There was only a week between mild chest pain and major surgery. As he waited for what would turn out to be a quadruple heart bypass, my father compared the situation to climate change. “You have to believe the experts when they show you the evidence,” he said.
Treatment for an illness he couldn’t feel required a profound surrender: to a series of medical professionals, to one surgeon in particular, to technology, to the care of his family, and to the rehabilitation program that followed. The experts had given him their tests; they had abruptly rerouted his fate.
I was on my way home from the hospital when I picked up Wayne Macauley’s new novel, Some Tests. This clever, troubling book begins with its protagonist Beth feeling “a little off colour.” Unconvinced that she is really ill, she takes a day off work. Her husband takes the kids to school and arranges a visit from a doctor. Since her usual GP is away, she is visited by the locum, who gives her a referral for some tests.
After a little wine and prevarication, she travels to a suburban clinic and submits to these tests. As a result, Beth is referred on to a second set of tests, and then a third. Slowly, she is shunted into a Kafkaesque labyrinth of examinations and trials, some of which are only vaguely medical. She encounters a series of apparently helpful people and submits to their instructions with little resistance.
When she does baulk, it is mostly at the expense; her middle-class thrift sends her along a track that is deemed appropriate for her income bracket. You can almost see the model railway structure of this novel, the switches where Beth’s route alters as she moves across a recognisable but slightly detuned Melbourne. Eventually she boards an actual train, by which point we are in deep allegory: the train provides a passage between the recognisable world and another social logic entirely.
Another writer might be satisfied by filling out the premise of Some Tests, but not Macauley. As with his previous novel, The Cook, reading Some Tests is rather like being the proverbial frog in the saucepan. The turning points are incremental, the rules obscure; the reader and Beth are in this pot together. Like The Cook, this is a book that takes an issue and, by following a single character’s journey, explores it at length. I’ll avoid spoilers, but there’s a different kind of key change here. Some Tests becomes an extraordinary treatise on the autonomy of the sick, a meditation on mortality, and an exploration of the nature of acceptance that is at once sinister and spiritual.
Throughout, Beth is one of those maddeningly passive characters often found in novels. She is a woman whose attachments to her work (in aged care), her family, and her life seem strangely thin. If she makes decisions, they are slight, and always doubted. At each step she gives up a little more autonomy to the experts, allows herself to be judged and prodded by them, and listens to their little self-indulgent speeches. What choice does she have but to trust them? Slowly, her uneasiness becomes the reader’s.
When the body is ill, it crosses a border. Susan Sontag’s Illness as Metaphor made the observation that illness is often seen as some kind of moral failure – an observation so pertinent to the AIDS crisis that she produced a follow-up, AIDS and its Metaphors. Sontag offered the consoling notion that we each have dual citizenship in the kingdoms of the well and of the sick, but in a sense, illness as failure is citizenship relinquished. In her essay ‘On Being Ill,’ Virginia Woolf wrote of sickness as a kind of refuge, a defection from life: the unwell “cease to be soldiers in the army of the upright; we become deserters. They march to battle. We float with the sticks on the stream; helter-skelter with the dead leaves on the lawn, irresponsible and disinterested and able, perhaps for the first time for years, to look round, to look up—to look, for example, at the sky.” It’s an idea that is doubly haunted – first by a longing for freedom, the idle freedom of childhood sick days; second, by our knowledge of how Woolf will die.
When I returned home from helping my parents through the crisis, I was terribly conscious of my own body’s fragility. For a few days, I was watching for signs the way a driver who has narrowly missed a crash watches the road, suddenly hyper-aware of the mad risk involved in getting behind the wheel. Was I even at the wheel of my body? If my father, fit and suspecting nothing, could have been felled by a heart attack at any moment, how could I trust that the weird combination of flesh, electricity and plumbing that kept me alive would continue to do so?
Contemporary medicine speaks a commendable language of patient autonomy, informed choices, good communication. But it operates in a world where reinforced social anxiety engenders self-doubt and often shame around the body. To inhabit a body that is read as female is to have your sovereignty over that body doubted. It means being judged, being given unwanted advice, being assessed by that hovering, abstract ‘male gaze’ as well as by actual men and women, until in mid-life you slowly become invisible. Seeing a doctor can be comical, made absurd by the presumptions and pruderies on display. It can also be painful, dismissive, and deeply dehumanising. There are plenty of quacks around offering alternatives: reassurance, meaning, answers that appear less clinical.
“I think we’ve gone into a historical phase where we prefer to shut death away from ourselves, that we institutionalise it,” Macauley recently told the Guardian. It’s often said that Western culture (whatever that means) is bad at accepting death and dying. We admonish ourselves for avoiding consciousness of our mortality. But what might this consciousness do to us? While medicine can certainly be disempowering, a constant concern with one’s own mortality can feel worse; it can be completely paralysing.
I wonder if avoiding the idea of death, outsourcing it, doesn’t in fact have its uses. We trust the experts and their tests because the knowledge they accrue is itself tested; clinical also means scientific, peer-reviewed, the best available evidence. In a world where science is under attack and vested interests sow doubt, the question of who to trust becomes more complex. Some Tests is at its best when it provokes questions about how that trust―in the experts, in the orderliness of a plan and a process, in one’s own ability to understand the signals the body is sending―is structured, and how it is compromised.
I suspect that this novel will be read very differently by those who have been seriously ill, and those who have not yet crossed that border; it may be read with suspicion by those who have been suicidal. If there is a right-to-die message here, it is not clearly articulated as it is in Steven Amsterdam’s The Easy Way Out, another recent book that deals with similar questions, but from another angle and in a very different tone. Some Tests might be marketed as a discussion of a social issue, but it’s better than that: it unfolds as a fairy-tale does, inevitably and with the strange-but-familiar logic of dreams. Throughout, the prose is so direct as to be hypnotic. While the philosophical speeches of its various medical experts sometimes jar, it is rescued from its messages by a deep ambivalence that refuses to be resolved.
Macauley is famously underrated – in 2012 he won the inaugural MUBA for The Cook. Perhaps it’s partly because he makes readers feel uncomfortable, unsettled in the everyday; one emerges from his books freshly uncertain. Many of the writers I know are fans of his work. Looking mortality in the eye is not for everyone, and Some Tests sustains its steady gaze right to the end. To surrender to it, to follow where it leads you, is to risk transformation.
Jennifer Mills is the author of the novels Gone and The Diamond Anchor and the short story collection The Rest is Weight. She is the fiction editor at Overland. Her new novel, Dyschronia, will be published by Picador in February 2018.