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It is a pity that people are told this is a science fiction book before they read it. I feel the least interesting thing about it is that it is science fiction. I mean this in much the same way that the least interesting thing one could say about 1984 is that it is science fiction. As a piece of literature I enjoyed it much more than Margaret Atwood's Oryx and Crake and even more than Huxley's Brave New World.

The themes that make this book most interesting are to do with the social alienation of groups of people on the basis of inherited genetic characteristics. In fact, as a critique of racism this book is utterly brilliant. Those being racially alienated are genetically identical (they are in fact clones) to those attacking them.

Plato believed those 'in the know' should tell lies to those 'who do not know' so as to protect them from the all too horrible truths about life. I have always hated this aspect of Plato, always finding it grotesque and frightening in its implications. Those implications are drawn out in all their disturbing horror here.

This book has much to say about the nature of 'illness' and how those inflicted with an 'illness' use the scars of that illness as the badges of truly belonging to the group. So that those 'less advanced' in the ravages of the illness don't really know or really belong to the group. As a portrait of victims adopting to being victims it says much about us as humans - thoughtful readers may find it says far too much. I write this on World Aids Day.

Ishiguro writes the most nightmarish novels I've ever read. In others, such as The Unconsoled or When We Were Orphans the nightmare feeling is due to the dreamlike oddity of the interconnection of events in the story. One reads these books in much the same way that one wakes from a disturbing dream, with feelings of disorientation and anxiety. Even though this is the most literal 'nightmare book' of his I have read - the world he creates being literally a nightmare, and made all the worse by being set in the recent past - it is a book totally lacking in that strange dreamlike quality so characteristic of these other novels. In this sense it seemed less of a nightmare than these others. If you struggled with these, you will not struggle with this in quite the same way.

He also has fascinating and quite painful things to say about the nature of love and how love has a proper time, a time that may be lost or missed. As someone who has loved, lost and missed I found this particularly challenging. The relationship between sex and love and illness is perhaps something people may find simply too much - not because this is handled in any way that is too explicit, but because I do believe we like to think that sex, as a manifestation of love, has curative and redemptive powers. A book that questions this, questions something we hold very dear and some readers may find this too much to ask.

This is also a book about betrayal. The betrayals we commit against those we love the most and yet that we barely can understand or explain after we have committed them - these are constant throughout the book. He is a writer all too aware of the human condition. The scene which gives the book its title is a wonderful example of the near impossibility of our being understood by others and yet our endless desire for just such an understanding.

There is nothing easy about reading this book - although it is written in the simplest of prose. It has an honesty of feeling that brands one's soul.

I loved this book and have thought about it a lot since I finished reading it and will think about it more. There is much more I would like to say, but there is no space. May we all be good carers before we complete.