This is the kind of novel which I both adore and, frankly, fear. Stephenson has already written a truly affecting memoir about the death of his brother in the Indian Ocean tsunami, Let Not The Waves Of The Sea, which rightly (to my mind) won the best first book prize at the Scottish Book Awards. He followed it with an experimental novel, Set My Heart To Five, which dealt with artificial intelligences, the blur between robots and humans and the enigma of consciousness – and did so using clever references to film and science fiction genres while at the same time enacting its fascinations at a linguistic level. This new book, Sometimes People Die, is again in genre, but this time a cross between crime and hospital drama. It reminded me a great deal of Josh Bazell’s underrated Beat The Reaper.

Why do I adore this kind of novel? It is intelligent, very witty in a very dark way, and does not flinch from serious and difficult questions. Why do I fear it? Well, being set in a hospital necessitates descriptions of diagnoses and I – my bad – can’t read about upgoing plantar responses or the symptoms of endocarditis without immediately wanting to check on myself. Part of Stephenson’s novel should be required reading for hypochondriacs, not as a gruesome guide but as a reminder of the difficulties medical staff have to face every day. A headache could be a hangover or it could be a brain tumour. The trick is to find out which.

The novel’s central character is a young, unnamed Scottish doctor who takes up a position as senior house officer in a struggling London hospital. He has taken the unenviable job because he can now practice again after having been suspended for stealing opioids for his own use in his previous hospital. A lot of the humour is obviously of the gallows or mess-room variety, but not insensitively so. There are equally acerbic remarks about the hierarchical nature of medicine, the rivalries between doctors and surgeons, the status of nurses, and a funny cadenza of where orthopaedics ranks in the pecking order (one friend of mine, retired from the NHS, remarked “oh, they’re always useful for DIY”, so the depictions here ring true, or at least are corroborated).

Author and former doctor Simon Stephenson. PIC: Contributed

If dealing with under-staffing, under-resourcing, fatigue both physical and emotional and perpetual stress is not taxing enough, our protagonist has another problem. It seems that in St Luke’s more people are dying than should be dying. The revelation of the “excess deaths” – to use a phrase we have all become used to over the last couple of years – is drip-fed, and when there seems to be a pattern, the horror looms that someone in the hospital is deliberately harming and killing patients. It allows for a police procedural to go alongside the medical procedural, and – inevitably – a vaguely aghast satire of media responses.

To an extent, Sometimes People Die conforms to the Midsomer Methodology. I fairly quickly ran the “least likely perpetrator” algorithm, and although it came out correctly by the end of the book, all credit to Stephenson for throwing in some decent red-herrings and a couple of surprising twists. It is also commendable that there is no sententious moralising. Towards the end it offers this instead: “it is the question we never ask in medicine, because we all know it has no answer… why?”

This is a stylistically bold book, with certain phrases used like recurring motifs. It is always useful to see when a title occurs within a book, and here “sometimes people die” knells ominously at different points. But so too do other phrases such as “mostly flat is asystole and asystole is death”, litanies of conditions and medications and references to the fictitious Smithfield’s Textbook of Human Disease. Diagnosis and detection become twinned here, and words like puzzle and jigsaw and unusual and “fiendishly complex” carry a double duty. There is also the brave decision to interleave the narrative chapters with case studies of medical staff who have gone on to murder, looking for reasons (which are multiple) why someone would use their knowledge for the opposite of its purpose.

A novel that can make you giggle and wince and think and feel a degree of righteous indignation in quite an achievement. It is worth observing that it is set rather carefully in 1999 and 2000, with a coda in 2019. This might seem a minor aside, but the sense of a health service buckling under pressure is therefore unconnected to the pandemic. If anything, the pandemic only made unignorable factors that were evident beforehand. It is also of note that, with three books, Stephenson has now written three very different kinds of books, each excellent in their own ways. That is an increasingly rare phenomenon in publishing, and one to be valued.

Sometimes People Die, by Simon Stephenson, The Borough Press, £14.99

Book review: Sometimes People Die, by Simon Stephenson