'Dirty Work' by Gabriel Weston is not your ordinary kind of novel. It is almost entirely an internal monologue by a young doctor, a gynaecologist, who has had a breakdown causing the near death of an abortion patient on the operating table. She does occasionally talk to people, but it's almost as if she is observing some other 'self' have these conversations, she is so utterly dissociated from her existence. There is an enquiry going on into the circumstances of the situation and in between interviews and assessments of her psychological state she remembers moments from her childhood and medical training, and spends her time sitting as close as she can to the ITU where the woman is being cared for, or failing that merely thinking about her. It is as she feels that by mere force of will and proximity she can repair the damage she caused:
"I have no job to go to, and snow falls on London. It stops, only to start up again. I lie in bed well past six, looking up at the sky, thinking of my patient. Anxious that the slow-falling processes in her body, the drifts of electrolytes across cell membranes, the sweep of inflammatory mediators and catecholamines, the piling up of work on vital organs should go in her favour and not against her. To bear her towards life not death. And there is nothing I can do." (p.46)
Despite the issue of abortion being something that is discussed at length in the media now the focus is on women who have abortions, the whys and wherefores, not on the doctors who perform them. For them too the process is a moral choice with ongoing emotional consequences. The story is not making any moral judgment or looking at the standard arguments for and against, it is simply presenting it as a fact; this is how it is and this is how this character came to be doing it and this is what happened. I felt it muddied the water a little by bringing some vague traumatic childhood sexual abuse into her background. It made you feel that her emotional reaction was more complex than just her struggling to handle her job. She is presented as someone who is already very withdrawn and self-contained, who tried to cope alone without asking for help. She takes her role as a doctor very seriously and early on vows to ensure she treats her patients with the utmost respect. But then she knows rationally that things are not right, and she steels herself to continue, for the sake of her patients.
The writing is very intense and intimate, you are right inside her head, feeling what she feels, thinking what she thinks, picking up the tiniest of sensory details about her physical surroundings. This quote is very vivid, and very familiar:
"Even from the outside, my primary school looked gloomy, a Victorian building set in the middle of black asphalt. The playground roared with boys, and they invaded everywhere, including the outside loos, which I tried to hide in during break-time. These loos stank and has see-through crinkly paper into which the pee didn't blot but ran off along its sharp creases into your hands." (p.10)
This one is more intense still, during the fateful operation when she is already aware of how she is loosing touch with reality:
"The antibiotic bullet is in my right hand. I hold it in a pincer grip between my thumb and forefinger. I don't want to look at this hand, would rather not discover if it is still mutinous. I prefer to control it by feeling what it needs to do, by stereognosis alone. The sanitary pad is in my left, reliable hand. The hand that belongs to me. The hand I can depend on. I am lifting the pad through the air from the trolley to where I will tuck it snugly just under my patient's buttocks, while listening to May. It looks fat and clean. I am pleased by its whiteness against the faraway gloom of the operating theatre behind it." (p.143)
The author is an experienced surgeon but it's not until the end that she spells it out for you. She very tactfully puts in in italics, inviting the reader to skip this bit if they so choose. We use very distant language when we talk about abortion: people are 'referred', sent somewhere else, to someone else, some nameless faceless person who actually does the abortion. It is all very clean and clinical and tidy. But you don't get off that lightly here. It is laid out for you in black and white, you are confronted with the reality. Don't shy away. If you believe in a woman's right to control her body you should not shy away. A woman's right to control her fertility is the most important way out of poverty. I think women should have lives that they are in control of. I think children should have the right to lives where they are wanted and loved and valued. The world will be a better place when these rights are available everywhere.
"At five or six weeks' gestation, this is the size of a woman's little fingernail. The sac and the desidua look quite similar at this stage. The way to tell them apart is to transilluminate the tissue. This involves floating it in a tiny glass dish, over a light. By doing this, you will recognise the gestational sac because it looks like a tiny piece of coral. It is fronded. It is not upsetting to look at. it is pretty, and looks like a plant. There is nothing humanoid about it.
...
But even before you switch the pump on, it is a hard situation to be in. We use ultrasounds all the time now. And before you even start, the ultrasound shows you a human image on its screen. After a while of course, this image and the subsequent disintegration of this image does not affect you as profoundly as it may do on the first occasion. Everything gets easier with time. This is not a mark of the abortion provider's moral decrepitude, surely? It is a fact of life, that some things get easier and easier.
...
Holding heavy forceps, feeling the mixture of give and resistance in the tissue they grasp, with only the instrument between my hands and the dismembering of a foetus: the dismalness of doing this for the first time is dreadful. It also feels like a moral act. You cannot just walk away from a problem. You cannot be a gynaecologist and leave this work to someone else. That is cowardice. That is what I think." (p.171-4)
Not for the faint-hearted.
Woman Care Global - a charity that works directly to provide reproductive healthcare
sounds like an interesting and powerful read...
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