Dirty Work

by Gabriel Weston

An informed and arresting debut novel about a young surgeon in crisis, by a writer whose "exactitude of expression is rare and uncanny." ( Rachel Cusk )Nancy Mullion, an obstetrician-gynecologist whose botched surgery has put a patient in a life-threatening coma, must face a medical tribunal to determine if she can continue to practice medicine. Nancy's fears about both her patient's chances for survival and whether she will be "undoctored" are made palpable to the reader. Throughout four weeks of intense questioning and accusations, this physician directly confronts for the first time her work as an abortion provider--how it helps the lives of others but takes a heavy toll on her own.Interweaving memories of Nancy's English and American childhood and adolescence, Dirty Work creates an emotionally charged portrait of one woman's life; the telling of seemingly untellable stories sets her free, as it can all women. Gabriel Weston has given us a truly original, courageous, and meaningful novel.

Genres: Fiction, Medical, Medicine, Contemporary, Unfinished, Audiobook

192 pages, Hardcover

First published June 6, 2013

Reviews

[Sharon · Rating 2 out of 5]

I had high hopes in the beginning of this book. Some of the writing was sooooo lovely -- in the first few chapters, there were many lines that I reread just to admire Weston's voice. I also thought the topic would be really interesting. I've worked in a perinatal unit and thought there was so much potential in the topic. But I just couldn't connect with the main character, Nancy. I felt like her reflections on her past were supposed to give me perspective into her but some how it all felt very disjointed and disconnected to me. I tired of Nancy realizing that she's tuned out and missed half of what another character said to her or rehearsing what she was going to say and then saying none of it -- I get that this was supposed to show how bewildered she felt by her own failure, how devastated she was by the fallout, but it just didn't work for me. At the end I just felt like I had wanted something more from Nancy.

[Carol · Rating 4 out of 5]

My initial interest in Gabriel Weston's debut fiction was prompted by an article I read about her memoir I liked that she pushed the envelope and will admit that surgeons are not infallible. They are human, they make mistakes. I know that Direct Red: A Surgeon's Story., a collection of twelves stories about her work in surgery, this still predominant male world and the patients she treats, will be read by me one day. In the meantime I picked up her debut novel Dirty Work to see what she's got.

Dirty Work is the story of Dr. Nancy Mullion, an obstetrician gynecology surgeon.

Nancy's specialty is abortion. She practically does these in her sleep until one day when something horrible goes wrong. The patient on her table is bleeding out and rather than being able to stop it, Nancy freezes, necessitating an emergency call to Nancy's supervisor who must take over in an effort to save the patient. Nancy is brought up before a review board. This method is used to give us the past, the present and possibly the future of who Nancy is.

Early on Nancy explains to us that surgeons pick an organ to look after.

"We gynecologists have the womb to look after. ... And whichever specialty we choose, each of us has to do something ruthless to keep our patient safe: We have to forget about the human significance of the organ we're operating on."

In a flashback she describes when she became herself:

There is a point in each of our lives when it seems that the real story begins, when we become the self that all our ensuing life somehow trails out from This may just be the time, around three or four, when memory begins. But my birth, in this sense, occurred during one flowing American fall. This is when I became myself. The girl before this time is a shadow like a soul who is practicing how not to become. She is the background, the hole in the fabric fro which the real shape is cut"

This is not an easy read as Weston explores the emotionally charged subject of abortion. Imagine what it would be like to be the outcast, the one who does the dirty job of terminating pregnancies? Her protagonist is low on the totem pole in the rank of surgeons. She lives without support from her peers, a solitary, sad, lonely role.

Fair warning, Dirty Work has scenes describing abortion that may be offensive to some. It certainly made me think, took me back to my own pregnancies, miscarriages and time training as an LPN. It has the makings of a good book discussion if participants can respect the view point of others.

