By Stephanie Paulsell

“It takes four angels to oversee an apocalypse,” Chris Adrian writes in his new novel, The Children’s Hospital. “A recorder to make the book that would be scripture in the new world; a preserver to comfort and to save those selected to be the first generation; an accuser to remind them why they suffer; and a destroyer to revoke the promise of survival and redemption, and to teach them the awful truth about furious sheltering grace.”

The Children’s Hospital opens as the recording angel takes up his pen and the apocalypse, in the form of torrential, flooding rain, begins to fall on an unsuspecting world. Unlike in other recent visions of the end of the world—Cormac McCarthy’s novel The Road, for example, or Alfonso Cuarón’s film Children of Men, based on P. D. James’s 1992 novel—the end comes quickly in Adrian’s novel. There is a brief reference to the stomach-churning “junior disasters” that played in endless loops on television before the flood. But there are no bombs exploding in coffee shops, no burning cities, no refugee camps, as there are in Cuarón’s film. Nor do we see the emaciated survivors, marauding bands of cannibals, and ashy air of McCarthy’s dying world. Adrian gives us the end complete. All the signs that fuel our fear that the end may, in fact, be at hand—terrorist attacks, wars and rumors of wars, melting ice caps, unrepaired levees, balmy Januaries—are washed away beneath seven miles of sparkling blue water. The rain falls on the just and the unjust alike.

The only survivors are the inhabitants of a children’s hospital that, as the floodwaters rise, becomes a kind of ark. Hundreds of sick children, from deeply damaged newborns to anorexic teens, and the doctors, medical students, and nurses who care for them survive, along with some of the parents and siblings of the sick children, the divinely inspired architect of the hospital (which expands to accommodate the survivors and their needs), a woman who runs a tamale stand, and one chaplain-in-training, “the last cleric at the end of the world,” a lesbian Unitarian known as Father Jane.

The story the recording angel tells embraces all of these souls, but centers around Jemma Claflin, a third-year medical student, to whom the angel has been yoked since her birth, his eyes fixed on her face, “the way better angels always look upon God’s glory.” And there is something Godlike about Jemma. Like her brother Calvin, whose gruesome self-martyrdom may have set the de-creation of the world into motion, Jemma also has cosmic work to do, but of the re-creating kind.

When we first meet Jemma, she is assisting at the birth of a baby so riddled by birth defects “she was her very own syndrome.” Known for her reluctance to hustle—”if you were too fast, after all, you got there first”—Jemma draws the withering ire of the arrogant resident in charge. Even the end of the world does not prevent residents and attending physicians from heaping scorn upon medical students and interns, asking the impossible of them, and quizzing them (“pimping” them, as the students put it) in operating rooms and at the bedsides of patients. As one doctor says to Jemma as she begins a new rotation on the oncology ward after the flood: “All I ask of you is that you do everything I say, read my mind, and give me what I want before I ask for it. I’m kidding! But not really.”

In addition to the ongoing tribulations of her medical education, Jemma is also burdened by grief. So, of course, is everyone. As the recording angel puts it, there are “billy-uns and billy-uns” of dead beneath the water. But Jemma’s grief predates the flood: she has already lost her brother to his spectacular suicide, her father to cancer, her mother to a self-immolation in the kitchen, and her first lover, Martin Marty, to a car crash. (Several theologians lend their names to characters from Jemma’s childhood—watch for young David Tracy and Johnny Cobb searching for a severed hand along a railroad track and the “hulking Niebuhr brothers” throwing their weight around in a lacrosse game.) Jemma’s loss is as acute after the flood as it ever was, and she feels oddly distanced from the emotion surrounding the loss of the “billy-uns and billy-uns.” Her lover, a pediatrician named Rob, cries himself to sleep each night thinking of his mother and his sisters, and her best friend, Vivian, a fellow medical student, spends hours making and remaking lists of potential reasons for the catastrophe, searching for the “straw that broke the patience and the promise,” but Jemma remains focused on her own particular worry: why does everyone she love die? And, if she returns Rob’s love, will she ensure his doom?

But if she is unable to grieve, or even really imagine, the drowned multitudes, the sick and suffering (and brilliantly wisecracking) children she encounters on her daily rounds do press in on her attention and her imagination and create in her a yearning for their health. When Rob suffers a subdural hematoma, this yearning erupts in a sudden ability to cure, to heal, to make things right. “No!” she shouts at his swollen brain, pulling the bolt from his head, “holding her hand up at the blood he spouted. It stopped like obedient traffic, turned around and vanished into his head. A blister of skin formed over the wound.” What could be more satisfying?

