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"I'm lost," a patient tells her psychiatrist in Hustvedt's fourth novel. "I'm cold. I'm all alone." She might be speaking for all the characters in this sombre meditation on the isolation of urban professionals, in which daily routines are nothing but "pillars in an architecture of need," erotic love is ephemeral, and friendship is the only source of consolation in a post-9/11 New York where everyone is always ...