This short, stark book is a frontline bulletin from the operating theatre of a British hospital, giving us a surgeon's-eye view of her work in painfully vivid detail. Gabriel Weston's unadorned style is superbly honest, and her descriptions of bodies under the knife are not for the squeamish. It is a revelation just how gory the modern operating room remains.

Weston unpeels the raw details of what goes on inside our bodies, of which we have, perhaps mercifully, so little idea; but she also appreciates their strange poetry. Up your nasopharynx, for instance, there is “a shady chamber flanked by the wonderfully named Caves of Rosenmuller”. She is also sharp on the human angle. Surgery may involve saving lives, sometimes with heroic effort, but it is also a lucrative career, with all the “sex, power, competitiveness, enmity” of any other working environment. Doctors and surgeons are most certainly not saints, and the worst of them combine tremendous arrogance with terrible, indeed fatal, laziness or incompetence, and a virtual refusal to communicate intelligibly with their patients.

There is a dreadful account early on of a young woman with abdominal gunshot wounds and extensive internal bleeding. However, her life could probably be saved quite straightforwardly simply by stopping the bleeding and plugging up the holes, ideally with some sense of urgency. Weston recalls the surgeon on this case first taking half an hour to come down to theatre, and then stopping for a coffee on the way, his “mannered slowness of action” supposedly signifying his effortless mastery of the situation. An hour later, the operation is a total mess, and he is crying out for help. The girl is still alive, just about, but she dies the next day “from multiple organ failure, probably as a result of massive blood loss”. Weston spares us no details. When she herself peels off her surgical scrubs, “my underwear was wet with this woman's blood”.

She tells us how heavy an amputated human leg is, and observes of the cadaver she dissects for two years as a student that it was a “body I had come to know more intimately than that of any other”. More intimately, indeed, than most of us will ever know anybody. She explains how in abdominal surgery the patient is simply sliced open from sternum to pubis, the guts then heaved out and dumped on the table alongside. She and an assistant have to stand up close to the table's edge to “stop the snaking mass of small and large bowel from slipping between us onto the floor”. The guts sit there still “writhing”, “vermiculating in our joint embrace”.

She is not just honest about the oozy material reality of surgery, but about the emotional context as well. The death of a beautiful 20-year-old man from bowel cancer causes her a passing sadness, a certain professional frustration. But afterwards she cycles home along the Embankment “feeling the pleasure of life and luck in my veins”. No longer remotely downcast or personally involved, she soon feels once more the surge of quickening life-force when somebody else dies but you live on, in rude and powerful health. Similarly, when she knows that a patient is already finished, already “in death's embrace”, and there is no more for her to do, she feels only a strong urge to get away from them - back to the land of the living.

One or two chapters are exceptionally painful to read. There's Ben, the 10-year-old admitted with a headache. Evidently meek and mild-tempered, he doesn't complain much. His parents go home, and Weston herself leaves him for the night. But Ben has a brain tumour, incredibly rare at that age, and he dies all alone that same evening. As she says repeatedly, a certain coolness and distance is crucial to her job. But she got this one wrong. She could have given Ben her presence “in the appalling solipsism of his pain”, “the only available source of human comfort” at that moment, and she didn't. She couldn't have known, but she still counts it as one of her greatest failures.

At the opposite end of the spectrum of human illness and suffering is the spectacle of A&E on a Saturday night. “The loss and viciousness...the drunken horrors, the strip-lit awfulness of life gone wrong.” And for the most part, the sickness and injury on view here is strictly self-imposed, through self-indulgence, stupidity and thuggishness. There is also the routine abuse that the denizens of A&E think themselves entitled to spray about. “Am I going to get called a c*** every single day in

this job?” she wonders. An older nurse tells her, “Just be grateful you're not being called a fat c***.” What a charming nation we have become.

Weston is not one of the great writer- doctors or philosopher-doctors, in the tradition of Sir Thomas Browne, Anton Chekhov or Theodore Dalrymple. She offers neither their wider speculation nor their humane consolation. Direct Red is a slim, precise volume that gives us a blood-red close-up rather than anything more extensive, and the author chooses to leave much unsaid. She lets one single revelation drop - that at the age of 10 she was often left to sleep in the house alone - but no more.

She does not have much sympathy for minor whingers - few doctors do. She does not bond well with children, find babies cute and cuddly, nor derive much pleasure from their appearance in the world. This last is especially surprising. For those faced daily with the remorseless conveyor belt of a modern hospital, the sick and elderly constantly dropping off at one end into the great offal bucket of death, you would think they might derive considerable solace from the fact that, at the other end of the belt, the supply is perpetually replenished by a steady supply of bonny pink or brown babies. Nevertheless, this is a valuable and unflinching account, for all its grimness and gruesomeness, since it so clearly tells us the truth.

Direct Red by Gabriel Weston
Cape £16.99 pp181

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