This disturbing novel explores with clinical precision the effects of losing power. On the widest scale, the book is about whites in a South Africa no longer governed by whites, but is also about being a scholar of opera and romantic poetry in a world that values commerce, youth, and the future, and more universally, about being a middle-aged man in a society where the power of older white men has been reduced. One can resist change, or one can respond as Lucy does [she is named, I think, after Wordsworth's Lucy, who becomes a selfless part of nature, "rolled round in earth's diurnal course, with rocks and stones and trees" ("Lucy," V)] by entirely relinquishing one's claims to power of any kind. She concludes that it is necessary, as a white person in South Africa--perhaps as a white woman, since women are, according to Coetzee, "adaptable"--to start again now, "at ground level. With nothing. Not with nothing but. With nothing. No cards, no weapons, no property, no rights, no dignity. Like a dog" (205). One may find in this a kind of zen-like serenity, but it is also a loss of humanity. At the end of the book, Lurie gives up his own dog to be euthanized. While not immediately or obviously about health care, Disgrace explores reactions to extremity and to the way in which most humans struggle, even when they have "nothing," to be human. (The book bears an implicit reminder, too, of the many South Africans who have far less than Coetzee's characters, and for whom the restoration of political power brings both hope and, for some, revenge.) Lurie struggles to write, to create, and he learns, in giving dogs a peaceful death, to provide a kind of care easily translated to medical settings: he learns "to concentrate all his attention on the animal they are killing, giving it what he no longer has difficulty in calling by its proper name: love".