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Mona Awad’s struggles with chronic pain and the health-care system fuel her new novel

All’s not well in Mona Awad’s new novel, “All’s Well.” Miranda Fitch, the pained, woebegone protagonist at the center of the book, once was a fairly successful, happily married stage actor. When the story opens, she’s a divorced, pill-dependent assistant theater professor at a “dubious college.” She is plagued by pain in her back and her hip. Her right leg is rigid as concrete, her foot feels like it’s being pulverized. (“I picture the leg of a chair pressing onto my foot,” Miranda thinks. “A chair being sat on by a very fat man. The fat man is a sadist. He is smiling at me. His smile says, I shall sit here forever.”)

On top of her physical ailments, which, we come to learn, elude a clear diagnosis, Miranda is also grappling with a mutinous gang of theater students. As the director, she chose the play “All’s Well That Ends Well” for the annual Shakespeare production. But the kids had other ideas. They wanted murder, madness, witches (a.k.a. “Macbeth”), and now they’re out for blood — Miranda’s blood — because she resisted. Chief among her detractors is Briana, whose parents donate to the school, which has everything to do with why she always nabs the lead role. Briana wants to play Lady Macbeth, and Briana will get her way.

Miranda describes her thus: “Briana of the burnished hair. Briana of the B-minus mind who yet believes she deserves an A for breathing. Reading an essay of Briana’s will make you fear for the future of America, will make you hiss What the f--- are you talking about? aloud at the bar where you have to go and get loaded on pinot grigio in order to grade Briana’s paper.”

It’s biting and wonderfully wry, as are many of the narrator’s observations. Miranda Fitch is an acquired taste. She’s wickedly bitter, but she becomes easier to take once you get used to her voice.

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That voice changes its tune once Miranda meets three somewhat sinister, dark-suited men in a pub. These men know things. They know her name. They know about her debilitating pain, her disgruntled students. They know about the endless parade of (male) surgeons and physical therapists she’s seen, who diminish and dismiss her agony, who tell her the problem is in her head. The suited men show her a trick that can change her fortune, that will make her well.

Having skimmed the book’s synopsis before cracking its spine, I expected a deal with the devil, a flirtation with the dark arts. I did not anticipate such a nightmarish, hair-raising, diabolically smart treatise on pain — particularly as experienced by women. The type of pain that is real, but invisible (and overlooked, ignored). That much of Miranda’s story is based on Awad’s experience with chronic pain makes this all the more harrowing to read. One of the most horrifying scenes takes place in a basement physical therapy center, when a cold, annoyed physical therapist performs “tests” and treatments that run counter to Miranda’s instincts. He pushes her body past its limits. She tries not to scream.

Some of the novel’s saddest moments show how pain warps not just bodies, but also entire lives. At one point, Miranda recalls when she first befriended her co-worker, Grace. “I hid my physical limitations from her at first. Prevaricated whenever she asked me to do something more strenuous than drinking. How about we go hiking? How about we go sailing? Want to take the bus to New York to see the ballet? I was always busy. Doing what? Grace would ask. Getting divorced. Seeing another surgeon, another wellness charlatan. Gazing into the void of my life.”

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Awad — whose previous books include “Bunny” and “13 Ways of Looking at a Fat Girl” — is a master at using language not only to describe, but also to mimic an experience. “All’s Well” is rife with repetition; words like “clench,” “fire,” “concrete,” “limp,” “drugged,” “tears,” “hobble” and “hunched” show up again and again. Sure, these terms are connected to physical anguish, but Awad recycles them so frequently that it feels purposeful. After all, chronic pain is repetitive. Aches recur. Different day, same stiffness, same slicing, same seizing.

For all its cleverness, “All’s Well” has its frailties. It could be a touch shorter. (Occasionally, explanations of Miranda’s misery — and later, her sudden wellness — belabor the point.) The plot could be a tad tighter. The magical elements occasionally feel a bit muddled. And yet.

Once I started to read the book, I just kept going and going. Taking it in this way left me reeling, but when I was finished, I knew one thing for certain: Awad’s writing isn’t merely intoxicating. It’s incandescent.

Nneka McGuireis a freelance writer in Chicago.

All’s Well

By Mona Awad

Simon & Schuster. 368 pp. $27

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