Heavy Years is Augustus Young’s most recent volume of autofiction, or fictionalised memoir, following from his highly praised Light Years and the more recent Brazilian Tequila. In this book, the unnamed narrator is a medical graduate, not quite a doctor, from Cork who moves to London to work for the NHS as a freelance researcher/process improver. He’s an idealist whose philosophy is summed up in a quote from Rudolf Virchow that serves as an epigraph to the book: ‘Medicine is a social science, and politics is nothing but medicine on a larger scale.’ The arc of the book describes the journey from this belief that the NHS and the politicians whose role it is to fund and nurture it should be focused in health rather than illness, prevention before cure, through a slow absorption into the status quo to a kind of resignation and the ‘redemption by default’ of early retirement.
Our narrator is employed on the recommendation of a senior consultant called Mal Combes whose intention is to use his protégé as a constructive disruptor who will challenge established patterns of behaviour within the health service to the benefit of patients. It’s a job he takes on with initial enthusiasm, and in the process he constructs a map of the NHS hierarchy, from ’the mandarins’ at one end to ‘the humans’ at the other, and decides to focus his efforts on the front-line staff who, he feels, are most likely to share his view of the proper role of medicine and less likely to be involved in politics for its own sake. All of this is accompanied by a Greek chorus consisting of the talking in his head.
He decides to use his outsider status as an Irishman to his advantage:
What could be seen as a disadvantage was an asset. I could use my Irishness, and English colleagues couldn’t. at least not directly. I did not disguise my accent, but spoke very distinctly (like my mother on the phone). I decided it was a magical weapon like Fionn MacCool’s gae-bolg (spear). It entered my enemies like a javelin and its barbs opened up inside.
[It hardly detracts from this to point out that the gae-bolg was Cuchulain’s spear.]
On balance, things go pretty well at first, until the election as Prime Minister of the woman he calls Mrs Sybil, known in the real world as Mrs Thatcher. The new, market driven, politics before health means he has two options, unemployment or compromise, and he settles for the latter. He had, in any case, begun to have doubts about Virchow’s ‘big idea’, having come to the conclusion that sickness, at a certain point, is inevitable as we grow older and that the inevitable outcome of a health-focused policy would be an aging, ill population. And so, he moves on to the ‘little idea’ of removing the patently incompetent from the system through a series of disciplinary proceedings. This, while generally effective, is unpopular and ultimately induces a kind of paranoia in the unnamed one as the higher powers in his hierarchical tree begin to take more interest in his actions. It also leads to a sense of change without progress, and as he moves closer to the higher powers in the system, his idealism is further diluted.
In a sense, this is close to the character of another Young doctor, Pedrinho Diaz, whose transformation from idealistic young medico to corrupt politician is at the heart of Brazilian Tequila. This, of course, leads to the uncomfortable conclusion that the NHS jungle is very much like the Brazilian rainforest, at least where the integrity of medical administration is concerned. It’s a conflict that also resonates through another recent book by Young, The Invalidity of all Guarantees: A Conversation between Bertolt Brecht and Walter Benjamin, where Brecht’s pragmatism is set against the purity of Benjamin.
Alongside this tale of woe, we see glimpses of the Irish wing of literary London, the scene of Young’s earlier autofiction Light Years. This mostly revolving around pubs, with some interesting sightings of the near-legendary figure of Donegal poet and aspirant bag-lady Madge Herron. It is in these low relief passages that Young’s characteristically rambunctious style is most in evidence:
She was built like a chick albatross, and her vocal range was that of a starling, calls varying from chortled warbles to alarming squawks with tender little trills in between.
It is also here that the elements of the Venn diagram that links the narrator, his inventor Augustus Young, and Young’s inventor, Dr James Hogan fully overlap, bringing the nature of the autofiction into focus. Hogan, after all, was a consultant epidemiologist in the NHS and, unlike the lone bachelor narrator, a married man. And so, the story takes on something of the nature of that most particular genre of fictional distortion, the fable. But what, if any, is the moral? Here is the tale of an Irish doctor working for the NHS in London inspired by the work of a German thinker and, in real life, whatever that is, retiring to writerly seclusion in the South of France. It is, in short, a European fable. Given the post-Brexit prospects for the NHS, the following passage seems particularly prescient, whether intentionally or otherwise (I suspect the former):
Newly formed companies were scrambling for consultancy work. Interest in the American health system included exchanges of visits by professionals. I could see on the horizon competitive tendering by multinationals for service takeovers. The talking shook its head sadly, ‘How long, O Lord, how full of cant you are. A nation of shopkeepers is never going to go global.’
Which is, of course, exactly what said shopkeepers and their customers, behind a tattered banner unfurled on the playing fields of Eton, now intend to attempt.
And so, for all its playful poking of fun at human and organisation foibles, Heavy Years is, in the end, a deeply serious book, a story of idealism broken on the wheel of power, but also a finger pointing at the anti-moon of a post-Brexit privatised health ‘service’ whose reality draws ever closer. It may be too late to undo the referendum, but the moral of this fable is that the NHS must be defended at all costs.