Who is really listening to us? How can we communicate evil when we are unable to speak or move? Alice is the supervising nurse in the 9B ward of Kate's Hospital, Sussex. She talks to Frank Ashcroft, a coma patient, admitted two months prior after suffering a massive stroke. Trapped within his own consciousness, Frank seems to know something that Alice is not telling him. Alice stares down at Frank's cadaverous head and body now "shrivelled like a line drawing," while "the respirator and monitor screen behind him click and beep away endless seconds." Instinct tells Alice that Frank is more conscious than his brain scans and test results show: "I can feel his presence, I know he's listening."
Alice works day in, day out with her fellow nurses, Carol, Mary, and young Lizzie to patiently administer drugs, change sheets, and hold the hands of the dying patients until their last breath. Alice's husband, David, finishes his architecture training while Alice struggles to fit into a wholesome family picture. Her several miscarriages have cast a long shadow over both her professional and personal lives. Surprisingly, it is Frank who is providing her comfort in her time of need.
Elgar constructs her thriller around the first-person voices of Alice and Frank, who tells us that his skin crawls. He's in a "persistent vegetative state," balancing between life and death. Alice is the only one who can sense Frank trapped within his body, "like a straitjacket." Frank never knows whether his next breath will come whether he'll die here today or be cocooned within himself as the months turn to years, while each day he decomposes just a little bit more.
New patient Cassie Jensen has arrived in the ward. She still smells fresh though the hypothermia has turned her lips and eyelids an unnatural ice blue. There's no ripple of response beneath Cassie's eyelids. Even with the bruises, the cuts and broken fingers, she doesn't look like she's in a coma. Apparently, Cassie went out in the dark to look for her dog in the early hours of New Year's Day morning. She was found in a puddle close to where she had fallen. Cassie's husband, Jack, sobs into the arms of Charlotte, his controlling, warm-scented mother. Cassie lies in situ, obviously in serious condition. Alice tells Jack his wife's in a coma, although the good news is that she is healthy, young, and at least breathing on her own.
The mystery behind what Cassie might have been running from becomes a web centering on a nefarious night visitor who stands over Cassie's bed; Cassie and Jack's wedding, "a sugary fairy tale for people with sweet heads and hearts"; and Frank's feeling that something dark and predatory is in his shadow. A strange, echoing fear ripples throughout, slipping through the cracks in Frank's memory. Forming an alliance of sorts with the ever-sleeping Cassie, Alice begins to ask questions about her final hours as the trail leads her into the orbit of Jonny Parker, Cassie's neighbor. Alice is used to seeing distressed and emotional friends and family every day; Jonny is different. He urgently wants to tell Cassie something: "she was scared." Jack's strange, melodramatic behavior leads Alice to believe there's something about the investigation just out of reach, something that shifts in her perspective about Jack his mother.
Somewhere in the journey between leaving Jonny and going home to Jack, Cassie's quiet logic seemed to twist and tangle, "like a thin chain necklace." She loves making jam for The Brighton Food and Drink Festival, and she welcomes her best friend, Nicky, to her newly furnished shed at Steeple Cottage, a home that has become a hideaway of sorts and a place where she gets to paint every day. Cassie tells Nicky that she's buoyed by meeting Jack just eighteen months ago, a courtship and a marriage that has quickly led her to glue her broken life back together like "fragments of a dropped vase." Cassie doesn't want to think about the death of her mother. Instead, she wants Nicky to keep sharing in the delights of being "Mrs. Cassie Jensen." As the voices of Alice, Cassie, and Frank melt into each other, most chilling is Frank, a reluctant witness to the myriad facets of the Jensen family. Poor Frank becomes a captive audience as near-strangers hover over him, poisoned by conflict and loss in a situation that becomes even more fraught after Frank suddenly begins to blink.
Although I guessed the motive behind Cassie's "accident" pretty early on, the novel's power actually comes from Alice's aching need to become a mother. Is this need a real construct or something a little less tangible? Elgar digs deep to the souls of her three insular, hesitant characters, instilling in them a silent hardwired communication that seems to bind them together forever.