This book begins as a satire of the health care system and hospital administrators. It turns into a mystery, a shift which is not entirely welcome. Senior physician Abe Nevski returns to his job as a physician in a large Australian teaching hospital. While he has been gone the hospital administration has become more draconian in pushing a program that is meant to (according to the administrators) allocate resources in a utilitarian manner, younger patients and to clearing beds quickly. To Abe, this sounds a lot like withdrawing care and signing death warrants of older patients. The administrators claim that's not the case. Abe thinks otherwise. There have also been a series of unexpected deaths among seemingly stable older patients. Abe tries to figure out what is going on while mentoring his registrar, Rebecca, a young doctor who is becoming disillusioned with the lack of humanity in modern medicine and the hospital-industrial complex. This sets the stage for a showdown between Abe, a doctor who cares about patients and has an excellent bedside manner, with the hospital administration, which is a cold and smarmy as one would expect a hospital administration to be.

As a social commentary on the modern healthcare system and cost-cutting measures, this is an excellent book. Komesaroff is a practicing physician. He clearly knows the medicine, the culture of the hospital, and the social issues facing healthcare. Dr. Nevski is a well-developed and believable character, and the hospital world is immersive. Where the book falls flat is as a novel. I found the book's ending to be completely ridiculous. This was such an uneven book. The beginning was excellent, but as the plot becomes more bizarre and more mysterious, it devolves. I utterly disliked where the relationship between Abe and Rebecca wound up (lawsuit!), and, as mentioned, the resolution to the mystery is unsatisfying. I think I would enjoy reading some of Komesaroff's non-fiction, as he clearly wants to address the inhumane elements of modern healthcare. ( )