What we do before time runs out, this thing we call life, forms the basis of Austin Duffy's debut novel, This Living and Immortal Thing. Set in a renowned New York oncology hospital and research facility, the book offers an honest, no-frills account of illness and death. The narrator is an Irish oncologist in his early 40s who is mid-way through a postdoc in cancer research at the hospital. Leaving behind a failed marriage in Dublin, he lives an isolated existence dominated by work and research.
From his sparsely decorated apartment in downtown Manhattan, his view is of the hospital building and its many windows. Weary of dealing with dying patients and their endless hope, he has chosen instead to dissect mice in a laboratory shared with an equally taciturn Indian doctor. As befits his profession, the narrator delivers his observations in a clinical and detached manner, no matter the subject.
The result is to immerse the reader in the world of medicine – the politics, career manoeuvring, terminology, fatalistic outlooks and constant wavering between life and death. Inured to the wavering, the narrator has allowed his preoccupation with death to develop into a marked withdrawal from life.
Infidelity, infertility and a vividly depicted miscarriage are all discussed in the same observational tone, as if he is a stranger overseeing proceedings as opposed to an integral part of them. His emotional detachment from his estranged wife shows a man unwilling to deal with messy human predicaments.
Instead, he seeks the comforts of controlled environments, the omnipotent power he lacks in life which can be almost replicated in the lab as he infects and disposes of his mice. “You set your own conditions and, to a large extent, the future is predetermined.”
The personification of the mice works to highlight his attachment to them, from Mr Miyagi to the narrator’s favourite, Henrietta, named after Henrietta Lacks, an American woman whose cancerous cells created the first human immortal cell line for medical research.
It is the details that bring the narrative to life, the clinician's eye for spot-on summaries. Duffy grew up in Ireland and studied medicine at Trinity College. He is a practising oncologist at the National Cancer Institute in Washington DC, where he lives with his wife and son. In 2011, the author won RTÉ's Francis MacManus award for his short story, Orca.
His first book is a blend of medical information and the story of a doctor struggling to differentiate between work and life, life and death. From cancer prognoses to BRCA, to the problem of too much data in research to the observation of how foetal abnormalities are handled in the US, there are plenty of interesting insights into the medical world.
The plot is secondary to the reflections and hangs loosely around a new romance with a mysterious Russian woman, Marya, and the subplot of the narrator’s partner Yvonne back in Dublin, whose pressing news reopens old wounds.
Marya’s plight is made real through convincing dialogue that gives a modern immigrant’s perspective on America and illness. Yvonne is viewed through her husband’s lens, resulting in a somewhat two-dimensional character.
There are issues with tense, a constant switching between past and present, and a tendency towards telling: “And then Berger did something as unexpected as it was blatant.”
On a date with Marya, the narrator notes: “She had clearly put in a lot of effort.” Leopard-print blouses appear on different female characters and other specific details – poor internet connections, news from emails – are at times frustratingly repeated.
The assured hand returns in the medical landscape. The burden of being a doctor is clearly shown as patients poignantly dress up in their best clothes, convinced it will somehow weigh a prognosis in their favour. “You are the next best thing, the tumour’s representative on earth.”
The ego of the oncologist is present, too, with a narrator who considers himself “too reasonable a person for conflict”, a trait which could easily be described in a harsher light from another perspective.
The question of whether the soul survives death, the immortality of the title, receives a scientific answer. In this pensive and stark novel, people die and everything is replaceable. “This morning a new Henrietta arrived, six of them, actually.”
