Oxygen

( 133 )

Overview

With the compassion of Jodi Picoult and the medical realism of Atul Gawande, real-life anesthesiologist Carol Cassella?s riveting national bestseller seamlessly melds compelling women?s fiction and medical drama to create an ?involving debut that?s just what the doctor ordered? (People).

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. ...

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Oxygen: A Novel

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Overview

With the compassion of Jodi Picoult and the medical realism of Atul Gawande, real-life anesthesiologist Carol Cassella’s riveting national bestseller seamlessly melds compelling women’s fiction and medical drama to create an “involving debut that’s just what the doctor ordered” (People).

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.

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Editorial Reviews

From the Publisher
"In Oxygen, Carol Cassella's taut novel, Dr. Marie Heaton, an assured anesthesiologist at the top of her game, is forced to face the personal and professional fallout from an operating room disaster. Marie finds herself on the losing end of dollars-and-cents medicine in a malpractice suit, questioning herself, her skills, her colleagues, and her life choices. I couldn't wait to race to the end to see how her story played out, and I wasn't disappointed." — Lalita Tademy, author of Cane River

"A subtle, compelling plot that twists and twists again. This quickly becomes a book you cannot put down." — The Dallas Morning News

"A finely crafted mystery, as well as a sparkling literary work." — THE DENVER POST

"Like her protagonist, Carol Cassella has the heart of a poet and the mind of a physician; the result is a striking meditation on the complexities of love, the fragile miracle that is the human body and the burdens and blessings of being a healer." — Stephanie Kallos, author of Broken for You

"More than just an assured debut novel, this book is a tour de force, as emotionally involving as it is intelligent. Carol Cassella writes with the clarity and precision that are the hallmarks of her other profession....The fine, sharp details of her portrait of a gifted doctor facing a devastating crisis will stay with you long after the book is closed." — Susan Wiggs, author of Fireside and Just Breathe

" A startling plot twist, combined with Cassella's first-hand understanding of our ailing healthcare system, makes this involving debut just what the doctor ordered." — PEOPLE

Publishers Weekly

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 détente 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 © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
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Product Details

  • ISBN-13: 9781416556114
  • Publisher: Simon & Schuster
  • Publication date: 6/9/2009
  • Edition description: Reprint
  • Pages: 320
  • Sales rank: 160,149
  • Product dimensions: 5.50 (w) x 8.30 (h) x 0.80 (d)

Meet the Author

Carol Wiley Cassella

Carol Cassella majored in English Literature at Duke University and graduated from medical school in 1986. She currently practices anesthesia in Seattle and is a freelance medical writer specializing in global public health advocacy for the developing world. She lives in Bainbridge Island, Washington, with her husband and their two sets of twins.

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Read an Excerpt

Oxygen • 1 •
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. Hospitals couldn’t absorb car accidents and emergency C-sections and gunshot wounds into an already crowded surgery schedule without a flexible, interchangeable anesthesia team.

That anonymity almost kept me from choosing this specialty when I was in medical school. I wanted to be involved with my patients’ lives, not just be a transient manager of their pain. I balked at the hubris of asking anyone to yield so much control to me after only a few introductory words. But within the first week of my anesthesia rotation I discovered that I loved this work—its precision and focus, its balance of technical skill and clinical judgment; finessing the interplay of heart and lungs while the brain sleeps; titrating narcotics and nerve blocks to that sweet spot in which a cancer patient’s pain is relieved and they can still enjoy the time they have left with the people they love.

And inside the scant space of my preoperative interview I’ve found an entire cosmos of healing: the quick read of trepidation or naive acquiescence; the flash of entrapment or submission; perceiving the exact phrase or touch that can transform me from stranger to caretaker, from assigned clinician to guardian. I can’t prove that rolling into the operating room believing you will be kept safe improves the outcome of surgery, but it’s where I find the artistry in my work.

I slip on worn blue jeans and a loose sweater, thankful that I only have to dress for the commute. The aroma of coffee lures me into the kitchen, still dark as midnight. Tasks start to crowd out dreams—my presentation on labor epidurals for the nurses is due next week, the pharmacy committee wants a rundown on muscle relaxants, I have a dozen phone calls to make, and I should have changed the oil in my car about 12,000 miles ago.

