:: Article

Random Acts of Reality

By Max Dunbar.


Direct Red, Gabriel Weston, Jonathan Cape 2009

I remember sitting in my pew and wrapping each enunciated male name around the physical memory I had in my mind, to try it for size and fit, as if by this I would capture the essence of a man I had never met but whose body I had come to know more intimately than that of any other person in my life.

Recently there’s been a slew of blogs and books by weary, angry public sector workers – police officers, teachers, paramedics, traffic wardens. Gabriel Weston’s Direct Red is like Random Acts of Reality for Guardian readers: a little up and to the left, but just as revelatory and compulsive.

The novel is written thematically, with ENT surgeon Weston flipping back and forth throughout a career spent elbow-deep in “the visceral soup of the middle-aged and unfit.” Direct Red provides observations on clinical hierarchies and tension, on professional communication, caring for children, connections and partings, emergencies and death. Doctors, Martin Amis wrote, are life’s gatekeepers. They are with you at both ends. And sometimes the process is botched. Surgeons, you’ll be reassured and terrified to know, are just as human as the rest of us. Weston describes the shocking incompetence of an anonymous consultant, called out for emergency surgery on a victim of gunshot wounds:

My foolish boss took half an hour to turn up. He appeared in casualty with his hands in his pockets and wasted time showing off his knowledge of firearms to the attendant policeman. He ridiculed my sense of urgency… When he finally did concede that we needed to go to theatre, he picked up an instant coffee on the way.

Another tragic episode occurs when an elderly patient in A + E is the victim of a misdiagnosis and has to be rushed to theatre: instead of dying peacefully in his wife’s arms, he dies in a strange room full of panic and chaos “at the hands of people who – though they aimed to be saviours – became his executioners.” As Orwell said, dying naturally doesn’t always mean dying well.

Again like the emergency blogs, we see the full range of human heroism and stupidity. There’s a patient, ‘Mr Smith,’ who comes in with a piece of glass stuck in his throat: the operation to remove it is (then) beyond Weston’s capabilities. How did this happen? Smith “had had a few, by which he meant ten pints.” He clocked an old enemy on the other side of the pub and, on the way to the toilet, had spat in the man’s beer. Returning from the bogs, Smith’s enemy smashed a beer bottle on the wall where Smith was standing. The glass base of the bottle landed in Smith’s pint. Smith’s response? To look his nemesis in the eye, down the pint – shard and all – and calmly hop on a bus to A + E.

Extreme professions can be fascinating in their structures and routines, and Weston strikes the right balance between providing the reader with authenticity and blinding the reader with medical jargon – a difficult task, considering the insular nature of the world she’s explaining to us. She writes exactly like you’d think a surgeon would write, with calm precision. There are the expected loving descriptions of surgical implements and processes, the passion for order and symmetry – although her theatre music is just commercial radio, rather than the rarified classical symphonies of the imagination.

There’s the frustration with public sector box ticking – juniors who present the least patients for surgery are well looked on by consultants, so there is an incentive to do half-arsed non-surgical jobs on sick patients. There is the obligatory med student gross-out moment: “When I had separated the two legs, I carried one of them to the sink – it was very heavy – and washed ancient, desiccated faeces from inside it.”

It’s a way of life where if you fuck up, “you will never forgive yourself or be forgiven.” And there’s unexpected poignancy near the end, where Weston discovers that she’s gained things more important than her career: that, as vital as it may be to society, there are more important things in life than your career.

Max Dunbar was born in London in 1981. He recently finished a full-length novel and his short fiction has appeared in various print and web journals including Open Wide, Straight from the Fridge and Lamport Court. He also writes articles on politics and religion for Butterflies and Wheels. He is Manchester’s regional editor of Succour magazine, a journal of new fiction and poetry. He blogs here.

First published in 3:AM Magazine: Tuesday, March 3rd, 2009.