A Little Something is a story of a medical catastrophe for a family: at a baseball game, 10-year-old Justin is struck in the face by a foul ball. He seems OK initially, but he has a loose tooth. His father takes him to a dentist, where, left unattended, he has a drug reaction and loses consciousness. Paramedics take him to a hospital, but he does not wake up. He becomes the still center of the book; three circles form around him.  The closest circle includes the attending neurologist Dr. Goldstein and, of course, his parents. His mother Kath is a pediatric physician; she follows closely the medicine involved and knows well the hospital where Justin is being treated. His father Sam is an introverted financial man; he measures everything in numbers. Their marriage is stressed even before the accident. Kath’s nurse at her clinic, Jonesie, is a steady support. Granny, a Licensed Vocational Nurse, comes to watch over Justin. In a moving scene, she bathes the unconscious boy.

A second circle includes other family and friends, the clientele of Kath’s pediatric clinic, the children, and their parents. These are largely Latino, underserved in Fort Worth, Texas, of 2001. (Kath has chosen a medical specialty that earns less money than other fields—in contrast to her money-grubbing mother, who is satirically portrayed.) Next door to the clinic is a firehouse, where Justin has visited and made friends. The blue-collar firemen are public servants who help make a community work.

A third circle is less defined but contextual for the novel: country folks, like Granny, who are not intellectual but practical. They believe in keeping going no matter what, a folk wisdom of realistic, durable hope.

For three-quarters of the novel there’s suspense about Justin’s recovery. At one brief moment, Sam is sure of a turnaround when he sees (or thinks he sees) a smile on Justin’s face. For nine days Sam and Kath experience hope, anger, exhaustion, expressed rage, confusion, and continuous uncertainty.

Finally there is “the meeting,” a gathering of the doctor, the family, Kath’s faithful clinic nurse Jonesie, and Father Red, a Catholic priest from Justin’s school.  Dr. Goldstein says there is no hope for recovery and gives the medical details of Justin’s brain death, which has both anatomical and legal certainty.

Kath and Sam decide to disconnect Justin from life support and allow organ donation. When Justin must be transferred from the children’s hospital to the neighboring one, Sam carries him in his arms. A surprise ritual is an honor guard of firemen who line the path of the procession.

We read the specifics of disconnecting the vent tube, watching the heart race on the monitor, then the flat line of the still heart. Father Red reads from the Book of Common Prayer. An hour later, a helicopter takes off from the hospital with Justin’s donated heart.

An Epilogue six months later describes a Thanksgiving dinner at the firehouse. Sam and Kath are closer now, and he plans for them a trip to Hawaii. There’s has been, however, no easy “closure,” and the couple combines memories with mourning. 



This novel provides an intimate view of a family going through a horrible experience, the sort of event that parents fear. While the trajectory is grim, the story is affirmative in several ways: the parents’ memories of Justin’s life, the wise professionalism of Dr. Goldstein (who draws on knowledge of international colleagues), the support of many people, and interspersed passages of humor. The final scenes of the disconnection take us through final separation in a sober but affirmative way. In our death-aversive culture, such scenes are rare and generally unknown. Unfortunately, the public is generally uninformed about how such deaths can be managed carefully and respectfully.

Throughout, the ethical and legal safeguards are clear and affirmed; these serve in contrast to such difficult cases as the contemporaneous Terri Schiavo.

A pervasive theme is the notion of limits: limits of medical science, rationality, and human control. While all these have uses and positive values, they cannot control uncertainty and mystery in human affairs.   

Near the end of the novel, various minor characters are recalled for resolutions of earlier conflicts, giving a further sense of order to the surrounding world of the book, even when there is local chaos. Indeed, Kath speaks of “Trying to make meaning of this senseless mess.” A realist, she says life is sometimes a “bully.” 

Kath’s pediatric clinic and the firehouse reinforce a general notion that it takes a whole village to raise a child and, yes, to care for all of its citizens. 

This novel is dramatic and sad, but it is also affirmative because of love, medical professionalism, and various caring communities. This is an insightful and well-crafted novel.


Richard Haddaway is author of a previous novel, Where the River Bends. His website is


Harvard Square Editions

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