[Fiona · Rating 5 out of 5]

A nuanced and powerful novel about abortion told from the perspective of a doctor who performs them. It looks at the realities of the procedure and the difference between early and later terminations, suggesting that if we are to accept the right to choose we should not shy away from what this really means - and also suggesting that those who are pro-choice are wrong to leave the images and the "truth" solely in the hands of the anti lobby. The author also suggests that to be theoretically in favour but to shy away from the reality is a form of cowardice.
It is a fascinating look at how we use narrative to try and make sense of the world. Also really interesting on the subject of medical negligence, how it feels to be judged, and what the impact of abortion is on those who provide it. I came away with a real sense of the main character as a brave and principled woman, and the author the same, for being prepared to write about a complex subject in a thoughtful way, showing all its shades of grey, in a field where arguments are so often polarised, simplistic and reductive. Compelling reading

[Michael · Rating 4 out of 5]

Gabriel Weston's thought-provoking "Dirty Work: A Novel" examines the ethical issues facing a doctor after a botched surgery. Dr. Nancy Mullion faces a medical tribunal over a four-week period, and during that time, she reflects on her life as an ob-gyn specialist who performs abortions. Weston presents the dilemma of doctors providing procedures while dealing with personal issues, including those they may not be aware of in their practice. Weston, who is also an ear, nose and throat surgeon in England, manages to keep the first-person narrative flowing, including the use of medical terms, as the protagonist agonizes about her fate--as a doctor and person. Louise Aronson, a professor of medicine at the University of California, San Francisco, notes that Weston "captures...the complexities of medicine in those areas where doing the right thing is imaginably hard." I concur. This is an insightful and informative novel that presents both sides of a controversial issue in society.

[Claire · Rating 1 out of 5]

I hated this book. I found the meek and passive protagonist to be completely unlike every doctor I've ever known and worked with, so much so that I disrespected her. The story itself was so poorly explained, all we read are one woman's endless self doubt and lack of assertiveness. At one scene in the "trial", they talk about her good grades, multiple publications, good reviews from supervising surgeons - I had a hard time believing that, and had a hard time believing that this person who passively allowed herself to be steered and directed- by boyfriends or by senior colleagues- would ever be a doctor worthy of a fellowship. She is never shown to be taking any responsibility for anything and never shown to be taking ownership of either her feelings or her actions. This is the antithesis of professionalism, imo.

[Magnus Jorgensen · Rating 4 out of 5]

Dirty Work is a painful and nuanced look at abortions, and how they affect not only the recipients, but the surgeons as well. I came upon this book by accident, and I picked it up due to the overturning of Roe v. Wade bringing reproductive rights squarely into focus for me. From all the blurbs and praise for this book, it sounded like a bold and uncompromising take framed around a doctor, Nancy, having to face a medical tribunal due to a mistake she made during a routine abortion. Weston did a good job weaving the main character's personal history with her present dilemma, it's one of those novels that moves very quickly, the writing style is very sharp.

When I described the book to my friend, I found myself having to reassure them that this was not a novel walking the line between pro-choice and anti-choice (I refuse to say pro-life, but I won't get into it). I need it to be clear that this novel is not anti-abortion, it just explores abortion in a different light then I am used to seeing it in. Just like how I am very pro-choice, but I wouldn't be able to perform a termination surgery, doctors who choose this specialty may not know how it will affect their mental health. Nancy has some combination of professional burn-out mixed with PTSD, which has been accumulating for what seems like her whole professional career. I'm happy I read this book, and I feel like I would recommend it to anyone who wants to see abortion in a different light.

[Melissa · Rating 3 out of 5]

Kind of both melodramatic and boring, but honestly how else do you expect a take on abortion surgeon life to be? 3.5 stars, I would read more of this niche

[Naresh Kumar · Rating 4 out of 5]

This is an excellent book providing insights on daily life and challenges of an abortion provider. They work so hard to become a doctor and have a harder job to do but still they are not given the same respect as given to their colleagues from other departments. Society and even doctors don't see them eye to eye.
They are doing a noble job just like any other surgeon. Yes, they are also saving lives and Gabriel Weston ends the book by saying it aloud in a very precise and concise manner.
Nice job on a debut novel.

[Bonnie Brody · Rating 4 out of 5]

Nancy Mullion is a trained surgical obstetrician/gynecologist. She has chosen to terminate pregnancies for a career. That's right, she is an abortion doctor. As the novel opens up, she is in surgery, having done four out of five procedures for the day and is on her fifth. Something goes dreadfully wrong and the patient starts bleeding out. Nancy is helpless to do anything. Everything she has learned leaves her and she watches helplessly as her patient lays there dying. Luckily, another surgeon on duty is called into the room to take over and the patient ends up in the Intensive Care Unit, hanging on to her life by a thread.

