"Healer:" A fall from privilege, and a return to a doctor's work

Seattle anesthesiologist Carol Wiley Cassella has written a smart second novel to follow her first, "Oxygen" (2008). Set mostly in the fictional town of Hallum, Wash., somewhere between North Bend and Wenatchee, "Healer" (Simon & Schuster, 295 pp., $25) takes up the story of a stay-at-home mother who must become the doctor she once trained to be after her biochemist husband bets their house and pension funds to save his bio-tech lab — and loses all the wealth that came suddenly to them with his first successful anti-cancer drug.

Claire and Addison Boehning sell their Seattle lakefront property, giving up their cocoon of privilege and pampered living, and Claire moves with their 14-year-old daughter Jory to their summer home in Hallum. Addison, meanwhile, is touring pharmaceutical conventions trying to attract companies who might back his next breakthrough drug.

Resourceful, humbled and furious with her husband for losing everything, Claire is not an immediately sympathetic protagonist; "recession lit" readers might not feel sorry for someone who has a second home and a medical degree to fall back on. She takes a job at a free clinic for migrant workers, the only place that will hire her because she is not board-certified.

Despite having gotten together when she was a medical student and Addison was a "lab rat" not expecting to earn very much, Claire reflects on their fall from privilege and marital trust; she tries to see how the sudden money smothered them, and whether they can recover as a couple. She has a memory "of a silent and monumental force carrying her smoothly, steadily up and up, only menacing because it gathers steadily enough to be missed. And the deadliest consequence of a tidal wave was ... if you failed to see it in time and rescue what is dear to you."

Though this is an accomplished novel, I have a few quibbles. There are no surprises in the marriage drama; and the homilies about "the resilience of adolescence" and mothering are clichés, especially when they turn away from the characters and address the reader: "Claire can keep up a front for Jory — motherhood teaches you that from the first reassuring smile you give your toddler after a tumble."

Far more interesting than Claire's reflections on parenting and marriage is her return to doctoring, when her focus shifts away from all that she has lost toward the lives of people in pain and poverty. This is where the storytelling is strongest. Claire learns that a Nicaraguan acquaintance's daughter may have had an adverse reaction to a liver drug she took in a clinical trial, and died from it. The possibility arises that her interests in ethical medicine and in financial recovery will collide.

Cassella excels at dialogue and creating distinctly colorful minor characters. The quirky doctor who hired Claire, Dan Zelaya, and his wife, Evelyn, are among the more fully realized characters in the novel.

Cassella's writing about medical care and ethics, pharmaceutical drug development and the conditions of migrant workers' lives is moving and sophisticated; let's hope this doctor has more stories to tell.