Love Marriage: Monica Ali’s novel encapsulates the complexities of life as NHS doctor

Ammad Butt is a foundation year one doctor and freelance writer. He is on X: @ammadbutt_

Ten years was the gap between Monica Ali’s last novel and the release of Love Marriage in 2022. Ironically, this is the same amount of time it would take to go through medical school and train to be a qualified GP. Despite never having been a doctor herself, she has created a story which shows the intricacies of life in the NHS, highlighting issues which affect its doctors to this day.

The novel’s main themes are class, sex, politics, infidelity and race. These are driven along the backdrop of a failing NHS. The protagonist, Yasmin Ghorami, a higher-trainee doctor considering a career in geriatrics, is the daughter of Shaoakat, a proud rags-to-riches GP whose in-laws paid for his time at medical school which he paid back (with interest) as he so loves to remind everyone.

There is a chasm between Yasmin and Shaokat in how they feel and navigate throughout their career. Yasmin longs to be in love with the profession as her father was, joining him in revising medical cases in the evening to please him. As the novel progresses, Yasmin realises that the stresses of the job mixed with personal difficulties mean that she is often wondering whether this is the career for her. She is the archetype of many British South Asians, a feeling many of us know too well – being a doctor is seen as the pinnacle of success and respect for the South Asian community. A source of trust and someone who can ‘do no harm’.

Yasmin finds herself conflicted with this image of a doctor within a community. Her actions outside of work, damaging to those closest to her, divides her from it, and eventually spills over into her work. Doctors can often be expected to be perfect humans. In some ways that is how they are seen to parts of the public. But those of us in the field know this is far from true. High levels of stress and anxiety in a field which requires immense amounts of training and academic pressure inevitably, in reality, create flawed humans Yasmin struggles to cope with this, reminded constantly of the phrase by her fiance, Joe, an obstetrics and gynaecology registrar, that she, ‘couldn’t hurt anyone’.

Similarly, Joe has to remind himself (during his therapy sessions) that he is a good person, who does good things on a day-to-day basis – saving lives and performing emergency procedures – to renew his sense of morality in response to the decisions he makes in his personal life.

The generational divide between Shaokat and Yasmin is interesting to see. Shaokat is from the era of migrated doctors to the UK. He believes in the hierarchy system which exists in the NHS. When Yasmin finds herself racially abused by a patient’s family, and they complain – an experience known to many of us in the NHS, her father suggests she should have swept it under the rug as her colleagues suggested for the benefit of her career, even though she had done nothing wrong. This, sadly, feels like a plausible scenario in today’s NHS.

When Yasmin notices a patient has a potential broken arm, but is unable to verbalise this due to comorbidities, the professor leading the ward round (a target-driven individual) chooses to ignore this, opting for an antipsychotic instead. Yasmin goes back and orders an X-Ray against the consultants wishes – which leads her to being mistreated for the remainder of the novel for undermining him. Now, this feels less plausible (I am sure all clinicians can recognise and treat a fracture), but the notion of meeting targets rather than focussing on individuals is a common occurrence. The NHS operates in such a way where numbers are more important than the patient in order to meet demand and remain at working capacity. The hierarchical nature of medicine may well persist to an extent where, very junior doctors often feel they cannot raise issues or ‘go behind’ a senior’s back to do what they deem right for a patient. There are various programmes at trusts to change this culture.

Joe, Yasmin’s partner, as well as Pepperdine, a consultant-turned love interest who Yasmin works with, both have a sense of security which both Yasmin and her father do not share. Both senior white doctors in their respective fields, they do not have the fear of losing their job in the same way the Yasmin and Shaokat do. Statistics show that white consultants earn 3-6% more than their ethnic minority counterparts¹ and are more likely to gain the job in the first place. Likewise, ethnic minority doctors are twice as likely to be referred to the GMC for fitness to practice.²

Despite the accurate depiction of core issues in the NHS, I can’t help but feel there was a missed opportunity to go further. There is a lack of discussion around the pay and working conditions doctors face in this country. For example, there is a mention of the doctors strikes from 2015 and that Yasmin was on the frontline of them, much to her father’s dismay. It could have been good to show that maybe Yasmin wants to strike, but simply cannot afford to – which many doctors are facing currently. Additionally, how they manage to plan a wedding and attend social gatherings and awards events whilst maintaining their obligations to their work schedule does not seem realistic. This would have been an interesting dynamic and could have added another angle to why the relationships falter in the book.

Monica Ali has done wonders portraying the life of a doctor from different viewpoints in the novel – it’s no wonder Adam Kay called it ‘the most human portrayal of doctors’ he’s read.¹ It is a must read for those who work in the NHS.

Featured book: Monical Ali, Love marriage, Virago, 2023 (paperback), ISBN: 9780349015507, £9.99

References

1. https://www.bbc.co.uk/news/health-45421437 (accessed 25/4/24)
2. https://www.gmc-uk.org/news/news-archive/gmc-targets-elimination-of-disproportionate-complaints-and-training-inequalities (accessed 25/4/24)
3. https://www.virago.co.uk/titles/monica-ali/love-marriage/9780349015507/ (accessed 25/4/24)

Featured photo taken 2024 by Andrew Papanikitas