Book Review: Sometimes People Die by Simon Stephenson

This is the kind of novel that I adore and, frankly, that I fear. Stephenson once wrote a really moving memoir about his brother’s death in the Indian Ocean tsunami, Let Not The Waves Of The Sea, which deservedly (in my opinion) won Best First Book at the Scottish Book Awards. He followed it up with an experimental novel, Set My Heart To Five, which dealt with artificial intelligences, the blurring between robots and humans and the conundrum of consciousness – and did so using clever references to genres of cinema and science fiction while staging its fascinations at the linguistic level. This new book, Sometimes People Die, is again in the genre, but this time at the crossroads of crime and hospital drama. It reminded me a lot of Josh Bazell’s underrated Beat The Reaper.

Why do I love this kind of novel? He’s smart, very witty in a very dark way, and doesn’t back down from serious and difficult questions. Why am I afraid of him? Well, being placed in a hospital requires descriptions of diagnoses and I – my bad – can’t read about rising plantar responses or symptoms of endocarditis without immediately wanting to check on myself. Part of Stephenson’s novel should be required reading for hypochondriacs, not as a macabre guide but as a reminder of the difficulties medical personnel face every day. A headache can be a hangover or a brain tumor. The trick is knowing which one.

The novel’s central character is an unnamed young Scottish doctor who holds a senior officer position in a struggling London hospital. He accepted the unenviable position because he can now practice again after being suspended for stealing opioids for his own use at his old hospital. Much of the humor is obviously of the gallows or mess hall variety, but not in an insensitive way. There are equally scathing remarks about the hierarchical nature of medicine, the rivalries between doctors and surgeons, the status of nurses and a funny cadence where orthopedics ranks in the pecking order (a friend of mine, retired of the NHS, remarked “oh, they’re still useful for tinkering”, so the depictions here ring true, or at least are corroborated).

Author and former physician Simon Stephenson. PIC: Contributed

If coping with understaffing, underresource, physical and emotional fatigue, and perpetual stress isn’t taxing enough, our protagonist has another problem. It seems that in St Luke more people are dying than should be dying. The revelation of ‘excess deaths’ – to use a phrase we’ve all grown accustomed to over the past two years – is dripping, and when there seems to be a pattern, the horror looms. that someone in the hospital is deliberately injuring and killing patients. This allows police procedural to accompany medical procedural and – inevitably – vaguely dismayed satire of media responses.

To some extent, Sometimes People Die conforms to the Midsomer methodology. I ran the ‘least likely author’ algorithm pretty quickly, and while it came out correctly at the end of the book, all credit goes to Stephenson for throwing in some decent evasions and twists surprising. It is also commendable that there is no judgmental moralizing. Towards the end, he instead offers this: “That’s the question we never ask in medicine, because we all know it has no answer…why?”

It is a stylistically bold book, with certain phrases used as recurring motifs. It’s always helpful to see when a title appears in a book, and here “sometimes people die” sounds ominous at different times. But so are other phrases such as “mostly flat is asystole and asystole is death”, litanies of conditions and drugs, and references to the fictional Smithfield’s Textbook of Human Disease. Diagnosis and detection become twinned here, and words like puzzle and jigsaw and unusual and “devilishly complex” serve a dual purpose. There is also the courageous decision to interweave the narrative chapters with case studies of medical personnel who continued to murder, in search of reasons (which are multiple) why someone would use their knowledge in the opposite of his goal.

A novel that can make you laugh and grimace and think and feel a degree of justified outrage at quite an achievement. It’s worth observing that it’s set quite neatly in 1999 and 2000, with a coda in 2019. That may seem like a minor aside, but the feeling of a health service buckling under pressure is therefore unrelated to the pandemic. On the contrary, the pandemic has only created non-ignorable factors that were evident before. It’s also worth noting that with three books, Stephenson has now written three very different types of books, each excelling in their own way. This is an increasingly rare phenomenon in publishing, and it must be valued.

Sometimes People Die, by Simon Stephenson

Sometimes people die, by Simon Stephenson, The Borough Press, £14.99

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