There is a brief chapter at the center of this absorbing first novel by a woman who has worked for many years with cancer patients in which the physical and mental suffering of one of them is explored in unremitting detail. For Joan Bentley, there is no hope, no relief. She is back in the hospital after a few months' remission of her uterine cancer, which now has spread to her bones. She is dismayed by new pain and nausea, homesick for her family and for the blooming flowers she had so recently tended.
"Now, each morning she woke to the sense of days drying and fluttering to the ground like the doomed leaves that filled her garden in the fall. She had begun to lose track of time in the endless procession of metal carts rolling to her bedside, filled with medicines and blood vials and catheters. Pervading everything like a dread fog was the constant specter of pain, like an old and persistent enemy: sometimes faint and dull, sometimes cruel and grinding."
There follows a description of her chemotherapy's side effects, the hardest to bear being the attitudes of visitors. A friend is terrified when she drops in unexpectedly and finds Joan without her wig; Joan's husband and sons, perching edgily on her bed, a stool, the radiator, are dutiful as they discuss cheerful topics. "She loved to see them all. They were tan and healthy. They brought, temporarily, air from another world."
Literature is very much into cancer and death these days, and hospitals, from soap opera to Broadway and the movies, from scary best sellers to profound moral and psychological investigations, are providing the setting for a variety of dramatic treatment. Until recently, these were almost forbidden subjects. At least they didn't sell very well. Suddenly many writers are asking, along with playwright Brian Clark, "Whose life is it anyway?" and hospitals are their metaphorical battlefields.
Sarah Allan Borisch's unsparing examination of life and death in the cancer ward of a large Midwestern hospital pits medical science, its practitioners working on the far frontiers of research, against those who seek a gentler experience for the terminally ill. She leaves little doubt as to whose side she's on, and such certitude detracts from the appeal of her novel.
Its strong points are the result of her obvious familiarity with the treatment of the disease -- with the wards where cancer patients are confined, with the doctors and other professionals who specialize in oncology and with their complex paraphernalia, and, most tellingly, with the patients themselves, who respond to their situations with terror and outrage as well as with courage and grace. Unless he has experienced these matters directly, the reader will finish "The Protocol" with a fresh appreciation of the human predicaments behind the statistics and the other everyday news about cancer.
Borisch's fiction debut is naive, with results both good and unfortunate. Her headlong determination to tell all infuses her story with authenticity, and she plunges fearlessly into melodrama; that works, too, for the most part. But her leading characters tend to be single-dimension mouthpieces for various points of view, caricatures of good and evil. Her villains are monstrous, her heroes saintly, so their confrontations often are denied credibility.
Virgil Prince, the hospital's renowned chief oncologist, is singularly despicable in his insistence on following the protocols of chemotherapy to prolong life, oblivious to the human needs of those who are incurably stricken. The author provides a most satisfactory comeuppance for Dr. Prince and his malevolent mistress, head nurse Brenda Stone. If you're a fan of the soaps, you've seen similar twists of fate on "General Hospital.