David Guterson’s protagonist in his novel East of the Mountains, Dr. Ben Givens, has decided to kill himself.  Still mourning the death of his wife, terminally ill with colon cancer and suffering the indescribable pain associated with the disease, Dr. Givens has concluded that the time has come to take his own life, in defiance of the sacred creed under which most physicians operate that forbids the taking of life: “He was, he knew, incurable; he had seen too much in his years as a doctor to delude himself that things were otherwise. He knew exactly what to expect and could not turn away from meeting.”

In addition to telling the story of this increasingly emotionally alienated individual, Guterson’s novel is also a noteworthy discourse on man’s failure to conform to his world in deference to his drive to force the world to conform to his commercial and cultural proclivities.  As the author describes Dr. Givens’ contemplations on this ecologically devastating intrusion into the planet’s natural environment, he has his protagonist reflect on how own and his family’s role in subverting that environment:

“He knew what had happened to the sagelands. He himself had helped burn them. Then men like his father had seized the river without a trace of evil in their hearts, sure of themselves but ignorant, and children of their time entirely, with no other bearings to rely on. Irrigators and fruit-tree growers, they believed the river to be theirs. His own life spanned that time and this, and so he believed in the old fast river as much as he believed in apple orchards, and yet he saw that the two were at odds, . .”

East of the Mountains, however, is not an ineluctable descent into Hell. Rather, it is the story of one terminally-ill man’s rediscovery of his proper role in the world and of his climb out of the depths of despair.  This is the context in which, late in the novel, Dr. Givens, previously committed to his own destruction, emotionally scarred from his experiences in World War II, and convinced of the world’s irreversible decline, saves the life of a baby when he encounters poor immigrants, a 15-year old girl among whom is in labor and having a difficult time.  The baby’s life is clearly in danger, although, as Given’s reassures the baby’s father, Jimmy Perez, “it’s still getting blood from the umbilical cord.” Successfully delivering the baby, Dr. Givens is reminded that he became a doctor – and not just a doctor, but a cardiothoracic surgeon, a medical specialty in which the patient’s heart is literally in his hands – because he valued life, just as much now as when he dedicated himself to a life practicing medicine during the war when he observed his war buddy’s life being saved by a surgeon.  After saving the baby’s life, he steps out into the light in a symbolic transition, Guterson describing the scene as follows:

“When he went outside it was first light.  The orchards nearby were hung with ripe apples.  The broad sky was pale, cloudless.  Things looked different now.”

Orchards play an important role in East of the Mountains, both as a symbol of man’s destruction of the natural environment and as a symbol of birth.  Earlier in the novel, the connotation associated Washington’s apple orchards is entirely pejorative.  Now, it is more nuanced, more balanced.  When he is thanked for being “here,” it is significant because, had he killed himself, he would not have been present to bring new life into the world.