IN HER SEMINAL ESSAY Illness as Metaphor, Susan Sontag, herself an intermittent cancer sufferer for 30 years, remarked: “All this lying to and by cancer patients is a measure of how much harder it has become in advanced industrial societies to come to terms with death.”

The Spare Room, the Australian writer Helen Garner's first novel in 16 years, is an agonising calibration of this coming to terms, both by the terminal cancer patient, 65-year-old Nicola, and by her friend, Helen, with whom she comes to stay in Melbourne to pursue a three-week course of dodgy alternative medicine at the Theodore Institute. Narrated by Helen, the novel is such an unflinching look at mortality and its effects on those who care for the terminally ill that at times you have to look away from its blazing and undeluded clarity.

Helen's solitary existence is blown to smithereens when Nicola walks in through her door. In the blink of an eyelid, Helen is consumed by the role of carer: washing, cleaning, cooking, shopping for groceries, doing the laundry, hanging out the sheets, driving Nicola back and forth from the Institute, where every other day a shocking 25,000 units of Vitamin C is injected into her by a drip, a treatment that almost breaks the frame of that poor woman, reducing her to an agony-racked, sweating, feeble detritus of a human being.

She suffers such extreme night sweats that the bed has to be stripped, the mattress turned over, and the laundry done several times over the course of one single night. The details of this kind of pain of the sufferer, the labour of the carer, and the ensuing exhaustion are harrowing.

At first Helen, extremely sceptical of the mumbo-jumbo that Nicola has decided to use as a last-resort lifeline, restrains herself from voicing her misgivings, but unable to cope with Nicola's physical pain and her refusal to try even orthodox painkillers, she drags her to a proper doctor and gets morphine prescribed.

But Nicola's enforced breeziness in the face of the seriousness of her situation, her bluff and brazen state of denial, her blind faith in quackery, her performance of mocking pity for those around her who are beginning to show the strain - all these finally drive Helen over the edge. In a terrible scene of reckoning, Helen and Nicola's niece, Iris, convince her to visit a proper oncologist. If the diagnosis is shocking, then the choices that follow for Helen are even more so.

It is here that the book's tough, unhypocritical moral arithmetic asks its most ruthlessly uncompromising questions: at what cost does the caregiver demand the end of denial on the part of the terminally ill? And what is the price paid for by the refusal to face death, both by the dying and by the survivor? What does it take to arrive at the understanding, as Helen does, that “the belief in the responsibility to be happy was the dumbest idea anyone ever had”?

Only great fiction demands us to reset our moral compass and look at our value coordinates all over again. The Spare Room achieves this by relentlessly working out the dimensions behind the simple words: “Death will not be denied. To try is grandiose. It drives madness into the soul. It leaches out virtue. It injects poison into friendship, and makes a mockery of love.”

And yet in a book this spare, written with such grace, Garner introduces in the interstices a calm, precise poetry: “The sky flushed and turned dusky. The coloured lorikeets darting in and out of next door's palm tree reminded us of the kookaburra that had swooped one day on her lunch table, snatched in its beak a fist-sized slab of expensive Danish butter, and soared away to a high branch: later we spotted the greedy bird standing in the undergrowth near the tank, leaning forward with its beak agape like a drunk outside a pub.”

The Spare Room by Helen Garner
Canongate, £12.99; 180pp
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