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“Taut, clever, compelling, and guaranteed to keep you on the edge of your seat.”—Paula Hawkins, #1 New York Times bestselling author of The Girl on the Train and Into the Water

From the bestselling author of Anatomy of a Scandal—a new thought-provoking novel exploring the complexity of motherhood and all that connects and disconnects us.

You think you know her…but look a little closer.

She is a stay-at-home mother-of-three with boundless reserves of patience, energy, and love. After being friends for a decade, this is how Liz sees Jess.

Then one moment changes everything.

Dark thoughts and carefully guarded secrets surface—and Liz is left questioning everything she thought she knew about her friend, and about herself. The truth can’t come soon enough.

With Sarah Vaughan’s signature “clever and compelling” (Claire Douglas, author of Last Seen Alive) prose, Little Disasters is a tightly-wound and evocative page-turner that will haunt you long after you finish the last page.

Chapter One: Liz ONE LIZ
FRIDAY, 19 JANUARY, 2018

It is definitely the short straw of hospital medicine. ER in a trauma center on a Friday night in late January; eleven thirty and the waiting areas are rammed. Patients glazed with boredom slump on every available chair, a queue is waiting to be triaged, and we’re nearing the mayhem that descends when the drunks and the lads whose fights have turned a bit nasty roll in: lairy, disruptive, laughing in the face of reason. If the abuse turns physical—walls punched, a nurse shoved, a Sri Lankan doctor spat at—security will have to be called.

A cold January means that the hospital is already busy: filled to 99 percent capacity. ER on the brink of turning away ambulances: almost on red alert. Many patients don’t need to be here: not least those who couldn’t get—or didn’t think to get—a doctor’s appointment and who now realize that a long and uncomfortable weekend stretches ahead of them unless they hotfoot it to the ER in the belief that doing so will make their virus swiftly better. They’re the ones who are the most vocal about the long wait, who hover by the nurses’ station ready to harangue them. The properly sick don’t have the energy to complain.

I wouldn’t go near an ER in a busy trauma center on a Friday night unless my life depended on it. Nothing short of a cardiac arrest, a stroke, a fracture, or a massive hemorrhage would force me through the automatic doors. So why am I here, breathing in the fetid fumes of others’ illnesses; tramping the corridors; peering at the faces of the frustrated, irritated, and those with life-threatening illnesses who wait two, three, four hours—or sometimes more?

Well, I don’t have a choice. This is my job. Senior resident in pediatrics at St. Joseph’s, West London: a major acute general hospital and trauma center at the cutting edge of clinical care. My career hasn’t been meteoric: two babies and two six-month maternity leaves, plus disappearing down a cul-de-sac of research, mean I’m still not a consultant, unlike the men I studied with at med school. But I’m only a year off and then I’ll have reached the giddy peaks of medicine’s hierarchy. Twenty years of study and I’ll finally be there.

I’m not a doctor who works in the ER full-time. I’m here because I’ve been called down from the children’s ward to see a patient. But I’m the sort of doctor on which every hospital depends. Sufficiently senior to make crucial decisions; sufficiently junior to be based in the hospital during long nights and on call weekends. Look at me, in my periwinkle blue scrubs, and you’ll see someone pragmatic, no-nonsense, approachable, empathetic; occasionally a little blunt, according to my teacher husband, but a good person. (I work with sick children and deal with distressed parents, after all.) Physically unremarkable: five foot six, wiry dark brown hair scraped into a ponytail, a permanent crease between my hazel eyes. Negligible makeup, no jewelry except for a thin gold wedding band, worn and scratched. White hospital Crocs: good for running. Easy to wash when splattered with blood.

I’m anonymous, dressed like this. Androgynous, too. No one’s going to assess the size of my hips, a little wider than I’d like thanks to night shifts when I don’t get a break until after ten and rely on vending machine chocolate or canteen chips. No teenage boy’s going to spy my cleavage when I bend over to examine him on a hospital bed. I’m a doctor, this pajama-type uniform says, as does the lanyard round my neck. Hello. I’m Dr. Trenchard. I’m here to do a job, and to do it well.

