They say that the question every author asks is, 'What if?'
But the question this author asks is 'What next?'
I'm interested in the time after the event that precipitate in the book -- in who is changed, affected, whose life exalted or cast down.
I know that All We Know of Heaven, although it is a youth book, meant for young people in high school, will get a great deal of attention, much of it controversial, because it is loosely inspired by two cases of mistaken identity after a motor vehicle crash, one just two years ago, one about ten years ago.
Trauma resuscitation is a subject very close to my family. As I have written here before, one of the closest friends I have, succumbed to a combination of factors last Christmas -- untreated strep, a frail constitution and perhaps a confusion of medications for diabetes. Stacey was only 41 when the respiratory event occurred. She was already hospitalized, in the ICU, and because she was a young mother of a baby daughter not yet two, doctors -- who must be forgiven for this -- "worked" on her longer than they should have, restoring her heartbeat and respiration.
But they could not restore her brain. The brain never heals.
Yes, parts of it can take over for other parts if it is damaged, particularly if the victim is young and the damage minimal. But even minimal damage can have maximum impact, while, because the brain is such a funny, fragile and flukey thing, people who have moderate damage, depending on where it is in the brain, may do much better than those who "should" thrive with less difficulty.
My beautiful friend Stacey did not thrive. She remains in a persistent vegetative state, a coma that has wake and sleep cycles but no awareness. The damage was to her whole brain and those cells would have to be "re-grown," by processes that don't exist yet for human beings. All that survives is the function of her brain stem, which controls involuntary reflex actions -- such as breathing and blinking -- and she remains lovingly cared for in a nursing facility. Her baby girl now is nearly three, my only goddaughter. Her husband copes, as we all must. Her parents alternate between prayer and grief.
After what happened to my friend, I became obsessed with the brain and with trauma resuscitation.
With the help of several friends who are emergency physicians, I was able to witness the trauma of a trauma resuscitation in two hospitals -- a process even more terrifying visually than witnessing the actual accident. There is a huge and all-out effort to save the injured, but it takes place even when, perhaps, it might be better to let go and allow the mortally injured person to die with some grace. It's a controversy among physicians -- who, for legal and compassionate reasons -- almost always try unless it is clear that far too much time has passed. How far should they go? For how long? Should the victim's family be present? Is it cruel to exclude them or to include them? How much should the victim's family know in advance about what lies ahead? Truly doctors do not know what lies ahead. Some patients who come into a trauma bay with brain damage that looks so serious that no one would lay odds that they will ever walk or speak again are in fact reading and resuming work within a year -- confounding any predictions.
More often, the picture is grim.
As one doctor in a brain rehabilitation unit told me, parents who come upon an interrupted SIDS death will almost certainly beg doctors, " Do anything. Save my baby." And when the baby is very small, he or she seems much like any other infant. By the time the developmental milestones that signal a normal brain function are beginning to take place, parents have often lived so long with their child on a brain-rehab floor that, as the doctor said, it's their baby. they love their baby for who their baby has become. Because of time, they have come to accept what would certainly have horrified them before.
But some physicians, including many prominent ones, believe that "bringing back" in such cases is a cruel fate that seems beneficent only at the time of despair. What comes later is far harder and a child whose body is healthy and whose brain is impaired may live a long, long life -- if, indeed, it can be called that.
So it was this, my questions about trauma recovery and brain injury, that led to the story of Bridget and Maureen, two best friends who, just two nights before Christmas -- and I guess it's not a coincidence that this also was the night last year that my friend was stricken, although I realized that only as I wrote this -- were brought into a sophisticated emergency room in an attempt to save two beloved young lives.
Only one life was saved.
But what happens after that fate, which is no secret, is the substance of the story.
It's a story of love -- the love of parents, siblings and friends. But it's also a love story.
It's a story of regret and vengeance, but also of courage and forgiveness.
And it was the most difficult book I've ever had to write, as a mother and as an author.
I deeply identified with Bridget and Maureen and their friends, their small Midwestern town and their parents -- so different from each other and yet so much the same, absolutely devout in their love for their children.
I also remembered myself as a young woman in the unlikely love story that followed the accident, which is a love story unlike any other I've seen written down. All We Know of Heaven made my 12-year-old daughter cry but it also turned the heart of a 19-year-old friend who read it. It raises more questions than it answers.
For this year, because of this book and "The Midnight Twins,' the first in a trilogy of mysteries about twins who are clairvoyant -- born a minute before and a minute after New Year's Eve, one is able only to see the future, one the past -- I'll have spent this year in the world of young adults. For the first time in ages, I won't have an adult novel debut.
That's fine with me.
These novels are important to me. I hope they'll be important to you. While there isn't a word in either of them you couldn't repeat to an 11-year-old -- I wanted these stories to reach as wide an audience as I could, and not have that process compromised by adult language or circumstance, they are not stories for the faint of heart. They're utterly real and the stakes are high.
If you read them, as a young adult or with your son or daughter, you'll be changed -- as I was when I wrote them.