Oxygen: A Novel

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 n

Anesthesiologist Marie Heaton, has the perfect job, she takes a patient's pain away before she gives birth or she gently slides them into sleep before surgery. She delivers comfort to the patient. She's proud of what she does and she's dedicated. So dedicated that her ex-lover Joe Hillary, an anesthesiologist as well, is now her best friend. Thirty-seven-year-old Marie's work is more important than her biological clock. Then one day the unthinkable happens and her life takes a drastic change when eight-year-old Jolene Jansen's heart-rate drops and her blood loses it's oxygen. Marie tries everything, but Jolene dies on the table. What makes matters worse for Marie is that after an autopsy, it looks like Marie may have been at fault and as she faces the questions of her colleagues and the specter of a malpractice suit, she goes over again and again what had happened in that OR. Their is plenty of suspense in this well written novel. If you're a fan of Tess Gerritsen or Robin Cook you're going to like Carol Cassella's story. Marie Heaton is a character who faces setback after setback, but who strives to overcome them all, and to add to the stories verisimilitude you have the fact that Ms. Cassella is anesthesiologist herself, so she know from what she writes and she takes you right into the inner workings of a hospital and now add in the ending that you didn't see coming and you really have a story. Reviewed by Vesta Irene

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 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

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