Wearing scrubs, like any uniform, also bonds you with your colleagues. We’re all in it together: an army working for a greater good we still believe in—the dysfunctional, fracturing, only-just-about-coping-because-of-the-goodwill-and-professionalism-of-its-staff, free-at-the-point-of-need medical system. And if that sounds sentimental or sanctimonious, I’m neither of these things. It’s just that when it’s your daughter’s tenth birthday and you can’t put her to bed because it’s impossible to swap a Friday night shift, and she’s said, piling on the guilt in a way that only your firstborn can: “It’s all right, Mummy. I understand that you need to work.” When this is the background to your fourth late shift in a row, and you’re exhausted and would really like to be in bed, curled around the husband you only grunt at during the week. When that’s what you’re missing and your reality’s very different: when you know your colleagues are racing to a crash call—hearts pumping as they run, shoes squeaking on the shiny floor, curtains whooshing around a bed; that fierce concentration as they crack ribs or apply paddles to shock a patient back into life… When, more prosaically, you haven’t had time for a wee… Well, you have to cling on to some belief in what you’re doing; you have to believe there’s a point in being committed to this sort of career. Because otherwise? You’d give up medicine or immigrate to Australia, New Zealand, or Canada, where the weather, hours, and pay are all far, far better.

Oh, don’t get me wrong. I love my job. I believe what I’m doing is important. (What could be more worthwhile than making sick children better?) It’s stimulating; and coming from my background—I’m the child of a single parent who ran a seaside café—I’m immensely proud to have got here at all. But this shift comes at the end of a string of nights preceded by an academic course last weekend and I’m shattered: my brain so befuddled I feel as if I’m seriously jet-lagged. Adrenaline will carry me through the next few hours. It always does. But I need to focus. Just ten more hours: that’s all I need to get through.

I’m thinking all of this as I trot along the shiny corridor from the children’s ward to the ER, my mood not enhanced by the art on the walls: a mixture of seascapes and abstracts in bright primary colors that are supposed to soothe patients and distract them from the unpalatable fact they have to be here. I pass the oncology and radiology departments and think of the lives being fractured, the hopes and dreams evaporating; for some, the lives ending, at this very moment; then shove the thought aside.

I’m on my way to see a patient. Ten months old: fractious, irritable. She’s vomited, according to the ER, though she hasn’t a fever. She may be no more ill than Sam, my eight-year-old, who’s just had a chest infection, though it’s odd to bring in a child who’s not genuinely poorly at this time of night. The junior isn’t happy to discharge and asked me to come down. My heart tips at the thought of a massively complicated case.

Because I could do without another terrifyingly sick child right now. My shift started with a crash call to the delivery suite to resuscitate a newborn: a full-term-plus-thirteen-days-overdue baby, blue, with a slow heartbeat and a cord pulled tight around his neck. I got him back—stimulation, a few breaths—but there was that long moment when you fear that it could all go horribly wrong and the mother who has managed to carry her baby beyond term would be mourning the child she has dreamed of. As every obstetrician knows, birth is the most dangerous day of your life.

Then a child with an immunosuppressant condition and a virus was brought in by ambulance: horribly, desperately poorly, and just after he’d been admitted, I had to deal with a three-year-old with croup. The mother’s anxiety made the situation far worse, her panic at his seal-like whooping exacerbating the condition until it became dangerous, the poor boy gasping for breath as she distracted our attention. Often parents are the most difficult part of this job.

So I’ve had enough drama tonight, I think, as I squeak along the corridor and take in the chaos of pediatric ER, filled with hot, disgruntled parents and their exhausted children. A preteen boy in football kit looks nauseated as he leans against his father: a case of concussion? A waxen-faced girl peers at a blood-soaked dressing, while her mother explains she was chopping fruit when the knife slipped. From the main ER, where the aisles are clogged with carts, there’s the sound of drunken, tuneless singing. “Why are we waiting?” half shouted, increasingly belligerently.