Nancy is up for review by the hospital board because of what happened. As she worries about her four meetings with the board, including one with a psychiatrist, Nancy goes back in her life to share with the reader what has transpired up to this time to make her the person that she is.

Despite her being suspended from practice and not allowed in the hospital, she goes to the ICU "where all my thoughts lie with my ailing patient". She sits in the waiting room keeping vigil, hoping that her patient does not die.

She often asks herself how she could have ended up performing abortions for a living. She states that she "considers it to be a life-saving procedure". "It's saving the life of a woman, it's something that saves a woman's freedom." She looks into herself to find that part of her that is compassionate and caring. She tries to put her patients' welfare first and is proud of the work she does. So what happened in that surgical room? Why was she unable to act when she saw her patient bleeding out?

Nancy also wonders, as she waits for the verdict, what her identity will be if she loses her ability to be a practicing physician. "How on earth will I manage if I am erased, removed, struck off the medical register? I will lose my entire farm of reference. And what would I have to replace it? What is a doctor, if not a doctor? Take that title away and there may be very little left over.

The reader gets to know Nancy as a child and as a woman. Aspects of her life that are relevant to the current situation are reflected on and considered. I wished for more of a background rather than the small amount that was offered. What was her relationship with Julia, her sister, like as a child? Why did she really enter the field of medicine?

The book is a psychological mirror into the life of a woman who is reflecting on what has brought her to face a hospital board for negligence in her field. It is also an in-depth look into the kind of work she does and how it impacts her emotionally.

[Robert Blumenthal · Rating 5 out of 5]

I would like to preface my review with the information that I am a strong supporter of a woman's right to choose to have an abortion or not. And I find much of the tactics and rhetoric of the pro-life movement to be very distasteful and ignorant of basic medical and biological facts. And yet, there still is something about abortions that are troubling to me, and I feel that it is important to understand all of the parameters of this procedure, both medically and emotionally. I found this short novel to be very provocative and emotionally rich. Although the author is clearly pro-choice (the main character as much as states that as clear as a bell), she also realizes that there can be much trauma around having the procedure and it can have a significant emotional impact on various people. I had a friend who had had an abortion and was strongly pro-choice. We went to a science museum where there was a display showing a developing fetus, and she had to leave the room because of how negatively affected she was by it. She never fully regretted having the abortion, yet she still had an emotional reaction to being visually reminded of it. This is how I look at this book. The narrator realizes how important the procedure of abortion is to the well-being of many women. And she also realizes that there is a "human" element to the fetus that is removed and subsequently destroyed. No, it is not taking a life and it is not a sentient being that is being removed. But it sure looks more like a human being than a kidney does. And the narrator was one who was emotionally affected by this fact and was temporarily unable to perform her duties as an abortion doctor because she had never really dealt with it. The novel is very well-written, with a back story of the narrator being presented as she waits to hear the verdict of what will happen to her after a patient of hers almost dies due to her inaction. There was a point in the book where I was afraid that the author was going to wade into pro-life territory, but, IMHO, I don't think she did. Lionel Shriver, one of my favorite authors, described this novel as "brave." I couldn't agree more.

[Courtney · Rating 1 out of 5]

Promotion of anti-choice ideas couched as an exploration of the ethics of abortion told from the perspective of an ob-gyn. I thought this book would be intelligent, balanced and scientific because I read about it on NPR. Instead, I found it disappointing and dishonest.

The premise didn't sit well with me, because boiled down to its essentials, it assumes that there is something "dirty" and shameful about abortions, and that, abortions terminate life. Physicians routinely perform (and have some clinical distance from) gut-wrenching procedures that seem repugnant to the layperson. Yet, here, our anti-hero purports that each abortion carries some degree of sadness. Moreover, in her view, with each termination, she, as a provider, crosses a theoretically immoral line of no-return. Simultaneously, she fails to recognize how critical her care was to her patients and the value of her profession to the world at large. I simply do not believe that the modern, ob-gyn community shares that view.

Where are the patients who are relieved, who thank her for helping them carry out an important, life-changing decision to not be forced to carry an unwanted pregnancy, or the women who, in fact, aren't sad about their choice? Where are the doctors who don't face inner conflict and guilt about performing abortions? In Weston's world, these people don't exist. This story does not do justice to the women who undergo the procedure nor the doctors who provide abortions.

