Ella needs time for finishing her doctoral dissertation on black holes she has been writing for years and thinks an illness could provide the time: “Just enough to take one semester off, to not have to teach all those planetary sciences classes to so many distracted students whom she had to instruct evaluate forget immediately (p. 6). Before she can decide which illness would best suit her purposes, a mysterious illness finds her.
 A sudden cramp shoots down the spine and then, stillness... (p. 9)
An unbearable stinging had settled into her shoulder neck ember... (p. 10)
She felt an invisible wound wrapping her up and suffocating her... (p.10)
A slight numbness that starts in the shoulder and extends along the arm to the elbow until it reaches the back of her right hand, the fingers where it all started. (p. 12)
Inflammatio. In flames. En llamas. Ardor without romance. (p. 10)
Quickly, then, the story shifts from Ella’s dissertation odyssey to her diagnostic odyssey. As she makes her way along this journey during the first chapter, other characters come into the picture: El, Ella’s long-term boyfriend and forensic scientist, is one. The others in her family history are “the Father,” “the Mother,” “the Brother,” and “the Twins”—none are ever named (neither, really, is Ella or El because they are “she” and “he,” respectively in Spanish). Except for the Twins, each of the subsequent four chapters center on one of these characters and how they figure into the family history. Just as in the first chapter, the stories are told through and around the health challenges each character faced; all harrowing, many life-threatening, and some metaphorical.

Ever present in these histories is the story of Ella’s birth mother,“genetic Mother”. She died giving birth to Ella. Ella’s stepmother, “the Mother,” is called at different times, “the volunteer Mother,” “the replacement Mother,” and “the living Mother.” The Brother, alternatively known as “the Firstborn,” shares with Ella her birth mother and was born nine years before her. The Twins, known separately as “the Boy Twin” and “the Girl Twin,” came after the Father remarried. Another dimension shaping the stories is both the Father and the replacement Mother work as practicing physicians. 

Ella’s prominence in each chapter makes her our witness to El’s recovery after an explosion rips through his mass grave excavation site, and his many surgeries for separate gastrointestinal troubles; the Mother’s aggressive and brutal breast cancer treatment; the Firstborn’s recurring bone fractures (an “osseous enigma”); and the Father’s bleeding ulcers and life-threatening hemorrhagic complications from prostate surgery. 

The author, Lina Meruane, structured the book in a somewhat unconventional form. She delineates sections within each chapter with asterisks centered on the page (“***”), and these sections rarely comprise more than two paragraphs. Dialog is neither separated from other text nor signaled with quotation marks. The text moves back in forth in time, from here to there in place (presumably somewhere in South America), and sometimes takes the form of pensées rather than plot narrative. But, overall, the book moves towards resolving some mysteries surrounding family history.


The Father tells Ella, “it [is] all about dodging obstacles in this sack race of life” (p. 105). That notion captures the essence of the novel. Some characters are pursuing aspirations and others are fulfilling responsibilities. All are confronting several serious obstacles to their health. The obstacles dominate.

How else could it be for this family? “For [Ella’s] parents, everything started in the body and ended in illness, and what happened in between was part of that same endless conversation” (p. 42).

Throughout the book, Meruane concentrates on the characters’ illnesses and injuries to a degree that at times obscures the character’s stories unrelated to health issues. Readers preferring novels more like a downhill ski slope than a slalom course might find the novel frustrating. Readers preferring novels with digressions, especially those digging into how illnesses shape lives, are better suited for it. Meruane rewards them with her different takes on how we can think about illness and injury, and often with clever wordplay and sophisticated analogies.

For example, during her diagnostic odyssey Ella is “electrocuted by her own nerves” when a needle is pushed into her back in search of spinal fluid (p. 51). In the midst of the explosion at his forensic excavation site, El can see “only dust, rocks, torn bee wings, bits of flesh scattered in the smoke: an airborne bonfire. And fleeting sparks falling onto him, burning his hair, spattering his skin, wounding his clothes” (p. 65). Of the Mother’s excruciating experience with radiation for breast cancer, Meruane composes an analogy that can make us wonder if modern medicine is at times any more advanced than medieval torture.
The singeing rays of radiotherapy were filling her mouth with sores and scorching her skin. It wasn’t so long between when they stopped burning sinner women to a crisp at the stake to save their souls and when they started applying radiotherapy to save their bodies. The radioactive pyre went on burning them alive, or furnished them with a slow death that became evident only decades later. (pp. 135-136)
Many more literary expositions of health problems and their treatments permeate the novel. But Meruane reserves her most powerful writing for the unrelenting and crushing effects the death of Ella’s birth mother has on the Father, the Brother, and Ella herself.

The Father is weighed down by grief, and haunted by thoughts that he might have been able to prevent his first wife’s death. Meruane uses the scene in which the Father tells his son that his mother has died to display how tightly grief can take hold of someone.
The Father walked to the table and sat down and leaned on his elbows and murmured something under his breath, under his teeth, and then he went mute, as though he’d already said everything he had to say to his son. He never mentioned her again, wrapped her in folds of his brain guts oblivion. (p. 155) 
But Meruane does not let the Father forget and shows how the forces sustaining his grief can arise from opposite poles of emotions; in this case those poles being, “the Firstborn’s wrath [a]nd his daughter’s unbearable forgiveness” (p. 210).

The Brother is in constant pain and engages in risky behaviors producing broken bones and enough physical pain to obliterate his emotional pain. Meruane writes of his frame of mind in these ways:
His mother’s absence was an organ that went on secreting anguish within his body. (p. 155)
To run wanting to catch up with the mother who’d left him behind. To suffer muscles hardened by lactic acid. To know that the painful substance, lactate, was also found in mother’s milk. (p. 159)

Suffering...going back over all the steps he’d taken, knowing that the pain had never been in his bones. (p. 174)
Ella labors through the guilt of possibly being responsible for her mother’s death. Meruane builds up Ella’s self-decimating guilt gently at first, “One woman out of every twenty died in labor, said the Mother under her breath, and the daughter was convinced she had made her mother part of that statistic” (p. 155). And then harshly with a cruel twist, “The Firstborn blamed Ella for having aborted his mama in labor” (p. 156). 

In a scene situated in an MRI during Ella’s diagnostic odyssey, Meruane plumbs the depths of Ella’s despair over how she could be responsible for her mother’s death, and whether her mother would think the same. Ella is placed in the MRI machine on her thirty-ninth birthday and, in her mind, returned to the womb on the day of her birth. Her doctors saw images of her spine, she saw images of her conscience. 

In the end, the novel sees illness and death as punishing and shattering, but also life affirming. Meruane condenses this idea in a succinct passage. 

We are probably always sick and don’t know it. And although as a child Ella had thought they were trying to scare her with all those stories of what a body can suffer, only later has she understood that those stories were nothing but a gloss. Because the strangest thing is to live. So much can go wrong, she thinks. (p. 203)

Meruane could have been more succinct yet: I’m sick, therefore I live.


Lina Meruane, PhD, is a clinical associate professor in liberal studies at New York University in New York City. She teaches Latin American Cultures, Arts and Cultures in the Core Program and has taught a senior seminar entitled Pathological Citizenship at the Global Liberal Studies Program. She is also affiliated to the M.F.A. in Creative Writing in Spanish.

The book was translated by Megan McDowell


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