(Random House)

Alice & Oliver” conveys the experience of cancer treatment with such grim immediacy that some readers may wonder whether they want to subject themselves to it. Charles Bock plunges right into an out-of-the-blue health crisis that sends new mother Alice Culvert to the hospital, where a test reveals that she has “zero white blood cells” and half of her remaining blood cells are cancerous. One page later, she’s getting chemotherapy and her hair is falling out. We get our first glimpse of husband Oliver’s approach to her illness when he shows up at the hospital with his own head shaved bald. “I wanted you to see it’s just hair,” he says.

Neither Alice nor Oliver will consent to be a passive victim, nor will they behave unfailingly well over the six months between her diagnosis of acute myeloid leukemia and the stem cell transplant that her doctor states bluntly “is the only option here.” Alice is a difficult patient; she has little faith in Western medicine and probably would not subject herself to the agonizing treatments required if she weren’t determined to survive to raise their infant daughter. Oliver, who is just the kind of control freak you’d expect the head of a start-up software company in the early 1990s to be, isn’t terribly good at hiding his skepticism about the holistic healing techniques with which Alice supplements conventional therapies or his frustration when she argues about the health risks of consuming processed sugar even though doctors are desperate for her to gain weight.

Oliver’s hard-driving nature comes in handy, however, when dealing with the byzantine health-care system. If you don’t hate insurance companies already, you will after Bock delineates Oliver’s struggles with their policy’s limits. The profiles of other cancer patients scattered throughout the novel provide more ammunition: the new hire who finds a lump on her breast but doesn’t say anything until her insurance kicks in after three months on the job; the elderly woman in the final stages of terminal cancer whose insurance company refuses to pay for a home health aide and determines that she “no longer needed care from an elite hospital”; and so on, until we realize that Alice is, heaven help us, one of the lucky ones. At least she doesn’t die from multiple rounds of chemotherapy while she waits for the transplant — squeamish readers be warned: There are lots of gory details — and she has a husband capable of negotiating the insurance bureaucracy to get the coverage she needs.

After Oliver finally manages to switch to a policy without a ceiling on in-network costs (at considerable expense to his fledgling software firm), he runs into the hospital employee who enraged him by putting a hold on Alice’s account because of their original policy’s limits. “I was really glad to see you all got that insurance problem handled,” she says. “Tell Alice my prayers are with her.” The seemingly cold corporate clone has a heart, and Bock treats a wide variety of health-care workers with similar nuance. A trash-talking receptionist who harasses administrators to get patients out of admitting and into beds, a nurse who is a perpetual winner of the staff’s weekly numbers lottery, a fashionista doctor who proves to have substance behind her unctuous manner — these and more are depicted with vigor and economy to give human color to the vast institution in which Alice and Oliver are enmeshed.

Author Charles Bock (Nina Subin)

Alice and Oliver are also skillfully portrayed, but we are held at emotional arm’s length from them and discouraged from wallowing in voyeuristic grief. Bock, whose first wife died of leukemia in 2011, clearly wishes to avoid pandering to those who enjoy a good cry, and his restraint is commendable, even if, at times, it gives the novel a slightly abstract air. Alice’s engagement with Buddhism is so lightly traced that the metaphysical doubts she confesses to a fellow patient don’t really register, and her charged relationship with that (male) patient doesn’t contribute much to Bock’s eminently clear theme that a life-threatening ordeal can both bring a couple together and drive them apart.

Like Bock’s previous novel, the equally unflinching “Beautiful Children,” “Alice & Oliver” has flaws considerably less important than its tough-minded commitment to truth-telling and to honoring the complexities, contradictions and even the cruelties of people under extreme duress. Lasting damage and lasting loyalties are equally part of the human condition, Bock reminds us in an elegantly rueful epilogue set in 2010: Death happens, and life goes on.

Smith is a frequent contributor to Book World.

Alice & Oliver

By Charles Bock

Random House. 399 pp. $28