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BOOK REVIEW / Making babies in the polka dot: 'Sugar Cane' - Paul Bailey: Bloomsbury, 14.99 pounds

'I WORK with human genitals.' This is the first sentence of Sugar Cane, and its theme: what people do with their reproductive organs, and why. Virtually the only thing they don't do, in the shadowy world of male prostitution and the VD clinic, is reproduce. Although one birth has occurred by the end of the story, the baby's father was only able to achieve paternal status by putting on a dress so that his woman could, excitingly, unzip him. The woman, incidentally, learns to relish the ritual: 'I fancy you in the polka dot tonight,' she says.

The woman is the narrator, Esther Potocki, a venereologist working in a London hospital. Her job allows Paul Bailey to introduce various oddities who present themselves as her patients: Marcus, who will not believe that he is healthy and keeps returning to the clinic to be cured of the gonorrhoea he could not possibly have caught; Mr Lollipop, who is tattooed with an accurate and detailed map of the island of Curacao; Horace, an ancient and filthy syphilitic tramp. These people walk into and straight out of the book, forming a background frieze of pathetic caricatures.

In the foreground is Stephen, whose mother, in a rare moment of tenderness, once called him Sugar Cane. The book is really his story. A half-caste from Halifax, he has run away from a brutal, racist stepfather to be picked up in London by a bogus Bishop and introduced to the 'circuit' as a rent boy. His best friend, Tonio, is dying of Aids in Dr Potocki's hospital as the novel opens. After Tonio's death, Stephen attaches himself to the doctor, appearing out of the blue as she leaves work and giving her presents. The first is a volume of Chapman's Homer, but if that provokes hopes of travelling in realms of gold, they are soon dashed. The details of his life that Stephen lets slip, in tantalising asides, suggest a tarnished and tawdry underworld.

Meanwhile the doctor's own life story is gradually revealed. Bailey makes his job of impersonating a female narrator easier by presenting her as utterly unfeminine. The only child of a Polish emigre with aristocratic pretensions, Esther proves to be too large to become the ballerina of her mother's dreams.

With her father's support she takes to medicine and marries a Jew, which is altogether too much for her mother. The father proves to have had a penchant for photographing the pudenda of her mother's friends, the husband dies rapidly of drink, the mother goes mad and Esther discovers Stephen.

The second half of the book is Stephen's story as revealed on a tape he presents to Esther before disappearing. As she listens, Esther describes it as his descent into Hell, but the story is told in a curiously detached, antiseptic way. Even the lurid practices, which he describes in some detail, somehow fail to shock. Perhaps that is the effect of enduring all the earlier case histories, or perhaps it is because nothing really very terrible actually happens to Stephen (in fact, nothing more terrible than a lot of . . . well, licking, actually).

The wicked bogus Bishop is far more comic than sinister. In his 'palace' in a Wandsworth warehouse, this combination of Fagin and the rascally Rector of Stiffkey lives like a lord on the immoral earnings of his acolytes. He is partial to vodka and fancy-dress and thoroughly enjoys hearing the boys' 'confessions'. For some reason, the local community admires him for his unspecified good works, the fishmonger even giving him smoked salmon for his equally bogus cat. After the only really horrible episode, when he has employed a hideous thug to beat him up, he appears on television the next evening as a panellist on 'Questions of Faith', and expresses abhorrence of sexual deviance, thundering 'I cannot forgive what is wicked'. It is hard to take seriously, and as irony it is pretty clumsy.

At the beginning of this book, under the copyright symbol is an odd little statement: 'The moral right of the author has been asserted.' Some variant of it occurs in most new books, presumably for legal reasons. In this case though, it sets you thinking. Paul Bailey is a clever craftsman, adept at playing with changes of time and voice, but the 'moral right' he seems to assert is a bleak one, offering only the tenuous hope that is voiced in the last sentence: 'I sense . . . a fragile need for enchantment sustained against a mountain of terrible odds.'