Peripheral Vision, by Patricia Ferguson

A surgical eye on the blurry side of life

Most successful writers of English literary fiction share the same difficulty: they lack experience of work as experienced by ordinary people. Pat Ferguson, a former nurse, has a very different problem. Despite winning the David Higham and the Somerset Maugham prizes for her early novels, and being long-listed for the Orange Prize two years ago with It So Happens, she cannot, in common with many other middle-aged writers, find a mainstream publisher. If you want to read Peripheral Vision - and anyone looking for the new Muriel Spark should do so, immediately - you will have to order it from the tiny independent Solidus.

Yet its subject is one that will be immediately recognised and enjoyed by fans of Kate Atkinson. How are three women, separated by geography and 50 years of history, related? Sylvia is an eye surgeon, in "the awkward position of having everything she had ever wanted". Successful, clever, pretty, she has been brought by childbirth into the mess that is most people's experience: "the waiting possibilities of pain, and fear, and death". Although it will do her no end of good in the end, she is furious. She can't love her husband or her baby.

Back in 1953, another child is being nursed by Iris. The child, George, is about to lose an eye due to an accident; the operation, described in tender yet gruesome detail, will not save his sight, but the real damage goes far deeper. George, too, is an unloved child, and Iris unwittingly does as much to heal him as Rob, the posh young doctor who wants to marry her.

George's mother Ruby is the daughter of an immigrant who has risen thanks to a good war. She wishes her son dead now his beauty has been ruined; harrowed by guilt, her perfectionism drives her mad. Humiliatingly, she even fails at suicide.

The third woman in the story is the most poisonous, and the most amusing. Rob's mother May has an unerring eye for quality, and is appalled at her son's fiancée. She knows that Iris comes from the kind of family that does not have a maid, least of all one as devoted to her as the silent, sinister Meadows. How the devoted Meadows deliberately destroys the couple's happiness and trust, and how their tragedy echoes down the generations is a story that is woven into a Modernist collage of past and present which, against many odds ends with love and optimism.

Ferguson skewers snobbery, selfishness and malice with deft, almost aphoristic phrases, and her intelligence needles her creations out of their individual ruts; but it is her understanding of suffering which cuts deepest.

As in her collection of short stories, Indefinite Nights, she has special knowledge, writing about things that can only have been seen by a doctor or nurse. "How could this personal instrument of the spirit have working parts, like a bicycle?" a surgeon wonders, mending an eye.

An utterly absorbing and captivating novel, Peripheral Vision explores both sight and insight, in which people miss noticing what is really important but, like Ferguson herself, not obvious - except, of course, with hindsight.

Amanda Craig's latest novel is 'Love in Idelness' (Abacus)