The Hospital at the End of the World

“My first writing teacher had a rule that the more fantastical your frame, the more ordinary and real had to be the lives that were lived inside it,” Chris Adrian explains in an online interview with McSweeney’s publishing company. Adrian is attempting to explain the reasoning behind his wildly imaginative second novel, The Children’s Hospital, where apocalyptical angels and a tamale-vendor cohabit a floating hospital.

The Children’s Hospital came out in hardcover last August, and since June it has been available in paperback from publishing house McSweeney’s. If you need a sobering read after a long, sun-soaked summer, this is for you. In The Children’s Hospital, Adrian leads an exploration of the things that matter most and asks important questions of life and death, grief, pride, madness and doom. Perfect for the start of a new semester.

In The Children’s Hospital, the world comes to an end, submerged under seven miles of water. All that survives after the apocalypse is one hospital and all its inhabitants. Within the hospital, a small society composed of doctors, nurses, medical students, hundreds of sick children, and their relatives is preserved and forced to forge forward, putting grief behind it as it attempts to recreate some semblance of normalcy in very surreal circumstances. In a dreamlike way, reminiscent of old Twilight Zone episodes, Adrian frames descriptions of very mundane, day-to-day events—nurses making their rounds, lunchtime conversations in the cafeteria, doctors condescending to medical students—in this extraordinary context.

Within the floating hospital, the main character, medical student Jemma Claflin, discovers that a powerful healing fire burns within her and that she is able to use this fire to cleanse the diseased children. Although she can help the children, her gift proves useless in protecting the adults against the greater wrongness within them.
Four angels supervise the apocalypse: one to preserve, who inhabits the core of the hospital and has the power to replicate everything that the inhabitants might need to survive; one to chronicle; one to accuse; and one to punish. This quartet, who are the only ones to know what is coming, take turns at narration and instill a chilling sense of foreboding in the novel: even at the best of times, when all is seemingly well, the reader can sense that something dreadful is approaching.

Readers will find themselves quickly immersed and accept the premise of the novel immediately and unquestioningly: we accept that the world is entirely flooded; that Jemma possesses within her the power to heal and save with magic green fire; that an angel has the power to produce any flavor of ice cream the inhabitants request. We suspend our disbelief because Adrian’s portrait of grief is so astute. He presents both big-time, end-of-world grief and personal, quotidian grief—the boredom and frustration, the meaningless routine and daily losses—in stark relief. Because the day-to-day sadness feels so real, we’re able also to experience the more unimaginable emotions and scenarios.

The fascinating aspects of Adrian’s work stem from his particular blend of theology and medicine. Adrian draws both on the experience he gained during a pediatric residency at the UCSF and the knowledge he acquired as a student at Harvard Divinity School. Thus, surgical operations are described in great detail, and the conditions of each child is systematically inventoried, from Ella Thims, who has “one of those terribly exclusive diseases, a syndrome of caudal regression that had left her incomplete in her bowels, and blank between her legs”, down to every last symptom of chronic nausea, constipation, and spastic colons.

The theological aspect is what makes this novel most powerful: it is the reason for which this is a novel that will keep you thinking for days after the final page’s end at the end of the world. An anagogy of the biblical story of Noah’s Ark, The Children’s Hospital deals with issues of compassion, grief, and doom in the face of utter destruction. In the world of Katrina, tsunamis and terrorism, these are issues that we all consider at some time or other. Adrian explains in his interview for McSweeney’s that he “was trying, in some really weird way, to sort out the everyday misery of being an American lately, part of an immensely privileged community in crisis, a community that in many ways sees itself as in some way chosen even as we quietly worry about the ways in which we are (unfavorably) judged.”

To give a more personal sense of these issues, Adrian blends into his novel scenes from Jemma’s childhood. Before the flood even starts, Jemma’s parents, brother, and her first lover have all died, through accident, suicide, or illness. The most chilling passages are actually those that deal with Jemma’s relationship with her brother, Calvin. Since these are easier to relate to, and because we know that Calvin committed suicide in mysterious circumstances, these poignant scenes mark the reader the most.

This is one of McSweeney’s first endeavors into fiction of a certain length (The Children’s Hospital clocks in at 615 pages), and can be considered a bid by McSweeney’s to compete seriously with the big literary houses. It certainly bodes well for the future of the company: The Children’s Hospital is challenging, varied and textured, and tragically beautiful.