[Damaskcat · Rating 5 out of 5]

Nancy is a surgeon. She is facing a disciplinary hearing at the hospital where she works because a patient suffered serious bleeding during an abortion which she carried out. The book covers the four weeks of the hearing which we see from Nancy’s point of view. During that time she reminisces about what led up to her mistake and how she feels and thinks about her work.

I found this a harrowing read and even though it is fiction it has the ring of truth because its author is herself a surgeon. As a study of how carrying out abortions affects the professionals involved it is devastating and searingly honest. Some of the images are likely to reappear in my nightmares. But this is not an anti-abortion rant dressed up as fiction – it is an absorbing novel which will almost certainly cause you to examine your own views of this always controversial subject.

Whether or not you like the narrator herself, and I didn’t always like her, I wanted things to work out somehow for her and for her patient to live. Human beings make mistakes – they are not perfect – it is in how we deal with those mistakes that our level of maturity is revealed.

[Emmkay · Rating 4 out of 5]

I read Gabriel Weston's memoir of her training as a surgeon, Direct Red,a while back and was very impressed but also unsure what I thought of it, perhaps because there is something in her measured, inward-looking prose that pushes me away a bit as I'm reading. Dirty Work,though a novel, has that same quality to it. It's not a bad quality though: it's one that makes me pay close attention to what's going on and my own reactions. This is a novel about a female ob-gyn whose practice has come to include providing abortions. One day she freezes in the face of an adverse event in the operating room, and as a result is subject to an inquiry into her fitness to practice. The novel is structured around the four meetings of the inquiry panel, and Nancy's inner thoughts as she considers how she has reached this point. I'm still not sure I would say I 'liked' it, which seems too anodyne a term, but it was challenging on many levels and gave me lots to think about, particularly on the themes of silence and gender. Very worthwhile reading.

[Jill Elizabeth · Rating 5 out of 5]

Wow. There is so much to say and yet, like this amazing book's protagonist Nancy, I find myself unsure of where to start and where to stop and how to manage it all without resorting to italics (that last bit will make sense after you read this incredible story). There are so many things I could say and so many things I want to say and so many things I feel need to be said - but there are also so many things that I need to think about, so I'm going to leave it at this: this is a radically necessary (yet all too often missing) piece of the long-running "conversation" (and yes, ironic quotes, because I rarely think there's anything even remotely resembling actual civilized conversation in this emotionally-charged topic) about abortion. What a read - not for the squeamish (in both descriptive and emotional contexts), this is a powerfully charged yet deftly maneuvered tap dance amongst personal and politico-moral (my own word, but you know what I mean) land mines. An extraordinarily well-managed handling - well done Gabriel Weston...

[Michelle · Rating 4 out of 5]

I bought this book ages ago--probably based on a review--and finally picked it up. I didn't re-read the cover copy, and I'm glad because it made the unfolding of what would be a beautifully-written but straightforward narrative more compelling. We know from the start this is about a doctor who has been involved in a medical procedure that went drastically wrong and the board is deciding whether to revoke her license. It's a slim tome, but gorgeously rendered. There are a lot of tough topics to analyze here and it's definitely not for anyone squeamish. It would make for a fantastic book club read but in many groups would prove extremely controversial. I wish there was a little more meat to the story...it's really more about the protagonist's career versus the protagonist herself. For me the strongest aspect to the story was the analysis of her career and how she ended up in this place. Well done.

[Sarah · Rating 4 out of 5]

Nancy Mullion is facing a medical tribunal at her hospital, after she freezes during a surgery and is unable to get her patient to stop bleeding. Another doctor is called in to save the patient, and the patient is in serious but stable condition. Dr. Mullion is a gynecologist, who performs abortions as part of her surgical rotation. Her medical background is impressive, and she's skilled in what she does. This novel takes a challenging look at the issue of abortion, and how it can affect those who perform the procedure, as well as the women who undergo them. Dr. Mullion has to face her responsibility to her patients, while maintaining enough empathy without it affecting her work.

Well written, quick read. Interesting moral conundrum.

[Dasha · Rating 5 out of 5]

I read this novel in two days. That is to say, it is a gripping and fast read, but not an easy one. In fact, in parts, it is deeply terrifying. It is a powerful and brave narrative, with a protagonist so seemingly absent and daydreamy at times, yet actually very thoughtful and complex. I liked Nancy (the protagonist), then I really disliked her, and then I liked and sympathized with her again. I applaud Weston for taking on such a difficult and political topic (abortions and women's right to have a choice), and making it so deeply felt and personal.