The phone rings just as I screw the top on my travel mug, one foot already out the door. I grab it on the last ring in a lunge across the kitchen counter that spills coffee down my arm and knocks over a neglected potted violet, more brown than green; bone-dry dirt skitters across the floor.

“Aunt Marie? It’s Elsa.” Her voice is muffled and I hear a squall of tears tangled in her throat.

I look at my watch. “Hi, sweetie. What’s up? You sound kind of upset.”

“Not much. I just wanted to talk.”

“It’s five thirty in the morning, honey.”

“Seven thirty. It’s seven thirty here.”

“Right.” I lock the phone under my chin and sweep dirt and desiccated petals into a ridgeline under the counter with the toe of my shoe. If I’m not out the door in two and a half minutes I’ll be late. “So are you just getting up or just going to bed?”

“Ha-ha. School starts in forty-five minutes.” Her breath blows loud across the mouthpiece and I know exactly where she is—curled on top of her tennis shoes and sling-back sandals, draped in folds of Gap T-shirts and Abercrombie jeans, the telephone cord snaking under her closet door. “Mom and I had a fight last night. Did she call you?”

I drop my keys into my purse and lean on my elbows across the kitchen counter. “No. I was working late, anyway. What about?” I shove the coffeemaker at an angle so the red numbers on the clock don’t glare at me.

“She just doesn’t get it!” Her anger erupts into sobs. She is fifteen, the eldest child of my sister, Lori, my only sibling. When Elsa turned fourteen I was suddenly promoted to autodial status; I am the nonmother with all the answers to the questions she can’t bring herself to ask her mother. As honored as I am, I have to suspect she turns to me because she knows I’m holding both their hands.

“Get what, sweetie?”

“Anything! She blew up because my Civics essay is overdue. But it’s only late because I had to practice for Debate.”

“When did you join the debate team?”

“Not like school debate. It’s a new club. We want to legalize marijuana.”

I stand up straight and count to five before I answer her. “Elsa?”

“Yeah?”

“Would you tell me if you’re smoking pot?”

“Oh God, Aunt Marie. I hate getting high! But this is, like, basic civil rights!”

This time I count to ten and decide to ignore her slip. “Well, maybe you’ve got a leg up on your Civics essay here.”

Elsa calls out to my sister that she’ll be down when she’s dressed, stop bugging her. “What are you wearing?” she asks in a bright new voice, her distress forgotten.

“What am I wearing?” I look down. A faded cable-knit sweater in army green, blue jeans and water-stained clogs. “A drop-waist hot pink rayon skirt and creamy cashmere sweater. And I just got my nails done—one of those French manicure things. With polka dots. Also pink.”

Elsa bursts out laughing. “Oh right, Aunt Marie. You are so lying.”

“Caught me again! Remind me and I’ll send you some scrubs. Tie-dye them for me, huh? My boss would love that. So, what are you wearing?” Her laugh could almost make me forget about time. Eight minutes later Elsa is out of the closet and on her way to school. If the traffic lights are with me, I’ll be OK.

•  •  •

First Lutheran Hospital was built in the thirties, a castle of art deco facades, a fortress against disease. I’ve worked here for seven years—long enough to have a good parking spot in the basement garage, avoiding the cold drizzle of Seattle in these early days of spring. I push the gearshift into neutral and turn the heat vent toward my face to enjoy a last second of solitude.

At this early hour I’m one of the few physicians in the hospital. But the lingering night staff and arriving day shift are already filling the hallways. They chatter in Tagalog and Korean and Urdu and Spanish and English—beneficiaries of an international recruiting effort that annually scavenges the brightest graduates of foreign classrooms to staff American hospitals. It takes a small city of personnel to move each patient from the parking garage where they arrive intact to the exiting wheelchair ramp that spins them back into their lives, stocked with clean bandages, pain pills and a ten-day-follow-up appointment. All of us dress for work in the same blue cotton pants and shirts, wearing the same blue hair caps and shoe coverings designed to keep our personal bacteria out of our patients’ open bellies, chests and limbs.

