In sickness and in health

 Vital Signs, by Tessa McWatt, William Heinemann, RRP£12.99, 176 pages

After Anna suffers a brain aneurysm, she finds her comprehension remains unaffected but her speech is transformed into a stream of poetic non-sequiturs, a condition known to doctors as confabulation. While Anna’s grown-up children gather round, her husband Mike broods. Estranged by language, he is also troubled by a more general inability to communicate, and by the guilty recollection of an old affair to which he has never confessed.

Books that use ailments – especially neurological ones – as metaphors often leave the reader feeling uneasy. In Canadian Tessa McWatt’s fifth novel, top-heavy symbolism is compounded by the illustrations that Mike, a graphic designer of informational signs, draws in an attempt to express what he cannot say in words. Reproduced in the text by the artist Aleksandar Macasev, they tend to distract from a story that, when it finally wrests itself free of self-consciousness, depicts the power struggles and compromises of a long marriage with bracing honesty.