Customer Reviews

Oxygen (Thorndike Basic)

5 star:		(81)
4 star:		(66)
3 star:		(43)
2 star:		(7)
1 star:		(1)

 

 

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

"Oxygen" begins with a lyrically written contemplation of the gas that gives life to every mammal on the planet. It hooked me immediately, and also pointed out something unusual: here's a doctor who can write. Unfortunately, the writing of the rest of the book never measures up to the level of Chapter One, although first-time novelist Carol Cassella certainly does try. The problem is her main character, Dr. Marie Heaton, a Seattle anesthesiologist who has no friends, no significant other, and no close co-workers other than an ex-boyfriend. When a case goes horribly wrong (and continues throughout the book to get worse and worse), she's instructed to talk to no one. So, she follows the advice to the letter. Under pressure from lawyers, other doctors and the hospital staff, she nearly cracks up from the stress, finally walking out on a procedure that reminds her too much of the accident that got her in legal trouble.

Finally, the book takes a sharp turn, and Dr. Heaton is embroiled suddently in her family life in Texas, where her aging father is going blind. She finally unburdens herself in conversation with her sister. The book spends way too much time on the traumas of this nearly abandoned side of her life. Then the ex-boyfriend swoops in, and they return to Seattle to face the hospital and the eventual trial.

The surprise ending didn't bother me half as much as the fact that Marie cannot express herself normally. Anyone in a similar situation would consult a friend or, if she were following legal advice to the letter, hire a therapist, and pour out the story there. But she can't because she's emotionally constipated. Marie is a poster child for the yuppie woman who lives for her job. It's a pathetic picture. Regardless of how Cassella tries to sugar-coat the ending, she's created a stunted, un-healthy main character that it's hard for the reader to root for.

I am a lawyer and my father is a retired surgeon. We both read this book, so we can give views from both sides of the aisle.

I found this book painful to read for its woeful lack of any substantive knowledge of how the legal system actually works. Lawyers are portrayed very badly; essentially we are all Brooks Brother wearing, BMW driving, yacht owning sharks out to get the poor innocent doctors. As I spend more than fifty percent of my practice representing abused kids, I was offended by the caricature. It is difficult to list all the legal inaccuracies without major spoilers, but I shall divulge a few. In the book it takes an extraordinary long time for the autopsy on the girl to be completed (this was something my father also noted as unrealistic). Before the autopsy is concluded, a case has been brought, experts have been hired and deposed (which would be very expensive) and the doctors have all been deposed. It would be impossible to adequately prepare a case without knowing what the cause of death actually was.

Once it is revealed, Dr. Heaton is told that she may be facing potential criminal charges. Again, this would never happen! The only time a doctor would be charged is in the event of gross negligence, e.g., performing surgery while under the influence of drugs or alcohol. That was not the case here.

Dr. Heaton has a huge "woe is me" attitude about why this is happening to her when all she wants to do is help others. There are many references in the book of other characters (particularly her sister) telling her that her work is so much more important than anyone else's as she saves people. At one point the character refers to herself as God helping people.

My father liked the book better than I did and would probably give it three stars. He liked the use of correct medical terminology, but thought it would be a bit dense for the average person to understand. I concur with him on this point. He also liked the twist at the end which I won't reveal. However, he could not buy that an anesthesiologist was left holding the bag for a potential missed underlying medical problem. It was his position that the responsibility for a medical history lay with the surgeon and not the anesthesiologist and if there were an error, it would be on all of them.

In summary, if you are employed in either of professions, I do not believe you will be able to suspend your disbelief enough to buy this story. If you are a "layman" take everything with a grain of salt. However, ultimately the character of Marie was just not that likeable. All she did was mope about why this was happening to her. There is a subplot that involves her estranged father, but never explains the estrangement nor is the plot resolved. This was not an enjoyable book to read

This was interesting material but I thought the book was just okay. Too many words at many points in the book, too many times when the narrator just went on and on and on....and then the ending seemed hurried.

I really got annoyed with reading, over and over, about how guilty Marie felt and also about her moping around. The dreariness of her everyday life and the too-long descriptions of her angst were just too much and did nothing to advance the story. Enough already!