This: In an extended literary tour de force, Jemma blazes through the hospital, burning up tumors, wrestling stubborn cells into submission, instructing once-damaged organs how to do their jobs properly, calling out new bone marrow cells “with the purest desire she had ever felt” until she heals every child. She finds herself able to hold the entire hospital in her head, like a piece of music in which she can hear the discordant notes, the wrongness of each child’s illness. But this is no gentle waving of a magic healing wand, and these pages could only have been written by someone who has witnessed up close the ambiguities of healing. “Healed by science or healed by Jemma, it hurt to get better,” the recording angel reports. And some of the wrongness she finds inside the children is beyond even her healing reach. She can weed the distortions from an anorexic girl’s brain, but when she encounters a shadow in a child’s mind “cast by a past horror,” it mocks her. As Gregory the Great, trying to describe the healing work of ministers, once wrote, “The wounds of the mind are more hidden than the internal wounds of the body.” Even Jemma cannot undo the past.

Jemma’s harrowing of the hospital inaugurates a brief utopian period in which put-upon medical students are liberated from the tyranny of their instructors and write “all better now” on the children’s charts; doctors organize classes in gymnastics and clogging for the children; Rob and Jemma get married; Jemma reveals that she is pregnant during a roller boogie extravaganza; the preserving angel sorts everyone into families; and Father Jane continues to lead the community into a deeper consideration of their purpose in language that manages to be “proudly hopeful instead of simply naïve.” Father Jane’s intuitive sense that the inhabitants of the hospital are not drifting, but are moving purposefully toward their destiny, is right. (A good liberal Protestant, she considers, but rejects, the possibility that “maybe it is just a vessel in my brain, all blocked up and causing trouble, or spreading lies in my head. I don’t think so.”) Soon, life on the ark of the children’s hospital—for humans and angels alike—gives way to something less liminal.

In addition to being a novelist, Chris Adrian is a pediatrician and divinity school student. His intimate knowledge of the lives of children, the hazing rituals of teaching hospitals, the struggles of ministers-in-training to speak meaningful words in difficult situations, and the history of theology undergirds the most intense pleasures of The Children’s Hospital—its antic, often side-splitting humor; its searching consideration of sacrifice, redemption, vocation, and grief; and the tender, palpable yearning for all to be well that is the engine of this remarkable story.

If there is one image that expresses something of the literary and pastoral achievement of The Children’s Hospital, it is the image of “rounding” that permeates the book. After the world ends, the doctors continue their rounds, but with greater intensity, because—as even the most obnoxious of them agree—in the face of the destruction upon which they float, “we can’t lose one more. Not even one.” Even after Jemma heals the children, many doctors cannot keep themselves from rounding; the practice seems hardwired into them, the way they receive and interpret the world. And when all the children have fallen into the deep sleep of fairy tales, and Jemma and Rob are the only adults left alive, they continue to visit every child every day, washing them, turning them, fluffing their pillows.

It is on rounds that doctors learn their craft, returning to the same patients again and again, bearing a desire for healing. On rounds, doctors sharpen their attention to particular bodies and particular illnesses; they accumulate detail and give it shape, a diagnosis, a story. Reading The Children’s Hospital is like following Chris Adrian on his rounds. In 615 pages, his attention to his characters, his questions, and the glorious details of his story never flags. With each visit to Jemma or Calvin or any of the multitudes that fill this book, we learn a little more, and our own attention sharpens and expands. As the details of their pleasures and their pains accumulate, we are tempted to sing along with the angels as they spin out one of their impromptu psalms in praise of the human lives they have been marshaled to record and remember: “Praise their unhappy fate. And praise their hours of joy.”

The epigraph to the novel is a famous medieval rhyme about the four-fold meaning of scripture: the literal sense, the rhyme goes, tells us what happened; the allegorical tells us what we should believe; the moral sense tells us what we should do; and the anagogical tells us what to hope for. The recording angel, given the task of creating scripture for the new world, is supposed to stick to the literal: “I am not supposed to use my imagination,” he writes. “I watch, and I listen, and everything is recorded, and nothing is lost.”

But as readers of scriptures of all kinds have always known, sustained and generous attention to the details of the story does more than tell us what happened. It opens space within and all around the story in which to imagine and then imagine again what we might believe, and do, and hope for. We are fortunate to have a recording angel like Chris Adrian working from the place where his vocations as writer, doctor, and minister meet, inviting us to join him in imagining a new world.