This is a very disturbing book, reveiling the darkness, and evil of the human animal. It is tragic in so many ways that one comes away with the feeling that humankind lives in a cesspool of selfishness, with no chance of redemption or any need for it. The world is as it is, violent and ugly. Pacheo, a surgeon and the central character, is as despicable and amoral character as there has ever been, but he bluntly makes no apologies for what he is or what he has done. He is the narcissistic sociopath extraordinaire, and as this book unravels we see that this surgeon, who publicly is respected, is actually very much more sinister. The story is gripping, and reaches a steadily rising crescendo until the last page. A book worth the read, but get ready for a good dose of human ugliness.