"Somebody somewhere says," Helen Garner says somewhere, "that ‘the urge to preserve is the basis of all art.' Unaware of this thought, you keep a diary. You keep it not only because it gratifies your urge to sling words around every day with impunity, but because without it you will lose your life." Set at ease by this display of befuddlement and vulnerability, we lay down our arms. We always do. Garner moves in almost imperceptibly for the kill:

Then one day it occurs to you that you can see a shape to the diary ... At first you simply transcribe. Then you ... try to make leaps and leave gaps. Then you start to trim and sharpen the dialogue ... You ... produce a horrible-looking manuscript ... So this is what it's all been for. What is it, though? Have you got the gall to call it a novel? 

By this time we're practically begging her to call it a novel. And so she does. Monkey Grip is called a novel, The Children's Bach and Cosmo Cosmolino short novels, and now The Spare Room (Text, 208pp; $29.95) is declared "a perfect novel" by Peter Carey on the back cover. But they are not novels. They are all of them fine works of art and innovative explorations of literary approaches to non-fiction, every one of them an outstanding example of stylish reportage, but none of them is a novel. So why does Helen Garner at the very least collude in having them called novels? And why does it matter? (Aren't signifiers meant to be floating these days?)

Perhaps she believes that with all that shaping, leaping, trimming and sharpening, her notebooks and diaries actually become novels. Perhaps she still (quite understandably) feels a need to cock a snook at those early critics of her work, such as Peter Corris, who attacked her for publishing her "private journals" rather than writing a novel. Random jottings, they seemed to be saying, about emotional entanglements in dreary suburbs with the odd thought about the meaning of life thrown in don't make you a writer. A real writer, it was implied, writes novels, and a novel is something more sustained, more imagined, more intricately patterned, more whole than the sort of thing Garner writes, however much she trims and transcribes. Just throwing in a bit of "purple prose", as she does in Cosmo Cosmolino, won't do the trick, either.

They had a point, surely, about diaries not being novels without a lot of restructuring and redecoration. A novel is primarily a work of fiction with an architectonic quality to it that transcribed diaries just don't have. However, Helen Garner is indubitably not just a writer, but one of our most gifted. Whatever sort of writer she is - tribal storyteller, memoirist, reporter, diarist, essayist - nobody's words on the page command attention quite like hers.

To call a book a novel, though, does raise certain expectations in the reader which Helen Garner never sets out to satisfy in The Spare Room. Why should she? The Spare Room is a hard-hitting, flinty-eyed report from the front, not a novel. It's a report, in fact, from two fronts: one in a cancer quack's surgery and the other a house in Melbourne's northern suburbs where Helen (that's the character's name), riding a surge of pity, love and anger, is looking after her dying friend, Nicola, for three weeks while she undergoes a miracle cancer cure. It reads like the monologue of an angry, exhausted friend, sitting across the kitchen table from you, telling you, since you haven't asked, what looking after poor, mad Nicola was like in gritty detail. She's a woman of penetrating intelligence, this friend of yours, plain-spoken and not given to lyrical effusions (at least on this occasion). Her speech is punchy because it's almost all subject-verb-predicate - "I put it down ... I grabbed her hands ... I said ... She tried" - making you feel she's telling the truth. It's a performance, of course - you know that. Shaped, rehearsed and dotted with lines she knows will cut you to the quick, such as, "The station was a seven-minute walk from my house, twenty if you had cancer." And it's a performance calculated to evoke empathy for Helen, not Nicola.

It's easy to feel sympathy for Nicola as she assures Helen with her ghastly rictus of false cheer and grotesquely rounded vowels that, after one more dose of intravenous vitamins or essence of cabbage juice, "I'll have the damn thing on the run." Sympathy is easy to feel for anyone in her situation of high-pitched fear and pain, but to create empathy in the reader requires the exercise of a different skill - a novelist's, perhaps - one that Helen Garner, in The Spare Room, is not in the business of exploring. Nor should she have felt obliged to. Reporters on the front line generally don't.

