Garth Greenwell was born and raised in Louisville, Kentucky; spent his high school and university years in Michigan, Missouri, New York, and Massachusetts; and has lived in the United States for the past decade, during which time he has become celebrated for his sensuous, searching novels and short stories. Yet in the minds of his readers, Greenwell’s narrators have always lived abroad.

His previous two books, What Belongs to You and Cleanness, were told from the perspective of a gay man with roughly the same biography as Greenwell who teaches poetry to high school students in Sofia, Bulgaria, as the author did for a few years between earning graduate degrees. Life in Sofia affords Greenwell’s protagonists a certain liberty: While Bulgaria is their chosen home, they remain relatively unfettered by its national character, its laws and customs; their main limitation is the local language. Yet unlike the students, whom his narrators tend to depict as straining for competitive professional opportunities in Britain and America, Greenwell’s expats are free to leave any time they want.

Now, in Greenwell’s third novel, Small Rain, a similar alter ego—one with a comparable backstory and style of self-expression—is living in an ICU in Iowa during the days of the Covid lockdown. He could not be more hemmed in by America if he tried.

In Small Rain, our narrator is mostly confined to his hospital room. He reclines in bed, worries about the news, and relies on his memory, or occasionally his phone, to move the story forward. In a way, it’s not much of a view. Sometimes he sends e-mails or recalls lines of poetry. Outwardly, his habits may not differ much from those of a writer at work—or, at least, one attempting to work, but who instead fixates on anxious thoughts of his nation in morbid decline. Only the intensity of his physical suffering and the frenzy of specialists prodding him at all hours distinguish him as a patient.

The crisis that necessitated this confinement began with a sudden eruption of pain in his stomach: what the narrator describes as a fist in his gut that just keeps squeezing. Although it’s the worst pain he’s ever experienced, he tells his worried partner L, a poetry teacher at the University of Iowa, to leave him in solitude. His pride demands it, as does the immobilizing power of this pain and the fear of compounding his affliction at a hospital. “Dangerous places, in the pandemic the likeliest places to get infected,” he thinks.

In the end, he has little choice in the matter. When the excruciating pain does not subside, he drives himself to the ER and endures a long wait, dotted with bouts of intense curiosity about his fellow patients. “I wanted to see into their lives but I had no right to,” he tells us (the narrator is always carefully gauging his distance from others). Medical staff at the clinic that sent him here had suspected appendicitis, but the ER’s initial examination shows that he’s lucky to be alive at all: He has suffered an infrarenal aortic dissection, a tear in the inner lining of the aorta, a rare condition that typically occurs in elderly people (the narrator is in his 40s) and in nearly half of all cases is instantly fatal. For those who survive the first attack, the mortality rate increases significantly every hour that the sick person isn’t treated. The threat of further deterioration is reduced only by constant monitoring, painkillers, and a steady flow of antibiotics into his body, which the doctors hope will kill the infection that precipitated the tear. If there even is an infection—the truth is, nobody knows how this happened to him. To the doctors, the narrator is a thrilling question without an answer, pure diagnostic poetry.

Meanwhile, our narrator is determined to find his own kind of significance in this dire situation, and in everything around him. Not just meaning, but a pinhole view onto infinitude, or at least a Whitmanesque “multitude,” the sort of ecstatic close reading that he teaches his students to practice and that he hopes, with varying intensities of belief, can renew in some small way our openness to one another in a socially distanced world. The democratic value of deep engagement—with a text, a trifle, another person—takes on more explicitly civic dimensions in Small Rain than it has in Greenwell’s previous books, and it is one of the novel’s driving currents. Issuing elegiac warnings about the plight of America’s democratic culture, our narrator opines on mask mandates, police protests, overwhelmed medical staff, and the mind-numbing technological distractions proliferating throughout contemporary life. “It was like we had outsourced consciousness,” he laments. “Turned inwardness inside out, we thought now in other people’s memes. It made me despair for my country, not just my country, for the endeavor of humanness—something it had become impossible to think of unironically, an idea that could only be mocked.”

In other, less despairing passages, however, our narrator’s engaged readings yield songs in praise of America’s communal spirit and—when one gets right down to it—of the narrator himself. On his first day at the hospital, he forges a bond with one of his ER nurses, Frank, over their mutual love of early choral music. This exchange leads Frank to pull out his phone and play a favorite recording of the 16th-century song “Westron Wynde,” whose lyrics the narrator has taught many times to his students (and from which Greenwell draws his novel’s title). From here, the narrator considers the years he’s spent teaching the lyrics in repeated classroom settings, reconstructing moments of scholastic reciprocity that finally end in his private illumination. “The poem,” having undergone so much interpretation, “becomes not just a message but an object of contemplation, of devotion even, inexhaustible. It had been my whole life, puzzling over phrases, trying to account for the unaccountable in what art makes us feel; it had been my whole life, sometimes it had seemed a full life and sometimes a wasted one, it had felt full and wasted at once.”

Greenwell pushes his narrator’s prodigious analytic gifts and humanist sympathies to their limits in a rhapsodic—and sometimes ridiculous—passage about that most humble of American products, the potato chip. His younger sister G gives him a bag of chips toward the end of his hospital stay, his first taste of noninstitutional food after days of medically mandated fasting. Eating one, he refers to the chip as “a miracle of engineering, a kind of transubstantiation of a root vegetable.” For several pages, he lingers on the chip and the vital associations it brings forth, from the chemists who formulated it to the agricultural workers who excavated its raw materials. The chip is also taken to task for social malfeasance: “one of the manipulations of capitalism, a deformation of our natural response designed for addiction…really it symbolized in miniature the utter decadence of all genuine value, the fall of a culture, absolute bliss.” This is one complex carbohydrate.

The word itself picks up on many of this novel’s concerns: the chips in our phones, the chip on the narrator’s shoulder, the crises that chip away at our health, the hours that chip away at our lives. Of course, a potato chip can’t possibly sustain such a vivid web of impressions; it can barely sustain someone who has skipped breakfast. And yet by the end of this litany, in a move uncharacteristic of Greenwell’s previous protagonists, the narrator arrives at a dramatic resolution: We each have only a fractional capacity to face the true scale of our responsibility toward one another, he thinks. Ultimately, all we can do is “acknowledge that it’s a failure to shut our eyes to it…a failure of perception and also a moral failure; acknowledge that the only vision of life we can bear is a lie.”