Friday, April 29, 2005

Just Read: Quality of Care by Elizabeth Letts

Quality of Care is a thought-provoking and entertaining novel that just pulls you along -- it's so readable that you forgive the too convenient coincidences that sometimes drive the plot (like protagonist Clara picking up a dog in the middle of the road and turning up an unmarked road to look for the dog's owner, who turns out to be the woman she went back to California to find, and who also just happens to be needing a stable girl and hires Clara on the spot...).

The premise of Quality of Care is irresistible: what happens when your college lover and his pregnant wife (who is your childhood best friend) turn up one night at the hospital where you are the OB-GYN on duty? What if within an hour this woman who once saved your life is dead, and her premature baby is barely alive? And what if you still feel pulled to this man, whom you once lived with and walked out on?

These questions are what drive the novel, and keep the reader turning the pages. We follow along as Clara has her privileges suspended by the hospital and her partner suggests a vacation. Suddenly barred from obstetrics (if only temporarily), Clara is cut off from her passion, and forced to confront the demons that drive her perfectionism, her obsessive need to avoid making any mistakes. So she runs away from her current life and returns to California to search for answers about her father's death. But running away doesn't bring the expected relief; Clara just can't forget: "My practice, my patients, my partner, my mother, the flickering candle of a frail baby, and the ghost of a person who everybody assumed I had forgotten had once saved my life. They had all come along with me here, my ghostly entourage" (p80).

Her California interlude at the horse ranch does help Clara figure out her life (I'll leave that for you to find out for yourself -- I wouldn't want to spoil it!), but Quality of Life is never maudlin or sentimental (even if the cover is emblazoned with the NAL Accent motto: "Fiction for the Way We Live" -- yuck!). I do have some qualms with the novel, but they are minor and didn't affect my enjoyment:

  • Those coincidences. Yes, they are handled well by Letts, so it's not manipulative, but still...
  • Unnecessary secondary characters that add absolutely nothing, and actually detract from the story. Prime example: Veterinarian Franny Baker (a childhood acquaintance of Clara's) is a red-headed red herring. It's annoying and distracting to keep mentioning her at the edges of the narrative when her involvement will never amount to much. Clara's frequent mentions of her are just unnecessary distractions.
For more information:
  • Elizabeth Letts's website. She includes an interesting discussion of some of her favorite books, "My Life in Books".
Letts, a practicing certified nurse-midwife has a keen eye for detail — both technical and physical. Her knowledge of horses and obstetrics makes the descriptions ring with authority, yet without ever burdening the reader with unnecessary terms or lingo. She is at her best when describing the coastal scenery (“The hillsides were variegated, some fields of tall grass scattered profusely with goldenrod, others a harmonious blend of dense low-lying chaparral, bluish green to grey, like a natural patchwork”) as well as in flashbacks to Clara’s developing relationship with the brilliantly-drawn Gordon (“I was drowning in him, plunging somewhere deep and fast — on that same speedy trajectory that a car would take when the land beneath it disappeared, or an icy airplane that decided to drop from the sky”). These stirring, evocative and sensuous flashbacks with their undercurrents of grief and mystery kept me reading, hungry to stay inside the story.

Letts delivers her story, much like the nurse-midwife she is — with deft hands, coaxing the reader on with absorbing dialogue and narration; providing them with a protagonist who never succumbs to excessive sentimentality...
  • An interview with Elizabeth Letts (contains some of the same passages as the author interview at back of Quality of Care:
When writing Quality of Care, it was the situation, or premise that came first — it’s virtually impossible to work in obstetrics without thinking about the what-if possibility that something terrible might occur on your watch . . . so I think the premise was incredibly compelling. Then I thought about a real worst case scenario — what if that patient had a special relationship of trust with you?

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