Among the quilters

Asya, the heroine of Michael Ignatieff’s novel of revolution and exile, is born into an aristocratic Russian family in 1900. As a child, she nearly drowns walking out over the thawing ice beneath which the River Vasousa roars. She has a vision there of a great skater. Her brush with death changes her and leaves her with a belief ‘even when fear had her in its clasp ... that it would let her go.’ The reader is thus guaranteed a courageous heroine. And a beautiful one. She is no Jane Eyre with only grit and tenacity to compel a hero’s love: ‘she had inherited her mother’s tall thin good looks. “You look like a fine pair of Borzoi hounds,” Father used to say of them in his jocular manner, meaning that they were fineboned and delicate of feature, with long, finely tuned limbs ... She had curly black hair, pale white skin and lustrous black eyelashes.’ But her father admires most her strong chin, wide downy upper lip and moth-grey eyes. About such a heroine a vast amount of tosh could be written. Ignatieff’s novel is subtitled ‘a love story’, which suggests it will rise, for better or worse, into the upper emotional register. Despite every opportunity of scene and action, it never does. He is too self-aware, or perhaps too fastidious, to abandon himself to a coloratura line. Instead, he chills Asya’s character to the point where he as narrator can safely handle it: ‘When in later life people said she was cold, she never disagreed. For she knew, and some inner recess of her body never forgot, how cold the river torrent had been.’

Asya ages with the century. In her teens she works for a military hospital in Moscow. When the Revolution comes she is with her ailing father. He dies, and she is abducted to nurse White Russian wounded. She falls in love with Sergei, an artillery officer, loses touch with him in the confusion of civil war and, as the first part ends, is aboard an Orient Line steamer bound for Toulon, still bearing the marks of its use as a troop ship at Gallipoli. The descriptions of civil war are terse and cimematic; the change from the sweetness of the old life to the disorder of the new is told in intercut scenes. Misty meadows and fruit ripening in the conservatory are juxtaposed with broken glass and torn fabric.

Asya’s first exile is to France; she finds she is pregnant and bears Sergei’s child. She is loved by a poet and a doctor, both Russian, both involved with émigré plots and factions. Then Sergei turns up on her doorstep – mysterious, and alarmingly marked by the experience of war. He becomes rich by trading with Russia. As the Second World War approaches, Sergei’s business comings and goings become hard for his wife to follow (his son accuses him of being one of Stalin’s spies); he disappears to the East. Asya escapes to England. At the end, a very old lady, she unravels the last threads of stories which time and the dislocations of war have left tangled and obscure.

Upon this plot are hung scenes familiar from the movies, as well as from other novels: the betrayals, assassinations and sad anxieties of émigré politics; the poet dead among the paste-pots and proof-sheets of his magazine; the doctor beaten up by the Secret Police; parties in wartime London; winter journeys in blacked-out trains and lovers beneath the August trees in St James’s Park. They are done with style, written with the elegiac flow appropriate to historical pageantry, and with plenty of detail about clothes, food and rooms which, carefully applied, guarantees the verisimilitude which wins praise for television costume drama. But Ignatieff has not put a mark of his own upon the story. This is not a novel in which to lose oneself. Worse writers, letting rip, forgetting the truth of particulars, have created more affecting heroines and more troubling stories.

Health and Happiness is a soap, so far as casting and locale are concerned. The life of the Alta Buena hospital and the Californian medical scene are displayed by means of half a dozen simple plots, all intercut. Switches between the story of Ivy Tarro, the pretty single parent whose admission with a swollen arm sets the story rolling, and those of Dr Evans (her physician, a man for the heroic intervention), Philip Watts (star diagnostician, properly modest on medicine’s behalf when faced with the body’s rebellions) and Mimi Franklin (paid volunteer, divorced, with a housing problem) come as neatly as commercial breaks. Interest does not flag and the medical detail is excellent. Great books about illness (The Rack, Cancer Ward) in which the struggle with illness engages with larger themes date back to the time before antibiotics when doctors had to look on knowing they could do little; moral crises now revolve around when to stop doing what you can. When to pull the plug is a real enough problem, but not one which presents patient or doctor in a heroic pose. For example, how to do the best for Randall Lincoln – young, black, successful and in a coma, dying from sickle-cell anemia, in pain when conscious, and costing one charity or another a lot of money when on dialysis – is a problem for the Morbidity and Mortality Conference. It is neatly solved when an unexpected remission makes him fit enough to be wheeled on as star at a fund-raising dinner. Dr Watts’s deliriously enjoyable sexual relations with his patient Ivy, unwittingly publicised by the Chinese intern, are (like an outbreak of cocaine-sniffing among the junior medical staff) a matter for low comedy and a little tactical blackmail, but not high drama.