I check with the sister in charge, and glance at the patient’s notes: Betsey Curtis. My heart ricochets. Betsey? Jess’s Betsey? The baby of a friend I know well? Jess was in my prenatal group when I was pregnant with Rosa and she with Kit. Together we navigated early motherhood and stayed close when we had our second babies, though we’ve drifted apart since Jess’s third. Perhaps it’s inevitable: I’ve long since left the trenches of early babyhood, and work, family life, and my suddenly vulnerable mother are all-consuming. Still, I’ve only seen her a handful of times since she’s had this baby and I’ve let things slip. She didn’t send Rosa a birthday card and I only noticed because she’s so usually good at remembering. Of course it doesn’t matter—but I had wondered, in a distracted, half-conscious way as I scooped up the cards this morning, if she was for some reason annoyed with me.

And now she’s brought in Betsey. I look at the notes again: nonmobile, irritable, drowsy, tearful, has vomited, they say.

“Ronan, is this the patient you were concerned about?” I double-check with the junior doctor.

He nods, relieved at deferring responsibility.

“I’m not sure what’s wrong. No obvious temperature, but Mum was concerned enough to bring her in. Wondered if you’d keep her in for twenty-four hours for observation?” he says.

I soften. He’s been a doctor for less than eighteen months. I’ve felt that uncertainty, that embarrassment about asking a senior colleague.

“Of course—but let’s have a look at her first.”

I pull the curtains aside.

“Hello, Jess,” I say.

“Oh, thank god it’s you.” My friend’s face softens as I enter the bay, tension easing from her forehead. “I didn’t think we should come, but Ed was adamant. It’s so unlike him to worry, it panicked me into bringing her in.”

I look up sharply. Panicked’s a strong word from an experienced mother of three.

“Poor you and poor Betsey.” It’s really not ideal, examining a patient I know, but with no other pediatric resident around, there’s no other option. “Let’s see what’s wrong with her.”

Jess’s baby is lying on the bed, tiny legs splayed against the paper towel coating its blue plastic surface; large eyes watchful, her face a tear-streaked, crumpled red. I’d forgotten how pretty she is. Almost doll-like, with thick dark hair framing a heart-shaped face, a Cupid’s bow of a mouth and those vast blue eyes peering at me. A thumb hangs from the corner of her mouth, and her other fist clutches a dirty toy rabbit. It’s the toy I bought her when she was born: the same make as Sam’s, an unashamedly tasteful French velveteen rabbit. Her bottom lip wobbles, but then the thumb sucking resumes and she manages to soothe herself. She is heavy-lidded. Looks utterly exhausted.

“Hello, Betsey,” I say, bending down to speak on her level. Then I straighten and turn to Jess, whose hand rests lightly on her little girl. It still surprises me that someone this beautiful could be my friend. She’s one of those rare, effortlessly striking women, with copper Pre-Raphaelite curls and slate-gray eyes, now red-rimmed and apprehensive—perfectly natural, since no one wants their baby to be this sick. She has fine bones, and slim fingers garlanded with rings that she twists when nervous. A tiny gold star nestles in the dip of her neck. Her glamour is incongruous in this world of specimen containers, rolls of bandages, and stainless steel carts. I think of the shadows under my eyes, the rogue gray hair I found this morning kinking at my forehead. I look a good five or six years older than she, though we’re the same age.

“Can you run through what you think is wrong?”

“She isn’t herself. Grizzly, clingy, listless, and she was sick for no apparent reason. Ed freaked out when that happened.”

“Is he here now?”

“No, he’s at home, with Frankie and Kit.”

I imagine her boys lost to the depths of sleep, her husband unable to settle, and Jess’s loneliness as she sits in the ER with a poorly baby who can’t tell her what the problem is.

She gives me a quick, tense smile, and pulls a charcoal cardigan around her. Her top slips, revealing a black bra strap, sleek against her blanched almond of a shoulder, her improbably smooth skin. The top of her ribs and her clavicle are exposed, and I realize that she is noticeably thinner than when I last saw her just over a month ago at the school Nativity play.

