Let me start by saying this book is not for the faint-hearted. From the moment I opened it, I was pulled into a world that felt uncomfortably real. The author doesn't shy away from the brutal truth of Willowbrook, and that's what makes this novel so powerful.

What struck me most was how Wiseman balances horror with humanity. Yes, there are scenes that made me physically recoil (I had to put the book down several times just to catch my breath), but there's also this incredible thread of resilience running through it all. The way Sage's character develops - from vulnerable to determined survivor - had me emotionally invested in ways I didn't expect.

The pacing is masterful. Just when I thought I couldn't take more darkness, Wiseman would introduce these fleeting moments of connection between characters that gave me hope. That said, be prepared - some sections are so visceral I could practically smell the antiseptic and despair of the institution.

What surprised me most was the ending. Without spoilers, let's just say it subverted all my expectations in the best possible way. After nearly 400 pages of tension, the resolution felt earned rather than contrived.

This isn't an easy read by any means, but it's an important one. It stayed with me long after I turned the last page - haunting my thoughts during morning coffee and making me appreciate modern healthcare in ways I never had before.