Diane Johnson has struck the right form for modern medical fiction. What other structure could so well show how modern medicine, while it has been unable to remove death from the wards, has so scrambled the traditional ending that the deathbed scene is now a sweeping-up, not a passing away? If a man can do something important for you in the physical line, his spiritual grace is of less account; even the elegant Dr Watts makes his best move, not with a cool hand and long bedside vigil, but with a jab of streptokinase (a drug about which the book has made us knowledgeable). That the hospital he works in is a service industry which, in offering the very best to paying patients, must limit what can be done for those who cannot pay is one of a number of matters (will he take the new job, the sexual attractions of Ivy Tarro, the behaviour of the interns, the physician’s distrust of surgical interventions) which preoccupy him.

The novel is about women and doctors, and in particular about patients and doctors (not much at all about doctors and nurses). The erotic implications of being helpless, literally and metaphorically in the doctor’s hands, of living out the naked-in-the-street dream which is the reality of hospital life for the patient, are exploited. Food and drink figure too: Ivy works for a smart health-food restaurant and the presentation of illness as an experience which (like eating) can be self-indulgent reaches the point where Ivy’s condition seems to be one of morbid, anxious luxuriousness. She is paying for all this time in hospital, and therefore (in a twisted way) she enjoys it.

If your last memory of hospital is an NHS ward, Health and Happiness allows you to consider the implications of a system the lavishness of which extends beyond the smooth organisation and the European marques in the doctors’ car park. In service-industry medicine the puritanical notion of hospital as the place where you suffer for your illness does not run easily. Here your position as consumer makes your suffering less important than your passive role as the occasion of therapies. Doctors need your illness. The hospital bill which is slipped into Ivy’s hand as she leaves, for treatments which were probably unnecessary, or made necessary only by earlier mistreatments, is very ‘large: $48,000. Insurance will cover half of it, but there is an excitement in the scene, as though the bill gives the kind of thrill a loss is said to bring to addicted gamblers. It reminds the patient just what he or she is worth: if a few running repairs cost that much, how much for the whole machine? Well, anything or nothing – which is what makes death such an embarrassment. All that repair work going up in smoke: you cannot take it with you, or leave it behind either. The desire to live almost begins to seem a vanity; Randall’s parents, willing to sell the house if that is necessary to pay for more treatment, make another commodification specific: his life is worth all they have.

Ivy, who has a bad time she did not deserve – her swollen arm was probably not the result of a blood clot, and the stroke she subsequently had probably was due to the medication she was given – enters hospital for a couple of tests and comes out weeks later a changed woman. The reader is agonised by the accidents she suffers or just misses (she is abducted by the admirable Dr Watts from the operating theatre just as the scalpel is about to bite), but Ivy comes out the other end with a lover and an ambition: she too will become a doctor; better, she will learn to wield the knife and become a surgeon. And that is not the only happy ending: Mimi is going to get a lot of money for her house, and shares in the doctors’ car park which will replace it. Philip Watts’s wife has untied herself from the role of medical man’s consort; a few have died, but we all have to; the show will run and run.

It is no surprise that the episodic-serial form of the soap should prove to be an efficient carrier of information – The Archers, we are regularly reminded, began as agricultural propaganda. Fiction which uses fact in this way is, however, often criticised for its impurity; and a swathe of it – from Kipling’s stories of work to thrillers of expertise – has tended to be dismissed as mechanical. One of its virtues is verbal – jargon adds zest to accurately recorded chatter.

Academic life should offer a background of this kind, yet the university novel has so demystified the academy, and the dramas natural to it are so parochial, that it is hard to make a hero out of a professor with a moral problem. In Carol Shields’s Happenstance Jack Bowman, cornered in his job at an academic institute, living with his wife Brenda in the suburbs of Chicago, has to see his friend Bernie through marital troubles just when his own career seems threatened by the announcement that an ex-girlfriend is about to publish on the subject he is writing a hook about. Meanwhile his wife Brenda is off at a congress of quitters where she undergoes the Open University summer-school experience: erotic and emotional thrills activated by a snort of heightened self-esteem and the conversation of strangers.

The two stories, husband’s and wife’s, are, entirely logically and very irritatingly, bound back-to-back. Each part covers the same few days, in the course of which Jack struggles at home and Brenda finds herself – among the quitters. Carol Shields writes at least as well as Diane Johnson: her characters are more fully realised, her angle is as original. The trouble is that the troubles she writes about have been too well-documented. When Jack visits his father he finds the old man has acquired a pile of the kind of self-help books which tell you how to bring your marriage to life, change your lifestyle, break bonds and escape binds. Jack finds it odd that his father should be reading about changes in direction so close to the end of the road.

Happenstance is rather good at showing how no time of life is free from its worries. It might have been constructed to supply case-studies of the crises in which self-help books deal. The tensions which exist between Jack and his teenage children, and which arise from Brenda’s increasing independence, his career problems, even the aborted suicide of a next-door neighbour, are humanely displayed and prove to be manageable. If there were a prize for agreeable, helpful novels which do their best to see that characters make the best of what they are landed with, Happenstance would be a contender. Shields writes well about decent people, and her resolutions are shrewder than those in the self-help books.