For empathy you need interiority. Nicola is an unforgettable character, precisely because of the lack of interiority. All we're shown is surfaces - her stagy accent, her grande dame affectations, her gutsiness, her warmth, her imperiousness "sweetened by a confidential note". In some ways she's memorable in the same way as certain fairly shallow Fauve and other post-impressionist canvases are memorable - a Dufy seascape, for instance, or a van Dongen portrait. As Gauguin famously said to one of the young artists in his group: "These trees are yellow, so put in yellow. This shadow is rather blue, so paint it with pure ultramarine. These red leaves? Make them vermilion." The result was startling to the eye, but didn't, and wasn't meant to, tell us much about the trees. It told us about how one man saw the trees. The Spare Room tells us what it feels like to be Helen, not Nicola. And there's nothing wrong with that.

The drama of being Helen, a suburban grandmother turned for three weeks into her demanding friend's palliative-care nurse (as well as cook, washerwoman, chauffeur, protector and counsellor), is paced by her transformation into the "punitive Mother". "Matron" is what Nicola calls her at one point, which cleverly catches both the "punitive Mother" and the stink of bedsheets, sickness and death, all in one fierce word.

But Helen doesn't want to be that kind of mother. She wants to be the embodiment of loving kindness, like her own mother, who would "spread the clean sheet across my bed" after one of her "bilious attacks", "stretch it flat and tuck in its corners, making it nice again for the disgusting, squalid creature I had become". But she can't. The bad faith from Nicola's dotty belief in her quacks (men, of course) and Helen's acquiescence in it poisons the very air in Helen's house. "The crimson of her shawl," as Garner puts it, "was leaking into the air around her, staining it."

There are no grand themes, in the orchestral sense, coursing through this short book. In Madame Bovary there's the powerlessness of women, in Death in Venice decadence and mortality, but here it's more a matter of subjects and leitmotifs, among them death. Helen doesn't like death "being in my house", "pushing new life away with terrible force". It's a sensation that the visits of her young granddaughter, who ducks in through a hole in the fence from next door, give stark, if brief, form to, but there is no meditation on death.

All the same, there are the rumblings of a theme or two beneath the women's sometimes heartbreaking exchanges. For example, Garner obviously wants to say her piece about charlatans preying on the gullible and getting away with it, and she does so with a nicely judged savagery we can all enjoy. One man's charlatan, however, can be another's saviour. It's unwise, surely, to make hard-and-fast rules about how others should cope with their extreme suffering. Indeed, Helen copes with her own distress by asking her sister to bless her. Having her sister murmur something about the Lamb of God and make the sign of the cross might be of great comfort to Helen, but this sort of thing will no doubt strike many readers as quackery no less dangerous to the sufferer's sanity and wellbeing than the ozone tent at the dodgy cancer clinic, and certainly much better funded.

Lurking somewhere there, too, among the tales of Nicola's misspent youth and failure to secure herself a husband, is the suggestion (perhaps not quite a theme) that if she had got herself a family, like Helen - that is to say, a proper Howardish family, with children and grandchildren you can go to Target with on Saturdays - it might never have come to this. We all know that a family guarantees nothing. Helen, it's true, is amused when Nicola says that her own life has been wasted, whereas Helen has been married - several times, in fact. She tries to laugh her marriages off as "train wrecks", but Nicola is not deterred: "You've made a family," she says. "I've wasted my life. Look at me. I'm sixty-five. What have I got to show for it?" "I could have poured out a thousand flattering protests," Helen says, "but ... she looked so dignified that it would have been impertinent to try to comfort her." If I had been in Nicola's shoes, I think I'd have liked her to have a go.

Nobody writes these reports from the suburban front line with quite the passion, the abrupt insights and kitchen-table candour of Helen Garner. The Spare Room is a quietly devastating book, written with superbly refined ordinariness, on ageing, women's friendship and how to look death in the eye.

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