthetize airline pilots, corporate executives, high school principals, mothers of well-brought-up children, judges and janitors, psychiatrists and salespeople, mountain climbers and musicians. People who have strutted and struggled and breathed on this planet for twenty, thirty, seventy years defying the inexorable, entropic decay of all living things. All of them clinging to existence by one molecule: oxygen.
There is a moment during the induction of general anesthesia when I am intimately bonded to my patient. A moment of transferred power. I squeeze the drug out of the syringe, into the IV line, and watch the face slacken, watch the last organized thoughts slip from consciousness, see breathing shallow, slow, stop.
I received an ARC of Cassella’s debut novel way back in early 2008. It sat on my desk for a few months and eventually found its way to one of my stacks of ARCs, where I promptly forgot about it. Over the course of that year, I started seeing great reviews for Oxygen and yet it remained in my stacks, soon to be completely buried. I’m not sure what finally prompted me to dig it out after more than five years, but I’m so very glad I did. Cassella’s narrative drew me in from the opening scene and I became completely engrossed, particularly with those sections involving a specific operation.
On the fear of flying:
Joe squeezes my hand as he pulls out into the runway and waits for clearance. He sounds different talking into his headset, a clipped song in the shorthand lingo of flight. My breath jumps high into my throat when we leave the ground. He banks out over the sound—the city looks like it's cupped inside the protective palms of encircling peaks: the eastern Cascades and western Olympics, the northern and southern volcanoes of Mount Baker and Mount Rainer. From this height the geometry of bridged lakes and islanded ocean sprawls like a rumpled quilt in greens and blues. It's worth the price of fear.
On Texas heat:
Lori lives in the plains just west of Fort Worth, where cattle drives used to camp on their way to the transcontinental railroads and settlers laid claim to Indian lands with barbed wire. Now, a grid of pavement allots quarter-acre swatches of azaleas and scrappy live oaks to homeowners who coax green growth out of the dust. The lushly watered lawns invite barefoot play, until the Texas sun slaps you back inside.
Carol Cassella is a consummate storyteller and when it comes to medicine, specifically anesthesia, she knows her stuff. She majored in English Literature at Duke University and graduated from medical school in 1986. She is a practicing physician, board certified in both internal medicine and anesthesiology, and has recently published her third novel, Gemini. As luck would have it, I came upon an ARC of Gemini a couple of months ago and I am very anxious to give it a read. And I can assure you that I won’t be waiting five years!
Have you read any books by Carol Cassella? If so, which is your favorite? Healer sounds quite intriguing, too!