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Fiction book review
Dirty Work
  1. Sam Rowlands,
  2. Shelley Mehigan Raine
  1. Clinical Lead in Community Sexual and Reproductive Health, Dorset HealthCare, Bournemouth and Visiting Professor, Bournemouth University, Bournemouth, UK; srowlands@bournemouth.ac.uk
  2. Nurse Specialist, Contraception, Bournemouth, UK;shellraine@aol.com

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Gabriel Weston. London, UK: Jonathan Cape, 2013. ISBN-13: 978-0-224-09128-2. Price: £14.99. Pages: 175 (hardback)

This book is written by surgeon and prize-winning author, Gabriel Weston. She is a gifted and creative writer who has taken background research for her book seriously. As well as being required reading for those interested in sexual and reproductive health, it would do well to be read by anyone who sits on General Medical Council (GMC) panels.

The book is written in the first person and concerns a doctor who has a career in abortion care, more by accident than design. The story itself surrounds the 4 weeks that she is appearing before a GMC panel, convened after a complaint is made about her actions (or rather inaction) during a surgical procedure. Suspended from work, she has suddenly been removed from her familiar surroundings not knowing who has blown the whistle and, now, uncertain as to what the future might hold for her. In other words, the rug has been well and truly been pulled from under her feet. She is being judged by a panel of seemingly alien people with her career and livelihood on the line. For the duration of this story she joins the ranks of those finding it difficult to adjust to tuning in to daytime TV. She finds herself surreptitiously creeping back into the hospital, where she feels at home, trying not to be noticed as she sits outside the ward where her patient is being treated. There is a clever juxtaposition of the doctor who always strives to perform surgical procedures to a high standard and the pervasive feelings of having failed her patient.

There are wonderfully evocative descriptions of the profound anxiety induced by this situation, which would make good reading for budding psychiatrists too. One can read a textbook for a list of symptoms including poor concentration, but how much better to read passages from this book in which huge chunks of what the panel is saying is obscured by memories of the doctor's childhood and adolescence plus more recent memories of her medical training. The description of such overwhelming anxiety is through the interweaving of present and past, the past taking up a disproportionate amount of time while she is the focus of the hearing. There is a very real sense of “How did I get here?”.

There are some fine references to the stigma associated with working in abortion: covering up reading material on the train; the psychiatrist who struggles to articulate the ‘A’ word; the self-censorship when mixing socially to avoid getting into the details of one's work. The author explores and gives voice to the concept that it is OK to feel sad about the need for abortion, while continuing to be involved in performing the procedure, believing it is necessary and must be available to women.

This is quite a short book and easily read within a period of 24 hours. Once you are gripped, you have to finish it. The admixture of professional and personal reminds us we all have our own backgrounds and values and we may need to offload when we are involved in emotionally challenging work. The author portrays the sense of isolation commonly felt by health professionals working in abortion care. Without being explicit, it demonstrates the need for support and the value of clinical supervision for those involved.

Despite the grim circumstances of the book, the doctor's humanity shines through and reminds us of the courage and self-sacrifice shown by those who work in abortion care.

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