Fiction - paperback; Fig Tree; 336 pages; 2011. Review copy courtesy of the publisher.
A couple of years ago I read Carol Topolski's Monster Love and found it one of the most disturbing novels I'd ever come across. When I discovered that Topolski had a new novel out, I was anxious to see whether she would up the ante. I think it's safe to say she has.
Do No Harm is billed as a psychological thriller, but it's not your typical page-turner. For a start it's structured in an odd way, interleaving several different story strands, told occasionally in the first person and at other times in the third person. The tenses are sometimes present and sometimes past. And yet, despite what could be described as a piecemeal, bitty approach, there's a narrative tension that builds and builds as you get closer to the climax. I read it with a sense of mounting horror, but the denouement, when it comes, is brilliant.
The story builds on our worst fears: that doctors, with whom we trust our lives, are capable of doing unimaginable things to their patients.
Dr Virginia Denham is a consultant in obstetrics and gynaecology working in one of London's top hospitals. She's held in high regard by her patients (for her genuinely caring manner) and her colleagues (for her brilliant mind, surgical prowess and management skills). But Virginia is a bit of an odd ball. While her staff are used to her somewhat unkempt, mannish appearance, no one knows the secret life Virginia leads when she leaves the hospital and goes home to her empty house at night.
In this secret life, Virginia has an odd system of eating in which she stuffs herself silly for three days in a row (which she calls "trips"), then starves herself for the following four (which she calls "quads").
Choosing to eat like this put me in absolute control and I never had to depend on Mother for food. I never went hungry for attention or felt full of her bile. On trip days I stuff myself with the most desirable foods I can imagine -- way, way beyond my appetite's outer reaches. Quad days starve me into submission. During the three days of the trips, I can believe myself the most loved woman on earth. The austerity of the following four stops me wanting more.
Virginia also gets her thrills by self-harming while wearing lots of rubber. Her imaginary friend Ruby is often close by, encouraging her to do bad things.
The story is told in chunks and moves backwards and forwards in time, from 1974-79, in which we follow Virginia's adult life, and 1938-1945, when we hear of Virginia's childhood and her mother's extra-marital affair.
Interleaved into this narrative are two other stories: that of Dr Faisal Usman, one of Virginia's colleagues, who was sent to England, from Pakistan, to be educated as a child, but has never been brave enough to return to his homeland; and that of Gilda, one of Virginia's patients, who has escaped the clutches of a cult and given birth to a son she doesn't want.
This probably sounds very confusing, and I admit there were times when I wondered where the story was going. But if you hold all the elements in your head, you will be rewarded, because the ending draws all the threads together in one neat, and genuinely surprising, conclusion.
Topolski, who is a practising psychoanalytical psychotherapist, has created an amazingly complex character in Virginia, a woman who is outwardly successful and incredibly intelligent but who is deeply troubled and cruelly flawed. But be warned: female readers, particularly those who are pregnant or having difficulty conceiving, might find Virginia's exploits too traumatic to stomach...