The tonality becomes darkest in the last three stories, lit by bright truths to drive you mad. A woman in traumatized remission from cancer; a baby with cancer; a woman who has accidentally killed a child and retreated from the deed into sudden marriage. But marriage has never been much of a haven in Mooreland, as its endurers report. "The key to marriage, she concluded, was just not to take the thing too personally." "Marriage, she felt, was a fine arrangement generally, except that one never got it generally. One got it very, very specifically." Marriage, another character notes, is an institution—as in mental institution. As for cancer: we are reminded of the title story in Moore's last collection, in which a woman is told that a mole removed from her back is precancerous. "Precancer," she repeats, "Isn't that...like life?" 

"People Like That Are the Only People Here" was the story I was most eager, but also most anxious, to reread (like most of the others it first appeared in The New Yorker). Eager because the subject matter—a baby with cancer—takes Moore into her toughest territory, where every pitch of tone, let alone any joke, good or bad, looks the most exposed. Anxious because when The New Yorker first published the story, they chose to illustrate it with a very large and fetching photograph of Moore herself. Since, in the story, the baby's unnamed mother is a writer and teacher living in the "Modern Middle West," as Moore does, the magazine was inciting its readers, despite the "fiction" strap, to treat it as a true-life account. This skewed the story and did Moore a disservice (it would still be a disservice even if the narrative turned out to be entirely autobiographical). In Birds of America it is freed into fiction; the rest of the book supports it, indeed builds toward it. 

This doesn't make it any the less precisely harrowing. What, after all, could be more cosmically bad-jokey than the world of Peed Onk, that jaunty, demystifying reduction of Pediatric Oncology? Here are parents preparing to bury children, unable to take the pain of their little bald boys (statistically, it tends to be boys) upon themselves, moving between guilt and terror, between tormented relaxation in the cramped Tiny Tim Lounge (which would have been larger had Tiny Tim's child survived, rather than died, at the hospital) and the curt professional lingo of the staff: "It's a fast but wimpy tumor," the oncologist remarks consolingly. Reflecting on the experience, the mother wonders, "How can it be described?... The trip and the story of the trip are always two different things." True, as elsewhere; and Moore gives "People Like That Are the Only People Here" some light metafictional embellishment to emphasize this. But the story can only work—as it compellingly does here—if it is loyal to the full tonality of the original trip, articulating its terrors and banalities, its boredom and its death-defying jokes.