The Royal Free

The Royal Free by Carl Shuker. THWUP (2024). RRP: $38.00. PB, 312pp. ISBN: 9781776922147. Reviewed by Nurus Van Vliet.

Author Carl Shuker certainly has a knack for extracting drama from human error, each turn of the cog cinematically engineered towards a looming crisis point. His 2019 novel A Mistake, finalist for the 2020 Acorn Fiction Foundation Prize and now a major motion picture, featured a gifted surgeon grappling with the consequences of a fatal mistake, her emotional spiral choreographed with interleaved scenes detailing the lead up to the 1986 Space Shuttle Challenger disaster. 

His latest outing, The Royal Free, is set in a London enclave simmering with xenophobic discontent fuelled by desperation and inequality. It’s a fantastic read, at once entertaining, compassionate, and stylistically exciting. A powerful rumination on modern loneliness, the novel is also a thrilling homage to the thematic preoccupations of protagonist James Ballard’s literary namesake, and a timely reflection of our not-so-fictional Ballardian urban society. 

Times are tough for James, a 38-year-old migrant from New Zealand and recently bereaved husband and ‘father of one Fiona Beatrice Ballard, aged six months and not more.’ His hours as a medical copy editor at the offices of the Royal London Journal of Medicine have recently been reduced, prompting him to work as a freelancer and generally make himself as useful as possible in order to keep said job at a time when there aren’t many others going. This sees him taking on more responsibilities, such as putting together the journal’s style guide, a crucial document in an institution that prides itself on the quality of its published work. As these individual stresses add up, it seems only a matter of time for things to reach boiling point.

The novel alternates between scenes at the office and James’ personal life, the contrast between the two notably jarring. At work, he forms part of a well-oiled machine, meticulously editing texts down to an acceptable standard, carefully ensuring a virus subtype isn’t misspelt for another. The final product is erased of technical errors, polished to a shine befitting the coolly clinical language favoured by such esteemed medical journals, its human stories removed of grit and wayward passion. As the ‘third oldest medical journal in the world,’ the R Lond J Med brand is larger than any of them. An influential part of the healthcare ecosystem, the journal prides itself on its principles and standing amongst peers and the wider public. It is, after all, in the business of caring.

James goes to work, returns home, pays the person he hires for both babysitting and sex, cares for his child, goes for a run through his anti-social neighbourhood, runs himself to the ground—again and again and again. There is no time for grief. There is no time for trauma. He can’t afford either. Care is a privilege. Does it matter if his burdens are too much to bear, when everything carries on as it should? If he can still labour, if they can all keep doing their jobs, if the whole of London can still grind away for the benefit of the few, if institutions of power can carry on as they have done, what does any of it matter?

This is a cleverly structured novel, polyphonic in more ways than one. Not only do the journal staff members each offer a different facet to the overall story, insights into the many aspects of James’ states of mind are nested through various parts of the text, such as a seemingly neutral style guide that does not immediately betray how charged each expression is. Disparities between his perceptions versus those of his colleagues versus the reader’s own understanding only add to the uneasy feeling that something is seriously wrong. The more mundane and humorous scenes at the office are also a welcome contrast to the world outside, providing levity and relief from James’ increasingly tense perspective, likewise mirrored in the tensions that play out in the city at large. 

How well do any of us really know another person, even our neighbours or those we work closely with? How well do any of us pay attention? The chasm between each staff member’s place in the office ecosystem and their own interior lives is as unsurprising as it is moot: none of it has to matter, as long as none of it gets in the way of publishing the journal. As tragic as it may be, the show must go on! Every relationship becomes insular and transactional. Attempts to express care would require time and space for genuine human connection, neither of which are readily available in a capitalistic, increasingly disconnected world. Modern technology erases the human from increasingly slick algorithms, dissecting once communal spaces into isolated silos. Modern living creates ever more impersonal ways of being. 

Society becomes sicker even as its National Health Service (NHS) vows to ensure compassionate care, to respond to a person’s distress with humanity and kindness, at pains to remind its consumers that ‘everyone counts.’ Like letters chaotically arranging and rearranging themselves in the eyes of a copy editor, comprehensibly incomprehensible text slipping past non-human digital software checks, words easily come to lose their meaning. 

‘It could be true that under certain conditions madness was always just a word or two away, or a letter – a decent to in sanity – the void was always there, hard long beside in the small space – slipping began with a space before a comma. Sliipng began with a space before a cmma .       ,’

When things boil over, when civic unrest gives way to riots, when a man is pushed beyond his tipping point, when whole systems are overloaded and the void is all-consuming, how do we make sense of what is left? There is a semblance of grace in knowing that any answers are beyond a single individual. That the stories we tell do matter, that they don’t have to be edited to oblivion, that the human be allowed to bleed through. To err is human. Grief is a human process. To forgive is divine. It starts with looking beyond individual mistakes to the systems that enabled them. Creating safer systems and healthier societies begins with allowing ourselves the grace to be human, and letting this influence how we choose to treat others, and ourselves.


Nurus Van Vliet is an avid reader and bibliophile. She posts about the books she’s been reading on Instagram @ns510reads.