Under the glare of the fluorescent strip lights, she seems more vulnerable, less assured. And very different from the woman I first met ten years ago, who buzzed with excitement at the thought of having her first child.
This reading group guide for Little Disasters includes an introduction, discussion questions, ideas for enhancing your book club, and a Q&A with author Sarah Vaughan. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

Introduction

In this new novel from the internationally bestselling author of the “cool, sharp, and beautifully written” (Lisa Jewell, New York Times bestselling author) Anatomy of a Scandal, a doctor is faced with an ethical dilemma when her friend’s child lands in the emergency room.

Liz Trenchard is an experienced pediatrician with a duty to protect all children admitted to her busy emergency room. So when her friend Jess turns up at the ER one night with her baby girl and a story that doesn’t quite add up, Liz is forced to question everything she thought she knew about her friend and about herself. There are so many secrets and so many lies. The truth can’t come soon enough.

With Sarah Vaughan’s signature “clever and compelling” (Claire Douglas, author of Last Seen Alive) prose, this is a tightly wound and evocative page-turner that will haunt you long after you finish the last page.

Topics & Questions for Discussion (12-15 Discussion Questions)

1. Consider the two epigraphs, “Morning Song” by Sylvia Plath and the excerpt from Shakespeare’s Macbeth. Why do you think the author chose to introduce her novel with these two selections? How do they set the tone of Little Disasters?

2. Sarah Vaughan explores the bonds of friendship throughout the novel. Compare and contrast Liz’s relationships with Jess, Mel, and Charlotte. What does Liz like about these three women? What does she find challenging or difficult to relate to in each of them?

3. One theme running throughout the novel is how people react to things outside their control. Which characters struggle with handling uncertainty? How do they manage their fears surrounding control?

4. At the beginning of the novel, Liz describes her advisor, Neil, and how, as a male doctor, his life is quite different from hers. Liz thinks to herself, “I want a wife” (page 33) and wishes she had a partner who could fulfill many of the duties historically handled by women. How are gender roles explored in the novel, especially with regard to parenting?

5. Liz and her mother are very different characters; do you think there are any ways in which they are similar?

6. There are many characters suspected of harming Betsey. Were you surprised at the two final twists at the end of the novel and how Betsey actually was injured? Did you have any idea who the real culprit was?

7. How would you describe Ed’s and Jess’s marriage? How does it change throughout the course of the novel? Do you think they will have a happy partnership in the future?

8. Do you sympathize with Jess’s instinct to cover up what actually happened on the day Betsey was hurt? Did you ever feel frustrated with Jess’s choices? How would you have handled this difficult situation?

9. How is mental health explored in Little Disasters? Who is struggling with mental health, and how do they cope with their issues? How do their struggles affect their family, friends, and selves?

10. Liz and Jess must both learn to trust themselves; do you think they have learned how to by the end of the novel?

11. The mothers in this novel are all judged for their parenting choices in one way or another. What dilemmas does Sarah Vaughan raise about modern motherhood? Do you think these issues are new or timeless? How have more recent societal changes heightened them?

12. Almost every character is hiding a secret of one type or another; whose secret most intrigued you? What was the character’s motivation in hiding the truth?

Enhance Your Book Club (3-5 Enhance Your Book Club Suggestions)

1. For your next book-group selection, choose another novel centered around a medical/ethical dilemma, like Jodi Picoult’s My Sister’s Keeper or Lisa Genova’s Still Alice. What themes are common to each novel? How do they differ?

2. Little Disasters explores the bond between mother and child. Write a letter to one of the mother figures in your life and share a special memory you have of the two of you.

3. Visit Sarah Vaughan’s website, http://www.sarahvaughanauthor.com/, for more information about the book.

A Conversation with Sarah Vaughan (8-10 Questions)

Note: Please make sure that questions are boldfaced and not numbered.

Q: What inspired you to write about a medical ethical dilemma?

A: I wanted to write another novel in which a professional woman has to make a tough call that will have a dramatic impact on others. Having created a female barrister in Anatomy of a Scandal, I decided to write about a female pediatrician whose judgment would have a profound effect on a child in her care.

I was also inspired by my surgeon husband, who has come home from being on-call having had to make similar safeguarding decisions. The decision to refer a child to social services may seem quite straightforward but there’s always the awareness of how emotionally distressing and disruptive this will be for a family who could be entirely innocent. I imagined how much more difficult that might be if the professional knew the family involved.