[Catherine · Rating 5 out of 5]

I won this book free on Goodreads and wasn't sure how I'd feel about this one in particular,but it turned out I thought it was a great book. It put a whole new outlook on my thoughts and ideas about some certain medical procedures. The Book was well written,easy to understand and follow,even with some of the medical terms. I read this book in one day that I was camping,so it would be a great book to head to the beach with.

[Louise Aronson · Rating 4 out of 5]

Small, powerful novel that explores an ethically complex issue (abortion) in a way that is not didactic and unfolds with the exploration of a character in a difficult situation.

[Lou · Rating 4 out of 5]

I’m not really sure what to say about this book it’s powerful that’s for sure But gets pretty graphic at times. I didn’t know what it was about, all the blurb on the back said was ‘two women in a room, one is dying, the other just sits back and watches, for both there is everything to lose. This really intrigued me which is why I picked up to read, so when I realised what it was actually about I was quite shocked. It’s quite a journey. Nancy is distanced from her own life she’s telling us what happens but there are gaps,and she isn’t focused or paying attention. It takes time to realise what’s happened to her, that her naivety and her desire to be a good doctor has clashed with the reality of doing the job she’s exceedingly good at. When it all comes to a head she is left with a patient bleeding to death on her operating table and no idea how it came to be like this. The novel is partly the medical investigation and partly her slowly realising what led up to that day. At times it could be hard to follow but only because she misses parts herself. One minute she is alert and listening the next an hour has gone past and she has no recollection of what’s happened. She really is in a fog, her whole career could crash around her and she has no one she can talk to about it. Or at least no one she lets herself talk to. She has been alone in some way her whole life.Abortion was always going to be a difficult subject to bring into a novel especially from the point of view of a surgeon. But the author doesn’t hold anything back it’s all there in graphic detail which made for uncomfortable reading at times, Especially towards the end of the book. I can’t decide if this is a three or four star, for because it was well written and dealt with the subject matter in some sensitive way stopping at three because there are still gaps in the story I would’ve liked to have seen from her sisters perspective for example how she was actually feeling about the whole situation and what her sister did.

[Jeff Koloze · Rating 2 out of 5]

Gabriel Weston’s novel of a British abortionist under review after a mother nearly bled to death isn’t a surprising read. The hospital panel eventually finds Nancy Mullion fit to be a doctor. Since the hospital allows her to continue to be an abortionist, the plot has a sad ending.

Mullion’s language shows that she is a typical abortionist. She has no religious foundation, views abortion as just something that any doctor should do in the course of his or her duties, and is antagonistic towards pro-lifers, even venturing the ad hoministic opinion that all “civilized” people are anti-life (116).

The passage where she offers “some kind of reverence” to the aborted child by making sure all of his or her body parts have been gathered after the abortion is ridiculous, yet credible, now that David Daleiden’s investigative journalism shows that the abortion business Planned Parenthood does just that when it sells aborted baby body parts (179).

Also, like a typical abortionist, Nancy does not see the unborn child as her patient equal to the mother. These characteristics are typical of abortionists.

One well-written passage of process analysis writing occurs when Weston shows how her narrator slid to becoming a mere abortionist instead of a doctor (121-125).

Overall, this is a standard narrative of an abortionist undergoing, as the book says, “perpetration-induced traumatic stress”, a category of PTSD assigned to those who kill (163). Since abortionists are killers, it’s no wonder that the narrator is tortured in her 180-page attempt to resolve her trauma.

Unfortunately, Nancy Mullion’s perpetration-induced traumatic stress will endure as long as she continues killing the dirty work of killing the unborn.

[Zef · Rating 4 out of 5]

I read this book as part of the Ultimate Reading Challenge: March, an author who is new to you.

The first thing I feel I should mention is that the key theme of this book is abortions. More specifically, it is written from the point of view of an abortion provider. When I started reading it, I had no idea. It didn't cause a problem for me, personally, but I feel that the topic is such a sensitive one that it might cause undue distress to someone who picks it up thinking it's about general surgery only to discover the true nature of its message.

I found the writing itself to be excellent; accessible and engaging. The author flits between current events in the life of the protagonist (Nancy) and memories of previous life-events which have impacted or influenced her emotional and career trajectory as well as her current state of mind.

