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State of Wonder
  1. Ailsa E Gebbie
  1. Professional Lead for Family Planning and Deputy Director, Chalmers Centre, NHS Lothian Sexual and Reproductive Health Services, Edinburgh, UK

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State of Wonder Ann Patchett. London, UK: Bloomsbury Publishing, 2012. ISBN-13: 978-1-408-82188-6. Price: £7.99. Pages: 368 (paperback)

If you haven't come across Ann Patchett before, I strongly recommend you read her earlier novel, Bel Canto, which won the Orange Prize for Fiction in 2002 and is many people's all-time favourite book. Patchett is a North American in her forties who lives in Tennessee with a medical husband. She was included in this year's Time magazine's 100 most infl uential people who inspire, entertain, challenge and change our world. One of her claims to fame recently has been to buck the trend of the big multinational booksellers and Amazon by opening a small independent bricks-and-mortar bookstore in her hometown of Nashville. She comes across as a determined woman and a strong moral code pervades throughout her novels. Her characters usually take bold, unexpected actions that often shift the paradigms of power.

State of Wonder evolves around a group of doctors working for a small US pharmaceutical company in Minnesota who are funding a drug development from tree bark found deep within the Amazonian jungle. Nibbling the bark enables women to maintain their fertility well into old age and a major pharmaceutical company is waiting to market the compound that will render egg donation obsolete. The elderly ethnobotanist Dr Annick Swenson is the maverick and reclusive researcher based in Brazil working on the project; her location is secret and she refuses to report on her progress. The pharmaceutical company, with shareholders to satisfy and a commercial desire for FDA approval, is agitating for evidence of effi cacy. The pharmacologist Dr Marina Singh is sent out to the jungle following the mysterious death of her colleague Dr Anders Eckman, and the story is mainly based around her personal odyssey. She is aware that Dr Swenson was her chief in Baltimore until a tragic mishap at a Caesarean section, which made Marina abandon obstetrics for pharmacology. The primitive Lakashi tribe innocently host Dr Swenson and her team but face the loss of their traditional unspoiled way of life if the economics of US pharmaceuticals win the day.

For those of us working in the fi elds of fertility and menopause, the biological basis for the tree bark to keep ova in perpetuity and menstruation forever doesn't exactly sound very scientifically plausible. In addition, the fertile period extends each month from three to thirteen days at an early stage of bark nibbling. The sharp-tongued, eccentric Dr Swenson has herself reached the conclusion that having pimples and cramps in your seventies is not enjoyable. Her research activities on the tree bark are in fact concealing an even more important drug development for malaria. For Dr Singh, who is childless and aged 42, the tree bark is potentially tempting as she ponders her romantic entanglement with the company boss, a much older man driven by corporate profi ts, and her love of a deaf native child, Easter, whom she hopes to bring back to the US. Ann Patchett herself has in interviews emphasised her personal lifelong desire never to have children and how having children is not just about ensuring that you have someone who may want to visit you in your nursing home. Many women postpone pregnancies for many reasons but undoubtedly a pill to maintain fertility until senescence sits uncomfortably with us.

Some feel that State of Wonder is a female version of, and has literary parallels with, the great classic, Heart of Darkness by Joseph Conrad. Certainly it plays to our deepest and darkest fears of the humid and claustrophobic tropical jungle with giant anacondas, screeching cries of death and slow, muddy rivers. It is a book of sharp contrasts. Patchett juxtapositions a hostile greeting with poison-tipped arrows with arriving at a 4th July barbeque in Minneapolis; journeys along river tributaries that at any turn could lead into a hotbed of cannibalistic tribesmen follow business-class fl ights from the US.

While this book slightly plays on Western truisms about indigenous people and distant lands, it is full of suspense and has an exhilarating ending. The fate of the boy Easter lingers in your mind after you fi nish the book. I don't think it is quite as entertaining as Patchett's Bel Canto, but it is a very readable book about strong women who have to make diffi cult choices but yet are emotionally interesting people. The Orange Prize for Fiction judges in 2012 described it as "An extraordinary novel of science and adventure handled with equally extraordinary grace and lightness and wit#. Consequently I was disappointed when this book failed to win Ann Patchett the Orange prize for a second time.

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