The hard facts of life - and death

Fiction: DEATH COMES FOR PETER PAN by Joan Brady, Secker pounds 15.99

When Theory of War was published in 1993, I thought it was the finest new novel I'd read for as long as I could remember. I've lost count of how many copies I have sent to friends. With re-reading, its spare elemental language grows richer all the time.

Death Comes for Peter Pan, Joan Brady's newest work, is also a gift, but a troubled one that must be treated as something brilliant, like a precocious and totally impractical friend. As a collection of ideas it boils with anger and courage, yet there is a brittle shimmering quality about the pain it describes that eludes the writer's grasp, making it difficult for readers to reach out and embrace the novel for fear it might just break.

The most robust pages are the last four, the non-fiction afterword in which Brady describes how, in 1988, she began looking into America's national medical programme for the elderly. Her aim was to write a long expose of Medicare and how it milks patients who are dying as well as their families. We learned a little about the American way of dying in Sherwin Nuland's How We Die, yet nothing prepared Brady for what she found when she took her terminally ill husband, the writer and consumer rights activist Dexter Brady, back to the US for treatment. As Joan Brady expanded her research for her book, she says, "I knew that I'd stumbled onto a huge scandal. I could hardly believe it myself ... I'd uncovered a savage wide-scale institutionalised violation of human rights, and I couldn't make anybody listen to me."

Notwithstanding the success of Theory of War, American publishers turned their back on Death Comes for Peter Pan. Knopf initially offered $100,000 for the book, but the deal fell through, and it remains unsold in Brady's home country. America, it seems, is not ready to hear about its dying rooms, even in fiction.

The narrative of the novel runs along straight lines. A young American wife, Alice Wexler, reacts with disbelief when English doctors tell her that her husband is dying and that she would do better to give in gracefully than rail at his fate. Angry and distraught, she bundles him into a car, a plane, and then another car to take him back to America. Far from finding solace in their home town, the Wexlers slowly learn - though Peter, Alice's husband, is barely aware of what's going on around him - of the full horrors of being ill in America, whether or not you've thought of taking out insurance.

In flashbacks, we also meet friends from Alice's past and learn the couple's strange story: that Peter was once her own mother's lover and is probably, though Alice doesn't know this, also her father. She met him first when she was three years old, lost her virginity to him in her teens, and for most of her life, not surprisingly, he has been her obsession.

As, one by one, the US doctors come to the same conclusion as those in Britain, Alice uncovers some horrible truths about the Wonderland that is the modern American dream. Staff in Medicare nursing homes are drawn from the lowest rungs of the labour pool, as no one else will work there. The patients are cheap to tend, they are grossly over-medicated and fed through nasogastric tubes which makes them as passive as vegetative patients. The US government underwrites these nursing homes, claiming they provide "hospice-type care".

In the trade, nursing homes are called "produce departments", a double entendre of huge proportions. A produce department is where supermarkets keep their vegetables. And these patients "produce" something - money.

Brady, through Alice Wexler, makes the case for mercy-killing, and perhaps it's this that turned the publishers' stomachs. Yet the thrust of her message is muddled, and many questions go unanswered. What would really be solved by replacing America's current unregulated care for the dying with systematic euthanasia? On a more metaphyiscal level, why do we in the West find it harder and harder to accept that we all must die?

The greatest weaknesses of Death Comes for Peter Pan are those that are exposed by the discipline of novel-making, here mostly characterisation. True, it's hard to make something alive out of a man who is dying and speaks only rarely (and then in a monstrous non-sequitur), even if he is an obsession. As a husband, lover and father, Peter Wexler was a lodestar to Alice and before that to her mother - Brady tells us that much. But you don't feel the heat. Alice Wexler, with nothing to bounce off, is hardly more alive herself.

There are strengths, though, which cannot be ignored. Brady's sheer joy at writing fine sentences is vivid - sentences like "That Peter had been young ... This Peter was grey through and through, grey eyelids over eyeballs as slippery white as lychee nuts."

This is not the definitive book about dying in America, but that doesn't mean Death Comes for Peter Pan shouldn't be read. On the contrary, we should read it for its strengths and stop carping.