Heavy Years, by Augustus Young: A Review

Heavy Years, Augustus Young, Quartet, 2018, ISBN 9780704374478, £20.00

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.

A Short History of Dominick Street, Dublin

This text is now available in print as part of my Hesterglock Press book The City Itself.


“This quarter was the first settlement of fashionable Dublin after it began to leave the city proper. Dominick Street, a wide thoroughfare crossing Bolton Street, was the residence of many of the aristocracy. The arms of the former residents are still emblazoned over some of the doorways. The cornices around the tops of the houses are sometimes adorned with mouldering statues. The iron brackets, from which the great lamps hung to illuminate the steps of the entrance, may even yet be seen. But the present population is so poor that the street is becoming daily more and more dilapidated. At No.36 was born Sir William Hamilton, a great Irish mathematical genius, who discovered the system of quaternions. This house, too, is marked by a tablet.”


Joseph Sheridan Le Fanu, author of Uncle Silas, etc., and editor of the Dublin University Magazine, was born in 1814 at 45 Lower Dominick Street, and afterwards resided at 70 Merrion Square South.”


“The crowds of children who perforce throng the streets in our overcrowded central areas make it so slow and dangerous for the motorist that many wide streets, such as Gloucester Street and Dominick Street, have virtually been lost as traffic arteries. No proper planning can solve the traffic problem if this is not remedied…

“There is the natural desire to retain, if possible, some of the most characteristic streets of the city. A careful survey has revealed that the structure of some of these houses is unsound and that, whatever the site is used for, these unsound buildings must be replaced. But a great number of them, so far as their major structural features are concerned, are sound, in addition to being of high civic dignity of appearance. Indeed a rapid and somewhat casual glance out of a car passing through Mountjoy Square, Gardiner Street and Dominick Street might lead a stranger to imagine that these North Dublin streets were as well occupied as Fitzwilliam Street on the South. A very little closer scrutiny reveals the difference.”


 “Mr. Dillon: This, as I have already said, on the Committee Stage, is a perfect “Marie Antoinette” approach to housing. First of all, it is laid down specifically that people must not set their houses in tenements and that the local authorities, in certain circumstances, may tell them that they are not to do so, quite oblivious of the fact that the only reason the house is a tenement house is because the unfortunate people who are living in the sordid rooms available have nowhere else to live. This point having been taken by our modern “Marie Antoinette”, his contribution is: “Very well”—if they have to live in a loathsome tenement at the foot of Dominick Street let us mitigate their suffering by calling it not a tenement but a “multiple dwelling”. That will greatly relieve the stress of their circumstances. So long as we do not mention tenements, we do not have to worry about them. Are we not travelling in this House along a most extraordinary road? These two sections are designed to prevent the spread of tenement conditions into new parts of the city…

“The word “tenement” to us and to anyone who understands the city has always connoted something. The words “multiple dwelling” connote nothing. You do not change bread into cake by calling bread “cake”; you do not change tenement houses into flats by calling them “multiple dwellings”. I exhort the Minister to eschew the role of Marie Antoinette, to be a realist for a little while and to withdraw this amendment and restore to its rightful place those words of evil omen, “tenement house”, until such time as they cease to exist, not as a result of an obliterating statute but as a result of the provision of adequate houses for those who are festering in the tenement houses. When that is done, there will be no need for euphemisms like multiple dwellings; tenements will be no more than a memory and the flats will be something to which no one can take exception, for which no one ought to be compelled to register at the City Hall, and which the local authority ought not to have power to prohibit. Then the necessity for these sections will disappear and any diminution of the powers of the bureaucrat to regulate them is welcome. I want to see the day speeded when that diminution will take place. I do not want to see the day dawn when we can still our conscience in this House by changing the name to something the existence of which we are ashamed to admit.”


When I was born in 1954, my parents were living in a tenement flat in Dominick Street, in a building that was later demolished as part of a slum clearance programme. That’s where I spent the first few months of my life, sleeping in a drawer in the bedroom. One toilet to the floor, good neighbours and bad; it was a place to live in, a place to leave.


“Mr. Sherwin: I want to refer to the hold-up of the sanctioning of schemes. Other Deputies have referred to it also. We in the Dublin Corporation are very annoyed at the length of time it takes the Minister either to approve a plan or to sanction a tender. Recently, Vicar Street was sanctioned by the Minister. I was told that the sketch plan for it was actually put before the Minister three and a half years ago and was not approved. Then there was a further delay in sanction. I understand it took several years also for two flat schemes at Love Lane in Rathmines. This is what we are worrying about, in view of the amount of unemployment in the building trade at the moment.

I would remind the Minister of Dominick Street. The traders there are all practically bankrupt. Four years ago, Dominick Street was emptied. Almost 5,000 men, women and children were removed from Dominick Street. I am not blaming the Minister for the delay up to now because it took almost two and a half years to house the people of Dominick Street. I am asking the Minister, when the tender comes before him, to remember the small traders of Dominick Street and not to hold up the sanction. We estimate that, even if there is sanction and there is no hold-up, the flats will not be ready for occupation until January, 1961. The House will appreciate now how the small traders in the area are affected. They must wait from 1954 until 1961. Therefore, the holding-up of approval of plans is a very vital matter to which I hope the Minister will give consideration.”


“Mr. S. Dunne:  I want to charge the ESB with conspiring to create a public impression that these houses [in Fitzwilliam Street] are falling down from dry rot and decay. This is a gross distortion of the facts and is completely untrue. These houses have never been in the category of the houses in Dominick Street, Fenian Street, Summerhill, Gardiner Street or anywhere else in this city. The speakers who have referred to Dominick Street, notably Deputy Timmons and my colleague from County Dublin, do not advert to the fact that Dominick Street, Summerhill, and all these places I have mentioned, and many others as well, became slum tenements 100 years ago. They were neglected to the last possible degree.

There was absolutely nothing done with them in the nature of repairs by the slum landlords who owned them. They were occupied by, as I have said before, not scores or even hundreds of families but literally thousands of families, living one family to a room, many of them being average Irish families with a large number of children. Goodness knows, the children who had to live in such conditions did not get much of a chance in life because the housing conditions in the slum areas of Dublin, areas such as Dominick Street, Gardiner Street and Fenian Street, were comparable with the worst in the world, and the infant mortality in such conditions was one of the highest in the Europe of its day.”


  • The Story of Dublin  By D. A. Chart, M.A. Illustrated by Henry J. Howard. (J. M. Dent & Co., London. 1907).
  • Dublin: A Historical and Topographical Account of the City. By Samuel A. Ossory Fitzpatrick. Illustrated by W. Curtis Greene. First published 1907.
  • The 1941 Sketch Development Plan for County Borough of Dublin and Neighbourhood by Professor Abercrombie.
  • Dáil Éireann Debates for 1947, 1958 and 1963