ENTERTAINMENT

As an anesthesiologist, Dr. Marie Heaton prides herself on her ability to put patients and family at ease before putting them under. Then a little girl dies on the operating table from anesthesia complications, and Heaton loses the confidence she spent 12 years building. Within a matter of days, she has become uncertain about her abilities and is the object of a lawsuit.

Heaton, a kind and caring doctor, narrates Oxygen. A suspense-filled debut novel by Carol Wiley Cassella, it benefits greatly from the fact that the author is a practicing anesthesiologist, as well as a good writer.

Oxygen combines realistic detail with fictional characters and events in a subtle, compelling plot that twists and twists again. This quickly becomes a book you cannot put down as you rush to learn whether Heaton, a conscientious, experienced doctor, must bear any of the blame for the child's death. She will not know for sure until the autopsy, and maybe not even then.

The hospital staff appears supportive, at least at first. Heaton's ex-boyfriend Joe, also an anesthesiologist and a masterfully drawn character, tries hard to bring her out of her pain and sorrow.

The author humanizes Heaton further by showing her interactions with her sister, her teenage niece and her father, a professor retired from Rice University. The anesthesiologist comes across as thoroughly likable, though seemingly incapable of a normal relationship with her father because of something that haunts them both. As the book continues, that secret, of course, comes out.

While set primarily at a hospital in Seattle, the novel also makes reference to Heaton's Dallas childhood, and has scenes in Fort Worth and Houston that feel familiar. Though the author currently lives on Bainbridge Island and practices in Seattle, she grew up in Dallas.

To encounter a doctor writing well is not unusual. (Think Anton Chekov, William Carlos Williams, Abraham Verghese, Ethan Canin.) What is surprising here is the newness of the voice and the specificity of subject matter. Here is an anesthesiologist writing passionately about the difficulties someone in her specialty can encounter, from sleep deprivation to drug addiction. Oxygen offers particular insights into this medical specialty, as when Heaton confides that the anonymity almost kept her from choosing anesthesiology. "I balked at the hubris of asking anyone to yield so much control to me after only a few introductory words," she says, noting that anesthesiologists are usually assigned to patients and meet them but briefly.

In the end, Heaton comes down hard on "a health-care machine that has outstripped our individual competence with its monstrous ambition and complexity." Whether that is Dr. Cassella's opinion, too, we can only guess.

Anne Morris, a member of the National Book Critics Circle, lives in Austin.

Carol Wiley Cassella

(Simon & Schuster, $25) Carol Wiley Cassella will sign Oxygen at 7 p.m. Tuesday at Borders, Preston Road at Royal Lane.