Thomas Moran
Allison & Busby, 1999; £7.99
ISBN 0 7490 0451 7
Rating: 3/4

James Bletchley has been in intensive care in a New York hospital for 50 days. When awake, he is an acute observer of his clinical surroundings. He watches the arrivals, ailments, and departures of other patients, his own drug regimen, and the various machines he relies on for breath and nutrition. He hears the medical opinions spoken softly or laced with jargon and he learns the intimate details of his carers' lives. He hears conversations as they attend to his intravenous injections, and the jovial comments they address directly to him (though he can barely respond). He spends hour upon hour observing their movements and expressions. He has seen the small white scars where his gregarious Irish nurse Brigit injects herself with fentanyl and he has seen the sadness that haunts her colleague and fellow country woman, Nuala.

In his dreams and even in his comas, he falls in love with Nuala. He follows her home, he imagines her past, he sounds the depths of her troubles, and he spends his motionless hours making her a new world.

The story is utterly absorbing. Moran's style makes easy reading, and he moves smoothly between commentary on the ward and the strange colourfulness of comas. That the ending is problematic is hardly surprising, since by then the reader is seeing through eyes clouded by unconsciousness a friendship that means so much but is grounded on so little. For several days afterwards, you are left wondering just how much actually happened, and how much was the result of a (literally) sick imagination.

The author was in intensive care himself for three months, so this novel is a rare insight into how it feels to be at the mercy of severe illness, dependent for breath on a machine, and slipping between various levels of consciousness, unsure of which is reality. The book is far more than that, though, for he has crafted a captivating story of the development of a relationship between a patient and his carer in the most extraordinary environment.