Medicine, Money and Murder by Anne Pettigrew

In Medicine, Money and Murder, Anne Pettigrew continues to examine the murkier side of medical ethics she first explored in her debut novels, Not the Life Imagined and Not the Deaths Imagined. Her background as a GP gives her access to a deeper understanding of the nexus between care and self-interest and she uses it to vivid effect in her work. Previously she has given us a Harold Shipman-like character to examine the ease with which a serial killer can slip into the depths of evil. In Medicine, Money and Murder, she serves up another deliciously wicked villain but she also turns her attention to the baleful effects of big pharma, to equally chilling effect. 

It is 1971, and Mhairi MacLean, a naïve young woman from Scotland is working as an extern in the Ellis Memorial Hospital in New Jersey as part of a three month summer programme. Away from home for the first time, Mhairi is struck by the differences between Scotland and America, the sleek new multi-storey hospitals compared with the Victorian buildings she was accustomed to back home, the more relaxed lifestyle, the confidence of the people. 

Gradually, though, she comes to realise the differences between American and British healthcare are more profound than she could have imagined. In particular, she is shocked by the way in which the American healthcare system is driven by finance. She wrestles with her conscience as she realises the extent to which health insurance and money are primary considerations. “It’s funny how much clinical practice changes when money comes into it,” she says at one point as it becomes clear that the level and quality of care received by an individual is entirely dependent on their ability to pay, rather than their need. 

Further, the culture of litigation dictates medical practice to an unhealthy degree. The first thing to learn in medicine, she is told, is that “diagnoses can be hummingbirds or sparrows.” And missing a hummingbird would mean getting “your ass sued off”. As a result, patients were exposed to unnecessary scans and procedures, purely to head off any possibility of a medical suit. What happens if the patient can’t afford it, Mhairi asks. “When the bills run up, you get into debt and have to deal with it,” she is told. 

Medicine, Money and Murder is a crime novel, and the mystery begins when a patient being transferred from one hospital to another seemingly disappears. The receiving hospital has no record of her being admitted. Bureaucratic blunder? Or something else? 

As Mhairi and her friends begin to investigate, one person comes to interest them, Dr van Lindholm, a senior Renal specialist at Ellis Memorial, and someone who appears to wield an unhealthy amount of power. Even the hospital’s Medical Chief, Dr Harper, seems cowed by him. As Mhairi continues to observe Dr van Lindholm’s dealings she grows more and more concerned. 

Medicine, Money and Murder is an exciting and fast-paced novel. The crime element is well handled and the medical background Anne Pettigrew weaves in is never intrusive but rather adds a sense of verisimilitude. Mhairi, very much a fish out of water in big, brash America, gradually matures and develops, and proves very much a match for the vested interests arrayed against her.

Not the Deaths Imagined by Anne Pettigrew

Not the Deaths Imagined by Anne Pettigrew

Beth Semple, the narrator of Anne Pettigrew’s terrific first novel the medical Tartan noir Not the Life Imagined, is back in an even better sequel, Not the Deaths Imagined. Still a GP in Glasgow, Beth becomes embroiled once more in a story of deaths and deceit and dodgy doctors. This time, though, Beth herself is in jeopardy, along with her family, and the book gallops along to a rousing and frightening climax.

As with the first novel, Not the Deaths Imagined is mostly narrated by Beth herself, and we get her highly moral, utterly decent view of a world which becomes increasingly murky. Interspersed throughout, though, are third person interludes where we are taken into the viewpoints of the other characters, particularly the dodgy ones, and this gives the novel a pleasing balance. The story unfolds and the reader is taken on the journey of good (Beth) and evil (David Goodman). We know a clash is coming and we wait nervously for it to happen. Supporting Beth along the way are a number of her friends whom we first me in Not the Life Imagined.

David Goodman is a doctor in another practice in Glasgow, one with which Beth’s practice has a reciprocal agreement for out of hours cover. It is during one of these occurrences that Beth is asked to sign a “Part Two” form for a recently deceased patient, permitting the body to be released for cremation. Beth, unable to honestly say she can agree the cause of death, refuses to sign. This honest, dutiful act sets in train the frightening events of the novel.

Goodman, it becomes clear, is a multiple killer, bumping off his more elderly or vulnerable patients having first ensured their wills have been changed to include him. Nothing much, not more than £5000 or a painting each time. Not enough to draw attention. Enough to be lucrative. Besides, there is the thrill of the act, which never diminishes.

Goodman is clearly insane, and it is notoriously difficult to write such characters effectively. Either they are too normal and the reader can’t buy into it, or the writer tends to ham things up so much the character ends up like Chief Inspector Dreyfuss in the Pink Panther films, driven to raging madness by Clouseau and his incompetence. Anne Pettigrew avoids these extremes and in the process she creates a deliciously monstrous villain.

It is obvious from reading the novel that the author was a GP herself. Her familiarity with medicine and general practice gives an air of authenticity and credibility to the drama that unfolds, so that you can implicitly believe what you are reading. Not the Deaths Imagined rattles along pleasingly and the reader is drawn into Beth’s increasingly frightening world, willing the deaths imagined not to include her or hers. In a dramatic climax, the answer to that hangs in the balance...

Not The Life Imagined by Anne Pettigrew

 

There are portents from the outset that Not the Life Imagined, a story about a group of medical students in the 1960s and 1970s, is not going to be your classic comic tale of medical misadventures and ineptitude, with James Robertson Justice BELLOWING across every scene at the “blathering idiots” under his charge. We are told, right from the start:

When did you last see a physician or surgeon? Were they charming, knowledgeable, reassuring and trustworthy? Are you sure? I’ve known some who are not as they seem. They had other agendas. One is dead and the other awaits his fate, just like me.

It is clear, then, that there is going to be darkness in this novel. And yet it is a richly humorous story, and medical misadventures and ineptitude abound. But these escapades are not, as with Richard Gordon or the like, the point of the novel, but its backdrop. We are in a much more realistic world and, as the novel unfolds, its loosely connected moments gradually coalesce to form something darker and deeper.

Most of the novel is told through the eyes of Beth Slater, and it is Beth who provides the novel’s moral compass. She is one of a group of students who arrive at Glasgow University to study medicine in 1967, a working class girl, naive and principled. Her classmates are a diverse bunch, all of them flawed in the way every human is. Over the course of the twenty or so years encompassed by the novel these flaws are itemised and probed and, if not exactly judged, then certainly exposed to critical scrutiny. And with each moral failing, each moment of weakness, each capitulation to greed or fear or plain desperation, the characters become more human, more like us, more like a mirror in which we can see our own flaws and frailties.

Not the Life Imagined is part bildungsroman, part crime thriller, part psychological character study, part comedy, part feminist admonition, part history of the NHS. Each of the characters arrives at university hopeful and ambitious, with ideas about how their lives will unfold. Life, of course, has its own trajectory and anyone who thinks they are in control of their own destiny is closing their eyes to reality. The reality, in Not the Life Imagined, is sometimes tragic, often traumatic, frequently amusing, but always compelling.