Her marriage tested by financial ruin, Claire returns to work and struggles with her family, in a downbeat domestic story drained by its preoccupied heroine.

Anesthesiologist Cassella's second novel (Oxygen, 2008), again with a medical theme, traces a wife and mother's efforts to hold on to her core attachments while her material world collapses. Claire Boehning's clever biopharm-researcher husband Addison made a fortune in cancer diagnosis but has secretly lost it again trying to float an anti-cancer drug. When the truth emerges, Claire must abandon her enviable Seattle house and lifestyle and relocate, with her spoiled, sulky teenage daughter Jory, to their second home in the country. Fourteen years ago Claire was a doctor, although she never achieved board certification because of Jory's premature birth. Now she's hired by Dan Zelaya, who runs a clinic treating poor locals and immigrant workers from nearby fruit farms. Grappling with fear, newfound poverty and anger at home, Claire is pulled into the lives of her patients, which are full of greater grief and difficulty. Worthy though Cassella's themes may be, Claire is often gloomy company. Plot developments are few and generally clearly signposted, although the big question, concerning Claire's marriage, does hold interest to the final page.

This tale of middle-class hardship touches buttons yet rarely plumbs real emotional depths.

Claire Boehning faces a bleak future when her privileged life ends abruptly in Cassella's second novel (after Oxygen). Addison, her biochemist husband, created a lucrative drug that secured the family's fortunes, but when tests on a new drug go awry and Addison's backing disappears, he loses everything. After the couple is forced to move from Seattle with daughter Jory, 14, to live in a rural, ramshackle house originally bought as a fixer-upper project when money was not an issue, Addison travels in search of new investors. Claire, meanwhile, searches for a position as a doctor, a profession she left after Jory's birth. But with her lack of experience and board certification, she finds few opportunities until she lands a job at a nonprofit clinic that serves poor, uninsured migrant workers. There Claire meets Miguela Ruiz, a Nicaraguan native with a mysterious background, and as the Boehnings struggle to reclaim some piece of their past life, Ruiz affects them in unexpected ways. Cassella (a real-life doctor) takes a hard look at a faulty health-care system to illustrate the power of money and class in this timely and multifaceted novel. (Sept.)