Mixing Vegas flash with US anti-socialised health care, Lynn provides an amusing juxtaposition that reveals itself to be neither as laughable not as big a juxtaposition as the reader hoped; but remains darkly entertaining.
Max Green is the best manager in the almost best of Las Vegas casino-hotels. But being that great means recognising Vegas is tied up tight enough that he’ll never move from fairly remunerated employee to obscenely wealthy power-in-his-own-right. However, he also recognises that US health care is an under-exploited revenue stream. And Samaritans Medical Center in Washington DC, a mediocre hospital with a CEO problem seems the ideal opportunity to get in before the top spots are allocated. After all, what difference is there between light entertainment and cardio-thoracic surgery once you cut out the emotion?
As befits a novel based around a theory that everything can be reduced to an identical set of economic structures and a trivial veneer of emotive assumptions, the opening section contains a noticeable amount of exposition and narrative. While this is perhaps drier than the start of most fiction, Lynn leavens the descriptions of hotel and hospital administration with amusing commentary and character pieces. Once this initial – and necessary – setting of the scene is finished, the book travels deeper into the absurd extremes of this economic reality. Therefore, readers are likely to be well served by granting Lynn some benefit of the doubt to begin with.
Satire at its heart is a Sophoclean endeavour: the author, like some naïve guide, leads the reader away from an ostensibly not-unreasonable point until they reach an entirely unreasonable one. Only satire seeks to entertain as well as expose flaws. And Lynn does not disappoint: arms-manufacturers see no contradiction in funding medicine; faith becomes a reason for sin; pharmaceutical reps treat doctors; and it is somehow more profitable to pay agency fees on top of wages than employ the same staff.
However, satire is more than just an absurd situation. It draws strength from the almost nervous laughter that comes from the realisation of how little separates reality from the absurdity. And this novel is built on tiny steps that, individually, seem a touch venal yet not implausible. Perhaps the strongest indication of Lynn’s satire not being mere absurdity lies in some of the radical opinions expressed by his characters being almost identical to public statements made by senior US officials a couple of weeks before this review was published.
While Green’s recruitment incites the absurdity, Lynn provides a second viewpoint on the changes at Samaritans: that of Andrew Sharp, a renegade surgeon recruited to be the first headline act in Green’s plan to treat health care like Vegas. Sharp’s desire to be the best surgeon, although it drives him to save lives, has no space for the ethical side of medicine; as such, it is as lacking in empathy for patients as Green’s rampant capitalism. This contrasting, yet still slightly extreme, perspective both highlights the issues with Green’s plan and provides issues of it’s own, enhancing the dark comedy of both by contrasts.
Green is a well-written character: engaging, active, clever and just sympathetic enough to not revolt utterly. While readers will be thankful he isn’t running any hospital they visit, the distance of fiction is enough that they can gain pleasure from discovering how he overcomes the increasing issues of treating people like poker chips.
Sharp on the other hand is a more traditional protagonist, discovering that he wants to be more than just great at surgery but that he has no idea how to be a better man.
The supporting cast are similarly sympathetic and yet not free of moral compromise. It is this use of shared slant in each character rather than any one definite evil that draws the reader in before revealing the farcical but troubling consequences: taken alone the characters don’t seem that bad; but placed together, they reinforce and redirect each other’s baser natures, creating plausible progressions to absurd outcomes.
Overall, I enjoyed this novel. I recommend it to readers seeking satire with just enough absurdity to not seem like reportage.
I received a free copy from the publisher with a request for a fair review.