While much of the city still sleeps, we heave in to set up medicine’s greatest show, the Barnum & Bailey of daring adventures inside the human body. Ropes of electrical cords are uncoiled between cautery devices, television towers, bypass machines, lasers, microscopes and mobile X-ray units. Scaffolds of surgical steel are autoclaved to cleanliness, instruments displayed like exotic cutlery along lengths of wheeled tables. A swimming pool of sterile saline is warmed to human temperature, ready to plug into blood vessels and pour into body cavities.

Bethany, our operating room manager, slides the jumble of planned and emergent surgeries, instrument trays, cameras, fiber-optic scopes, technicians, pumps and personalities together into a functioning organism. She’s mastered a balance of fawning and authoritarianism that keeps our surgeons grudgingly cooperative. She sits at her high desk behind a sliding glass window, clacking away at her computer keyboard with long purple fingernails, a ruling priestess over the operating rooms.

I scratch my own bare nails across the glass to annoy her, and she looks at me over her rhinestoned bifocals, looped by a turquoise beaded chain around her neck. “Hi, Bethany. Where am I today?”

“Scratch that window one more time and I will tell Dr. Scoble you volunteered to take every holiday call.”

“I’m already on three this year. You’ll have to come up with something scarier.” I steal a cinnamon candy from a paper cup on the window ledge and pop it into my mouth. “Speaking of call, I have friends coming to visit week after next. Any idea how busy things are looking? It’s spring break, so some of the surgeons ought to be out of town.”

She fishtails her computer mouse across the desk, clicking through screens. “Looks like . . . three generals and two vasculars are out. Should be OK.” She slides a pad of paper toward me. “Write the dates down. I’ll try to put you in light rooms. If you bring me more pralines.” I gave the OR staff boxes of my favorite Texas pralines last Christmas and Bethany’s now addicted.

“A whole crateful. How does today look?”

“Bad. Hope you slept well. Fifty-eight cases scheduled—three hearts—and I’ve already got six add-ons. Be glad you’re not first call.”

“I’m fourth. Any emergencies yet?”

“One. Subdural hematoma going in twelve.”

Sometimes I think the hospital administrators would like us to staff every operating room twenty-four hours a day; it’s one of the few sectors of hospital care that predictably generates money. But we at least make an attempt to accommodate normal circadian sleep rhythms by rotating the length of our days throughout our anesthesia group. Once or twice a week I take the first call duty and stay in the hospital all night doing whatever emergency operations come in. One of my partners takes second call, staying until late in the evening and being available to come back to the hospital if two of us are needed. Then the call peels down sequentially from there, a higher number designating a shorter workday. But all days are eventually ruled by surgical imperative—tumors encroaching on vital organs, the brittle, broken bones of old age, gangrenous limbs that threaten sepsis, twisted fallopian tubes and obstructed bowels.

Bethany says, “You start in five with Stevenson, then I’ve got you covering eight in the afternoon, unless I have to slide one of the add-ons into five. Hillary’s in eight until you can relieve him—he was on call last night. McLaughlin got pulled away for a long case in radiology, so I don’t have anybody free to give breaks until after twelve thirty. Sorry. If Janovich keeps to his schedule Kuciano should be free to get you out for lunch. Maybe.” She lays out the day she has meticulously choreographed to move as many patients as possible through the system before overtime has to be paid.

I look at the immense whiteboard across from Bethany’s desk that displays the entire list of surgeries and operating rooms, scheduled cases in black felt-tip pen and emergencies in red. Beside the number 5 runs a list of three short cases—a mastectomy, a ventral hernia repair and a central line placement—followed by one longer pediatric surgery. The first three anesthetics should be relatively simple and straightforward, if the patients are healthy. I’ll have to talk to Don Stevenson, my surgeon, about the child. We don’t take care of children as often as adults at First Lutheran, so those cases always seem more stressful. If Don can finish his surgeries reasonably close to the predicted time, I’ll be able to move into room 8 by three o’clock and let Joe Hillary go home to sleep. But I’ve worked with Don for a long time and know his tendency to overbook his day.

I tell Beth, “Better get a backup for Joe. Stevenson will run late, which will push that last case past three, I bet. Who’s on General Surgery call today?”

“Marky.”

“Oh God. Marconi. We’ll all be here late.” Sean Marconi is famous for working all night. Even on fourth call I am at risk for a long day.

Bethany winks at me over her glasses. “God Marconi or God God?”

