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Despite having enjoyed several of his other works, I opened Ian McEwan's latest novel expecting disappointment. As I read it in the surgeons' coffee room, a consultant grabbed it from me. 'A novel about a neurosurgeon? I bet it's just one big cliché,' he said, expressing concern that I wasn't reading Bailey and Love or some other such character-building surgical text. His assumption about the book was not unfounded.
Neurosurgery enjoys a certain mystique in public perception. Many outside medicine consider it on a par with rocket science in its technical difficulties and intellectual challenges. And the media has played upon this image. One example is in the American television sitcom Friends in which the witless actor Joey lands his most famous role playing suave Portuguese neurosurgeon Drake Ramore in a TV soap. A leading article in The New Yorker even elevates the discipline to a high-performance art form, comparing the 'physical genius' of Californian neurosurgeon Charlie Wilson to that of Wayne Gretzky at ice-hockey or Yo-Yo Ma in a cello concerto.1 Even the British Medical Association's recommended careers guide for medical students and junior doctors, entitled So You Want to be a Brain Surgeon?, panders to the popular image of neurosurgery2—though many outside the specialty find truth in its tongue-in-cheek description of neurosurgeons as 'clever egotists, some of whose patients end up as cabbages'. Few could deny that neurosurgery is a specialty with little margin for error and a need for both pragmatism and optimism. Any specialty that invents a disability rating scale where a corpse scores a fifth of the available points, as they would in the Glasgow Coma Score, deserves such a reputation.
McEwan has gained a formidable reputation for fictional chronicles of people in seemingly stable situations that rapidly deteriorate into catastrophes; thus a neurosurgeon was a good choice for the chief protagonist of his latest novel. In Saturday,3 he breathes life into Henry Perowne, an affluent London doctor as he goes about his affairs on the day Britons took to the streets to protest the threatened war in Iraq. What sets Saturday apart from McEwan's other novels is that it is confined to twenty-four hours, cataloguing the life of one man on his day off. Fortunately, Perowne is a very busy man, making the most of his leisure time on a very unusual day.
McEwan has clearly done his research into neurosurgery and neurosurgeons. He vividly conveys craniotomies and laminectomies and discusses convincingly the risks of cerebral air emboli and the symptoms and surgery of pituitary tumours. Perowne's routine, surroundings and professional relationships are also very plausibly portrayed, from the tuna sandwich he eats during his fifteen-minute lunch to pithy judgments he makes of his registrars and theatre staff. A compelling voyeuristic attraction of McEwan's writing is his subtle though piercing dissection of the private lives of members of the British upper middle classes. Literary genius is in the detail (as Perowne's poet daughter points out), and McEwan's attention to detail in Saturday is impeccable. He laces Perowne's thoughts with terms such as mu receptors and anosognosia, and his medical jargon is stereotactic in its accuracy, with GCS, MCA and EVD making appearances among the TLAs.
However, Saturday is not about neurosurgery. It is a novel about personal routine and daily life set against the background of a nation preparing for war. As the story unfolds we see that the author has chosen the viewpoint of a neurosurgeon precisely because of the public image the specialty has. Contented, successful, pragmatic and rational, Perowne deals with intimately personal dramas, not world affairs. He likes and is liked by his grown-up children. He loves and makes love to his wife. He lives near Harley Street and takes pleasure in driving his S-class Mercedes. He fixes people's brains and, having a 'neurosurgical personality', suffers little discomfort or doubt about either the world or his place in it.
And despite his erudite observations of the world, and his ambivalence over the Iraq war (in the past he has operated on an Iraqi professor beaten up in one of Saddam's jails), Perowne is only mildly troubled by the global concerns. His fleeting dissatisfaction, if he has any, is very personal. In one of his many reflective moments, he muses that 'there must be more to life than saving lives'. Avid McEwan readers will sense Perowne's minutely perturbed equilibrium as a prelude to one of the author's trademark catastrophic twists of plot, cause and consequence and the author doesn't disappoint.
Saturday is a novel that anyone could become absorbed in. Unusually, and despite its recurring references to blues music, poetry, dementia and neurosurgery, it is about happiness and contentment rather than tragedy. Indeed a recent Guardian article facetiously commented, 'McNasty serves a McHappy meal'. It should interest a medical audience in particular with its vivid characterization of a successful medical professional not immune from random events. McEwan demonstrates time and again how the vagaries of chance and circumstance affect outcomes, and in doing so illustrates powerfully how a seemingly infallible doctor's life can become altered as much by others as he is able to alter their lives.