Groundbreaking advances in medical technology give a young woman a second chance at a “normal” life, but Mitchard’s novel runs aground on the conflict between exceptionalism and the ordinariness of romance, poor choices, and a life forever dominated by medical miracles.

At thirteen, Sicily Coyne loses her beloved firefighter father in a holiday chapel service blaze that horribly scars her once-beautiful face, her world changing in that one fateful afternoon. Now in her 20s, Sicily has made a career as a medical illustrator, her circle of friends necessarily small, accommodating the difficulties of a functional life while presenting a face to the world that often frightens or shocks the unwary: “Interacting with clients was like wearing a cardigan made from fishhooks.” About to be married to a childhood friend who was at the fire, the young woman isn’t sure she wants to accept a facial transplant when it is offered. (The novel is set in the future, when such procedures are more successful and relatively viable.)

Reintroducing the Cappadora family from The Deep End of the Ocean, Mitchard uses familiar characters to make her tale more palatable. Eliza Cappadora has joined a highly-regarded Chicago transplant team led by a surgeon with great skill and equal compassion for her damaged patients. With Eliza comes the iconic Beth Cappadora, intuitional mother of a recovered kidnapped boy, who has an ongoing existential argument with the theory of “statistical impossibility,” a theme the author uses to bridge many awkward transitions from Sicily’s exceptional life to the more manageable proportions of everyday existence. The Cappadoras become Sicily’s most stalwart supporters, the girl doomed to remain extraordinary by virtue of her situation and the consequences of the transplant.

Breaking up with her fiancé after a devastating revelation, Sicily has a successful transplant that requires a lifetime of injections to avoid tissue rejection. With the support of her Aunt Marie (a mother surrogate), the compassionate transplant staff and the Cappadoras, Sicily’s world expands in unexpected ways. A flirtation with all she has been denied, a brief romantic - but passionate – encounter, and Sicily is beset with the rocky emotional terrain of a young woman thirsty for the recognition of the opposite sex, a naïf in a sophisticated environment whose insides have yet to catch up with her outsides. (Here Mitchard piles on another medical/ethical dilemma, a highly controversial and emotionally-charged situation that adds considerable drama to a story already boiling over with situational conflicts.)

Mitchard’s structural problems are all of her own making, overreaching the boundaries of probability (a nod to Beth Cappadora), a weighty ethical and moral decision, the impossibility of an ordinary life, Sicily damned by her own exceptionalism and hero-dominated family history. Of course Sicily will survive it all, but the author doesn’t fare as well, the subtle, nuanced power of The Deep End of the Ocean cast aside for the extravagances of Second Nature. Hard to criticize this one, though - Sicily is a bona fide heroine straight out of the all-American playbook, burdened by everyone else’s expectations and her own tentative grasp of a recognizable future. Seduced by happy-ever-after fantasies, conflicts remain regardless how Mitchard orchestrates the ambiance, the voices of angels, the dim lights…