This is a dark, bitter book, written by a young doctor, or rather former doctor, which seeks to depict the experiences of a junior hospital doctor in today's National Health Service. A few years ago Mercurio was responsible for a hard-hitting television series called Cardiac Arrest which also depicted life in the NHS, but whereas that was at least partially a comedy, this book is hardly comic at all. In some ways I was reminded of Kafka: the narrator feels trapped in an all-powerful system from which he cannot escape. Indeed, even the physical atmosphere of the hospital is dense and oppressive.
There is also a resemblance to Kafka in the fact that the first-person narrator is not named. At the outset he has just qualified and arrives on the wards full of enthusiasm and idealism, but he is quickly disillusioned. Overworked and undervalued, harried by demands on every side and exhausted by sleeplessness, he takes refuge in cynicism—an attitude he shares with all those he works with, junior staff, consultants, and nurses alike. He has no time or energy left to feel anything for the patients in his care so he labels them, caricature-fashion, by their diagnosis or their appearance: the Young Headache Man, the Breathless Lady, Sweet Breath (a diabetic). The public are civilians, reflecting the professionals' feeling that they are involved in a war. And in this war there are casualties: mostly patients, but also a junior doctor who makes a suicide attempt. And the narrator, of course, is another casualty. The characters make full use of hospital slang, some of it new to me since my service in the trenches 40 years ago, but footnotes are provided for the benefit of civilian readers.
The narrator's cynicism, though profound, is not total. He experiences agonies of remorse because he fails to take a patient's breathlessness seriously and so allows her to die of a pulmonary embolus which he might have prevented, and he feels outrage at the callous incompetence of a casualty consultant that leads to injury and death for the man's patients. His sexual encounters are described in explicit anatomical detail but one relationship extends beyond the merely genital and indeed trembles on the verge of sentimentality, hinting at the theme of redemption by the love of a good woman. In spite of everything he is on the way to becoming a good doctor, but then he is faced by a dilemma: whether to denounce the incompetence he has seen and so make himself a marked man with no possibility of future employment, or to keep quiet and compromise with the system in the hope of later starting to reform it from within—not an encouraging prospect, since a newly appointed consultant he worked for has been suspended for trying to do exactly that.
This is manifestly a book written out of a feeling of helpless rage at a system that stifles idealism in those who work within it. Non-doctors who read it are likely to be appalled, and to wonder whether this is really what hospitals are like behind the scenes. In fact, of course, an insider's view of almost any form of human activity—the catering trade, the Army, the Church—is likely to shock outsiders, but in spite of some well-publicised medical disasters in recent years many people still have a romantic idea of hospital life. Doctors will certainly recognize the authenticity of much of it, but they will also realize that although all the events described could really happen, it would be indeed a very bad hospital in which they all happened in quick succession, as here. In other words, for the purposes of fiction, Mercurio has compressed, conflated, and on occasion exaggerated the iniquities. Nevertheless, it remains true that working in the NHS today is hard, and that many young doctors who start out on their careers with the highest ideals become disillusioned later when they find that they have to compromise those ideals if they are to survive. The issues that Mercurio has dramatized in this book are real.