I found myself getting annoyed with Marie for not being more proactive - she should have seen a counselor if she was not allowed to talk to anyone. But then again, who would she talk with? The woman had no friends, not even any close acquaintances. She was such a loner and emotionally bereft, a woman with no life other than her work. This was surprising to me because the author apparently has a very full life as a doctor and the mother of four children.

I suspected that a mistake had been made at the beginning of the surgery and wondered why someone who was as "in control" as Marie would allow another doctor to do something so important. That did not make sense to me.

There was a good plot twist at the end that I had suspected but not in its entirety.

Will I read her next book? Yes, because I think this author has a lot of potential.

Like the author, I am a practicing anesthesiologist, and because of this, was very interested in judging this book for any anachronisms. I can attest that "Oxygen" doesn't violate medical realities and accurately depicts the operations of a busy operating room. The descriptions of physiology and pharmacology are a bit exuberant - but that's why she wrote the book and not me. This thrilling first novel also covers life issues involving love, family, old age, reconciliation, and medical malpractice. Marie Heaton is an anesthesiologist who has her self-image torn asunder when an eight year old girl, undergoing a simple operation, dies somewhat mysteriously under her anesthetic care.

Many times, I have seen good physicians emotionally affected, sometimes severely, when sued for poor outcomes. I'm sure some of the lawsuits are deserved, but to the physician named, he/she is tried and convicted by the papers, by reputation in the community, and by self-doubt - regardless of the validity of the suit. Starting with the initial letter from the attorney, the accused is subject to vicious name-calling and assignment of intent to harm in what might otherwise be considered an unfortunate but routine turn of events. To my satisfaction, this situation is well-covered.

Dr. Heaton eventually faces not only malpractice charges but also criminal charges. She is forced to take a sabbatical where she confronts her past and end-of-life issues with her father. Just when things seem to be slowing down, the case takes several new conspiratorial twists, catapulting the characters to a surprise climax.

I highly recommend "Oxygen" and congratulate the author on such a professional first effort. The book is hard to put down.

DB

Dr. Marie Heaton is an anesthesiologist working at First Lutheran Hospital in Seattle, who loves what she does, the joy of being able to comfort surgery patients just before they go under and knowing that she is the first person they see after surgery. Then on what was to have been a busy ordinary day every doctor and parent's worst nightmare occurs. A routine procedure goes awry. An eight-year-old mildly retarded child is dead; her mother, a single mom, has lost her only child; and Dr. Heaton's comfortable life is turned upside down as she is faced with a medical malpractice suit.

OXYGEN is one of those novels that you can neither put down nor say too much about or you will spoil the plot that will surprise you again and again. Nothing is as it seems. Suffice it is to say that Carol Wiley Cassella, an English Literature major at Duke University and a practitioner of anesthesiology, knows what she is writing about as she ably takes you inside the operating room, giving you necessary medical information and terminology without being pedantic in the process. She writes beautifully with cogent insights about people. She describes operating rooms as "semisealed vaults of technological marvel." Mount Rainer is a "melting scoop of ice cream suspended in the city smog." Marie's sister Lori's house is a "cornucopia of synthetic abundance." And Lori's comment about her daughter Elsa rings true: "'It's been two years since you've seen her, Marie. Two years of estrogen and internet chat rooms. And Abercrombie and Fitch--or whoever decided it was indecent to cover your navel. Biggest problem is that she is a child. She just doesn't look like it anymore.'" Actually sometimes Dr. Heaton, the narrator, speaks too much like an English major. I sometimes heard the author's voice rather than the narrator's.

Cassella makes statements about both the medical and legal communities as she pits doctors against lawyers. The characters, however, are real people; both groups have good and less-than-perfect qualities. Charlie Marsallis, Marie's second attorney, is particularly sympathetic, someone you would hire in a minute should you need the services of an attorney. Dr. Heaton, a compassionate person, is riddled with guilt over the death of the child and goes over every event that happened on that fateful day, trying to recall something she could have done differently that would have saved the little girl's life. She goes so far as to attend the child's funeral, something that both her medical colleagues and attorneys would have advised against her doing, had they known of her intentions. Two characters beautifully drawn are Joe, a fellow anesthesiologist and Marie's former lover and current best friend; and her father, a retired history professor at Rice who at seventy-nine is losing his eyesight. Her relationship with her father is a knotty one, and we find out the reason near the end of this rich novel.

