THE MYSTERY OF BREATHING

A Novel By Perri Klass

Houghton Mifflin: 344 pp., $24


The Healing Power of Words

Reviewed by Paula L. Woods, August 1, 2004, Los Angeles Times

At first blush, the interests of medicine and literature appear incompatible. Medicine, with its analysis and synthesis of immense amounts of data in the service of clinical problem-solving, would seem the antithesis of literature's concern with layered characterizations, plotting and vivid language. Yet there have been a number of physicians who have successfully blended these left-brain/right-brain activities into works of literature that have both enlightened and entertained readers for generations. Physician-writers such as William Carlos Williams, Anton Chekhov, Michael Crichton and Tess Gerritsen have made their mark, offering insights into the human condition in stories, plays, poetry, nonfiction books and medical thrillers.

Author Perri Klass is a pediatrician specializing in infectious medicine and medical director of Reach Out and Read, a nonprofit organization that promotes literacy as part of pediatric primary care. She has blended her interest in medicine, fiction and nonfiction over a career spanning almost 20 years. Her output has included contributions to the New York Times' Hers column when she was in her 20s, a pair of novels, two collections of short stories and "A Not Entirely Benign Procedure: Four Years as a Medical Student," a nonfiction collection of diary-like essays widely used in the medical humanities courses that have sprung up in medical schools over the last decade.

In speaking of her own career and indirectly about the literary physician, Klass has said, "Writers and doctors, I would argue, have many overlapping traits — a fascination with the many stories out there in the world, an eagerness to probe for details and complexity, a willingness to reformulate and retell. I suspect that by now my writing and doctoring 'selves' are profoundly intertwined — and certainly I hope to continue doing both jobs, with their particular challenges and satisfactions."

In her latest novel, "The Mystery of Breathing," her protagonist, Maggie Claymore, is a dedicated yet driven neonatologist at Boston's Blessed Innocence Hospital for Infants and Children. Just shy of 40, Maggie approaches her career with a single-minded sense of entitlement reminiscent of a gladiator: "She is on her way to work, and this is her job, taking care of those babies … making it go right when it starts to go wrong, helping the hearts and lungs that cannot do it on their own …. This is her moment, this is her window, this is where her game is played."

As the novel opens, Maggie is pulled from a hallway by a panicked emergency-room resident to take over the care of a premature infant boy, 22 weeks' gestation, born to the 14-year-old daughter of a famous politician. The scenes set in the neonatal intensive-care unit not only bristle with authenticity and suspense but also with the certainty that Maggie is a capable, competent healer who fights for this and other infants under her care with a ferocity that almost excuses such self-aggrandizing comments as "Maggie's history is his destiny…. She knows her business … and she does not question her right."

Others do, most disturbingly an anonymous critic, who has sent Maggie a hate letter accusing her of cruelty, harshness and doing "harm to your patients and to young doctors who come to you for training." The letter is unsigned and no one, not even the odd duck who runs the mailroom, seems to know how it got into Maggie's mailbox or who sent it. Maggie is understandably distressed but almost perversely analytical about the letter, mentally correcting punctuation errors as if that would make it "less suggestive of the run-on hatreds of a boiling angry mind."

Maggie soldiers on, checking in on the patients she has saved, teaching residents, politicking to be selected as the head of neonatal services, even seeking comfort from her husband, Dan, a clinic internist who works with underserved urban populations. But as the letters accumulate in Maggie's mailbox, her office and those of nursing supervisors and medical colleagues, she finds it increasingly difficult to hold on to the carefully composed persona she has crafted from the raw clay of a sad childhood.

Aspects of Maggie's past are revealed in flashbacks that trace her road to medical school and suggest reasons why she's become so cynical and condescending. The flashbacks also reveal secrets she would rather not expose to the harsh scrutiny of her colleagues. Yet Maggie's quirks and secrets — as well as those of many co-workers and friends — become fodder for a private investigator hired by hospital administrators more interested in damage control than in protecting Maggie's reputation. As the investigator begins to dig into the neonatologist's past and her tormentor steps up the campaign, Maggie comes unglued — haunting the hospital's hallways at night and going ballistic at a sensitivity workshop, one of the book's funny scenes.

As juicy as this sounds, "The Mystery of Breathing" is not a medical thriller or even a mystery as the title might suggest. The novel does create doubt about who could have sent the letters. Is it Erika Donnelly, one of the nurses who finds Maggie difficult? Or one of the hospital's residents, a recipient of Maggie's pointed lectures on patient care?

Yet Klass, who based the novel on a real-life experience, is concerned with greater mysteries: Can Maggie save herself from leading a narrow, pinched life, as her mother did? Can writing about her pain in a journal — the act of creating fiction — save her? Will she reconnect with the faith she abandoned when she began her medical odyssey?

Answers to these questions make "The Mystery of Breathing" a worthwhile, engaging read even when the simpler satisfactions of seeing the guilty punished or right win over might are conspicuously absent.