“Does Marconi know the difference?” She laughs and I add, “You never heard me say that, Bethany. We have enough gods here as it is.”

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Introduction

Discussion Questions:

1. After Jolene's death, Marie thinks almost as much about Bobbie as she does about her own experience. Why is it so important for her to see Bobbie? What does she hope to accomplish?

2. Marie says that no death she has witnessed affects her as Jolene's does, yet one experience was different: the death of her mother. How do you think learning of her mother's condition and attempting to help her parents understand it while she was in medical school affects Marie as a doctor? How was the time of her mother's death a turning point between the life she was raised for and the life she chose?

3. When Marie learns that the Turner Syndrome revealed in Jolene's autopsy could make losing the case and therefore her career more likely, she wonders "if all the money and possessions were stripped away, what, exactly, would be left?" What choices does the case force Marie to reconsider? What doubts does she have about her life and career?

4. Discuss the relationship between Marie and her sister, Lori. Why doesn't Marie tell Lori about what happened to Jolene immediately? What conflicting emotions does Marie have about Lori's life and marriage?

5. When Marie and Joe are in the hotel in Texas, he describes his theory of the "Big O," a theory that could apply to several characters in the book, perhaps Joe most of all. Why is it significant that Joe be the one to hold this hopeful belief? In what ways are each of the characters "cloaked"?

6. Marie's father is literally going blind, and yet each of them is blind in a way, unable to see through their estrangement and past wrongs. What does Marie learn about how her father "sees" her during her visit?What does she "see" in him? What is the significance of the gift of her mother's ring?

7. The balance between vulnerability and control functions on several levels in the novel: Between doctors and patients in the operating room, during the legal battle in the aftermath of Jolene's death, and in Marie's relationships with her father and Joe. What happens when the balance shifts in each situation? What does Marie learn about control within each context, or from each person?

8. Joe is one of the most surprising characters in the book. He buoys Marie up, he gives her strength, but in the end he is revealed as the weak one. Were Joe's feelings for Marie genuine? Does his letter change your opinion of him? Ultimately, how does Marie feel about him?

9. Betrayal is an important theme in the book. Marie is betrayed by Joe and the hospital. Bobbie and Jolene are betrayed by them too. Marie's father believes she betrayed him and his faith when she was a teenager. What other betrayals can you think of? What motivation is at the root of each betrayal?

10. Consider the depictions of hospitals and doctors on television versus in Oxygen. How does the novel's authentic portrayal of medical culture, its routines and its dilemmas, differ from what you see elsewhere?

11. The ending of the novel is particularly bittersweet. Marie's innocence is intact, but Joe's innocence, and her relationship with him, are undone. Were you surprised? Were you satisfied with this resolution?

Enhance Your Book Club:

Consider the ethical dilemma presented in the book and discuss the responsibilities of physicians and hospitals. For more on medical ethics, visit the American Medical Association's principles of medical ethics page http://www.ama-assn.org/ama/pub/category/2512.html.

Rather than buy the wine or food that your group would usually have, consider donating to a charity such as the one for which Marie works in the novel's epilogue. Learn more by visiting the websites for Changing Faces (http://www.changingfaces.org.uk/) or Facing the World (http://www.facingtheworld.net/).

Carol Wiley Cassella majored in English Literature at Duke University and graduated from medical school in 1986. She currently practices anesthesiology in Seattle and is a freelance medical writer specializing in global public health advocacy for the developing world. She is the mother of two sets of twins and is working on her next novel. Visit the author at www.carolcassella.com.

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Reading Group Guide

Discussion Questions:

1. After Jolene's death, Marie thinks almost as much about Bobbie as she does about her own experience. Why is it so important for her to see Bobbie? What does she hope to accomplish?

2. Marie says that no death she has witnessed affects her as Jolene's does, yet one experience was different: the death of her mother. How do you think learning of her mother's condition and attempting to help her parents understand it while she was in medical school affects Marie as a doctor? How was the time of her mother's death a turning point between the life she was raised for and the life she chose?

3. When Marie learns that the Turner Syndrome revealed in Jolene's autopsy could make losing the case and therefore her career more likely, she wonders "if all the money and possessions were stripped away, what, exactly, would be left?" What choices does the case force Marie to reconsider? What doubts does she have about her life and career?

