One moment of Anna DeForest’s Our Long Marvelous Dying, just published by Little, Brown and Company, captures the immense grief at the root of their new novel:

In the interval between giving a dose of intravenous opioids and seeing the peak effect, I will sometimes pass the time by catching up on the news. There is almost always a disaster imminent…You get used to it…

A sense of resignation and detachment pervades the story told by an unnamed narrator, who works as a palliative-care fellow in New York City after the peak of the early COVID-19 pandemic. In the first chapters, she recounts aspects of her training as a specialist, who “serves as a sort of illness interpreter, bringing the jargon of clinical medicine into the life and language of the patient who is living the experience.” It’s a specialty also “trained to be comfortable with [prescribing] the stronger stuff: morphine, hydromorphone, fentanyl.” As the fellow learns these skills, an assessment of how her specialty serves the dying patient and her colleagues becomes clear:

The trouble that the other doctors have is not a lack of gentleness. Well, not only that. More often what they cannot do is tell the truth. They pack death up in so much misdirection, talk about the success or failure rate of this or that procedure or treatment, when the truth is the patient will be dead soon no matter what we come up with to do in the interim. That’s the part they need a specialist to say.

We also get glimpses of the narrator’s personal life: her relationship with her husband Eli, the dark ground-floor apartment they rent, the chess games she plays with her young niece Sarah, who her brother has left with them. We learn about the death of her father. Throughout the novel, the narrator seeks ways to withstand suffering—the global and local, present and past—in her daily existence.


Anna DeForest (they/their) is the author of the novels A History of Present Illness and Our Long Marvelous Dying, and a palliative care physician in New York City.

Photo by Stephen Douglas

Our Long Marvelous Dying is DeForest’s second novel and in some ways narratively follows A History of Present Illness, published in 2022, which challenged the lore of medical education through the story of a student managing her own personal trauma and the wider trauma of American healthcare. Reviews of DeForest’s first novel linked the writer, who works as a palliative care physician at Memorial Sloan Kettering Cancer Center in New York City, to the narrator—and the same might apply to Our Long Marvelous Dying, as many moments seem pulled from the firsthand experience of a physician versed in hospice and palliative care.

In many of the novel’s settings, bereavement surrounds the narrator and often consumes her. But the grief that grounds the story and proves most unsettling for the narrator stems from the death of her absent and unkind father. DeForest structures the story to reflect the narrator’s apprehension towards him. We see him in pieces between scenes in the hospital, and can’t put him together as a whole until the very end. In managing the arrangements for his death, the narrator takes us through their fraught relationship. His favorite story to tell her romantic partners when meeting them for the first time is how whenever she cried as an infant, he said “I never liked you from the beginning.” But the cruelty of his abandonment is in its persistence—he is a “latent monster,” a “ghost” from whom she never stops craving acknowledgement.

Beyond her family, the narrator guides us through additional layers of grief in a way that we never stay long enough in one place to take up the devastation. The world offers constant tragedy—floods, destruction of coral reefs, extinction of thousands of species. And every day the COVID-19 pandemic rages. The reader hears about the refrigerated trucks lining New York City blocks, but what the reader sees in specific detail are the causalities for healthcare workers: their loneliness and coping mechanisms of alcohol use, disordered eating and SSRIs for suicidal ideation. During rounds, for example, an attending physician recounts the peak of the pandemic and says absently, “I am on an SSRI.” Meanwhile, the narrator notices the spring air coming through the window in his office that has “no bars, no screen. Fourteen floors up, with a view of the Empire State Building.” There is an omnipresent threat of self-harm, if not from one tragedy, then from the weight of so many others.

But Our Long Marvelous Dying is not a trauma dump. It confronts the obvious truths we train ourselves to overlook: the truth of death in a hospital, the truth of our own progression to death. It forces the question of “what is the purpose of living?” and does not give a satisfying answer. In this way, the novel’s title does not allude to the hidden deaths in the hospice wings, it alludes to us. Without despair, the narrator states “that all of us will die…that all of us are dead already.” The narrator acts as a palliative-care physician for us all, interpreting the jargon and euphemisms that drown the simple truth of daily tragedy. The sugar coating has dissolved, and she wants to communicate that “no one is coming to comfort you” and “nothing will help.”