I believe Ms. Cassella got it wrong--a minor flaw-- when the narrator says that the plaintiff's attorney is chalking up billable hours to make more money. Plaintiffs' lawyers throughout the country take malpractice cases on a contingency fee and receive a large slice of whatever the case settles for or a court awards the plaintiff. This would have certainly been the case here since the plaintiff would have never been able to pay an hourly fee. We know, for instance, that she drives an old car and that her daughter was a Medicaid patient as her life is contrasted with the affluent life of a doctor.

I kept thinking as I read this novel that Dr. Abraham Verghese, another good writer and physician who just recently published CUTTING FOR STONE, would like this fine novel.

When Anesthesiologist Dr. Marie Heaton is held responsible for the death of a patient during surgery, she begins the emotional and professional battle of her life. First time novelist Carol Wiley Cassella sucks readers right in with surgically precise descriptions of life in the operating room. The drama starts fast, and Marie grows on you quickly.

Despite Marie's appeal and charm, she spend the bulk of the novel feeling guilty and moping around by herself. The reader grows weary of hearing Dr. Heaton describe her guilt in a hundred different ways. This distracts from an otherwise interesting, original plot. Why do writers think that any audience will be entertained by witnessing moping? It just makes the reader depressed, bored and annoyed. Despite this flaw the novel's plot engages until the end.

Author Carol Cassella brings medical realism to this drama, which opens with Dr. Marie Heaton's carefully ordered world falling apart in the operating room. Dr. Heaton is an anesthesiologist, with the professionalism and attention to detail that makes her excellent at her job. A bad outcome, a bereft mother, and the round of self-recrimination begins. The expected legal difficulties can't match Marie's guilt and obsession. Had she missed something in her patient's physical condition that led to the disaster? Night after night she conducts fevered research but the sense of something missed continues to haunt her, until the department head insists that she take some time off from her work. Marie uses the time to visit her sister in Texas and deal with her father's failing eyesight, depression, and inability to care for himself.

Like the main character, Carol Cassella is an anesthesiologist. Oxygen: A Novel is pitch-perfect as the first-person narrative of a medical doctor, both in the OR scenes and, more subtly, in the way Marie perceives the people around her. Her father's physical frailties, for example, are seen in terms of his bodily systems and symptoms. Some of the representations of "the mission of practicing medicine" are possibly given with a sardonic slant; for example, "We are righteous in our mission to challenge the limits of life, scratching every last breath from flesh. It is our job to rage against the dying of the light." The fact that Dr. Heaton is so serious about her doctoring adds irony to her moral and legal predicament.

While the language is impeccable, the book is somewhat noticeably divided into two parts. Approximately the first third, set in Seattle, develops the story of the surgical misadventure and Marie's legal difficulties. The rest of the book is largely set in Texas with Marie dealing with family issues. Threaded throughout is the story of the renewed relationship between Marie and a good friend who is a former lover. The integration of the two main themes is not as thorough as it might be.

Another issue with the book is the rather slow movement through the middle third. Marie is distraught and haunted by guilt: that point is established early and often -- possibly more often than necessary. We find sections without a lot of active plot development here; if that's important to you, you may have a problem with Oxygen: A Novel. If moody, evocative language painting a psychological portrait is enough to carry you through sections with little action, then you will probably enjoy it very much.

Though the book is not a thriller, we are led to expect dramatic revelations that will exonerate Marie Heaton and set her free from her guilt -- both in the surgical death and in the flawed relationship with her father. Both are achieved, though they are not the book's strong suit.

For me this book was a four-star read: the less than robust plot is compensated for by the beautifully nuanced use of language.

Subject line is from DO NOT GO GENTLE INTO THAT GOOD NIGHT by Dylan Thomas.

Linda Bulger, 2008