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Intense novel captures a doctor in crisis

The Laws of Invisible Things, By Frank Huyler, Holt, 320 pp., $25

What's wrong with Dr. Michael Grant, the central figure of Frank Huyler's first novel, "The Laws of Invisible Things"? Is it just depression, or is he in the grip of some new killer microbe? The stethoscope is pointing at the doctor rather than at the patient in the most intense moments of this layered novel, which behaves like a medical thriller at some points and an existential crisis novel at others.

Huyler is a physician who previously published "The Blood of Strangers," a well-received book of medical vignettes based on his emergency-room experiences. In "Laws," his hero is a young doctor who is starting his life over in a new place and a new practice after the breakup of a marriage. The book is set in a small North Carolina city, one of America's new nowhere lands, where Grant is living an anonymous life for reasons he doesn't fully understand himself. He goes through the motions, following his daily calendar of office appointments, forgetting to eat, and going home to his empty house. Patients break down in his office, but he does not feel their pain.

What wakes this near-automaton -- reminiscent of Meursault, the narrator of "The Stranger" -- is a child's death he might have prevented with a more conscientious approach to routine duties. Beyond the tragedy of the child's death, Grant undergoes the complicated moral horror of holding himself at fault but hiding the facts from others for liability reasons.

Paradoxically, the emotional pain revives enough of his soul to make him care about those who suffer from this preventable death -- and give the reader a reason to care about him. It also places him in the moral debt of the child's grandfather, a black minister, who asks him to treat the puzzling illness his son has contracted. Out of guilt, Grant begins breaking professional practice rules, including his own policy against making house calls. And because he has now stepped into the complicated universe suffering mortals inhabit, his act of moral reparation involves him in more pain and error.

The death of the child has also created tensions with the older doctor whose partner he seeks to become. This meticulous, unfeeling man of science, Dr. Gass, is more than a cold medical fish, he is the bad example of what comes from using medicine to keep emotions of any sort at a clinical remove. But like an ogre in a folk tale, he has a beautiful daughter. Though the reader knows Grant's entanglement with her is inevitable, it takes the author a long time to breathe energy into a connection that is never fully off life-support.

But for the most part, this book has the dark pleasure of a near-disaster recollected in tranquillity. In Huyler's well-devised fictional universe, the medical and the moral are all mixed up with one another, and neither life nor death -- an ever-present reality in this novel -- comes easy. Doctors know things the rest of us don't. Huyler's insider knowledge gives us authoritatively dramatic accounts of the blood-and-gut wrestling of medical expertise with failing flesh. Combined with his powers of psychological observation and storytelling skill, this privileged perspective gives us the inside story on both sides of the mortal collision in the ER, when Grant himself is the patient and a young resident is trying to save his life.

The doctor's enigmatic disease moves through the novel with the scary power of a killer organism in a genre thriller. The book's moral development, on the other hand, leans a little too close to the black-and-white. Dr. Gass, his role-model GP, is a kind of Strangelove of the examination room. And the locked-up Grant, who begins questioning his path at age 35, sometimes appears in need of a personality transplant. His scenes with Gass's unhappy daughter sometimes have the curtailed vocabulary of translations from the language of self-denial. They're like two prisoners released from Plato's cave who don't have words for the sun. The Rev. Williams, on the other hand, the dead child's grandfather, is fully and heartbreakingly drawn. There's no clinical remove from pain in the author's storytelling.

Huyler is equally hard on his own profession, whose attentions none of us will escape. One of the novel's lasting moments comes during the emergency-room crisis when the fast-fading Grant pulls himself together sufficiently to bark out, "I'm a physician." Grant watches, Huyler writes, as the resident treating him puts him in another category in her mind.

Those of us who aren't able to make the same claim had better hope that our caretakers have meditated on the wisdom and compassion of books like "The Laws of Invisible Things."

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