Laugh till you bleed

by Lucy Ellmann

Bloomsbury, 224pp, 12

FACE LIKE AN ANGEL, LUCY ELLMANN. I know. I kept breaking off from reading Doctors & Nurses to double-and triple-check her picture on the back flap. She's got a face like an angel, all right, but that pen - oh, that pen of hers streams like a sewer. Such language! So many blunt references to body parts and their functions, especially those connected to eating and fornicating. You just wouldn't credit it, judging by those big soulful eyes.

Nor would they prepare you for the vitality of her writing. Enormous it is, and so energetic it requires the constant employment of capitalised words and exclamation marks. These intrusions should test a reader's patience - certainly their appearance on every page scared me at first. That sensation faded by page five when, having succumbed to Ellmann's unique rhythm, I laughed out loud for the first of many times. It was the appearance of one of her trademark lists (which an earlier reviewer likened to poetry). Here it's a roster of institutions with names comprised of initials, which her protagonist, Jen, hates (she hates immoderately and widely, so this represents the mere tip of the iceberg): "She hates the BBC, the NHS, Bhs, HSB, the DHSS, B&Q, R&B, B&Bs, the BMJ, BMs, BMXs, C&A ..." ad infinitum. Not surprisingly, for she is a woman of enormous girth, Jen does like BLTs.

Jen's a nurse fleeing the disappointment of a failed friendship, and has arrived in a rural backwater to take up a post in Doctor Roger Lewis's surgery. Though it's never specified in the text, some years ago Ellmann announced this rural backwater would be East Lothian. She loathes East Lothian. That's not surprising, since like her heroine, Ellmann abhors with gusto, as a tour through this and each of her previous novels proves beyond a shadow of a doubt. She despises life's utter pointlessness, its cruelty and its bitter disappointments. She cannot abide the ignominy of death or the sadness of loss. She loathes human interaction, which can only lead to betrayal. Self-hatred? Don't get her started. As fans might expect, Doctors & Nurses reads like a stream-of-consciousness rant after way too much caffeine. Ellmann's actually far smarter than that. Careful readers will recognise that her work is thoughtfully composed and sharp as a rapier.

Most of all, it is hilariously, eye-wateringly funny. It's blistering and raw, and just goes to show that even a small city like Edinburgh, which can feel claustrophobically provincial, is intellectually spacious enough to nurture diversity, giving us both the gentle bemusement of Alexander McCall Smith and the altogether more raucous outbursts of this transplanted American, one of the many writers who have found their spiritual home in Scotland's capital (another being husband Todd McEwen - also American).

Jen and Dr Lewis are a perfect match, professionally and personally, though superficially they couldn't be more dissimilar. Whereas she is repulsively obese, Lewis is a god. That is, he resembles one, with his blond locks, tall slender physique and dashing cleft chin. He has a bit of a problem with patients, though, a distinct lack of patience with their problems and nagging ailments. Isn't it enough that he's memorised their names? He'd rather concentrate his thoughts on sex, his spiffy Jaguar, how heroic he looks in an orange air ambulance jumpsuit, and diving holidays off the coast of Belize. This suits Jen down to the ground. She despises sick people. Both have a habit of cavalierly offing their patients, accidentally and on purpose. "Dr Lewis killed people every day, people who wanted to live. Those that wanted to DIE, he saved. It's a system!"

Those patients they don't kill, the pair manage to ruin in other ways, in what amounts to a gloriously vicious and thought-provoking send-up of the medical profession. Dr Lewis has Jen write to all his female patients insisting they come in for smear tests. "These are of dubious medical value and have an established record of failure, but Dr Lewis was going to get a big fat BONUS from the NHS if 50 per cent of his women patients could be conned into having the test, TRIPLE if he could rustle up 80 per cent!" Naturally, Jen compounds the problem by getting the slides all mixed up. Further panic ensues when she lets it be known that Lewis favours the MMR jab. His adoring patients follow his every whim, and children arrive in droves. "Wiping away a tear or a blob of blood afterwards, Jen would say, 'There now, you'll live!' and she was pretty much right: only a few kids died, two or three got autism, and NONE WENT DEAF. And Dr Lewis got another BONUS!"

Obviously these two are destined to fall in love. That's how it happens in every single doctor/nurse book, and this is no exception. But no sooner than you can shout "Mrs Rochester", as the happy couple hotfoot it towards the altar, out pops Lewis's demented wife, who turns out to have been lurking underfoot all along. As if life in this chaotic surgery weren't hectic enough, Ellmann ratchets up the pace, and all hell breaks loose, including two more gruesome (but funny with it) murders and Jen's zealous conversion to a proselytising form of naturalism thanks to an epiphanic encounter with the Naked Rambler. All loose ends and body parts are tied up via a properly satisfying conclusion, in which everyone gets what's coming to them.

Those parts of the book not devoted to medical mishaps are given over to extended passages of shock, awe and repulsion at the workings of the human body, and the rapaciousness of the female sex. Not the species, the actual bit between ladies' legs. Jen loves hers as fervently as she hates everything else. One manifestation of this devotion is her promiscuity; another is her vast collection of handbags which, Ellmann convincingly argues, are highly symbolic objects: "Women like things that OPEN. They like CONTAINERS. They like soft, rounded, glinting secret things with colourful folds suggestive of something PRECIOUS. Oh COME ON, they like anything resembling a C***. Men have their phallic ties, women their labial handbags." This, she posits, is because we are no longer free to display the real thing, as in prehistoric, clothing-free times. Thus substitutes are required.

If you're not laughing by now, check your pulse. Her knack for piling on repulsive absurdity after repulsive absurdity evokes early Martin Amis, except the magnificently talented Ellmann evinces more soul. In the three novels I've devoured so far (this, Dot in the Universe and Varying Degrees of Hopelessness), while her characters are largely unsympathetic, they're also achingly human, which is a testament to the author's depth of empathy and intelligence.

Ironically, Ellmann has said she felt like the dunce of the family growing up amid geniuses (for a start, father Richard was the internationally renowned biographer of Joyce and Wilde). She claims she was slow to read, and a disappointment later, when she chose not to enter the groves of academe. As an adult, Ellmann was rocked to the core by her parents' deaths, especially that of her mother, whose passing triggered a breakdown and left her angrier than ever.

Such is the truth of what Ellmann has to say about the human condition, and the tremendous depth of her emotional awareness that her characters' hurt, frustration and phenomenal self-hatred is vivid and raw, rendering their bonkers behaviour not so much excusable, as weirdly logical. What's the point of life, she continually asks. One answer is: to be tickled pink by these novels. As one who prefers her home truths laced with malice and hilarity, I have found a new hero in Lucy Ellmann.

Doctors & Nurses by Lucy Ellman is published on Monday by Bloomsbury, price 12.