THE GRACEVIEW PATIENT, spooky #Deathtober scarefest (for rational reasons)

THE GRACEVIEW PATIENT
CAITLIN STARLING
St. Martin's Press (non-affiliate Bookshop.org link)
$14.99 ebook, available now

Rating: 4* of five

The Publisher Says: Misery meets Invasion of the Body Snatchers in this genre-bending, claustrophobic hospital gothic from the bestselling author of The Death of Jane Lawrence.

Margaret lives with a rare autoimmune condition that has destroyed her life, leaving her isolated. It has no cure, but she’s making do as best she can—until she’s offered a fully paid-for spot in an experimental medical trial at Graceview Memorial.

The conditions are simple, if grueling; she will live at the hospital as a full-time patient, subjecting herself to the near-total destruction of her immune system and its subsequent regeneration. The trial will essentially kill most of, but not all of her. But as the treatment progresses and her body begins to fail, she stumbles upon something sinister living and spreading within the hospital.

Unsure of what's real and what is just medication-induced delusion, Margaret struggles to find a way out as her body and mind succumb further to the darkness lurking throughout Graceview's halls.

I RECEIVED A DRC FROM THE PUBLISHER VIA NETGALLEY. THANK YOU.

My Review: I've had gout for decades, starting in my earliest twenties. My family has gout throughout it. I'm convinced, and medical orthodoxy agrees, there is a genetic component to the condition. If someone had told me in the 1980s "we have a truly horrifyingly painful way to rid you forever of your gout" I'd've had my bags packed for the trip to Graceview Hospital before I stopped smelling the garlic the utterer had eaten for lunch.

So this story was a "sign me up!" from giddy-up to whoa. As I got to know Margaret, to be in her familiar-but-dreadful world of "how much is there for me to do, versus how much is there available for me to do it with?" calculus of living, worry with her as she tries to balance practical necessities, dealing with a narcissistic parent, and leap with joy at the sudden promise of the lifeline she's flung, I wanted so badly for things to go well for her.

Bait-and-switch much, Author Starling? It's a spooky place, Graceview, and Margaret's a very vulnerable lassie. Bad stuff's gonna happen! It's part of the read!

As Margaret gets deeper and deeper into the meddical hell she was warned awaited her, odd things occur. One of her nurses becomes a patient. The weird offness of Graceview Hospital intensifies, though of course the medication and the extreme nature of the treatment combine to present mental-health challenges to the participants. As you'd expect! Still, having experienced medication-induced psychosis first hand, I can tell you Margaret's utter horror at the psychotic break's symptoms is spot-on.

So that's the secret to my four-star rating of this weird, creepy, deeply unsettling story: I never for an instant believed this was anything other than a perfect;y reasonable side-effect of a perfectly horrible medication that was meant to cure something previously incurable. Spooky stuff seldom gets even this far up in my literary estimation because I'm so deeply materialist in my worldview.

Author Starling writes her socks off creating this setting, making it a very real place, imbuing it with eerieness and thus setting Margaret up for her nightmarish experiences. That she would've had them no matter what is what kept me from feeling this was more or less a prurient exercise in psychological torment as entertainment. It is real and honest in its presentation of what a psychotic break feels like. The terror of being unmoored from reality while undergoing very physically challenging treatment to improve your quality of life is the central fact we're dealing with here.

And that is the reason I enjoyed this story as a horror read for #Deathtober. It's got gothic rags draped over its granny-panties, so I can trust it to deal with the scary stuff as *feelings* not Reality, which they manifestly are not. Mostly, anyway.

The lack of even a fraction of a fifth star is down to a more serious problem I had: the ending is as ambiguous as possible, leaving every concerning thing well and truly unresolved. I'm as unhappy as the next reader when authors spoon-feed me a little-bow-wrapped ending; but there exists a middle ground between "the end" and this book's stopping place.

I'd say more but y'all're really, really spoiled and complain about spoilers with the verve of the wronged adolescent denied the car keys.