Reviewed by Alyson Baker
James Ballard is a recently bereaved single father to a baby daughter, and a medical editor tasked with saving the ‘third oldest medical journal in the world’, the Royal London Journal of Medicine, from the mistakes no one else notices – the misplaced apostrophes, the Freudian misspelling, the wrong subtype of an influenza strain (H2N1 or H5N1?).
His job is utterly boring, but – or so he tells himself – totally crucial: the Royal London is a stronghold of care for the human body, a bastion of humanism in a disintegrating world. In the London outside of the office, the prognosis for the body politic is bad: civic unrest is poised on the brink of riots.
Attempting to grieve for his lost young wife, while haunted by a group of violent North London teenagers in a collapsing city, James is brought to crisis…
The Royal Free depicts the fracturing of a stable reality – personal, institutional, and societal. James Ballard is a grieving widower with a six-month-old daughter, Fiona. He is a copy editor at the Royal London Journal of Medicine, the: “third-oldest medical journal in the world.” The Royal London is dealing with the surrender to online-only publishing, and the deep-fake takeover of scientific journalism. Ballard’s apartment is in a housing estate being besieged by young thugs, and his London is one of constant riots and mayhem, sparked by the police-killing of a “29-year-old black man”.
In keeping with the themes of disintegration, The Royal Free meanders from intra-office politics and foibles to Ballard’s personal difficulties, to national and international chaos. The point of view changes, at one point even being that of Fiona, probably a Ballard projection, but maybe not. The only theme that is consistent is Ballard’s plodding digitisation of the journal’s multi-volume style guide. Such a Baroque urge to order and uniformity is a stark contrast to the surrounding pandemonium: “It was very quiet but for the sirens outside.”
“Nothing quite like a six-month-old baby to adjust your expectations of yourself.” Ballard finds himself wanting when, after farewelling Tatia (“23, Lithuanian, ‘economics student’”) after a week of Fiona-minding and sex-providing, he goes for a run. Leaving Fiona in the neglected apartment, alone. Shuker is an expert in the looming dread – the reader horrified at all the things that haven’t happened but that might. Ballard has similar forebodings when he encounters a group of youths on his return. And thereby starts a sequence of events, with at one point Ballard doing “a stupid, stupid thing” – “They would come back for him.”
The Royal Free highlights how modern life is increasingly wanting of a style guide, of “man as an ordered political animal, civilisation, and its critique”. There is no madness in a way, as all is madness. People behave as though they’re avatars in an online platform game, hurling rocks and bottles at anything, to see if they get a reward. First responders must often curtail treatment to just get the injured to a hospital. Or those wanting to cheer up the masses with entertainment end up regretting their choice. There is little social cohesion: catching public transport is to enter the domain of an individual – a driver who will rip you off, and who you have to just hope will take you to your intended destination.
Ballard loses himself in the monotony of the style guide. He and his colleagues appear a nit-picking, arrogant lot – an editor’s job is to be judgemental after all. And they are in the specific field of the medical – a group that don’t know the meaning of “petrichor” but don’t stumble over “vesicovaginal and rectovesical fistulas”. They edit “A Patient’s Tale” by a young Nigerian woman, an awful tale geographically distant from themselves – little knowing how soon her plight might be one befalling those closer at hand. They are more concerned with their journal going solely online. Some compare it to the fate of the OED: “Gives the word ‘Help’ in the menu bar a whole different feel, doesn’t it?”
The arc of the book, really a rapid descent into darkness, is provided by Ballard – his discoveries in Fiona’s nursery, a decapitated cat nailed to his door grill, his ending up always walking with a knife in his pocket. However, themes also emerge through the stories of his workmates: Dr Ibrahim al-Reyes, impeccable, dealing with the trauma of personal atrocities in Syria, watching horror movies with “the sense of cruising hostility and blankness”. The terrifying commute to work for Annabel Pitti, after her bike has been stolen out of her backyard shed. Kristian Shattuck, losing his sight, desperately volunteering for more and more work, making more and more mistakes – “words holding together the things that are falling apart”.
The book is like the sexist banter of some of the Royal London staff: “a weird, doomed fin-de-siècle finality that soon became a lurching inevitability.” All characters are fraught and flawed, the only judicious character being an uncanny Rhodesian Ridgeback. I think The Royal Free will be polarising; there will be those who worry that it doesn’t hold together, and those that think that that is Shuker’s point. The novel itself disintegrates. I was initially destabilised by the book, but I ended up finding it riveting. And increasingly disturbing the more I recognised that for many in this world, what is described would be their own non-negotiable, lawless reality.
Alyson Baker is a crime-loving former librarian in Nelson. This review first appeared on her blog, which you can check out here.
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