Ambivalence is one of Miller's strengths. He enfolds the reader in the present tense and wields his writing style as coolly and precisely as a scalpel. The narrative starts in 1772, with Reverend Lestrade (Dyer's alter ego) watching two doctors extract his dead friend's heart. Dr Burke "cuts below the ribs to make an inverted cross, bloody-edged, moist", "takes hold of a flap of skin and fat" and peels it away from the "matter" below, simultaneously searching for evidence of an "invisible tenant". What makes a man more than the sum of his parts?
The narrative hops back a year, to James Dyer's last few months, when he has found compassion but lost his surgeon's nerve. He nearly kills Reverend Lestrade during a routine bleeding. Lestrade wonders later, "What does the world need most - a good ordinary man, or one who is outstanding, albeit with a heart of ice?"
The final time-shift is a leap to James Dyer's 1739 conception. From here the plot effects a chronological ten-league-boots swagger. Mrs Elizabeth Dyer, wife of a Somerset yeoman, is raped during an afternoon of ice-skating. Her resulting fourth child, James, is indifferent, even when smallpox wipes out his family. Barely into his teens, James packs up a mechanical toy of the planets and sets off on a picaresque journey. His first stop is the low-life freak show of corrupt quack Gummer, his second is the gilded home of Mr Canning, who collects freak prodigies in the name of medical research.
Each stage of Dyer's travels has symbolic significance. Canning's house sets Newton's age of science against the forthcoming Romanticism. James acquires knowledge by reading books, including the anatomy of Vesalius, from Canning's library, but is haunted by Canning's fantastical mermaid. Meanwhile, Miller is expertly manipulating a sense of foreboding. The reader's sigh of relief as James slips away from Canning is cut short by the appearance of a gang of sailor-robbers.
The next phase of the book - James's escape to sea in a man- of-war - is told largely through letters sent retrospectively by ship's crew-members to Reverend Lestrade. Here Miller shows his technical skill. Just at the right time he can change tone and pull back to give a variety of views of his central character, whom by now we dislike.
Miller revels in his anti-hero's ruthless bid to become a feted surgeon. However, when Dyer wins a place in the "extraordinary race between the doctors" to inoculate the Empress Catherine of Russia, Miller's pacing falters. It seems Miller doesn't thrill to redemption. Dyer in the madhouse, embracing humility, physical love and the pain of loss, remains distant even though the rest of the book has brought him vividly to life. Dyer's enlightenment may not be totally convincing, but his death is still moving.
Miller's evocation of the period is thorough. Many of his sentences speak paragraphs, his paragraph pages. Ingenious Pain is a book that gives visceral pleasure.Reuse content