This reading group guide for Healer includes an introduction, discussion questions, ideas for enhancing your book club, and a Q&A with author Carol Cassella. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

INTRODUCTION

Claire Boehning’s life of privilege and ease in Seattle comes crashing down thanks to her husband, Addison’s, gamble on a biotech venture. Now they must retreat with their 14-year-old daughter to a bare-bones ranch house in rural Washington, where Claire struggles to revive a long-dormant medical career in order to support her family. The follow-up to Carol Cassella’s national bestseller Oxygen, Healer explores the fallout of broken trust, the ongoing struggle to be truly understood, and the ultimate redemption of love and family. 

 
QUESTIONS AND TOPICS FOR DISCUSSION

1. Claire’s new life in Hallum seems a cold reality compared to her wealthy life in Seattle--a perception only compounded by the harsh winter weather. She feels out of touch with her husband, who spent their life savings without telling her, out of touch with her teenage daughter, Jory, who is much less communicative with her than with Addison, out of touch with her profession, where she experiences both a language barrier and a lapse in practice of several years. At one point, she even explains that she, along with the rest of her family, “had forgotten how heartless the universe could be” (p. 70). In a sense, Claire had been living in a protective, sheltered bubble, cut off from reality. How do you think this bubble was created? How does she deal with her new life?

 

1. How does Claire’s job at the clinic help get her out of her protective bubble?

 

1. Claire’s work at the clinic, caring for her patients, also leaves her less time to care for her daughter, Jory. She thinks “time travels faster for a forty-three-year-old than a fourteen-year-old” (p. 129). Do you agree? How well do you think Claire handles this difficult situation?

 

1. There are references in Healer to deserving what is coming to you. Addison believes that “Angiovastin deserved production, deserved its market share and more,” (p.155) and, by way of creating the drug, he deserves a lucrative payout. Even Claire, when they hold the estate sale in their old home, “recognized how deserving she had grown to feel” (p. 167). Contrast this perspective with what Claire observes in Dan, “a placid acceptance that paths have been laid out for all of us and there is no point beating about for alternatives” (p. 58). How do the themes of fate and free will play out in the story?

 

1. Claire is shocked and angry to learn the extent of Addison’s financial gambling, and feels betrayed that he hid it from her. However, Claire also hides her true feelings from Jory, so much that it exhausts her. Why do you think she does this?

 

1. What role does money play in the relationship between Claire and Addison?

 

1. The story provides several examples of the relationship between mothers and children: Claire and Jory, Miguela and Esperanza, and Frida and her son. How are they similar and different? How do these relationships illustrate the sacrifices made for the sake of family?

 

1. How does Miguela’s struggle, her quest to find out what happened to her daughter, affect Claire’s perspective and her relationship with Jory?

 

1. Do you think Addison is a dreamer? Is he selfish? Is he more scientist or more businessman?

 

1. Claire considers Addison’s actions, and “one bright flash before the moment of sleep revealed how much the illusion of his superiority mattered to her, and how much it was anchored by trust. Until all of this, until all was stripped bare, she had not seen it” (p. 168). Addison needed Claire to believe in him, but she also needed to believe. When he gambled away their money he jeopardized that trust. Were Addison’s actions to blame for all the trouble in their marriage?

 

1. How do their shared experiences affect the relationship between Claire and Addison by the end of the story? They leave lasting scars, but do they also make it stronger?

 

1. When considering the words “I love you,” Claire thinks, “maybe those three words can mature and grow old just as the union itself grows old, no longer pristine and fresh but still vital. Maybe it proves that love is like any living thing--capable of almost unrecognizable change over the decades, scarring over astonishing wounds, so the words can still be true, just not in the way they began” (p. 128). How does the meaning of those words change for Claire?

 

1. Do you think Claire’s use of the money from the sale of her engagement ring was a way to get back at Addison? Or is it simply a much-needed gift to Miguela?

 

1. Do you think Claire, Addison, and Jory will stay in Hallum after the story ends?

 

1. The first page describes how “Claire still understands the human body. She understands the involuntary mechanics of healing. But how an injured marriage heals--that remains a mystery.” Do you think the resolution, the healing, of Claire’s marriage to Addison by the end of the story was voluntary or involuntary?

ENHANCE YOUR BOOK CLUB

1. Check out the author’s website: www.CarolCassella.com. Send her an Email request to attend your group’s discussion, either by conference call or web cam. Also, read Cassella’s first bestselling novel, Oxygen.
   
   
2. Learn more about the history of the Nicaraguan conflict through your local library or on websites such as Wikipedia.
   
   
3. Look up a recipe for gallo pinto or other Nicaraguan specialties to serve at your book group. An excellent place to start is www.Nicaragua.com.
   
