Dirty Work, By Gabriel Weston. Jonathan Cape, £14.99


In Gabriel Weston's first book – prize-winning Direct Red, a memoir of life as a junior surgeon – she related an incident in which she panicked doing a tonsillectomy, and asked for the consultant. The answer was stark and brutal: JFDI ("just fucking do it"). Many doctors will be familiar with this moral dilemma, with juniors pressurised to do tasks for which they feel unprepared.

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A similar ethical conundrum forms Weston's first novel. Nancy, a gynaecologist who carries out abortions, is up before a panel of General Medical Council investigators assessing her fitness as a doctor. This follows an incident in which she froze in theatre while a patient almost bled to death.

The subject matter is brave and necessary. Abortion tends to polarise between those who condemn or condone it absolutely. Many who believe in the right to abortion but would be uncomfortable facilitating or performing one are unrepresented in the debate.

Weston is a superb writer of lucid and evocative prose. She captures with striking power the emotional impact of abortions on women cornered by circumstance: "There is nothing easy about the tears that sneak out horizontally from a woman's eyes, that course not down her cheeks, but towards the ears, because she is lying down."

The stress of fitness tribunals is conveyed with stomach- lurching plausibility. Nancy's ordeal is interspersed with fragments from her past – tending an injured childhood friend; her first love and its aftermath; seeing a much-admired surgeon behave with callousness towards a distressed patient. Weston is a subtle writer, not a bludgeoner: growing cress seeds is a metaphor for creating life, a contrast with her future job. There is wry humour in her portrayal of the difficulties female doctors face, such as forgoing a private life to succeed, or the hostility from other females who resent other women impinging on "their" territory.

Apart from one short, harrowing section, this is not a dark book so much as a deeply thoughtful one. I would make it obligatory for the medical curriculum.

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