Synopsis:
Margaret’s rare autoimmune condition has destroyed her life, leaving her isolated and in pain. 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.
Review:
Hello again dear reader or listener, I hope picking up again after the haze of the break hasn’t been too traumatizing for everyone. Speaking of trauma, let’s talk about a book whose review I’ve been sitting on for months because it’s taken me this long to unpack my feelings over it.
With huge thanks to the St. Martin’s Press team for granting my eArc request of this title, let’s get to it!
The Graceview Patient is the polar opposite of a feel-good story. In fact, I’d go so far as saying this was my hardest read of 2025. And I simply could not put it down. But, as I said, it took me a long time to actually be able to put into words why.
It is confusing, delirious, claustrophobic, at times downright bleak, and frankly horrifying for so many reasons. Yes, I can almost guarantee that Starling’s raw and brilliant fever dream of a medical-horror novel will haunt you. Why? Because it is, to date, the cleverest and truest show of an unreliable narrator that I have read, while also presenting intelligent and nuanced studies into chronic illness, bodily autonomy, medical ethics, healthcare systems that seem to care more about profit margins than the lives they’re supposed to be saving, and disability. What happens when you cannot trust our own mind? Can things be too good to be true?
With Graceview, Starling cemented the characteristically dizzying and disjointed Hospital Gothic subgenre, delivering a tale of unrelenting anxiety, endless uncertainty, and utter dread. It is food for thought and harrowing catharsis in one horrible and quite psychedelic package that will have you questioning everything you thought you understood. It will show you parts of yourself you may not have considered before, while also educating those who may not have any kinship to the protagonist’s plight, in ways that will stick indelibly.
This isn’t Starling’s first book that I’ve read, (The Death of Jane Lawrence has a special place in my heart) so I had an idea of what to expect from the author’s affective narrative style and poignant writing, but boy did she not allow me a single moment of being able to guess what would come next. I thought I’d be able to go through this story with a clear idea of who I could root for but, the further in I got, the more I started to doubt my own self, much like protagonist Margaret. Was I on her side and rooting for her to get through the horrors, or was I feeding into her delusions and thus “harming” her in the process by not being the clear headed and steady objective point of view that understood everything she was going through was a nasty side effect, but ultimately her only chance at a normal life? Or was I being naïve and too trusting when I should’ve been fighting alongside her against malpractice and paranormal horrors? What was real and what was imagined? Any time I thought I finally had the answer based on the cleverly woven context clues, something else would be said or happen and I’d be back to square one! Was I being gaslit or the one doing the gaslighting?!
I still don’t have answers; Starling what have you done to me?!
But I don’t want you to get the wrong impression, dear reader. This book is not the kind of badly written headscratcher where you’ve mentally checked out because nothing makes sense and poor skill is disguised as erudite prose you just “can’t get”. On the contrary, everything makes maddening sense to the point where you simply cannot decide because you have all the facts in a way that makes it impossible for you to find the so-called correct answer. And it is magnificent. The point of this book – like any Gothic worth its salt – is not to figure it out. I’d argue the point is to revel in the discomfort of this thickly atmospheric narrative and find someone else to read it with and debate it. It is a fascinating psychological thriller, carrying us through the various stages of a person’s breakdown, even past what they thought was their rock bottom. It views the repetitive/cyclical nature of chronic illness, as well as the isolation it can cause, under a stark light. It is as unforgiving as it is important for those who need to feel seen or for those who are trying to understand someone who might be going through a similar erosion of self.
The sterile isolation and fear pervading the hospital setting is not merely the author’s fancy but a very real phenomenon for anyone who has had the misfortune of spending more than a few hours in the ER. Intellectually you know you are in a space of healing and care but what if you start feeling like you can’t be sure? Trust and forcing yourself to rest is incredibly hard when your perspective and inner strength is no longer as rock solid as you remembered. How do you cope with the pain, loneliness, and desperation of needing another’s touch while at the same time both resenting and fearing it? How can you hold onto the fact that in order to get better you need to get worse first, and that’s if you can make it through?
This is a discomfort book. I finished it with the concurrent realization that the bitterness in my mouth was both from knowing it couldn’t have ended any other way without feeling facetious or patronizing, and yet kinda hating while being in awe of it nonetheless. But there lies the brilliance of Starling.
I don’t think I’ll ever read this again. Certainly not any time soon. But I am nevertheless glad that I did and will absolutely be recommending it to everyone looking for this kind of psychological horror. It made me think and ponder and it made me feel strongly and empathize, even when I couldn’t for the life of me find the answers I thought I needed. Starling horrifies yet dazzles with her incredible writing skills and well-honed talent for the grotesque. She is unrelenting and I think everyone should read her work for they will be richer for it.
You just might need a little recovery time after like I did, at least in regards to The Graceview Patient.
Until next time,
Eleni A.E.
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