Oxygen
By Carol Cassella '78.
Simon & Schuster, 2008.
288 pages. $25.

We put such faith in the tools of modern medicine. Clinical breakthroughs and sophisticated technology seduce us into thinking that whatever ails us can be taken care of with a dose of medicine or a surgical intervention. But in the opening pages of Carol Cassella's debut novel, Oxygen, we're reminded of the fragile hold we have on life.

"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," writes Cassella, who, like her book's protagonist, Marie Heaton, is a seasoned anesthesiologist. "People who have struggled and strutted 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."

Heaton is a seven-year veteran at First Lutheran Hospital, a skilled member of the surgical teams that keep the center's revenue-producing operating rooms booked solid. She's good at what she does, and dedicated to her job, often arriving before dawn and taking overnight call duty once or twice a week. From routine hernia repairs and mastectomies to the riskier heart surgeries or emergency C-sections, Heaton savors her role as "medicinal artist, a chemical hypnotist beckoning the frightened and uninitiated into a secure and painless realm of trust."

The book opens on a typical workday, with Heaton showering while it's dark outside and driving through the streets of the still-sleeping city of Seattle. At the hospital, she checks her caseload, swaps small talk with co-workers, and pops in on surgeries already under way, subbing for tired anesthesiology colleagues while they duck out for coffee during a lull. Even though her fourth case seems fairly straightforward—removing a congenital cyst from the base of an eight-year-old girl's spine—there are a few complicating factors. The girl is mildly retarded, lacks comprehensive medical records, and is being reared by a single mother with no network of family or friends. Still, Heaton has faced far tougher cases before, and assures the girl's mother before surgery that her daughter is in good hands.

In the middle of the operation, moments after Heaton injects a narcotic into the patient's IV line, an alarm sounds. The patient's blood pressure and heart rate plummet. Heaton scrambles to identify the problem—a blocked airway passage? Undiagnosed asthma? An allergic reaction? Heaton and the rest of the surgical team mobilize to employ all emergency protocols at their disposal, but even though every attempt is made to identify and remedy the problem, in a frighteningly small span of minutes, the girl dies on the operating table. It's left to Heaton to relay the news to the mother, sitting alone in the waiting room where she'd held her daughter only hours before.

As the consequences of the death take shape, Heaton is gripped by guilt and self-doubt. The hospital's legal machinery moves into high gear to prepare for the inevitable lawsuit. Oxygen follows Heaton as her personal and professional life slowly begin to come undone. Despite initial reassurances by top-ranking hospital administrators that everything will be fine, such collegial encouragement gradually gives way to detached advice and revised worst-case scenarios.

Heaton's primary support system includes best friend Joe Hillary, a fellow anesthesiologist at First Lutheran, and her only sibling, Lori. Through these relationships, Cassella provides the reader with insights into the twin impulses of Heaton's character—she is both tenacious and sensitive, a compassionate perfectionist. A subplot involves Heaton's aging, estranged father, who is losing his sight but refuses to relinquish his independence. Long-simmering family tensions come to a head as the medical malpractice case winds its way toward the courts.

While the secondary story line eventually helps explain some of Heaton's perspectives on work, love, and family, it is less effective than the central plot. Cassella offers a persuasive and chilling example of how a person can be doing everything right, when circumstances beyond her control conspire to forever alter the course of untold lives. One day Heaton is a valued and trusted member of a medical community; the next she is subject to concerned glances, unspoken judgments, and public accusations of professional misconduct.

In advance publicity for Oxygen, publisher Simon & Schuster compares Cassella to such medical-genre novelists as Jodi Picoult, and such writer-physicians as Atul Gawande. Unlike Picoult, Cassella has professional medical authenticity and a genuine ear for how physicians, health-care CEOs, and malpractice lawyers really talk. (Plus, Cassella is the better writer.) Given her clear-eyed understanding of the medical profession, one hopes that like Gawande, she will provide us with further opportunities to peer into the mysterious and unpredictable nature of the human condition.

— Bridget Booher