4. Discuss the relationship between Marie and her sister, Lori. Why doesn't Marie tell Lori about what happened to Jolene immediately? What conflicting emotions does Marie have about Lori's life and marriage?

5. When Marie and Joe are in the hotel in Texas, he describes his theory of the "Big O," a theory that could apply to several characters in the book, perhaps Joe most of all. Why is it significant that Joe be the one to hold this hopeful belief? In what ways are each of the characters "cloaked"?

6. Marie's father is literally going blind, and yet each of them is blind in a way, unable to see through their estrangement and past wrongs. What does Marie learn about how her father "sees" her during her visit? What does she "see" in him? What is the significance of the gift of her mother's ring?

7. The balance between vulnerability and control functions on several levels in the novel: Between doctors and patients in the operating room, during the legal battle in the aftermath of Jolene's death, and in Marie's relationships with her father and Joe. What happens when the balance shifts in each situation? What does Marie learn about control within each context, or from each person?

8. Joe is one of the most surprising characters in the book. He buoys Marie up, he gives her strength, but in the end he is revealed as the weak one. Were Joe's feelings for Marie genuine? Does his letter change your opinion of him? Ultimately, how does Marie feel about him?

9. Betrayal is an important theme in the book. Marie is betrayed by Joe and the hospital. Bobbie and Jolene are betrayed by them too. Marie's father believes she betrayed him and his faith when she was a teenager. What other betrayals can you think of? What motivation is at the root of each betrayal?

10. Consider the depictions of hospitals and doctors on television versus in Oxygen. How does the novel's authentic portrayal of medical culture, its routines and its dilemmas, differ from what you see elsewhere?

11. The ending of the novel is particularly bittersweet. Marie's innocence is intact, but Joe's innocence, and her relationship with him, are undone. Were you surprised? Were you satisfied with this resolution?

Enhance Your Book Club:

Consider the ethical dilemma presented in the book and discuss the responsibilities of physicians and hospitals. For more on medical ethics, visit the American Medical Association's principles of medical ethics page http://www.ama-assn.org/ama/pub/category/2512.html.

Rather than buy the wine or food that your group would usually have, consider donating to a charity such as the one for which Marie works in the novel's epilogue. Learn more by visiting the websites for Changing Faces (http://www.changingfaces.org.uk/) or Facing the World (http://www.facingtheworld.net/).

Read More Show Less

Customer Reviews

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See All Sort by: Showing 1 – 20 of 134 Customer Reviews
  • Posted July 9, 2010

    "Some Things Don't Ever Get Settled..."

    "...You just make a place for them. Learn to let them sit there with you, side by side with the good."

    Dr. Marie Heaton is an experienced anesthesiologist who has dedicated her life to her craft - partly because she loves what she does and who she is professionally, but also because she is running from who she is personally. Working insane hours, always on the verge of absolute exhaustion, she has little time for her extended family and personal life.

    But thankfully, this story isn't about finding satisfaction and completion in her personal life. Rather it's her professional life that is in shambles. Despite being a very good anesthesiologist, an 8 year old girl dies after a routine operation. Although initially supported by the hospital and her fellow doctors, it soon becomes apparent that due to impending litigation, loyalty becomes a precious commodity. Dr. Heaton must come to terms with her perceived betrayal of the very institution to which she has given so much of herself. And things only get worse when it looks like criminal charges might be coming.

    This book offers interesting insight into the relationship between medicine and the law and the pressures the law exerts on doctors involved in malpractice suits. The very people with whom a doctor should be able to review a case, to discuss all possibilities, are the very people who could be compelled to testify against that very same doctor. Hence, being accused of malpractice thrusts the doctor into an extremely lonely world.

    Almost peripherally, the author also delves into Dr. Heaton's familial life. Having been forced to take some time off, Dr. Heaton visits her sister with whom she is close, but has always been guarded. There, she realizes that it's time to make peace with her father, whom she hasn't seen in three years. I must admit that at times it seems that Dr. Heaton's personal story lines are added almost as filler - as a way to make her seem more human, but does little to advance the story line.

    Still, the writing is impeccable, although a little complex at times. But its technicality is what makes the book so authentic and genuine. Dr. Heaton thinks and speaks exactly as you would imagine a doctor to do so.

