With the compassion of Jodi Picoult and the medical realism of Atul Gawande, Oxygen is a riveting new novel by a real-life anesthesiologist, an intimate story of relationships and family that 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 lover, Dr. Joe Hillary, becomes her closest confidante 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's 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.
Powered by Cassella's 25 years in the medical field, this nicely wrought debut follows the travails of an experienced Seattle anesthesiologist after an eight-year-old patient dies while under the knife. In the aftermath, Dr. Marie Heaton is entangled in both her grief and a malpractice lawsuit. As the many meetings with attorneys blur together and autopsy results are awaited, Marie, who regrets having missed out on the "intended stream of marriage and motherhood," mediates the domestic squabbles in her sister's family; leans on and gets leaned on by colleague and ex-lover-turned-best friend, Joe Hillary; and tries to come to a detente with her widowed father, who is losing his vision and with it his autonomy. As Marie is increasingly scrutinized, a few unexpected twists slyly work themselves into the investigation of the death, and the ice between Marie and her father slowly thaws. The prose is competent and the plot moves at a brisk pace, but the real hook is Cassella's knowing portrayal of the health industrial complex's inner workings; she knows the turf and doesn't spare readers the nasty bits. (July) Copyright 2008 Reed Business Information.
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Simon & Schuster
June 30, 2008
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Excerpt from Oxygen by Carol Cassella
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.
The entire complex human machine pivots on the pinnacle of oxygen. The bucket brigade of energy metabolism that keeps us all alive ends with oxygen as the final electron acceptor. Take it away, and the cascade clogs up in minutes, backing up the whole precisely tuned engine until it collapses, choked, cold and blue.
Two portals connect us to oxygen -- the mouth and the nose -- appreciated more for all their other uses: tasting, smelling, smiling, whistling, blowing smoke and blowing kisses, supporting sunglasses and lipstick designers, perfumeries and plastic surgeons. Seal them for the duration of the morning weather report and everything you had planned for the rest of your life evaporates in a puff of imagination.
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.
If I deserted my patient -- deep in that swale of sleep, as suffocation colored blood blue -- the lips would turn violet, pink skin would dull to gray, and the steady beep, beep, beep of the heart monitor would fade, then falter. Like an archaeological ruin, the brain would die in levels; personality, judgment, memory, movement collapsing like falling bricks to crush the brainstem's steady pulse of breath and blood.
There are points in an otherwise routine day when I am struck by how precariously this unconscious patient dangles, like a hapless fly on a spider's thread. It is like drowning, but blessed unconsciousness precedes desperate air hunger. At the last instant I swoop in and deliver a rescuing breath, adjust my machine to take over what the brainstem can no longer command -- make the lungs move oxygen in and out to keep the heart beating, transferring each oxygen molecule to the cells. It becomes so easy, after years of the rescue. It becomes so routine, to watch the ebb of consciousness followed by the ebb of breath, and then to spring up as the obligate hero. It no longer feels like power. It feels like a job.
I am an anesthesiologist -- a practitioner of the art and science of anesthesia. The word means, literally, "no sensation." In our modern lexicon it denotes a temporary loss of sensation, an absence of pain during an otherwise painful procedure. That is how I see my job: to make painful events painless; to coax and manipulate the human mind to give up its fierce clutch on control, its evolutionary reflex to flee from dismemberment and violation.
Granted, most patients come to surgery out of choice: the shoulder that stiffens on the squash court; the gallbladder that pangs upon digesting a rosemaried leg of lamb; the nuisances of body fat or age lines. Then, of course, there are the unfortunate twists of nature that destine some of us to die before a graceful blur into old age: the cancers creeping into baseball-sized tumors while we pay our bills, prune our roses, plan our children's birthday parties. Or the silent shearing of aortic aneurysms and coronary vessels and carotid arteries that snap our smoothly humming lives in half while we argue with our teenagers or make love to our husbands and wives. These events bring us to the doors of doctors and emergency rooms, place us supine on the white-sheeted gurneys rolling down the long, green-tiled, fluorescent-lit hallways into the cold and windowless operating rooms of this nation.
Today is a day like any other workday for me. I shut off my alarm before five and stand shivering beside my bathroom heater while the shower runs to warm. Somewhere in the city my patients are also beginning to rouse, anxious about their operations, worried about the ache or illness that can only be cured with a knife, trying to imagine the inevitable scar, trying to anticipate the pain. Maybe even trying to envision me, a stranger, the only doctor directly involved in their care whom they've never met. People may select their family practitioners based on comfort and trust, and their surgeons through reputation or referral, but anesthesiologists are usually assigned to an operating room rather than a particular patient.