One of the most provocative aspects of DeForest’s work is their ability to situate the reader in the day-to-day clinical world. The narrator normalizes death, dying and the grim collapse of human bodies that happens, not because of dispassion, but because of routine. While contributing to the book’s undercurrent of grief, the hospice unit provides meaning on a quotidian basis. On a phone call, in response to a mother’s dismay that her daughter may die before they arrive, the narrator reflects: “of course she can and does die alone.” In another situation, she reflects that an aging actress “dies the same as anyone.” These are tragedies that are contained, expected and managed.

Despite submission to muted sorrow, the narrator still attempts to manage her trauma. The palliative-care fellowship itself, in the view of its program director, draws those with personal layers of grief in addition to their professional interest. For the narrator, her work keeps the despair at bay and allows her to reflect on the minutiae of existence—for example, describing her underground commute as “the long stretch of track between where I live and everything that matters.” In revolving her life around the care of others, she does not have to generate her own will to continue living.

She also tries to endure by tempering her connections, especially to her husband Eli, a “well-adjusted” and handsome chaplain with a network of friends who adore him. The constant in their marriage is the restrained threat of its end, from “red flags” or laments that “it isn’t working.” This sense of detachment also manifests with her niece Sarah, who she describes as her “temporary daughter” while Sarah’s father is unable to care for her due to his substance use. We learn that an intergenerational dearth of attention and love has conditioned the narrator to the security of pain rather than love; the cycle of abuse contributes to her decision not to have children. The place where she seeks connection is a monastery out of the city, where she arrives and departs anonymous to her peers.

While there is no neat resolution, the protagonist steadily approaches the grief that eludes her—the death of her father. We see this through the lengthening of the scenes themselves. Initially, we learn about her father in brief moments between scenes of her palliative-care fellowship; by the end, we are allowed to linger as she sorts through his belongings. For a person who asks uncomfortable questions (Are you happy?) and speaks revolutionary words in a hospital (death and dying), the narrator takes her time to confront his death. She asks a rabbi at the hospital what to do after death about the bad acts her father committed in his life. Just as she can cut through medical euphemisms and jargon, he cuts through her question: “The weight you feel, he says, is not a need to forgive anyone. Just call it grief. Call it trauma.”

In Our Long Marvelous Dying, DeForest challenges our discomfort with death and instead leads with loss and our search for meaning within it.—Margo Peyton


Margo A. Peyton is a resident physician in neurology at Massachusetts General Hospital and Brigham and Women's Hospital. Prior to medical school at Johns Hopkins, she worked in film and television story development for DreamWorks Animation. Her essays and book reviews have appeared in The New England Journal of Medicine, JAMA and the Boston Society of Neurology, Neurosurgery, and Psychiatry.

A wonderful meditation on death and dying. I thoroughly enjoyed this book. Characters were believable, and well developed.

This felt like a good convincing look at the life of a palliative care physician and how tough that job can be, especially in a pandemic.

"Our Marvelous Dying" by Anna DeForest is a hauntingly beautiful meditation on mortality, blending poetic prose with profound reflections on the human experience. DeForest's writing is both tender and unflinchingly honest, offering a deeply moving exploration of life and loss. This book leaves a lasting impact, inviting readers to embrace the beauty in the inevitable.

This story follows a doctor during a pandemic who tends to the dying.

This concept was really intriguing to me, but the writing style was not for me. It felt very stream of consciousness in a way and I just couldn't get into it.

I always look for solid, life-like portrayals of dying, death, loss and grief in literature and this book provides that. Additionally it offers the reader good insight and understanding through a palliative care healthcare provider lens. This is a powerful book that people should read. Congratulations to Anna DeForest for writing intimately and knowledgeably about a part of life that impacts us all.