The story has some intense emotional themes and was disturbing in places. However, I felt that this was powerful and enlightening. Many people are aware of the distress that abortion can cause to those who experience it as a patient: I know I never truly thought about what it might be like to those practitioners who provide this service. As a pro-choice woman, and a mother, I genuinely believe in a woman's right to control what happens to her body and, ultimately her life. But what would happen if, despite being legal, abortions were unavailable because there were no doctors willing to perform them?

This book truly opened my eyes to something that is still very much not spoken about. One reviewer described the novel, by author Gabriel Weston, as brave. I agree. It takes courage to openly tackle such a taboo topic and elegance to do it without being confrontational or derogatory.

[Wendy Greenberg · Rating 4 out of 5]

A surgeon, an error, major haemorrhaging open this novel which circuits the abortion debate. A debate focused not upon the ethics but about those performing the different procedures and the constant grey areas of medicine.

The book's structure holds the arguments well. It is divided between the incident itself to the stages of the GMC investigation into professional misconduct which we hear from Nancy, the surgeon. We see both the buildup to this moment and experience the panel enquiry within her headspace of past and present. It is the conflict between her personal beliefs and what brought her to the moment she froze that feeds the narrative.

The undercurrent of how to identify her failing that haunts the protagonist and gives the reader an uncomfortable ride. Wanting to do the right thing for her conscience? Doing what is required? Not dealing with doubts as they festered? Or even just that she has accepted the scope of her position and all its "dirty work" without interrogating herself? Not living up to professional standards?

[Lisa (the.running.bookworm) · Rating 2 out of 5]

I picked up this novella at the library on a complete whim; not knowing any thing about it or what to really expect. It turned out to tackle the issue of abortion and followed one doctor’s journey through a disciplinary hearing after she allowed a patient to bleed out on her operating table.
I feel the author was brave to take on this topic and the story line was there, however I do not feel it was executed very well. I found some of the writing laboured and forced. It did not flow very well, and at times I felt like medical jargon was included just to show the author knew the terminology. I also found the last few pages to contain far too much graphic detail on abortion I did not need to know.
Great topic, could have been so much better.

[The Book Posh · Rating 4 out of 5]

Dirty Work by Gabriel Weston tells the story of an ambitious young surgeon whose surgical mishap sends her head-on into a journey of intense scrutiny by the medical board and a personal review of the steps leading up to the incident that left her patient in a coma. The story weaves in and out of her childhood in England and America and her medical internships. She takes her reader into the operating room with fantastic imagery and tells a deeper story about the "dirty work" involved in her profession. This short novel is courageous and draws the reader into a doctor's feelings. This novel is original, passionate, difficult, and necessary. It is a deep and thoughtful read.

[Bookwormthings · Rating 4 out of 5]

Challenging, interesting, but unresolved.

I thought it handled well the dichotomy of what you present to the world, not necessarily matching your internal feelings. Her very passivity and detachment from tribunal are part of the sequence of events which have brought her to the tribunal.

The issue of abortion was carefully handled and challenges anyone who is pro-choice to face the reality of what it is like for those who carry out the procedure. Profoundly uncomfortable but no less important.

[B99 · Rating 3 out of 5]

The surface narrative of this story is the week on week account of a local General Medical Council process taking a month to examine a junior doctor’s fitness to practice after a life-threatening surgical complication reported to them by the anaesthetist.
Woven into this is the story of the protagonist’s somewhat traumatized childhood and how that led to her life choices. It raises questions about motivation in medicine, specialty choice, coping styles, and senior support. It covers a number of topics that are rarely dealt with in novels: surgical ethics, hospital politics, and professional self-regulation in medicine.

Weston has a flair for describing tangible sensory moments conjuring scenes to life. This was notable in her first book “Direct Red” and remains her style. Setting the book around four meetings works well giving a neat feeling of a stage set which contains the plot allowing the mental meanderings to stray – but not too far.

