• What does the cover of the book indicate the book will be about?

• Two elements of fiction are conflict and theme. 

• What is the conflict in this story?  Is it coming from the inside (internal) or the outside (external)?

• What is the theme (message) in this story?  

• Do you have a favorite character and why?

• Do you have a favorite patient and why?  (Mo White, Cindy Valerio, Matt Savic, Juni)

• Who is Grotto?

• Marty frequently visualizes emotions in icons.  Are they real?  What do they symbolize for Marty? 

• Marty’s dad died of stage 4 colon cancer.  What effect did his dad have on Marty, in life and at death?

• What is chronic righteous indignation and how does it apply to Marty?

• St. Salacious is a complex grown over 125 years from the seeds of a small abbey.  To Marty, the complex reflects the American medical system.  How?

• The story highlights Marty’s angst about many components of the medical system.  For example, and briefly discuss:

  - The wound aspirator is no more complex than an aquarium pump yet costs hundreds of dollars a day.  Why?

  -  How do you feel about doctors leveraging equipment purchases as part of the hiring process?

  - Marty:  “insurance companies bet on the misfortune of others but never gamble.”  What does he mean?

* Questions: Courtesy of Nancy Zetlmaier