Although Middenrammers is set in 1970s England, it is not the England of English literature which Helene Hanff discovered in 84 Charing Cross Road.

Bart Middenrammers

Freehand Books, 2016

Nonetheless, the hospital which lies at the heart of the story does have a familiar air to it, for narrator and reader alike.

“Sweport Maternity had the same air of dilapidated efficiency of other hospitals where I had worked. Snapping Sisters in starched blue and white, their fiefdoms at the ends of long corridors with chip-marble floors that curved up gloss painted walls, all the corners rounded.”

Not all the corners are rounded, however; Brian runs into some sharp edges in his placement.

“Don’t look gobsmacked, Brian,” said Arjun. “This is only a small part of what goes on here. There’s more to come. We are in a misogynist’s playground.”

The instruments on the cover of John Bart’s debut novel are potentially life-saving tools, but in the context of Arjun’s observation, their gleam can be more menacing than promising.

“My life was now centred round the Delivery Suite. When I was there life was technicoloured, urgent, fulfilling; outside of it there was nothing of any importance. I was unbalanced, like a soldier in a distant war, cut off from home, but needed where he was.”

The natural tension of the delivery suite is echoed in other stresses and strains in the story, from memories of student protests overseas to local issues revolving around workers’ rights and the lives of trawler fishermen.

Overall, ironically, Brian is looking for harmony. Not only because he becomes involved in a romance. But because of his history with conflict.

“At any rate, least said, soonest mended; I did not want to argue with a man who believed so deeply. I had been through that with David, my radical friend, and come off the worse for it each time.”

Relationships, friendship and love, can be both liberating and restricting, can be filled with both promise and confinement.

“Barbara folded her apron, “Albert always told me it was harder to know if Sweport women were more trapped by their men or their religion.”

On a broader scale, characters have to make choices in which risk is attached to every option.

‘It’s hard to change from what you’ve taken to heart,” I said. “But sometimes you have to. You get boxed in by life.”

Traditionalism abounds. Despite a few heroic individuals spearheading change, there is a sense of a pervasive undertow.

“It’s like that bloody fish-gut smell, one-off and no escaping it.”

John Bart’s use of language is spare and direct, embodying the matter-of-fact-ness that one imagines a small-town physician would acquire with years of experience dealing with crises large and small.

Although it is clear that the events recounted in Middenrammers are viewed from the perspective of years having passed, the author avoids the tendency to instruct readers as to the appropriate response to the story, although Brian’s perspective is inhabited consistently.

This sense of detachment leaves readers strangely unmoored when a climactic scene erupts suddenly, although the scene is clearly necessary to aid the narrator in making a difficult decision which will have a life-long effect and which aids readers in understanding the basis for his choice.

Another writer might have emphasized this sense of dislocation (which is certainly credible in Brian’s life, given the “technicoloured” and “urgent” work he does), allowed the scene to close the novel without commentary.

This would have ended the story abruptly, just as Brian’s character abruptly understood that what he had interpreted as a decision was really something he had already decided, and this event was simply a confirmation. But it also would have left readers with the taste of blood in their mouths.

Middenrammers does scratch the skin, but there’s a plaster to salve the cut, so that even sensitive readers will be satisfied in the end.