Surgeon-turned-author Gabriel Weston made her literary debut with a gripping medical memoir. In her first novel, Dirty Work, she again turns to medicine for inspiration, this time investigating one of its most morally fraught procedures: abortion. In a behind-the-book story, Weston explains why she felt drawn to explore this contentious issue, and why she believes the two sides may be closer together than we think.


What would you do if you had an untellable story? Of what does a doctor’s morality consist?

What surprised me most about writing my first book, Direct Red: A Surgeon’s Story, was the reaction it elicited in some of my colleagues. I had read quite a few memoirs written by men in my profession, and although I was always impressed by their operating achievements, I felt slightly weary of reading heroic tales of life-saving antics, proud accounts of bloody machismo.

What I decided I wanted to put alongside these chronicles was a story of surgical inadequacy. I wanted to describe what it feels like to be a surgeon in those moments when one does not feel in control, when one is uncertain of one’s ability, when one is terrified, when an operation is not going well. Instead of cataloging what a surgeon can do, I wanted to talk about how we feel and what we do when we haven’t got a clue.

After publication, surgeons came to me quietly or wrote to thank me for having said and described things they had felt intensely themselves during their training but had never been able to admit. I was touched by these comments but, even more, I was interested. I started to wonder to what extent we all carry an untold version, the untellable truth of our own existence, folded tightly away within ourselves. I started thinking about what it might mean to keep aspects of our lives secret as well as the implications of suddenly having to speak out.

I started to wonder to what extent we all carry an untold version, the untellable truth of our own existence, folded tightly away within ourselves.

I also started to consider what it means to be a good doctor. Many of my colleagues claimed they were afraid to own up to feelings of uncertainty in case doing so damaged their reputation. I realized that doctors still feel, in some sense, that they should behave like paragons. I wondered where our moral core resides and what it would take to break that brittle image. What would it take for a doctor to go from being considered good to being thought of as bad?

It was from these questions that my main character emerged. Nancy is a woman with an unspeakable story, a woman physician who carries an indelible moral taint. Despite her best intentions and perhaps even by accident, Nancy has become an abortion provider. Her very existence is taboo and yet she is forced, by the circumstances of a mistake made in the operating theatre, to tell her story, to justify her actions not only to an external panel of judges but, perhaps hardest of all, to herself.

I happened upon the subject of abortion for this reason, not because I had any particular political ax to grind. I have never had an abortion myself, nor have I performed one as a doctor. But as soon as I started researching the area, something fascinating struck me. None of the books or articles that I read on the subject seemed to allow for even a degree of ambiguity. Everyone, from whichever side of the fence they were preaching, seemed so sure that they, and they alone, had the right answers. In some ways, it seemed to me that people were being dishonest in their certainty. And whenever I told someone I was embarking on a novel about an abortion provider, the conversation stopped dead. Even my agent and publisher cautioned me that if I wrote the book I intended to, no one would want to read it. It was like a red flag to a bull, and all the encouragement I needed.

It has been my experience, in the process of writing this book, that the thing that makes us all so very uncomfortable when the subject of abortion is raised, is the mysterious compulsion we all feel to have a completely absolute and watertight opinion on the subject. This seems crazy to me. I have stood on anti-abortion picket lines in the Midwest of America, and I have understood exactly why the people who wave their banners are so upset. I have also witnessed countless women gain access to the abortion services that they absolutely deserve. In Nancy, I hope to have created a character who holds all this ambiguity within herself. In writing her, I saw the room for a moral person to feel completely torn between a sense of righteousness and a corrosive guilt.

I saw the room for a moral person to feel completely torn between a sense of righteousness and a corrosive guilt.

First and foremost, what I hope to have written is a gripping, un-put-downable novel. But I hope also to show that even the most extreme positions on this thorny subject may be held within one consciousness, that the enemy camps are pitched much closer to each other than one might think.

 

This article was originally published in the August 2014 issue of BookPage. Download the entire issue for the Kindle or Nook.

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