Dr. Terry McKechnie works in the emergency room in a Los Angeles hospital in the early 1990’s, and is having an affair with Virginia Lee, the new wife of an old friend of his from medical school. Virginia works with snakes. She is attracted to danger. She falls in love with Terry immediately after deciding to marry the reliable Rick, with his predictable dermatologist’s hours and habits.

Virginia is bitten by a rare snake and drives herself to Terry’s hospital. The drive is terrifyingly described, time seeming to move at two speeds at once, as Virginia sits stuck in traffic trying not to panic, the terse prose capturing her efforts at clarity even as the rapid effects of the venom begin to cloud her thoughts. Because she is allergic to horses, the antivenom, made of horse serum, cannot be given to her, and she begins to bleed. Unfortunately, she also has an extremely rare blood type.

As well as being a doctor, Terry is a "universal donor": his blood can be given to people with most other blood types without danger of rejection. His gift fails him at this point, however: Virginia must be given blood of her own type. One person has such blood: a psychopath on the run from the police whom Terry had previously allowed to escape. The novel’s plot culminates in Terry’s search for and encounter with the convict, in which he persuades him to give his blood (and, necessarily his freedom--he is arrested in the hospital) and Virginia survives.


This novel traces Terry’s struggle with the meaning of being both a physician and a fallible human being. As a "universal donor "--the term comes to mean something like "ideal physician "--he believes that the capacity to save others runs quite literally in his veins, connecting him with all the patients to whom he can give his blood or his professional service: "Being a universal donor carried an odd sense of intimacy, the notion of being attached in some practical way to other people." (p. 154)

The events of the novel unsettle this secure faith, forcing Terry to recognize his own fallibility. He falls helplessly in love with his friend’s wife, and then is only able to help her by participating in criminal activities (the psychopath bribes him into holding up a liquor store) and then by betraying this man to the police.

The rare snake bite reveals the limits of medical knowledge, for no-one is quite sure what its effects will be, and the many other patients whom Terry encounters expose the limits to what even a "universal donor" can give. The novel’s first crisis is the death of a teenager who has inhaled butane. Terry manages to restart his heart but he dies anyway, evincing the limitations of even successful care. Terry’s desire to "keep [this patient] alive" had been "the purest thing" he "had ever experienced." Constant ruptures like this are what drive Terry to Virginia, and her near-death and the cost of saving her are symbolic of the inevitability of disillusionment.

As a child, Terry is asked by his physician grandfather to explain the Hippocratic Oath. Confusing the word with "hypocritical," he answers that it means a doctor must not "say one thing and believe another" (p. 100). He later misquotes the first rule as "Do no wrong," until his grandfather corrects him. As an adult, he has to confront the compromises honesty can demand, and to recognize the minuscule difference between harm and wrong, error and evil.

Trying to understand the logic of the snake’s venom, he recognizes the force that thwarts medicine’s struggle to be universal donor of cures and miracles: "What eluded him . . . was the malignant principle behind such a mechanism . . . . He just knew it was there, waiting for a chance to use any tool that came along." (p. 188). In confronting this principle--finally, the only thing he can do for Virginia is pray--Terry becomes the more balanced physician and human being he is by the end of this very thought-provoking novel.


Houghton Mifflin

Place Published

New York



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