Nurse will see you now in the hairy closet

Coping with her first few weeks in Trauma, "strawberry blond" Nurse Swallow is, well, trauma-tised, by her overwhelming crush on the unit's aspiring young surgeon, the "devilishly handsome" Mr Steele. His suave, manly charm and her crushing jealousy of a flirtatious anaesthetist combine to give Nurse Swallow's ardour the eager-yet-imperilled aspect of a breathless romantic heroine. Given Toby Litt's usual precision of language and tone, this is sufficient to arouse early suspicions of something peculiar about his rumbustious new novel, Hospital: Mills & Boon is not his literary home turf.

Meanwhile, an anxious boy with stomach pains has escaped from his ward and is fleeing the clutches of two security thugs. He runs down a corridor that gradually becomes hairy and moist, and steepens until he falls headlong down it, almost drowning in its mucal content. Grasping a door handle, he finds himself tumbling out of a cleaner's cupboard - only to meet the Rubber Nurse. Tall on her six- inch stilettos, squeaky with head-to-toe latex, she is the caricature of a teenage boy's fantasy, scouring Hospital for "naughty" people to punish. "Step into the hairy closet with me," she pleads, as the boy turns tail and runs.

In the chapel on the 13th floor a gathering of Satanists, greedy for the promised elixir of eternal life, are preparing to sacrifice a newborn smuggled out of Neo-Natal. Down near the incinerator, the union of Haitian porters are gathering for their voodoo ceremony. One of them senses that "extremely powerful forces were pent up within Hospital, waiting to be liberated." By now, Nurse Swallow's pent up ardour for Mr Steele feels like a refreshing blast of human communion.

On the stroke of midnight and the climaxes of these ghastly rituals, Hospital's power fluctuates, and the new day brings in a bizarre and fundamentally altered world. If hairy closets and Black Masses squeezed between surgery seem unorthodox (compared, say, to NHS delivery benchmarks), then the second half of Hospital quickly pulls us into an altogether more surreal dimension. Limbs pickled in jars down in Pathology begin to regenerate. Trees grow through several of the building's 22 storeys. Prickly little points of light form a drifting mist, each point the exact spot where someone had died. Shrouded by a thick and lethal fog outside, Hospital (never given a definite article, and so almost a presence itself) becomes entirely cut off.

Hospital has the feel of a satire, often with a Swiftian bite to it, but what, precisely, it is satirising is harder to fathom. Litt doesn't indulge in easy snipes at topical crises of staffing, disease or medical incompetence, and no general or political tilt is levelled at the groaning body of the NHS. Rather, Litt generates a subversive humour from an amplification of human foibles that, in the second half of his exuberant novel, are unbridled by any restraining fear of physical harm or consequence.

Mayhem ensues, fuelled by an escalating siege mentality amongst Litt's enormous cast of characters. As with some of Haruki Murakami's later work (whose surreal landscapes are reflected in some of Litt's wilder imaginings), it's not always rewarding to look for a metaphorical footprint amid general weirdness when the novel as a whole, despite a few minor flaws of internal logic, is carried on its narrative verve. Quest, adventure, lust and betrayal are all squashed into the converging dozen or so discrete stories that Litt deftly established in the novel's early sequences. Hospital is an impressive and solid achievement, a fast-paced and highly entertaining apocalyptic comedy peopled with robust caricatures that behave, on the whole, extremely badly.

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