Chris Adrian's theme is grief. It was explicit in his first novel, Gob's Grief (2001), a book replete with the national grief that America felt in the wake of the Civil War. Despite its historical setting, that novel incorporated elements of the fantastic, though its most striking image (a glasshouse whose panes were made up of glass photographic plates showing the war dead) just about adhered to the mainstream. In the same year that novel was published, Adrian gained his M.D. and has tended to practice in pediatrics, especially pediatric oncology. This came out in his second novel, The Children's Hospital (2006), an explicitly science fictional, or at least post-apocalyptic work that merged the grief of survivors with the grief of child illness. In "A Tiny Feast" (The New Yorker, April 20th 2009) he turned these concerns into overt fantasy with a story about Oberon and Titania transported to modern day California and faced with nursing a changeling child through terminal cancer. It is a story that seemed to divide readers: those who approached it simply as a modern fairy story were disappointed, but I found it a powerful evocation of coping with grief when one has never known grief before. It is the sort of situation Adrian must face frequently in his working life, but by putting the arcane language and modern magic of medical science in opposition to a far older form of magic, Adrian found something new in the situation that was haunting and deeply moving.

Now "A Tiny Feast" has been incorporated as chapter three of his third novel, The Great Night. What follows is all aftermath. Secreted under Buena Vista Park in San Francisco, Titania remains literally incapacitated by grief. For months after the death of the changeling she was unable to leave her bed: the failure of her magic, of her entire way of life, was bad enough, but it had also meant coming to terms with death which had never been part of her world before. Even when she did rise from her bed, she was unable to take any part in the feasts and rituals of fairy life, drifting away to stand vigil over the preserved corpse of her changeling. Eventually, she even drove away her husband, Oberon. Now it is Midsummer's Eve, the Great Night, the most joyous date on the fairy calendar turned into a miserable travesty by Titania's grief, and as the fairies parade out into Buena Vista Park she commits a fatal error: she lets loose Puck, who has been held in thrall to her for a millennium. On this one great night he sets out to extract revenge for centuries of slights and cruelties.

What we are reading, of course, is a distorted reimagining of A Midsummer Night's Dream, so there are inevitably star-crossed lovers and rude mechanicals caught up in all the madness and mayhem that follows. And being Chris Adrian's star-crossed lovers and rude mechanicals, they come burdened with their own private griefs.

The star-crossed lovers are Henry, Will, and Molly. Each, unknown to the others, has entered the park en route to the same party, and each, for their own reason, is rather reluctant to get there. Henry, who turns out to be one of the two doctors who treated Titania's changeling, is in mourning for a failed relationship; but there are deeper problems there. At one point, during his childhood, he was kidnapped and some years later was rescued from a pedophile's home; or at least, that is the story he has learned, though he can remember none of this. But the effect of those lost years has been catastrophic, bringing out an obsessive-compulsive disorder that has made him impossible to live with and that almost certainly brought about the end of his relationship. Late in the day, we learn that there was more to the alleged kidnapping; he had actually been a changeling, and the supposed pedophile had been running a sort of halfway house for returned children, where Henry and his new friend Ryan spent their time trying to find a way back into the fairy realm under Buena Vista Park.

Molly is a lonely and insecure girl who barely escaped from her claustrophobic evangelical Christian family thanks to a relationship with a boy called Ryan. But Ryan committed suicide, for reasons that are never made explicit (though we can probably guess), and Molly's own life fell apart as a result. Attending this party is going to be her first attempt to get out and enjoy life again.

Will is also grieving over a suicide, in this instance his younger brother. He is a would-be short story writer who makes a living as a tree surgeon. This brings him into contact with Caroline, a strange girl whose own brother, Ryan, has also just committed suicide. Shared grief brings them together, but isn't enough to hold them together. As the novel opens, they have recently split up; Will is going to the party because he knows she will be there and he has the (patently false) hope that he might effect a reconciliation.

And yes, it is the same Ryan in every case, it is the same party they are heading towards (but never reach), and no, the three have no knowledge of each other before the events of the novel bring them together. It is an artificial, not to say a schematic, set up. Apart from the wonderful flow of "A Tiny Feast," which comes at just the right point to remind us how fluent and powerful a writer Adrian can be when he lets himself, Adrian spends far too much of the early part of the novel letting the machinery show. The coincidences and echoes are so carefully, so painstakingly laid out that we spend too long waiting for the story to take flight, and wondering whether it ever will. And in the end, this mechanistic working out of links and associations counts for less than it should, so you are left wondering what all that buildup was about.

Yet the novel does, eventually, take flight. This is due, in part, to the comic relief. The rude mechanicals are a group of homeless people led by Huff. Huff and his friends have noticed that some of their fellow homeless are disappearing from the streets, and after watching an outdoor screening of Soylent Green, Huff has become convinced that the city's new mayor is having them killed and eaten. His radical solution to this is to write a musical version of Soylent Green which he and his friends will stage and so shame the mayor to make him stop. It is, like the Tragedy of Piramus and Thisbe, a doomed enterprise, but by the malign influence of Puck the fairies find themselves involved in the production while Titania becomes wedded to Huff's substitute Bottom. The comedy is as broad as in the original, but it brings life to a story that could all too easily stultify under its own worthy misery; and indeed it brings life back to Titania.

But the novel works even more when Adrian stops putting overt fantasy centre stage. As the novel progresses, we more and more turn away from the events of the Great Night to explore the backgrounds of Molly, Will, and Henry. The fantastic is never entirely absent in these passages, but here it becomes something glimpsed from the corner of the eye, an oddity that we, the readers, notice but that the actors in this drama are not necessarily aware of. Instead, the focus is the mainstream concern of what makes these people the way they are. The more we are taken into their lives the less they seem like awkward literary devices and the more like flawed human beings with whose fate we can more easily sympathise. Chris Adrian seems to be a writer who can never avoid bringing the fantastic into his work, but is strongest on the mainstream realist virtues of characterization and setting. Here the tension between the two is less well-balanced than in his previous novels, but where he gets it right the effect can be breathtaking.

Paul Kincaid is the coeditor of The Arthur C. Clarke Award: A Critical Anthology, and the author of the Hugo-nominated collection of reviews and essays, What It Is We Do When We Read Science Fiction.