Looking at reviews elsewhere makes me focus on Weston’s choice of protagonist. Readers do not like Nancy. She is a young woman who is not charming and engaging, who is ambitious and “unfeminine”. Many novels invite easy identifications and projections from the reader onto the hero or even the anti-hero, giving these figures some foibles or monologues that catch the reader. Books that do not do this, particularly when well written, invite distaste and a desire to push away the whole book. They do not seduce one, and for this they are not easy reading. I think this device is used in this book to force the reader into the position of some antipathy towards her, a feeling of irritation with her detachment and her interest in what the bosses think with an almost complete lack of awareness of what she wants and believes. Self-reflection is almost absent and thus she drifts, terrified of losing her key identifier “being a doctor” through these weeks and this judiciary process. She goes over her personal narrative but that remains superficial only seeming to emphasize her inability to develop a meta-discourse about what underpins her choices. The areas she dwells on seem to be turning points where if she reflected on her motives and choices she might find a way to help herself in her predicament. But she seems absent from these points and this leads to a moment of enacted dissociation in her practice that nearly kills a patient. This leads up to the core of the book, an inner monologue about the problems and practicalities of being an abortionist. Interestingly, having dwelt on the unsaid within the narrative, the author here encourages one not to read this. What is it to perform abortions? How does it sound and feel? What do you see? But if you cannot speak of it where can you retreat to? In what silences is it accepted, signed up for, performed? It is a powerful unflinching spotlight on this procedure and those involved in it.

The dysfunctional coping style of the protagonist is rendered beautifully and the writing forces you to follow and identify this structure. As we are told of her inner thoughts we respond to her frightening lack of intimacy with her own self. Even before “dissociative” gets used in the book it was tangible in her blocking out of inputs and not attending to what is said in the hearing. As a psychological study this is good, it examines the personal cost of never being honest to oneself, maintaining a childhood choice of defense that makes her so brittle later.

The psychiatrist in the story has a position that is both in the wrong but broadly speaking supportive of Nancy. As readers we know more about formative events than the psychiatrist does, he has been fed a censored version of events. Despite this obstacle he seems to formulate a “good” diagnosis – framing her case as a form of post-traumatic stress disorder experienced by people who perpetrate acts normally thought of morally reprehensible even if they do so under circumstances when they are permitted or even expected. This narrative strand might well be used to discuss how “taking a history” is affected by the patient and the circumstances. The role of the psychiatrist in judicial situations is fraught with a different relation to truth because of what is at stake for the “patient”. Here the protagonist wishes to ensure that a certain picture of herself is secure, in other situations there are other stakes and outcomes.

This book would be an interesting way to talk about reflection with colleagues and students who are skeptical as to the value of reflective practice. It shows concretely the impact of its lack, both in one’s practice of medicine and in life in general.

It is obvious that it would provide good material to look into questions surrounding fertility and abortion ethics and for junior medical students. However within “Dirty Work” there are several other questions about medicine
– what is supervision about? Who does it? Where is the senior support when things go wrong? And similarly, how and why are roles in medicine accorded status? Is abortion “dirty work”? are neurologists brainy? And orthopaedic surgeons strong but dim? Who and what do these stereotypes serve, and do we as professionals wish to support them?

This is a complex book whose primary narrative would be of great interest to those teaching medical humanities, however there is far more to it than just a discussion of abortion.

[Julie · Rating 1 out of 5]

I wanted to like this book, I really did. However it was a struggle for me to even finish it. The doctor performs abortions--at times she seems very meek and ashamed of what she does and at times she is upset that her colleagues don't take her seriously and leave human part pranks for her. She does not seem to have any conviction that she is doing the right thing or the strength and ego that is commonly found in doctors. She is not a very believable character. This is not improved by the fact that she spends most of the book be by unsure of her mental status and whether it is her fault a surgery went sideways. There is both a pro life and pro choice voice here in the book, but it appears often that the character herself is apologetic throughout ghost the book for the specialty she chose. Sadly, I do not recommend this book.

[Leanne Rathbone · Rating 3 out of 5]

Great read though definitely check trigger warnings before reading because some readers will find the content and the story very upsetting.

I found it fascinating and also a little on the sad side to hear about the surgeons side of things in gynaecology.

Decent read and it was a little bite size book so I devoured it within about half a day.

[Susan Dennis · Rating 2 out of 5]

I'm wavering between 3 stars or 2. I enjoyed this story enormously until the end. And then end revealed it to be way more political - and with a distinct opinion on the opposite side of mine with no cogent or rational argument to convince me. In other words, I feel duped. Ok, I'm going with 2 because while 95% of the book was an artfully told story, the last 5% left me wanting my $$ back.