   
4. Research Ruben Dario, his poetry, and find out more about the literary movement Modernismo.

A CONVERSATION WITH CAROL CASSELLA

Your first novel, Oxygen, is a critically acclaimed national bestseller. Was that particularly intimidating or challenging as you worked on Healer?

Yes, it was way more intimidating than I’d anticipated. As a debut novelist I didn’t expect Oxygen to find a wide audience. In fact I knew it was a long shot to be published at all, so I felt quite unfettered. My original goal was to finish a novel and gracefully park it on my closet shelf until my grandchildren discovered it decades from now. By contrast, Healer was already under contract when I started writing it. I knew it would be read and critiqued, which made it harder to smother my own editorial harping. I completely threw out the first two drafts and only then discovered the heart of this story and this family.

To grow as a writer I have to push myself toward different voices and characters, and even genres-- not write the same book again and again. That can feel risky. But at some point it’s critical to stand back from your own work as an author and let it march into the world without you, let the reader own it, analyze it, and take it forward.


In Healer you write eloquently about the struggles of being a working mom. Did you rely on personal experience to inform that aspect of the book?

Very much. But I also drew on the experience of friends, family, in fact most of the women I know. Almost nothing changes your life as dramatically as becoming a parent, and parenting is a completely consuming job. I’ve spent many days at work feeling guilty about not being home, and plenty of days at home worrying about my job. But we live in an era when most families need two incomes or are single parent households. We have a highly educated and talented generation of women who want to work outside the home. At the same time, American families have dispersed; relatives and grandparents aren’t there to help out and high quality child care is expensive. It’s as if we fixed one half of the problem--expanding opportunities for women in the workplace--but we are sadly lagging in realistic options for every income level.


When doing book readings and events, what is the most valuable or helpful aspect of meeting your fans?

I have a theory that a book is a collaborative art; it isn’t complete until readers absorb it and animate the page with colors, scents, sounds, and the emotional responses borne of their own experience. That’s when characters and story fully come to life. Meeting readers is my chance to discover if what I envisioned made it onto the page intact. Writing fiction is an incredibly solitary pursuit--in some ways it’s utterly selfish narcissm (not that we can’t all use a little selfish narcissm now and then). That can be forgiven when a reader is entertained or enlightened or distracted from their own problems by the words I wrote. The other thing I love about meeting readers is having a chance to thank them in person for keeping books and publishing alive. If people don’t buy books, books will go away.

 
What prompted you to include a character from Nicaragua? How would you describe your experience traveling there for research?

I live on an island off the coast of Washington and I volunteer for an NGO that supports projects and developments on an island in Nicaragua. The more I learned about the history of Nicaragua and the United States’ economic role in Nicaragua’s political development, the more I decided it was the perfect country of origin for my character Miguela. Since the early 1800s the United States has played an intrusive and often dark role in Nicaragua’s struggle for democracy. That is certainly not a unique political story, but it is a good example of how power and money can change the course of a nation and crush the dreams of its citizens. While it’s easy to say that those who work hard can better their lives and increase their standard of living, for most of the world the place and position into which you are born will dictate the life you lead.

In 2008 our family traveled to Nicaragua and spent two and a half weeks touring the country. It is violently beautiful, a land of volcanoes, jungles, raw coastlines and ecologic wonders--still largely unspoiled by tourism, with people who are welcoming and generous. It was one of the best trips we’ve ever taken; a chance to show our children another culture, stepping outside the bubble they had come to assume was normal.

With your website and Facebook page, you have a significant presence online. Do you feel that the internet allows you to have closer interaction with your readers?

Compared to a lot of authors (and certainly anyone related to me under the age of 25) I have a fairly minimal footprint on Facebook and Twitter. But the Internet has completely transformed the way readers and authors communicate today. As much as I worshipped authors when I was young, I don’t remember ever writing one a letter. Now I hear from readers all the time through Facebook or my website. It’s a gift to get such spontaneous feedback from people--honest reactions to my novels, parallel stories from their own lives or their medical experiences. It’s given me an appreciation for the breadth of opinions a book can generate: praise, catharsis, emotional identification or disagreement, criticism, and controversy. All from the same 100,000 words printed in exactly the same way! 

Facebook and Twitter and my website let me send announcements about my books, my talks, even photos and stories about my personal life to the general public, targeted groups or specific individuals. That has unprecedented power, because it turns me into a real person instead of just an author’s name stamped on the front of the book. And it lets readers propel books based on their own passions--the viral power of connecting one friend to another and another. On the other hand, like any dazzling new toy, the Internet can be a Pandora’s box. It’s easy to let social media take up too much space in our lives. In the end the most precious commodity any of us has is time.