    The negatives of this book? There are times when Dr. Heaton seems a little unlikeable because she is so self-absorbed. For example, she attends the 8 year old's funeral because she feels she needs to, never thinking about the girl's mother and what she needs. So soon after the girl's death, the person who is possible responsible for her daughter's death is the last person that should be there - and yet, Dr. Heaton decides she has to, for her own sake. Yet, the unlikeable moments are few and far between. And for the most part, the book remains a good medical/legal drama.

    11 out of 17 people found this review helpful.

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  • Anonymous

    Posted July 14, 2008

    If you only read one book this summer...

    It should be this one. Brilliant doctor, brilliant debut. The kind of book you can't wait to tell your friends about. IN fact, I'm going to call my mother right now...

    7 out of 10 people found this review helpful.

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  • Posted September 27, 2010

    more from this reviewer

    Great Read

    This is a novel about Dr Marie Heaton an anesthesiologist in Seattle who after 7 years of excellent patient care finds herself in the middle of a malpractice lawsuit. This story grips at her pain and frustration about why this patient died on her table. The truth is a shocker. A must read for all but definetely for anyone in the healthcare field.

    6 out of 7 people found this review helpful.

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  • Anonymous

    Posted April 23, 2009

    Breathless

    The formal review compares this author's sensitivity in her writing to Jodi Picoult and I can see the connection, but in my opinion, Cassella is a step above. She capably moves the original plot along and lets the reader fully understand her characters, filling her story with deep emotion while not grasping for a forced simile or metaphor at every turn like Picoult all too often does. The novel revolves around seasoned professional anesthesiologist Dr. Marie Heaton and the tailspin her personal, professional, and especially her emotional life takes when an 8-year old child dies during a routine operation she participated in. Casella deftly handles explaining the medical terminology and what has gone wrong without leaving the non-medical reader feeling lost or bored. She also presents a variety of characters that are genuinely likeable despite being flawed, and gives the reader a glimpse into the harsh realities of the world of medicine and hospital bottom lines. Casella's writing rings true of her experiences in this field and her story ending, while not a "happily-ever-after" scenario is satisfying. This is a definitely a writer worth following.

    6 out of 7 people found this review helpful.

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  • Posted July 27, 2010

    Great Book

    This was a great book. One of those that you pick up and can't set back down. I would reccommend it to anyone who loves a great suspense book. Can't wait to read other books by this author!! Definately a 5 star book!!

    3 out of 4 people found this review helpful.

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  • Anonymous

    Posted November 8, 2013

    Free Friday books?

    Is B&N no longer offering Free Friday books?

    2 out of 11 people found this review helpful.

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  • Anonymous

    Posted May 26, 2013

    Exhilarating and empowering!

    It's amazing how a story with pain and depression can bring out empowerment in the reader! Well done!

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted September 9, 2010

    Disappointed

    This book was not captivating. The plot and characters were ordinary. If you enjoy twists and turns that keep you guessing, I would not recommend this book.

    2 out of 3 people found this review helpful.

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  • Posted August 29, 2010

    I Also Recommend:

    Not what I expected...........

    By reading the synopsis I thought this would be a good book. I was somewhat disappointed. The writing style is dry, no real character development. The main character is an anesthesiologist who basically ends up losing a child on the operating table. Was it her fault or not? She basically is haunted by this and cannot get over it. After the incident it seemed the story just dragged with no real suprises or twists. Quick read, but not worth buying.

    2 out of 2 people found this review helpful.

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  • Posted October 4, 2009

    more from this reviewer

    Engrossing!

    This story is truly a page turner. It is the story of an anesthesiologist, Dr. Marie Heaton, and gives a graphic, realistic read of her daily life and one day, a tragedy. It is centered in Seattle, a place that I've visited often, and it's description of the area and places is right on the money. It's also not "just" a medical read, it gives romance and a wonderful mystery/twist. It doesn't hurt that the author is, really, an anesthesiologist! Would love to find another book by the author someday. Soon!

    2 out of 2 people found this review helpful.

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  • Posted July 25, 2009

    more from this reviewer

    Medical Thriller

    Excellent!!!

    2 out of 3 people found this review helpful.

