In Every Moment We Are Still Alive is an autobiographical novel by Swedish poet Tom Malmquist. Some autobiographical novels are light-hearted; Malmquist’s is not, but it does conjure a reading experience not-to-be-missed in its first 63 pages, and a reckoning with grief and the past in its latter two-thirds which may resonate with some readers, but which I was not quite as taken with for reasons characteristic, I think, of auto-fiction generally.

In the first 63 pages, the author’s pregnant girlfriend, Karin, is rushed to the hospital and diagnosed with an advanced form of leukemia. Tom sits in meetings with medical specialists, who explain in the technical, but very matter-of-fact language of doctors that Karin’s prognosis is grim. They must deliver Karin and Tom’s baby via C-section and then take desperate measures to save Karin’s life. The scene at the hospital is a rush of activity, Tom rushing to be with his wife, getting locked out of the room, meeting with family, holding off the family from bothering Karin, meeting with doctors, being in the room for the C-section, feeding his prematurely born little girl in the Neonatal Ward, rushing back and forth between there and his ailing wife, being told by the compassionate nurses to get some rest and go for a walk or he won’t be able to keep it up—and all this amid a whirl of technical and visual details inaccessible to mere memory, but which (as Malmquist candidly explains in an interview) the medium of the novel allows a writer to reconstruct and zoom in on details with the freedom of fiction.

The actual details of what was happening became important to me, psychologically, when I was at the hospital, and when I first got home; they were linchpins, holding me together. When I transcribed them into the book, they became linchpins of the narrative, too. They became emblematic of life, its vividness and diversity. If death is complete emptiness, I have come to see this richness of detail as its opposite.

Malmquist engulfs the reader in this world of activity from the moment the story begins in media res, “the consultant stamps down the wheel lock of Karin’s hospital bed,” and he begins firing a stream of medical jargon at the intensive care nurses—pregnant woman, week thirty-three, child reportedly in good health, started feeling ill about five days ago … sats about 70, ambient but responds to oxygen with higher saturation, RR about forty to fifty, BT a hundred and forty, HR a hundred and twenty—a block of fast, uninterrupted action and speech with nary an article, speech tag, or quotation mark in sight. And from this moment, Tom notices the most evocative details: a male nurse’s sword tatoos, the blue tints of the hospital corridors, “a fluorescent tube and an immaculate, blindingly white ceiling,” that Tom looks up at in despair.

In another scene, Tom and a team of doctors and nurses need to rapidly move Karin—along with her catheter and a defibrillator machine that are attached to her, through a group of underground tunnels without allowing the devices to come out or cease functions (which, we are told, would result in quick death.) The scene is really the highest pitch of action in a 63-page sequence that is high on action, that is tense with suspense, even if as readers we understand pretty much where all this is heading, the prognosis keeps getting worse, the doctors continue to speak in non-commital terms of doing everything possible for Karin, we get vague inklings that she will not survive the night. And finally, at the end of 63 pages, the inevitable comes to pass; and we get a blank page signalling a new and uncharted section of the book.

The first 63 pages of In Every Moment We Are Still Alive used present tense narration, surreal descriptions, and tag-free speech to compel readers to keep reading till the end. What now? Our narrator is a widower. He has a baby girl, Livia. This is a unique situation that certainly intrigues the reader in anticipating how the author will handle it, but will it stand up with the torrid first third of the book?

Somewhat. But before entering into the plot I as the reader really wanted to know about—Tom and his newborn baby girl—he instead sends readers into a flashback scene, depicting Tom, his mother and father, his in-laws, his cousins, and a pregnant Karin, all at a family dinner. We’re introduced to all of these characters from Tom’s past, shown them joking around, reminiscing about old times, and so forth. This scene is really the first part of the book where Malmquist reclaims his autofictional prerogative from the reader; as readers we want excitement, sensation, pain, emotion, healing, but by doing no more than going back and showing us his family—who, at least at this point in the book, are by no means very interesting—Malmquist sends the subtle message that this story is his story, involving his family, who he is going to introduce into his book because as autofiction he is turning the personal into art, but must necessarily introduce all these family members in order for the art to be individually true to him.

To which the uninitiated reader like myself may respond: Okay, but that chapter washed over me to little practical effect. Tom’s situation is interesting. Tom’s family—at least in this chapter—is not. (Though curiously, we only later find out that Tom’s father is an interesting man indeed: one of the great Swedish sportswriters of his time, the personal friend and ghostwriter of tennis great Björn Borg, and a writer who was controversial for breaking news of a gambling ring around Swedish hockey in the 1970s—and I wonder if this information is kept in the background for most of the book because Malmquist wanted to keep the book focused on himself, Karin, and Livia.) In any case, the opening section’s intense and demonstrative style does not necessary make the entire context of Tom’s situation clear in the latter two-thirds—this is one of those counterfactuals to the idea that authors must always be showing rather than telling—though it is still very useful in conveying the experience of being a father, of being unemployed with a baby at home and changing diapers and trying to get sleep, even as a double tragedy comes on as Tom’s father is on his last days as well. This is interspersed with a number of flashbacks showing Tom and Karin’s first dates, troubles in their relationship, fights, Tom being sometimes a jerk and former high school hockey player who throws an F-bomb every third sentence, and other material that is poignant on some level, but which also feels more scattershot, like Malmquist needed to get all of this down because there was no knowing which parts of the recollection might be significant further down the road.

This is fair, I suppose; as readers we allow that autofiction belongs not just to the reader but to the author, that in order for there to be a we who feel together, there must be an I who experiences individually, and so we can give the author leeway to bring up subjects that may not seem entirely germane to the plot the reader wants to know about, but which seem germane to the author and his or her personal experience. One can’t help feeling, however, that this latter part of the book is more diffuse and skippable in parts than those sensational first pages. If there is a section I would direct readers to in order to absorb the kernel of these latter sections, it would be the highly affecting final ten pages, in which Tom apostrophizes to Karen and describes his most indelible memories of her and describes life with Livia, how “I cook, I bathe her … I scour the floors, I let her sit on my shoulders, I talk to her, I explain why I am doing what I am doing” and “she laughs because I’m smiling at her,”and how he says (heartbreakingly) “Daddy is not sad because of anything you have done.” This seems to me the most concentrated and beautiful evocation of the grief and healing that takes place in the latter part of the book.