You are a practicing anesthesiologist. How did you come to write about a woman who had been away from medicine for several years?

I’ve always been interested in the gap between the image we present to the world and who we are in our private lives, riddled with insecurities and stalled dreams. The world of medicine provides great fodder for this topic, because when you decide to become a doctor you adopt an identity. You wear a white coat and put two new capital letters behind your name, and a new title in front of your name. You are assigned a rank in society, auto-populated with presumed intelligence, education, and authority. It can be seductively easy to hide behind the veneer attached to the profession. 

It takes so long to go through medical school and residency and fellowship and the stressful years of a new practice that it’s too late to turn around if you discover medicine is not the career you’d imagined. So I sometimes wonder if there isn’t a larger-than-average cache of self-perceived charlatans lurking in the medical world--people who don’t always feel like they belong. Maybe this is only my fiction-writing mind at work but the idea intrigues me, and it’s much more fun to write about characters when I get to scrape away their polish and tattle on their flaws. The gap in Claire’s working life set these flaws into higher contrast: she never really got a chance to establish her medical career. The timing of Jory’s premature birth collided with a professional catastrophe that made it easy for Claire to turn away from medicine and pretend it was all for her daughter. Then there’s the question of money. Once Claire no longer had to support herself or her family, how much courage did she really have to go back to a job that had nearly overwhelmed her? What did she need to discover about herself when she had no choice?

In Healer you portray unflinchingly realistic characters, emotions and dialogue. Are there any challenges to writing so realistically?

No matter how moving or engaging a story is, if the characters in it don’t ring true to life the story feels flat. And while I don’t write autobiographically, I do use my life and experiences as an emotional sounding board--testing dialogue and reactions for veracity against my own emotional responses even when a character behaves contrary to my personality. It can be exhausting, but also illuminating and provocative. Readers often assume that I am my protagonist, and friends and family wonder how much I’ve borrowed from them. I haven’t seen any permanent rifts from that yet, but it can be a struggle to keep stories honest when I sense they are paralleling some recognizable event. On the other hand, that’s also one of the main attractions of reading isn’t it? Discovering pieces of yourself in new worlds and imagined characters? It can go a long way toward making one feel less alone in the world.

The book depicts the sometimes great disparity between medical school training and real world practice. Is this something you personally experienced?

Definitely! Every doctor feels it. You skate out of medical school confident that you are a master of medical facts, and then you collide with the patient who can’t be diagnosed, saved, or even satisfied. Humans aren’t cars or airplanes. They respond differently to medications and therapy. They manifest the same disease in variable ways, which is why no physician can precisely answer questions like, “how long will I live with this?” It’s why a doctor who’s treated a hundred cases similar to yours can boil the ocean of numbers and statistics down to reasonable advice for your particular situation. It’s also why the Internet can be a potentially unreliable source of medical information. Years ago I was asked to write flow diagrams for a dot.com startup company that intended to sell point-and-click diagnoses and treatment plans to patients and physicians--a laughably hopeless business plan, because it included no link for perspective: that intuitive and invaluable skill that develops only with time and careful attention, year by year, patient by patient.

 
How do you maintain a sense of balance between fiction writing and your medical career?

Well, if you envision balance as standing in the middle of a see saw or bongo board, you know it’s not a static point. It’s a continual shifting of weight and muscle, taking and giving and sometimes failing. I work at both endeavors part time, which seems to add up to one and a half jobs! One advantage of my medical specialty, anesthesiology, is that my direct patient care responsibilities largely begin and end in the operating room, so when I’m off duty I’m not worried about my patients and can more easily immerse myself in what I’m writing. But medicine and fiction are more complementary than might be obvious--after all, look at the number of exceptional plays and poetry and novels that have been authored by doctors, from Chekhov to Carlos Williams to Verghese. 

I had a literature professor in college who said, “Without death there would be no poetry!” I’m not sure I agree with that--even immortal teenagers can get mighty emotional. But I do see patients every day who have been cheated out of decades of life, and writing is an outlet I use to make sense of the inequality of biological fate. And when I take a longer view of these two mixed careers, I recognize that staying challenged on more than one front keeps me from getting complacent about who I am and what I am capable of doing. As long as I have certain constants in my life, my family, I love to surprise myself by testing my limits.


What are you working on now? Do you have plans to write another book?

I have succumbed to the personal fact that my need to write is similar to being infected with a chronic virus. It seems to be the only cure for quieting the incessant narration of life that goes on in my head. Within a week of figuring out the ending to Healer I heard some new characters dancing around in there, and they’ve already begun their journey.