All three members of the Martin family, the nucleus at the center of Kristin Waterfield Duisberg's sophomore novel "After" (Engine Books, 304 pages, $15.95), carry within themselves enough dramatic elements to support about a novel each. The book opens with Nina, the wife and mother, learning of her diagnosis of breast cancer, while her pre-teen daughter Audrey begins to exhibit characteristics that suggest that she might be located somewhere on the autistic spectrum (Nina's pregnancy came late in life). To top it off, Nina's stoic and no-nonsense husband, the considerably older and German-born physician Martin, is dealing with the personal issues of shame in regards to Nazis — actual German Nazis! — in his family tree.

This soap-opera style shotgunning of narrative elements might seem like a recipe for a cloying, over-sentimental mess, and in the hands of a lesser author, it probably would have been. But Duisberg has the rare ability to ground the most grandly emotional moments of life to the small details, both within her characters' hearts and with how they interface with their increasingly dire situations. In each regard of the three-pronged dramatic assault, the reader assumes that she must be writing from experience. (Whether or not she actually is hardly matters, of course.)

Nina, brought to face her mortality, perceives the oddity of her own existence with as much awe and interest as a character of James Salter's ("All That Is"). Here Duisberg gives us her mental state while struggling with the simple fact of why the state of things must be one way rather than another: "She had wondered from time to time if her acceptance of her life's smallness suggested that she was too simple, her cognitive capacity for the big questions insufficient, but as far as she had been able to tell, life was very much a sequence of actions and consequences, impulses and thought-out decisions that were acted upon and that intersected with the impulsively undertaken and well-thought-out actions of others."

Thanks to wonderfully introspective prose like this, the novel is, believe it or not, not a fire-show of anguish but rather a deeply internal and even quiet book about coming to terms with much more than just the fact of our physical expiration date. It also contains one of the most affecting scenes related to mastectomy ever committed to paper. That this reviewer feels the need to add as a warning that one shouldn't attempt to read it unless prepared for major emotion should only speak to Duisberg's talent with catharsis.

Nicholas Mancusi's criticism has appeared in the New York Times, Washington Post, Miami Herald and other publications.