I first came across the writer and medic Gabriel Weston when I read her debut book and memoir Direct Red (2009), which won the PEN/Ackerly Prize for Autobiography. I liked it. Weston’s personal account of the challenges of balancing clinical committment in a morally ambiguous (male) world resonated strongly for me.

Weston’s current book is also her first work of fiction. However, with the scenario remaining firmly within the world of medicine, the workings of a medical mind behind the pen of Dirty Work were apparent throughout. Clinical moral dilemmas remain pervasive in the novel, specifically in this case that of doctors performing abortions.

I enjoyed the experience of reading Dirty Work, particularly when Weston’s medical background facilitates thought-provoking reflections:

‘A good doctor needs to know how to spin a yarn. That’s what they teach you at medical school, though no one ever says it in so many words… They call it history-taking, this supposedly neutral process in which a patient and doctor collaborate to weave a shape out of what’s gone wrong. They make it sound straightforward.’

Weston continues to consider how, as doctors ‘take the history’, they encourage patients to dwell specifically and exclusively on symptoms, ‘ignoring the white noise of emotion’.

‘The doctor is rewriting the patient’s story while seeming only to bear witness to it.’

A mistake, a clinical error, results in suspension for the female medical protagonist, who is subsequently investigated by the hospital Fitness-To-Practise committee. The novel follows her throughout the three week questioning period, and witnesses her change of attitude towards medicine in general, as well as the part she herself plays within the field.

She learns much about herself throughout this process, and concludes:

‘I have done much worse than not articulating the particularities of my own experience. I have been deaf to those of my patients.’

‘What a doctor needs…is a quiet appetite for truth.’

I enjoyed the experience of reading this book (an experience that reminded me of Louise Doughty’s Apple Tree Yard, perhaps the not dissimilar themes of female protagonist, career woman, moral dilemma, ‘perfect’ life going astray…).

The plot went a little off track for me towards the end. The ending itself left me dissatisfied, and brought to mind something I heard the film director Mike Figgis say recently. Figgis deliberately chooses open-endedness in his films, this sense of not being finished or closed allowing viewers to create their own conclusions. Whenever he reads a book, he stops 20 pages or so before the end, as most imposed closures ultimately disappoint. I can relate to this. The ending in Dirty Work was not a ‘bad’ one. It just left me a little disappointed, and flat.

It will be interesting to see where Weston’s writing heads from here. To date, her medical background informs the content of her books. Whether she will stick to this theme or whether she will explore other literary terrains, remains to be seen.