A stream of consciousness novel focused on the effects of illness and dying on people's mental health and relationships. Feels like the perfect time to read it as we slowly make our way out of the global pandemic. Will have you question your mortality.

Thank you to the publisher for my e-copy.

I have been fortunate enough to have read an ARC of Anna Defrost's debut novel and just finished an ARC of her sophomore novel, OUR LONG MARVELOUS DYING. As a healthcare professional, I appreciate her raw, honest and enlightening voice on palliative care. I think whether or not you have worked in healthcare or have experience caring for a loved one at the end, this is a very important read. Thank you for the eARC!

Such an interesting read, I quite liked how this was sort of an observation of death in the sense of it being the time you most reflect on your life and learn to appreciate the small things. Definitely leaves you thinking! I will recommend this to anyone intrigued!

"Our Long Marvelous Dying" by Anna DeForest is a poignant exploration of the human experience in the face of mortality. DeForest's lyrical prose beautifully captures the complexities of life, death, and the spaces in between. The characters are intricately developed, and the narrative unfolds with a delicate blend of heartache and hope. This novel is a compelling meditation on the ephemeral nature of existence, offering readers a profound and reflective journey through the lens of mortality.

This book was both what I hoped for and also not what I was expecting, all thanks to the author's choice of writing in 1st person.

The connection I felt to the narrator was unmatched. Being on their side the entire time, it felt like you were in the rooms as an intern. The thought process and experiences discussed were refreshing in a "wow, I'm really not alone" way, which was validating to say the least.

I thoroughly enjoyed how the author hints at COVID being the main illness, but never explicitly mentioned that's what the story revolved around. This detail allowed for a personal experience without throwing me back into the real world.

The only issue I may have with this book is the tendency to go off on a tangent. I found myself wanting to continue the thought, but the narrator had already moved passed it. Not a large issue, once you realize this is clearly an unreliable narrator, but still minorly confusing at times.

This was a truly thought-provoking read that I would easily recommend to anyone having difficulty registering the pandemic and/or the deaths that came of it.

As my medical school graduation is 3 months away and I have a keen interest in palliative care, I loved this book. It was a reflection on the emotionally impossible work that palliative physicians do each day, along with the roller coaster of home life, and navigating relationships with others and oneself. I also loved that Medical Assistance in Dying (MAiD) was mentioned a couple times, as I have done a palliative rotation back home in Canada and participated in quite a few MAiD cases.

I am both looking forward to joining this field of work in the near future, and for a reread of this book when things feel too much.

Thank you to Netgalley and the publisher for this ARC!

DeForest's auto fiction is a powerful exploration akin to Annie Ernaux's work, transcending relationship details to delve into human existence and our encounter with death. The narrator, a palliative care doctor, weaves personal regrets with those of her patients, navigating the complexities of the Covid era. The narrative is a mix of joys, horrors, and the truth of life's end. Balancing travel's solace and home-life anxiety in NYC, the narrator seeks inner calm amid chaos.

Writing about death and dying isn't easy and I applaud DeForest for a book about both. The title and cover made me want to read this one. I didn't love the story but gathered what DeForest was trying to explain. Thanks to NetGalley for the ARC.

DeForest does a wonderful job of connecting with the reader for topics that tend to be avoided in conversation. The logistics and dialogue was comfortable, yet thought-provoking at the same time. Truly an intelligent and entertaining read if you struggle with dying and what comes of it after you're gone!

The title and cover immediately drew me in. As someone who contemplates their existence, the fragility of life, and death at least once a day, it was nice to be inside the mind of a main character that feels the same. I'm actually finding it difficult to articulate my thoughts on this book. It’s certainly unlike anything I’ve read before. I can’t say that it was an enjoyable experience, but I don’t think it’s meant to be. We follow along a freshly graduated female palliative doctor during COVID. Deforest speaks with such heart and experience. It was just as depressing as it sounds but I found it very thoughtful and insightful. This will appeal to a very particular audience, but if the synopsis catches your attention it is worth reading.