Q: What kind of research did you have to do in order to write from Liz’s perspective?

A: Some of the day-to-day information about being a doctor I had absorbed, as if by osmosis, through living with my husband, but I also interviewed several pediatricians and one of these was incredible in talking me through scans, reading through bits of drafts, and advising me on what I needed to change. I also read several recent memoirs by doctors. To research Jess and her background, I read about narcissistic parenting, interviewed a consultant obstetrician and a perinatal psychiatrist, and spoke to women who had experienced maternal OCD. I also read several books on the subject, including a textbook entitled: Dropping the Baby and Other Scary Thoughts, Bryony Gordon’s Mad Girl, and, on OCD more generally David Adams’s The Man Who Couldn’t Stop. I don’t think there was one standout piece of information I learned, just a gradual accruing of knowledge that meant I could write about such emotive subjects with increased confidence.

Q: Liz is such a strong, fresh character; were there any doctors from literature, film, or television who influenced her development?

A: No! Instead, I’ve drawn on women doctors I’ve come across in my research and socially. Liz is no one person but she does share their decisiveness and a certain inner strength and outward confidence that comes from having to make such decisions. Writing’s a career that allows for almost infinite possibility—the story could go in innumerable directions. In contrast, medicine demands that you step up to the line and make decisions. It’s something I’m fascinated by.

Q: You write from several characters’ perspectives; was there one narrator in particular you especially enjoyed writing?

A: Jess. I didn’t mean to feel such intense sympathy for her but as the novel progressed it was clear I felt closest to her—despite writing her in the third person and Liz in the first. I had very mild maternal OCD after my second child was born and I tend to catastrophize so it was very easy to get inside her head. In fact, at one point, I had to strip out pages and pages of her internal thoughts.

Q: Do you think Liz and Jess will remain friends?

A: Absolutely. They’re obviously very different, most notably because Liz’s identity is tied up in being a doctor and Jess has chosen not to return to work—and I think those different life choices can often create tensions between women. But I wanted the reader to conclude that, although they’d neglected their friendship, they could pick it up again and resolve to make it stronger. After all, they’ve endured some pretty emotional times: Jess has helped Liz see the importance of forgiving her mother, and Liz has helped Jess recognize that she has a mental health issue and needs help. (Even if it takes Liz far too long to get there; she really is a pitifully bad doctor in that respect!) The easiest thing would be for them to quietly drop each other, embarrassed and resentful; the hardest—but the most fruitful—is for them to build on this new honesty. At the end of the novel, I wanted to give them that chance; to show that, unlike Janet, who was isolated and friendless, they can rely on each other “when we’re exhausted, or anxious, or it all feels like a bit of a struggle.” Parenting can be tough, but I wanted to end with a sense of optimism and to show them sharing a high of motherhood: one of those “perfect, necessary moments” that will get them through.

Q: Was there a particular aspect of the parent-child relationship you especially wanted to explore?

A: I was interested in exploring protectiveness. Jess is overprotective. Apart from her desire to protect Frankie, her maternal OCD is actually a form of vigilance: by imagining terrible things happening to her children, she’s trying to ensure they don’t happen. (There have been no cases of mothers with maternal OCD harming a child.) Liz’s duty of care is to the children she treats. She has a duty to keep them safe as well as make them better. And Janet, Liz’s mother, failed to protect—both in neglecting Liz and Mattie, and, although she had postnatal depression, in smothering Claire. Charlotte, of course, is deeply irresponsible, and cruel, in not only not protecting Betsey but in exposing Frankie—and forcing him to take the blame. Motherhood has been the most profound experience of my life and the level of protection I feel for my own kids obviously fed into this.

Q: Did you know from the very beginning who had hurt Betsey? If not, when did you decide who the culprit would be?