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  • Anonymous

    Posted August 8, 2008

    Can't Wait for your next book, Carol Cassella

    The PERFECT read. Great characters and character development, suspense, factual information--Oxygen has it all.

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted August 29, 2008

    OXYGEN Needed for this Breathless Thriller!

    Carol Cassella¿s mixture of mystery and medical thriller, supported by the authenticity of her many years as an anesthesiologist, results in her page turning debut book, Oxygen: A Novel. Casella¿s Dr. Marie Heaton is also an anesthesiologist who is passionate and professional about her life¿s work. She works at Seattle¿s First Lutheran Hospital where she prides herself in the care and expertise with which she conducts her everyday life as a physician. Starting out as a routine day, with a busy schedule that includes a pediatric case of an 8 year old, mentally challenged girl later in the afternoon, Dr. Heaton¿s day suddenly turns into every doctor¿s worse nightmare. What should have been a simple operation to remove a cyst on little Jolene Jansen¿s back, results in tragedy and finds Marie shockingly facing a malpractice suit as she questions herself as to what went wrong. What follows is Marie¿s life falling apart as she is enveloped in legal paperwork, autopsy results, self recrimination, and the realization that people who were her supporters are quick to abandon her. Her one time lover, Dr. Joe Hillary, becomes the person she thinks she can count on to help her make it though this horror and try and save her career. Add to this, a problem in Marie¿s personal life as her aging father is becoming more dependent on others as his eyesight fails. Marie finds that the responsibility for his care suddenly comes to her even though her connection with her family in Texas has not been a close one for years. Her sister Lori, however, is busy raising a family and so Marie is left with not much of a choice as to the care of her father. Everything in Dr. Heaton¿s once precisely ordered life begins to crumble as everyone and every part of her life suddenly seems to be crashing in on her. How Carol Cassella brings the story to its climax and Marie Heaton¿s life turns out, is told with the expertise of a seasoned writer. The truth of the profession and the workings of medical field are never glossed over by Casella as she gives the reader a REAL look at what goes on in this medical industry while still engaging us in a thriller that only leaves us wanting more from this wonderful new author. Submitted by Karen Haney, August, 2008

    2 out of 3 people found this review helpful.

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  • Anonymous

    Posted June 16, 2008

    Fabulous Book

    I must admit that I seldom complete a book cover to cover, but this one I did! What a superb story. It kept my interest from the beginning to the end, including some unsuspecting turns along the way. Please keep writing more just like it!

    2 out of 3 people found this review helpful.

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  • Anonymous

    Posted November 8, 2013

    Harriet klausner

    Of course harriet klausner has to step in with her cliff note book report and ruin another book with her over excessive plot spoiler. Bn when are you ever going to take down this posters plot spoiling posts and delete them? She ruins every book she so calls reviews. Please do something to this poster and her plot spoiling posts.

    1 out of 2 people found this review helpful.

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  • Posted May 2, 2013

    Excellent and gripping story. Fast reading but still kept your

    Excellent and gripping story. Fast reading but still kept your interest. Recommend for summer read on the beach

    1 out of 1 people found this review helpful.

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  • Posted April 3, 2012

    Definitely Worth Reading

    I would highly recommend this book. Cassella does an amazing job of developing her characters, but not too deliberately which makes it a smart read. Dr. Heaton is very likable and I found my emotions mirroring hers many times throughout the book. The ending will be a huge surprise...I highly recommend this for great writing, likable characters and an interesting plot. If you're tired of the same of chick lit, pick up this smart read and enjoy! :)

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted March 28, 2012

    Highly recommended

    Well written, several unexpected twists and turns, good book!

    1 out of 1 people found this review helpful.

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  • Posted January 8, 2011

    Awesome Novel, Must Read!!

    One of the best books I have ever read! All of the characters are captivating! Every page is a mystery as Dr.Marie Heaton tries to uncover the reason of the unnecessary death of a young child while in her hands. The ending, and the REAL reason for the child's death, is such a shock!

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted August 29, 2009

    Nice detail about the life of anesthesiologists

    Interesting story woven into a quilt of information about how surgery is performed. I found the book most interesting for its comments on the health care in the US -- the book jacket says the ailing healthcare system.

    1 out of 1 people found this review helpful.

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