Editor’s note: This review contains a mild spoiler.

Austin Duffy, an Irish oncologist working in New York, has chosen to set his début novel (Granta, 2016) in a setting he knows well – a large oncology centre in New York.

The narrator in the novel remains anonymized, as if in a clinical trial himself. He has chosen to pursue a research career in oncology, sequestered away from cancer patients and his family in Ireland. Yet he maintains a relationship with Henrietta, who is revealed early on in the narrative to be a mouse in the drug treatment trial he is conducting.

It’s not that the narrator lacks empathy – perhaps he has too much – but he chooses the life of a medical hermit to protect himself in objectivity. He has seen too many stricken faces in the world of terminal cancer.

He also chooses emotional isolation from his wife and family; there are few scenes of human warmth in this book. His New York relationships are superficial and his romantic foray with a translator is conducted in a slow, deliberate fashion.

Framing his life in a laboratory setting achieves the required detachment for him to function: “You set your own conditions and, to a large extent, the future is predetermined.” From his apartment window, he watches people in the “tiny compartments” in the hospital building, like observing experimental mice.

This book is as much about the cruel perfection of cancer cells as the narrator himself. There is a suggestion that he admires the beauty of malignant cells (“dotted through the lungs in an infinite array like the sky at night”) and their facility for achieving immortality. In fact, his relationship with cancer is his sustaining raison d’être, even Henrietta will have only a transient impact on his life.

There is no sense that the narrator is excited by the potential of a cure for cancer; instead, he is focussed on the routine of his research to limit the condition. He accepts the co-existence of illness and humanness, even when it touches him personally.

Duffy shows the art of capturing internal narrative and rendering it into a credible story for the reader. When the narrator recalls the occasions when he had to deliver bad news to patients, it rings poignantly true. This insight from the author’s role as oncologist is rare in literature, as so many stories are narrated from the other side of the doctor’s desk.

Duffy also give an insider’s view of the medical jostling to achieve pre-eminence among peers. There are evocative passages of prose but the insistence on medical metaphors can become a little stretched (“… a connecting passageway…joins the two buildings umbilically”). The technical jargon is sometimes overdone and unnecessary.

But this is an insightful and thought provoking début. Duffy’s next novel will be set away from the medical world. It will be interesting to see how he fares in another milieu.