“Breaking Point,” by Christopher Fahy; Limerock Books; paperback, $14.95

When does a man reach his breaking point? Is it after being laid off? Is it after losing his small business? Is it after his wife’s cancer has returned after months of painful treatments? In Christopher Fahy’s new novel, the character’s breaking point doesn’t come at these points, but when he reaches the limits of the American health-care system.

The novel, “Breaking Point,” opens with 40-year-old Sharon discovering a lump in her breast. Despite the hope that she and her husband, Michael, share, the lump is cancerous. And despite their persistent hope, the mastectomy and two rounds of chemo fail to rid her of cancer. The last chance for treatment, Dr. Jacobson tells them, is a stem-cell transplant.

Sitting before Dr. Jacobson, Michael tells him that their insurance will not pay for the $200,000 treatment. Jacobson simply nods and says, “Not surprising.” Michael suppresses the anger that arises from Jacobson’s cold response. He explains to the doctor that he is self-employed and his insurance considers the treatment “experimental.” Jacobson simply nods. With no house to mortgage, with no church or relatives able to help, Michael and Sharon are left without options. Jacobson ends their consultation with a flat “maybe we will think of something.”

No help anywhere

Michael’s anger mounts as he revisits his insurance company, his bank and the state board of health. None of these institutions can extend him credit or support the “experimental treatment.” Later, as he storms about his sister Ruth’s kitchen, Michael considers her suggestion to contact Dr. Jacobson’s wife. Lois Jacobson, Ruth explains, often appears in the society pages for raising money for children with cancer. Why wouldn’t this socialite use her resources to help Sharon?

Ruth herself has reached the end of the health-care system. On Medicare, she is unable to get the hip replacement she needs and secretly drinks to quell the constant pain in her hip. Between cigarettes, Ruth tells her brother, “I think Medicare hopes if they wait long enough, you’ll die and they won’t have to pay.” It is this caustic fatalism that makes Ruth is the most compelling character in the novel. That fatalism will lead her to be the caretaker for Michael’s next desperate plan.

When Michael calls Lois Jacobson at home to ask for her assistance, she is as dismissive as her husband. After several drinks, he decides to drive by the Jacobson’s home to try meeting Lois in person. Driving down their street, Michael recognizes a 5-year-old on the sidewalk because photos of young Claire sit all over her father’s consultation room. Michael has reached his breaking point. He steps out of the car and grabs Dr. Jacobson’s daughter.

Dangerous deal

If Dr. Jacobson can so easily bargain with the life of his cancer patients, Michael reasons, then Michael will bargain with the life of Jacobson’s daughter. Michael will return Claire unharmed if Dr. Jacobson will perform Sharon’s stem-cell transplant. From the moment of their deadly bargain, each character is put to the test of their own desperation. Ruth, who must care for the young Claire, has never been able to care for herself. Jacobson must keep Sharon alive through a very dangerous procedure in order to save his daughter. And Michael must hold the transaction together with care, cohesion and threats.

Christopher Fahy is careful, finally, not to make Dr. Jacobson or his wife into villains. Nor is Michael vilified for kidnapping and for his death threats.

Fahy’s ire solidly points at the health- care system and the desperation of those it leaves behind.

Readers in favor of health-care reform will be deeply satisfied by the novel. Readers in favor of a good thriller will be equally satisfied.

Kirsten Cappy is a bookseller in Portland.

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