Excerpt from All My Puny Sorrows by Miriam Toews, plus links to reviews, author biography & more

She asks me what that horrible sound is and I tell her I think it's dishes falling onto the concrete floor in the corridor, but she asks me if somebody is being shackled out there in the hallway and I say no, of course not, and she begins to tell me that it happens, she's seen it, that she's terrified, have I heard of Bedlam, and she doesn't want to let anybody down. She says how sorry she is and I tell her nobody is angry, we want her to be okay, to live. She asks me how Will and Nora are, my kids, and I tell her fine, fine, and she covers her face with her hands. I tell her that she and I could mock life together, it's a joke anyway, agreed, okay? Agreed! But we don't have to die. We'll be soldiers together. We'll be like conjoined twins. All the time, even when we're in different cities. I'm desperate for words.

A chaplain comes into the room and asks Elfrieda if she is Elfrieda Von Riesen and Elf says no. The chaplain peers at her in wonderment and then tells me he could have sworn that Elf was Elfrieda Von Riesen, the pianist.

No, I say. Wrong person. The chaplain apologizes for bothering us and leaves.

Who would do that? I ask.

Do what? says Elf.

Just ask another person in a hospital if she's who they think she is. Aren't chaplains supposed to be more discreet?

I don't know, says Elf. It's normal.

I don't think it is, I say. I think it's totally unprofessional.

Things are always bad for you if they're unprofessional. You always say oh, that's so unprofessional as though there's some definition of professional that's also a moral imperative for how to behave. I don't even know what professional is anymore.

You know what I mean, I say.

Just stop lying to me about what life is, Elf says.

Fine, Elf, I'll stop lying to you if you stop trying to kill yourself.

Then Elf tells me that she has a glass piano inside her. She's terrified that it will break. She can't let it break. She tells me that it's squeezed right up against the lower right side of her stomach, that sometimes she can feel the hard edges of it pushing at her skin, that she's afraid it will push through and she'll bleed to death. But mostly she's terrified that it will break inside her. I ask her what kind of piano it is and she tells me that it's an old upright Heintzman that used to be a player piano but that the player mechanism has been removed and the whole thing has been turned into glass, even the keys. Everything. When she hears bottles being thrown into the back of a garbage truck or wind chimes or even a certain type of bird singing she immediately thinks it's the piano breaking.

A child laughed this morning, she says, a little girl here visiting her father, but I didn't know it was laughter, I thought it was the sound of glass shattering and I clutched my stomach thinking oh no, this is it.

I nod and smile and tell her that I'd be terrified of breakage too if I had a glass piano inside me.

So you understand? she asks.

I do, I say. I honestly, honestly do. I mean, what would happen if it broke?

Thank you, Yoli.

Hey, are you hungry? I ask her. Is there anything I can do for you?

She smiles, no, nothing.

Excerpted from All My Puny Sorrows by Miriam Toews. Copyright © 2014 by Miriam Toews. Excerpted by permission of McSweeney's Books. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.