In A Heart Full of Miracles, Stephanie Mittman returns to the late 1800s Midwest. This is a setting that really plays to her strengths, and indeed this book is much better than her last two, which both departed from her usual style. While it takes a while for this book to really come together, it’s a heart-warming, two-hanky read.

Abidance (Abby) Merganser has loved Dr. Seth Herndon for years and years – as long as she can remember. His younger sister Sarrie was Abby’s best friend, and her recent death after a lingering illness has profoundly affected both Abby and Seth. It was Sarrie’s illness that prompted Seth to become a doctor in the first place, and when she died he felt like a failure as a doctor. In fact, he has pretty much decided to leave Iowa altogether and find another doctor to take over his practice. Abby has other ideas. As Seth prepares to leave town, she steps up her campaign to make him fall in love with her. She pops in at his office with food almost every day, and suggests that he write a medical column for the newspaper where she works so that they can spend more time together. She even resorts to creating a fictional suitor in St. Louis, hoping that he will become jealous.

But just when Seth starts to see Abby as a woman he could love, tragedy strikes. One of Seth’s medical columns lists symptoms of a brain tumor, and Abby has nearly all of them. The column mentions that the odds of survival are very low, so Abby decides that the honorable thing to do is break things off with Seth. Since his sister’s death almost destroyed him, Abby doesn’t want him to have to go through the same experience with her. Reluctantly, she pretends to become engaged to her fictional suitor. Seth is confused and devastated by her apparent betrayal, so he continues his plans to find a replacement doctor so he can leave town. The last third of the book is just heart-wrenching, and suspenseful as well. Will Abby tell the truth? Will Seth find out before it’s too late? Will Abby even survive?

I enjoyed this book, but it does take some time for it to really get going. The first third has a somewhat choppy feel to it, almost as if the author had originally included several more chapters that got pruned at the last minute. Some additional background definitely would have helped, especially where Abby’s large family is concerned. There were a couple of family members who popped up now and then, but I had no idea how they were related until the book was almost over. An early introduction would have avoided a lot of confusion.

However, once this book gets going, it’s quite good. Both Abby and Seth are well-drawn characters, and they are both easy to care about. At first Seth is really a “glass half empty” kind of person. He’s been hurt by his loss and doesn’t have a lot of self-confidence. He is sure that he doesn’t want anything to do with Abby; she’s such a happy person that he’s sure an “old man” like himself would just ruin her life. I’ve seen heroes like this before, and usually they treat the heroine like dirt so they can show her what a mistake she’s making by falling in love. Seth is never cruel or mean, and he doesn’t spend the whole book fighting the relationship either.

Abby is an endearing character, and the reader can really feel her heartache as she discovers that her illness will likely be fatal. In most other instances I would be furious at a heroine who pretended not to love the hero to save him from the truth. But I know from personal experience that terminally ill people can go to great lengths to shield those they love from their illness, so I found the heroine’s behavior believable, even though it was a little maddening. And rest assured – although there are some tense moments, the ending is definitely a happy one.

The Americana setting works well here, and author Mittman adds some interesting details about her medical research at the end of the book. A Heart Full of Miracles isn’t quite up to the level of Mittman’s earlier books like , but it’s much better than her last two. If you enjoyed A Taste of Honey and The Marriage Bed, I’d encourage you to give this one a shot.