Carol Cassella, M.D., anesthesiologist, spouse, mother (two sets of twins ages 13 and 14) and author of the 2008 debut novel Oxygen, seems to personify the 21st century ideal of the woman who does it all, has it all and is it all, balancing her many roles with grace and ease.
“ It’s not true,” she says, denying the role model image. “There is no balance. It’s like being on a Bongo Board; there’s never a static point. I’m always adjusting, seeking equilibrium — which isn’t there. The last year has been the most stressful of my life.”
Most of us, even while leading active lives ourselves, would find the 15 years Cassella spent prior to the release of Oxygen somewhat chaotic. In that time she moved from Texas to Seattle and completed residency in internal medicine, got married, changed medical specialties and completed residency in anesthesia, gave birth to four children within 15 months, built a house (husband Steve is in construction), rebuilt (they needed more room than planned) and moved from Seattle to Bainbridge Island.
“Shock and awe” are the only words Carol and her husband could find to describe the realization that they would be the parents of a second set of twins not long after the birth of their first set. “We discovered quickly that it was impossible to take care of four babies without help. Luckily we found the greatest nanny in the world — she is still a part of our lives and a close family friend,” she says.
Although apparent bedlam seemed to be the norm for Cassella, I was curious about what made 2008, the exciting year of Oxygen’s release, the most stressful of her life. As it turns out, it wasn’t the combination of obvious factors before the book was released that gave it that designation: having to meet stringent deadlines while parenting four adolescent children, coping with the illnesses of both her mother and father-in-law, exposing her inner thoughts and writing to readers’ appraisal, and concerns about her colleagues’ reaction to her heretofore secret writing career. It was the additional demands for her time that came after the book was published that amped things up: the frenzy of the book tour, numerous requests for speaking engagements, an abundance of e-mail from enthusiastic readers who wanted a reply, and then the proverbial “straw,” a new set of demanding deadlines imposed by a contract to write a second novel. ”My already crazy life became geometrically crazier. I realized any semblance of balance was a fantasy. I started to have doubts about what I was doing, where I was heading.”
In contrast to Oxygen’s lengthy incubation, Cassella had only 12 months after it hit the shelves to finish her second novel, which is planned for release in July 2010. From her experience with Oxygen, she knew exactly what her reading audience expected from her: “entertainment and engagement, immersion in the practice and culture of medicine and anesthesiology, a journey where larger questions about values are addressed, challenge and stimulation, and emotionally real characters.”
“Before, writing Oxygen,” she says, “I was just hoping to be published. Now I know I will be published. I signed a contract for the second book along with the first. The pressure is on. I do want to please people. I want to meet readers’ expectations, of course, so that contributes heavily to the stress I’m still experiencing. Plus I have my own beliefs and desires about writing — to use the English language well and rise to the heights of possibility.”
The ideas for Oxygen germinated during the early days of Cassella’s anesthesia residency. The main character in the novel, Marie, is a single anesthesiologist with the same kind of career and relationship questions many women in their mid-thirties have. Has she made the right decision, pursuing a career that leaves little time for men, marriage or children? Does she fear commitment or has she just not met the right man? Is she negligent or in denial about the needs of her family for her attention?
When professional trauma strikes early in the book, Marie’s concerns are immediately displaced by all-out fear, anxiety, doubt, grief, insecurity and a demoralizing sense of aloneness. The complexity in both her personal and professional relationships increases as the consequences of her situation broaden. She becomes a different person, estranged from herself and others, as she struggles to make sense out of what has happened to her.
Cassella acknowledges some autobiographical connection with Marie, but fortunately has experienced less drama and more enjoyment in the medical profession than has her protagonist. The Library Journal declared her story one of the ten best debut novels of 2008. Oxygen is a national best seller according to the publisher who is releasing the paperback in June 2009.
Cassella envisioned herself a writer from childhood and majored in English at Duke University despite her parents’ admonition that writing might not be the pathway to financial independence. She ultimately followed their counsel and went to medical school, yet she knew in her heart that she would always be a writer. When her four children started school, Cassella began a connection with Field’s End, the writers’ community on Bainbridge Island, to fulfill her childhood and early adult craving to write. She was first in line on the doorstep of the Bainbridge Island Library when Field’s End founders Nichole Vick and David Guterson presented their initial class offerings. She took them all, participated in roundtables and conferences, and met writers who supported each other in their common mission.
Cassella is definitely made of the writer’s cloth. “I certainly wanted to write long before I wanted to be a doctor,” she says, “so the writer has lived inside my mind ever since I learned to read. I don’t think I could have felt complete at the end of my life if I hadn’t given writing a dedicated and serious effort. But I also can’t imagine having missed out on my career as a physician. It is such a unique type of work, presenting so many intriguing intellectual, scientific and technological challenges, along with the strong emotional component of the patient relationships.”
Cassella began writing Oxygen in 2001. Through Field’s End she developed a writer/coach relationship with author Michael Collins who acted as her touchstone, helping her sustain her commitment to writing. After three years of intensive spurts of writing followed by no moments to write, she came to a “can’t stop” point. “I had too much invested in the book to stop for anything beyond the minimal essentials of work and family. I could never have completed Oxygen without my husband Steve’s support; he shouldered the majority of responsibilities when I had to intensify my focus on writing.”
Sometimes fulfilling all of the responsibilities that come with working two or three days a week at the hospital, co-parenting four teens, co-managing a household, writing 30 minutes here and 10 minutes there, while still making time to sleep, eat and stay healthy, feels unattainable to Cassella. When thinking about it all she sometimes wonders, “Should I have added writing to my already crazy life? Have I invited a beast into my house?” And when referring to the demands of writing a second novel, one she finds more difficult than the first, she asks herself, Should I still continue on this path? Will I have regrets? Am I being selfish by writing? Am I missing family events and experiences that I’ll be sad about forever? Is what I’m doing good for the children? Or at least not bad for them?”
She answers herself by saying, “Ultimately I have to believe that the children know they are loved as unique individuals, and the consequences of such a busy, crowded childhood will be made up for in other ways. I hope they grow up to be as close to one another as I am with my two sisters. I only wish their childhood could pass a little more slowly, with more chance to savor the five or six years we have left together.”
Many parents in dual career relationships would probably share Cassella’s sentiments about raising children well while working full time. Although she aspires to high achievement in all aspects of her life, with her family as the “center of her universe,” she has accepted, with poise and relief, that she is not, cannot and never will be perfect — or attain more than a second or two of equilibrium on life’s big Bongo Board.
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