‘Dirty Work’ by Gabriel Weston

Fiction – hardcover; Jonathan Cape; 192 pages; 2013. Review copy courtesy of the publisher.

Gabriel Weston is a practising surgeon. Many of you may be familiar with her first book, Direct Red, which explored what it is like to be a surgeon, and went on to win the PEN/Ackerley Prize for autobiography in 2010. She sticks with the medical theme in her first novel, Dirty Work, which is a dark, oppressive tale about a doctor who makes a terrible mistake and then must face the consequences.

The kind of surgery no one talks about

From the opening line — “I have never seen so much blood” — this novel transports you directly into the fascinating world of surgery, where every decision (and incision) can make the difference between life and death.

But this is not the kind of surgery we normally talk about, for Nancy, the narrator of this story, is an “abortion provider” — she never calls herself an “abortionist” — and her career is not something she can freely mention in company without being shunned or condemned. Even fellow surgeons look down on her line of surgery, which is viewed as “dirty work”.

When she makes an error during a procedure, her world is turned upside down. She is investigated by a tribunal appointed by the General Medical Council to explain herself. If she is found to be negligent she will be struck off the register and unable to practise as a doctor again.

A novel in four parts

The book is structured around the four sessions of the tribunal (one a week for a month) — what happened in theatre; a psychiatric assessment; her recent performance as a doctor; and the verdict — but the narrative does not follow the cut and dried Q&A to which she is subjected. Instead, it ebbs and flows around Nancy’s memories — her childhood split between the USA and England, how she got into medicine, why she began providing abortions, the support she receives from her sister — which occur to her before, during and after each session.

This is a successful technique, because not only do you come to know Nancy very well and empathise with her predicament (it’s clear she is an excellent surgeon), you keep turning the pages because you want to know the verdict, which is delivered in the final pages of this short novel.

Compelling and claustrophobic read

I read this book on a four-hour plane journey and I have to say I was hooked from the start. It’s not a light or fun read though, because it covers such dark territory and there’s an oppressive atmosphere which resonates off the page.

While Dirty Work is told in a cold, detached manner, the author manages to make it incredibly moving in places. It’s an extraordinarily powerful novel for those prepared to read about a topic told in such a frank, forthright and often unnerving way.

But it’s real strength is the way in which it explores lots of issues and medical ethics and is able to show that nothing is black and white. This is not a book that examines the arguments for and against abortion; instead it looks at the mindset of those carrying them out. For instance, what makes a doctor want to become an abortionist? How do you rationalising saving life with terminating the unborn? And what kind of psychological impact, if any, does this kind of surgery have on those providing it?

For another take on this novel, please visit Jackie’s review at Farm Lane Books.