A: Initially I thought Frankie was culpable and I wrote the first draft as if he had caused the accident and Jess had, understandably, lied to protect him and herself. Then I started thinking that that was too predictable and that there had been a slew of novels in which mothers protect children who commit crimes. I was intrigued by the tensions among a group of school-gate mothers who had only come together because they’d had children at the same time. I thought about the jealousies that could arise, particularly if one mother was married to a lost love—and that’s when Charlotte’s role increased.

Q: What scene was the most fun to write? Why did you enjoy writing it?

A: I loved writing the friendship group scenes—so the barbecue, the nightclub scene, or the book group. It was such fun to write a character like Charlotte, and to show these women interacting with each other. But I also loved writing Chapter Ten, the chapter in which we realize that Jess isn’t acting rationally. Her intrusive thoughts seem entirely reasonable to her on one level, even though she knows deep down they are irrational. Writing shouldn’t be therapy but, with the benefit of distance, I found this quite cathartic.
Photograph by Philip Mynott

Sarah Vaughan studied English at Oxford and went on to become a journalist. She spent eleven years at The Guardian as a news reporter, health correspondent, and political correspondent. Sarah lives in Cambridge with her husband and two children.

"Compelling, beautifully written, so perceptive and emotionally devastating. Like Anatomy of a Scandal, it feels like an important book as well as a brilliant read."

– Lucy Foley, New York Times bestselling author of THE GUEST LIST

"Each character is brilliantly drawn, and the book delivers surprise after surprise."

– Claire Fuller, author of BITTER ORANGE

"A true psychological thriller shows us, as all the best ones do, that the scariest place is not the dark alleyway but inside the pathways of our own minds."

– Araminta Hall, author of OUR KIND OF CRUELTY

"Will have parents – in fact, all readers – turning the pages deep into the night."

– Louise Candlish, author of THOSE PEOPLE

"A brilliant storyteller, Vaughan serves up every mother’s nightmare with consummate skill and a big heart… Impossible to put down."

– Eve Chase, author of BLACK RABBIT HALL

"Absolutely brilliant; an emotionally devastating story, brave and honest."

– Emma Curtis, author of ONE LITTLE MISTAKE

"I loved it and didn’t want to put it down."

– Laura Marshall, author of FRIEND REQUEST

"An immaculately researched and compelling story about the devastating fallout from one mistake."

– Jane Shemilt, author of THE PLAYGROUND

"Gripping, meticulous, and touches the raw nerves of parenthood."

– Terry Stiastny, author of CONFLICTS OF INTEREST

"A fabulous twisty look at early motherhood and friendships brave and brilliant."

– Fionnuala Kearney, author of THE BOOK OF LOVE

"Every bit as brilliant as Anatomy of a Scandal. Superb."

– Cass Green, author of THE KILLER INSIDE

"Another masterful page-turner… a truly gripping read."

– Catherine Isaac, author of MESSY, WONDERFUL US

"I read this with a fascinated, mounting sense of horror because it could all be too true. Compulsive reading with an ending I didn’t see coming."

– Jane Corry, internationally bestselling author of MY HUSBAND'S WIFE

"A deep dive into the dark side of motherhood. Highly recommended."

– Erin Kelly, author of STONE MOTHERS and HE SAID/SHE SAID

"Little Disasters takes on another topical and emotive issue with the same skill and command Vaughan showed in Anatomy of a Scandal."

– Cara Hunter, internationally bestselling author of NO WAY OUT

"Gripping and compassionate, but most importantly a novel that will change lives."

– Bryony Gordon, author of MAD GIRL

"An emotionally terrifying story. Sarah has impressively created characters whose pain and fear is all too real. I could not put this book down."

– Heidi Perks, internationally bestselling author of NOW YOU SEE HER and HER ONE MISTAKE

"Vaughan's intense novel digs into universal issues: the strains of motherhood, tests of friendship, sources of obsession, and the rewards of forgiveness. For those legions of readers who like edgy, contemporary tales."

– Booklist

"Vaughan is proving herself a master of suspense and an author willing to probe the darkest reaches of our psyches."

– CrimeReads, "Ten Novels You Should Read This August"

"This thrilling and emotional depiction of family drama, friendship and trust will have you on the edge of your seat."

– CNN

More books from this author: Sarah Vaughan