Postal Reading group
April 2020
Notes on the book If I die before I wake by Emily Koch

Emily Koch has taken the concept of the psychological thriller and added an unusual twist in If I die before I wake. With the tagline “How do you solve your own murder?”, it promises to be a “stunning psychological thriller with an unforgettable narrator”.

The basic idea is that Alex is in a coma following a climbing accident. However, unknown to his family and the doctors in the hospital, he is really conscious, yet unable to communicate or to otherwise signal this. Also as he lies in the hospital bed, he learns from his visitors that his fall from the rock face might not have been an accident after all. In the immortal words: “Did he fall, or was he pushed”? Faced with the possibility that it might have been a case of attempted murder, Alex must try to solve the case of his own death.

Initially, given the unusual plot I was quit interested to read this. Unfortunately, however, it wasn’t long before I became disillusioned and disappointed by the book. I note that this book has been generally well received by this group, and therefore accept that I might be in the minority here. However, my unease about the book is two fold: Firstly, the development of the plot is quite slow (realistic enough given Alex’s condition), and lacks the tension that you expect from the genre. Secondly, too much space is devoted to the depressing details of hospital routine, which made it something of a chore to read. I was hoping that the book might open with Alex in hospital before quickly moving back as he recalled the details of the climb, how he met Bea, and so on.

In a way, this does happen, but much of the story is set in the hospital, and Alex is dependent on whatever information he can glean from the somewhat one-sided reports that his visitors bring. Although I can admire Alex’s tenacity in ‘solving’ the case given his position and the limited information at his disposal, this alone is not sufficient to rescue the book for me. Similarly, although there are some ‘creepy’ aspects to the plot, Bea’s stalker, for example, these feel sufficiently remote that the story still lacks what I usually associate with psychological thrillers.

Indeed, I wonder if the real idea behind the book wasn’t to explore some of the questions raised by ‘locked-in syndrome’ about the nature of life, whether such a life is worth living, and the ethics of withdrawing treatment in such cases. Perhaps important and worthwhile, but also controversial. Trying to produce a thriller might open the book to a new audience, and make for an easier read than moral philosophy would. However, my concern is that, in this case, the book has done neither well. As an aside, whatever your views on the issue, the repeated failure of politicians to grapple with the medical ethics of such situations hasn’t served the patient well. I fail to see how the options of letting Alex starve, or allowing bacteria to finish him off, are dignified!

Beyond this, I thought there were two additional themes in the book. Of these, the arrogance of the medical profession is well represented, in the form of Dr. Lomax, in particular when he brings the students on a visit (p. 131-134). Although, to be fair, this is perhaps indicative of the conditions in which doctors must work, it is difficult to see how such an attitude is conducive to patient recovery. Equally, such an attitude must be far removed from their, hopefully laudable, motivations when they joined the profession. All life is sacred, but apparently its alright to treat apparently unconscious patients like a circus exhibit. Once again, I wonder about the ethics of this!

Finally, I was interested in Alex’s musing on how seemingly inconsequential decisions and events can dramatically alter the course of your life (p. 284). If he hadn’t applied to work at Bow Camp; if his father hadn’t bought him his own climbing boots. Although this doesn't work quite like the butterfly effect in meteorology, or chaos theory in mathematics, there is no denying that life is sensitive to small changes in the initial conditions. I once tried rock climbing at school in my late teens. I realised that it is a spectacularly dangerous pursuit, and that I didn’t enjoy it enough to take the risk. With hindsight I can at least say that I got that one right!

In conclusion, I was disappointed by this book. I thought that, as a thriller it lacked the excitement that I would expect from the genre, while I’m not sure that I was ready to grapple with the more philosophical and ethical aspects at this time. Beyond this, I thought the book spent too much time on the hospital routines to be really enjoyable. Although there are some interesting parts, I still found it difficult to engage with the book, which is a shame as the original plot idea had much to recommend it. However, this may be a minority view, so please don’t let my comments influence your own views of the book.

Comments by Nicholas Cutler