The Death of Innocents : OTHER WOMEN’S CHILDREN <i> By Perri Klass (Random House: $19.95; 285 pp.; 0-394-58699-9) </i> Reviewed by Billie Fitzpatrick

In her second novel, “Other Women’s Children,” Dr. Perri Klass, a pediatrician as well as the author of several works of fiction and nonfiction, has written an engaging narrative in which her protagonist, Dr. Amelia Stern, also a pediatrician, struggles among the demands of a career, a child and a marriage. Truly a woman of the ‘90s, Amelia is a juggler, and one who does not lack humor, even in the face of the gravest prognosis.

When the novel opens, Amelia and her husband Matt are interviewing and being interviewed by the admissions counselor at a prestigious private school in Boston in hopes that they will secure a spot for their 5-year-old son, Alexander. This blatantly yuppie predicament is immediately countered by the parents’ ironic distance from the situation, and in turn, the author’s deliberate and successful fight against the sentimental. “They are serious consumers, comparison shoppers, out to find the best possible education for their child. Tee hee, please let us in, please give our darling access to your superb wonderworking facilities. . . .”

Known for her fast-paced, clean prose style, Klass here has attempted to give her narrator a more substantial voice by letting the book’s fragmentary nature expose Amelia’s complex emotional personality. Moving around the hospital quickly and efficiently, Amelia is forced to confront the death of the most innocent on a daily basis. She becomes most involved with Darren, a 3-year-old boy with AIDS.

As the narrative matter-of-factly shifts from sick child to sick child, we get a strong sense of what a pediatrician at a public hospital has to deal with: Besides Darren, there is Sara, a 14-month-old girl with “failure to thrive”; a toddler who falls to the city street from an open window, and a SIDS (Sudden Infant Death Syndrome) baby whose life is claimed before it even reaches the Emergency Room. Klass has powerful control over the language of the ER, the ICU and the wards, never disrupting the texture of the novel or alienating the reader.

Alternating between third and first person, we hear and see Amelia from two apparently different vantage points. We like Amelia: She is an insightful woman and a very human physician. Despite very real responsibilities and conflicts, she does not take herself too seriously, often poking fun at her bad habits and neurotic tendencies. Why then does the author find it necessary to break this third-person narrative with an intrusion of the first person?

Apparently, the first person is used as a device to introduce a metafictional element into the novel. Amelia, as first-person narrator, tells us she is concerned with how she is “using” children in “her” novel. She says, “This is not the story I was intending to write . . . . How can anyone write about children who get sick, children who die?” And although we appreciate the author’s gesture of frankness, we become distracted from her immediate story. Furthermore, the narrator’s allusions to classic children’s stories such as “Little Women” and “Uncle Tom’s Cabin,” and her obsession with the treatment of children in literature becomes deliberate and forced. At one point, Amelia reacts to a story, “The Doom of the Griffiths,” by Elizabeth Glaskell: “This makes me so mad. She had no right to use that baby that way. Scarce one- quarter of an hour indeed; she created a happy beautiful bright baby just so she could casually murder him.”

Instead of adding a fictional dimension, Klass unintentionally draws our attention to a weakness of the novel: Despite the strength of her narrator’s voice, there is a definitive lack of a strong central plot to move the story forward.

The subplot which opens the book (the anticipation of Alexander’s acceptance into private school) and the one that develops (Matt’s threat to leave Amelia and take Alexander with him) are either dropped and picked up casually at the close of the book, or not developed enough to become emotionally convincing.

Amelia’s struggle with her own sense of guilt that results from caring for very sick children during the day and returning home to a perfectly healthy and otherwise gifted child of her own, who is also in need of her attention and love, and the consequent strain on her marriage is clear, but, like the fatal prognoses of some of Amelia’s patients, inevitable.

What does keep us engaged in “Other Women’s Children” is Amelia, and her interest (and therefore ours) in her sick children. The fragmentation that Klass achieves so well in her characterization of Amelia’s voice and narrative structure seeps over, attempting to bring all the subplots together. In times of crisis, it is both Amelia the narrator and Amelia the character who “get through the evening on the strength of Louisa May Alcott.”

Ultimately, we care about Amelia and all of her children, for as she so archly states: “Soppy literature notwithstanding, the death of a child is a terrible thing.”