Symptoms of a Heartbreak

At age 16, Saira Seghal is the youngest doctor in America. After graduating from prestigious pre-med and medical schools, she has accepted an internship at Princeton Presbyterian, the hospital where her mother works. In addition to being the basis of her mother’s pediatrics practice, Princeton Presbyterian is also where Saira used to accompany her childhood best friend, Harper, to cancer treatments, until Harper’s eventual death from leukemia.

Despite still hurting from her friend’s death eight years ago, Saira is determined to help more people like Harper and has returned to the pediatric oncology department to try to save lives. She is smart and determined, but the internship proves to have unexpected challenges. She gets off to a rocky start with her fellow doctors and has trouble winning the trust of patients’ families, who don’t trust a teenager to treat their sick children.

Things only get more complicated when Saira meets a boy her age in the oncology ward and immediately falls in love. Link Rad—short for Lincoln Radcliffe—is an aspiring musician whose career has been put on hold because of his leukemia remission. When Saira is assigned to his case, her emotions get in the way, and things get awkward. The book follows Saira as she tries to get Link a bone marrow match, prove her competence and maturity to the other doctors, and grapple with the fact that as a doctor, she won’t ever be able to be a normal teenager.

Despite being a prodigy, Saira is a relatable character—sometimes, she’s a little too relatable. Readers might find themselves cringing with second-hand embarrassment when she arrives late to the first day of her internship, breaks hospital rules, and talks back to doctors twice her age. Saira’s family plays a big role in the story; they are both supportive and embarrassing. Readers may enjoy the honest and heartfelt portrayal of a big Indian family and the detailed descriptions of traditional Indian food.

At the heart of the story is Saira’s relationship with Link. They start out awkwardly. Link feels betrayed when he finds out that Saira is a doctor and not a fellow cancer patient. The fact that Saira and Link’s relationship is a forbidden romance makes the relationship awkward instead of heightening the chemistry. However, Link’s character is endearing and charming.

This story is sweet and often sad, but some of the points at the emotional center—Saira’s unusual coming of age, and her grief over her dead childhood friend—aren’t given the space they need to be really effective.  The narrative moves quickly and is jam-packed with subplots, including Saira’s tense relationship with her school friends, four patients’ battles with cancer, and her cousin’s brain tumor. With all this going on in such a short book, it often feels like the story doesn’t leave the reader time to settle into the setting and watch Saira do her everyday work in the hospital. Despite this, fans of hospital dramas may still enjoy this book for its familiar elements and relatable main character. However, if you’re looking for an excellent romance, leave Symptoms of a Heartbreak on the shelf and instead grab I Believe in a Thing Called Love by Maurene Goo or Don’t Date Rosa Santos by Nina Moreno.

Sexual Content

• Saira’s family believes she is dating Vish. In reality, Vish is gay, and the two are close friends. However, Vish’s family is religious and homophobic, so they keep up the appearance of a relationship. Their families both believe they’re “totally PG,” and while the ‘couple’ “kissed a few times” when they were younger, they never went any further.
• When Saira and Link kiss, “his mouth is salty and sweet, a grapefruit sprinkled with sugar. His arms curl around me, his embrace stronger than I expected. My arms wrap around his neck, and I lean back into the couch, taking him with me.” The scene ends there and skips to later, but Saira’s narration informs the reader that she spent more time “making out” with Link.
• When Saira and Link have an intimate moment in a car, Saira describes “his mouth smashing mine, teeth clashing, tongue pushing into my mouth… Our kisses skip tentative altogether this time, instead lingering long and slow but somehow super urgent, mouths soft and open, tongues salty and slippery, his hands wandering up my shirt and over my breasts and roaming the waist of my jeans, a question.” Saira is hesitant to have sex because of Link’s fragile condition, but Link tells her that “sexual activity can be beneficial to patients undergoing chemotherapy and other cancer treatments.” They end up not having sex for other reasons. The scene lasts for approximately five pages.
• Saira’s sister offers her relationship advice for her “relationship” with Vish. Her sister says, “At some point, you know, things might get a little more intense. And if you need to talk about birth control…” Saira declines her offer and says that she and Vish “are not having sex any time soon.”
• Saira’s mother “reads everything, from medical journals to pulp novels in Hindi to bodice rippers.”
• In the communal staff bathroom, Saira catches two of her adult coworkers together in a shower when she hears “a decidedly male groan” from behind the curtain. She doesn’t see or hear anything more explicit than this. Her coworkers are embarrassed and apologize.
• Saira’s sister tells her she’s going to be in a production of the musical Hair, “where they’re all naked onstage.” She says, “it’s about art and expression.”
• Vish told Saira about discovering he was gay. Saira remembers him telling her about “Luke, this boy he met at lacrosse camp. They kept it a secret the whole time there – hard to do when you’re stealing kisses in the boathouse.”  

