Cassie, the main character in "The Book of X" by Sarah Rose Etter, is born with a knot protruding from her torso. Alongside her mother and grandmother, she is written about in medical journals. Despite the attention, no doctors understand enough about the knots to remove them or explain their occurrence. Cassie's knot often throbs. It takes up an inordinate amount of her mental real estate.

Her youth is difficult because her peers are often cruel or indifferent to the cruelty visited upon her. Her mother is self-conscious about her own appearance and loops Cassie in to whatever "wellness" trend she is partaking in. Cassie is often envious of her father and brother, who spend their days working in their family's Meat Quarry, harvesting meat to sell at a market by ripping it from the walls.

Etter writes her weird world with elastic prose, as stripped-down at certain points as it is lyrical in others. The book is composed of short narrative sections, often multiple to a page, broken up with "visions," italicized sections of situations Cassie wishes were reality but alas are not. These are perhaps the most compelling features of "The Book of X," as Etter finds a way to make them feel truly aspirational and revealing.

In the first one, Cassie is looking at herself in the mirror: "I am thin at the arms and legs, brown hair down to my shoulders, bright eyes. I have small breasts, and just below my ribs, my abdomen is flat." In the next, her aspiration is for more than just physical change: "I'm the queen now," it begins. She is still careful to mention that her abdomen is flat, but Etter strips the rest of the earlier physical details, trusting the reader to infer them. The sections, characterized by this restraint, build on one another from there.

The book is also broken up into three parts, the first taking place in her adolescence and the latter two in her adulthood. Etter doesn't allow the wide spread of time to interfere with what seems to interest her most, which are the everyday type of conversations that characterize life. A recurring element is Cassie's boss' insistence that she be a happy addition to the workplace while not caring at all about her life outside the office.

"Did you ever notice that you're radiating a deep sadness lately?" he asks her. "We agreed you would be a smiling presence here and I just … I don't feel it these days." Etter does not have to linger on this moment. The indignity shines through, and her ability to shape this scene just right is what makes "The Book of X" such a powerful novel.

The Book of X by Sarah Rose Etter

Bradley Babendir has written for the New Republic, Pacific Standard, the New Inquiry and other publications.

The Book of X
By: Sarah Rose Etter.
Publisher: Two Dollar Radio, 284 pages, $17.99.