Breath, by Michael Symmons Roberts

In Michael Symmons Roberts's novella, we enter an unnamed country which has recently seen the end of a brutal civil war between North and South. There is peace but the reconciliation process operates at a formal public level, rather than in the attitudes of citizens. A choice of liquor or the playing of certain tunes on a flute remain hair-triggers for tribal atavism. The entire society takes its definition from the divisions that people are allegedly striving to overcome. Self-definition by hostility to the Other seems not merely an unfortunate habit but a functional necessity.

Andrews, a hospital manager in the southern capital, discovers that his son has been killed in an accident – trying to beat the lights but knocked off his bike by a dog from a feral pack. Andrews, of all people, is surprised to find himself asked for permission to use the boy's organs for transplant, but he agrees that everything bar the eyes can be used. The crisis defeats his hard-won resolve not to drink, and he enters a purgatorial night-world where he renews a failed liaison with a female colleague. In perhaps the outstanding episode, he finds himself intimidated into giving up his turn at the pool table by the lobotomised entourage of a sporting and military hero. Andrews's night is not yet over.

In the North, over the abolished border, a patient lies fretfully in a private hospital room, waiting for a lung transplant. Baras is afraid and in need of absolution from the hospital chaplain, but she requires him to make a renunciation of his sins rather than simply going through the formalities. If ever anybody needed formalities, though, it's Baras, a war criminal who ordered the use of poisoned gas.

He needs either to be told that he's forgiven or to be relieved of what Peter Porter has called "the smell of self". The surgeon in the case has views and intentions of his own. Meanwhile, a pilot is making her first solo delivery of transplant materials, flying blind over the mountains to the North, unbearably curious about the contents of the refrigerated box strapped to the seat next to her. Her own partner has been involved in reprisals against Northerners.

With its careful interlocking of the lives of strangers, its assured treatment of the dissonance between larger necessity and the meagre, needy, compromised world of the individual, and above all with its siting of both in a present mired in myth and prejudice, Breath is an absorbing fable of the here-and-now, or perhaps a parable whose religious teleology has been withheld or lost.

In its economy, which rigorously excludes the odds and ends of ordinary existence, it strongly resembles a medical soap opera – earnest Casualty rather than ER, perhaps. In popular culture, medicine has assumed the role formerly occupied by religion, whereby everything has meaning and all experiences offer a lesson in humanity. Yet despite the careful banality of the message, the teaching manifestly fails to translate itself into action in the messier world outside the screen. It's very sad, but what can you do?

You can turn the genre on its head, as Symmons Roberts does. You can undercut the moral assurances and make all improving tendencies compete for space with impulses more energetic and at some level more satisfying than weary injunctions to be good. Situated amid the wreck of humanism, amid ignorance and degeneracy – racism, drug-taking, excruciating public sentimentality, technology whose users are unworthy of its wonders – Breath is not without human sympathy, but it seems quite bare of illusions.

What are we like? We're like this: like the parsimonious illiterates venting their envy on the BBC News website; like the shoppers on the bus nursing their prejudices; like slaves who love their chains. As to the message – because a fable is obliged to have one – it's strangely hard to say, but how about do as you would be done by, or else? Obvious, really, but impossible nonetheless, it would appear.

Sean O' Brien's 'The Drowned Book' won this year's TS Eliot Prize