Violence

• Saira gets into a playful fight with Vish. “Fake punching him… and he ducks and kicks back, nearly catching me on the shin for real. Then he headlocks me from the back, wrapping one arm around my neck and the other around my waist.” The playfight is resolved peacefully.
• While it isn’t violent in nature, readers may find the following content upsetting. Saira’s young cousin has a seizure, and “vomit spills from her little lips, and they’re turning from pale pink to blue. Her eyes roll back in her head… her body flops and goes stiff, then starts flopping again… Fluid spills out of her mouth and onto the floor.” The cousin receives medical attention and ends up okay. No descriptions of medical procedures/events in the book come anywhere close to this one in detail.

Drugs and Alcohol

• Saira’s family brings alcohol to a family dinner. Saira’s father spikes a soda “with some vodka from his water bottle, pretending no one notices, even though the waiters know exactly what’s up.”
• A friend calls Saira from a party and says, “Vish’s wasted. Like, trashed. For real… And, okay, I’m trashed, too.” The friend asks Saira to come pick them up.
• Saira goes to the party and discovers everyone has been drinking sangria because the host’s parents “don’t consider it to be real alcohol.”
• Saira drinks “one cup, maybe two” of sangria. “It goes down okay.” She feels hungry later, and wonders if she has “the munchies? Or wait, is that pot? Yes. But I’m still snacky.”
• Saira and her two friends take a car service home. Vish passes out; Saira takes him back to her house, where she hides him in the basement. She doesn’t want to risk him getting in trouble with his strict parents.
• The next morning, Saira wakes up with a hangover. “I put my hand to my throbbing head. Two cups of sangria? That’s all? Never. Again.” Vish tells her, “That sangria was spiked with tequila and rum.”
• At a later get-together with friends, Saira is offered a drink from “a little cart that’s piled down with vodka and all the fixings – I know because I recognize them from my dad’s bar. A variety of juices, some wine coolers, cherries and stuff.” She declines to drink even though her “dad will sometimes offer me a glass of champagne or whatever when we’re celebrating.”
• At this get-together, Saira’s friends pressure her to drink. One of her friends says, “It’s sweet, Saira. You’ll like it.” The friend becomes agitated when she won’t drink.
• When his cancer treatments are causing him pain, Link asks one of his doctors, “Can I get another dose of morphine? I need it.”

Language

• Profanity is used infrequently. Profanity includes: Shit, damn, crap, ass, and piss.
• Saira occasionally uses “Gods” or “oh my god” as an exclamation.
• “Fuck” is used three times, but never in a sexual context. Also, a character says “AF” once, which is an abbreviation for “as fuck.” For example, jealous AF translates to jealous as fuck.

Supernatural

• Saira’s friend reads tarot, and her sister likes astrology. Saira dismisses these as “delusions. Pseudoscience.” Neither tarot nor astrology are mentioned later in the story.
• A young patient tells Saira he’s watching “this anime about this kid, Nate, who can see these troublesome spirits that are up to no good.”

Spiritual Content

• Saira’s father “thinks Vish’s parents are too religious.” Saira notes that this is because her own family is “hardly religious at all. Too many doctors in the family.”
• A doctor talking about treating cancer says, “We’re playing God here.”
• A patient’s family member says that she “spent a lot of time praying” about the patient’s cancer.
• When she’s exhausted, Saira describes wanting “to slip out of this body entirely, the way Dadi always says old souls can.”
• Link has “a small brown mole sitting right below his left ear,” which reminds Saira of “a kala tilak to ward off the evil eye.”
• Someone says a deceased patient “is in a better place now.” Saira says, “We don’t know that.”

by Caroline Galdi