Annabel's House of Books

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The unsaid side of obs & gynae

Dirty Work by Gabriel Weston

Dirty WorkI was profoundly impressed by Gabriel Weston’s literary debut – Direct Red – a slightly fictionalised memoir of her time as a junior surgeon.

Her second book, Dirty Work, is a novel that looks at one of the toughest things that obs & gynae surgeons may ever have to do – provide abortions. I will say at the outset, that it was not an easy book given its subject matter, but it was completely compelling to read.

Briefly, we follow the life and career of Nancy, a young surgeon who has specialised in obs & gynae.

For the first few months, I only did the occasional abortion, just as they happened to crop up on Mr Kapoor’s general list, among all the other gynaecological procedures I was becoming a dab hand at. But the day came when my boss asked me if I’d be interested in doing more. […] I do remember the deal. For one day per fortnight I would get my own termination clinic in the morning, followed by an operating list in the afternoon. Real independence with the safety net of a consultant working nearby at all times.

This isn’t how the story starts however. It begins on the operating table with a routine operation going wrong. Nancy has a crisis and has to be taken off, suspended pending investigation. Her peers and colleagues will have to supply reports, she will have to undergo a psychiatric evaluation, and the case be assessed by a senior team, possibly referred upwards to the GMC (General Medical Council).

The story of the disciplinary hearings runs alongside that of Nancy’s life and career. These two parallel threads finally converge give a deep insight into this world. During Nancy’s psych session she makes it clear how she sees herself:

‘I can see you’re a plain-talker, Nancy. So. Why don’t you tell me this. What kind of person becomes an abortionist, do you think? What-‘
‘Abortion provider. Not an abortionist, an abortion provider.’

It is important to Nancy to distinguish the terms. She considers herself to be professional, competent, expert at her job; she is proud of her skills and doing it well. The novel never seeks to judge the issue. Our legal system permits abortion under specified circumstances; someone has to do it, to ‘provide’ the operation – but then again, some obs & gynae doctors and surgeons refuse.

By necessity, there are some medical details that make for very difficult reading indeed. You don’t have to read these passages, but they helped me to appreciate the entirety of what is involved from the surgeon’s point of view. I can understand why O&G doctors don’t freely talk about this side of their work.

Dirty Work is not a long book. Weston’s style is spare, almost clinical at times – particularly when describing the medical matters. But that’s not to say that Nancy is at all passionless, (for Holby watchers, she’s no Jac Naylor – although we all know that Jac is secretly in emotional turmoil inside). Apart from her speciality, Nancy is a normal person, as full of insecurities as the next, and she clearly does care about her patients; she does usually possess that surgeon’s necessary ability to disconnect in theatre though.

I hope that Weston will continue to write thought-provoking books, whether fictional or not, that take us into the world of surgery. Well-written books such as Dirty Work give real insight into these difficult areas. Highly recommended. (9/10)

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Dirty Work by Gabriel Weston, Jonathan Cape 2013. Vintage paperback Jun 2014, 192 pages.


  1. I thought this was a very fine, very brave book, Annabel. As you say, it’s far from an easy read but definitely a worthwhile one and I wish had received more attention. I have always been pro-choice – I dislike the word pro-abortion, it’s something that desperate women will always be driven to so far better to make it safe – but it made me think about what doctors have to face when they perform abortions. I hope she continues to write, too.

  2. Another author I need to add to my list of new writers to be explored. Given that she is clearly tackling such difficult subjects I wonder if the very act of writing is her way of making sense of some of the terrible things she must see in her work?

    • Her surgery specialism is ENT so I understand – but she must have seen a lot of things during her training. Direct Red was memoir (slightly fictionalised) and was ultimately very reassuring about surgeon’s skills – beautifully written.

  3. I loved this book too! Weston’s insights into the problems that doctors face were really well written Such a difficult subject, but I thought she handled it really well.

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