Peace Corps Writers

Quality of Care

Quality of Care
by Elizabeth Letts (Morocco 1983–86)
NAL Accent
March 2005
288 pages

Read the interview of Elizabeth Letts done by Terez Rose.

Reviewed by Terez Rose (Gabon 1985–87)

Quality of Care, Elizabeth Letts’ debut novel, should come with a warning: do not attempt toPrinter friendly version begin this novel prior to undertaking an important task. I brought the book home one evening, opened it to the first page and stood reading for five minutes, coat still on, dinner unprepared. Then I sat and read until my son came in and asked if I was going to make his dinner since it was past eight-thirty.
     Letts takes an irresistible premise — what happens when you are unable to save the life of the person who saved yours? — and delivers a riveting, fast-paced story with compelling characters and polished, highly-charged writing.
     Clara Raymond is an obstetrician. One night a pregnant woman arrives at her labor and delivery clinic with minor complaints. The woman turns out to be Lydia, a childhood friend who once saved Clara’s life in a horseback riding accident. Their reunion, however, ends in unspeakable tragedy, with the ensuing days a distorted echo of Clara’s unresolved past. Temporarily suspended from her practice, Clara decides to return to the root cause of the pain in her life — the place of her childhood, and the haunting events she’s tried to put behind her.
     When Clara arrives at an estate in the coastal California community where she grew up, its dressage facility throws her back immediately into the world of competitive horse riding. The owner of the property is wealthy Eleanor Prescott Norton, the dressage judge who disqualified Clara from a pre-Olympic equestrian trial competition when she was fifteen. Eleanor is also the chairman of the hospital board of trustees who contributed to Clara’s father’s professional downfall. Eleanor mistakes Clara for a stable hand applicant and offers her work. When Clara catches a glimpse of a dressage horse named Benedetto, reminiscent of the beloved horse she once owned, she decides to stay for a few days.
     Clara’s pain and confusion over Lydia’s death are further complicated by the fact that Lydia’s grieving husband is Clara’s first love, as well. Gordon — orphaned at nineteen, charismatic yet adrift at the university they both attended, who alone could understand her silent grief, and she, his. A local memorial service for Lydia has now brought him back. Will their sorrow, loneliness and electric attraction once again draw them together?
     Quality of Care weaves a tapestry of past and present, accident and fate, choices made and their consequences. Is Clara willing to hear what Eleanor knows about Clara’s deceased father’s demise? Is Eleanor as cold-hearted as she appears, or does she care that Clara’s fellow stable hand, a teenager named Jazmyn, is heavily pregnant, her health and security at risk? The story asks the question, “Where is the line between trying to help the people you love, and letting them go to act out their own destinies?”
     Letts, a practicing certified nurse-midwife has a keen eye for detail — both technical and physical. Her knowledge of horses and obstetrics makes the descriptions ring with authority, yet without ever burdening the reader with unnecessary terms or lingo. She is at her best when describing the coastal scenery (“The hillsides were variegated, some fields of tall grass scattered profusely with goldenrod, others a harmonious blend of dense low-lying chaparral, bluish green to grey, like a natural patchwork”) as well as in flashbacks to Clara’s developing relationship with the brilliantly-drawn Gordon (“I was drowning in him, plunging somewhere deep and fast — on that same speedy trajectory that a car would take when the land beneath it disappeared, or an icy airplane that decided to drop from the sky”). These stirring, evocative and sensuous flashbacks with their undercurrents of grief and mystery kept me reading, hungry to stay inside the story.
     Letts delivers her story, much like the nurse-midwife she is — with deft hands, coaxing the reader on with absorbing dialogue and narration; providing them with a protagonist who never succumbs to excessive sentimentality, which helps the reader follow Clara through her painful journey to the story’s ultimately uplifting resolution. The novel is not perfect — there are a few inconsistencies in characters’ voices, and plot developments often rely on coincidence. The prose occasionally lacks the smooth veneer of a seasoned novelist, but even this works to bring us closer to the flawed but loveable Clara. Chosen as an alternate selection for the Literary Guild, Doubleday Book Club and Rhapsody Book Club, Quality of Care is a novel that will appeal to women, to horse lovers, to anyone who wants to immerse themselves in a powerful, heartfelt story.
Terez Rose’s writing has appeared in the San Jose Mercury-News, the Milwaukee Journal-Sentinel and Peace Corps Online. Anthology credits include Women Who Eat: A New Generation on the Glory of Food (Seal Press, November 2003), A Woman’s Europe (Travelers’ Tales, June 2004) Migrants and Stowaways (Knoxville Writers’ Guild, October 2004) and the upcoming Italy: A Love Story (Seal Press, June 2005). She is finishing what she vows will be the final draft of her first novel, set in Central Africa.
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