Thank you Netgalley, Penguin Random House Canada, and Vincent Lam for free e-ARC in return of my honest review.

Vincent Lam's novel "On the Ravine" offers a powerful and thought-provoking exploration of the complexities of the doctor-patient relationship and the ethical dilemmas faced by medical professionals in the midst of a public health crisis. Set in downtown Toronto against the backdrop of the Fentanyl Crisis, the story follows Dr. Chen, a dedicated physician grappling with the weight of responsibility and the haunting specter of lost lives.

As Dr. Chen navigates the challenges of his profession, the narrative delves into the intersecting lives of his patients, including Claire, a talented violinist caught in the downward spiral of addiction. Their paths converge in unexpected ways, forcing Dr. Chen to confront the limits of his practice and the moral implications of his decisions.

Lam's nuanced portrayal of characters and their interconnected struggles is a testament to his deep understanding of human nature and the complexities of empathy and compassion. The novel shines a light on the personal and professional dilemmas faced by healthcare providers, painting a vivid and emotionally resonant portrait of individuals grappling with life and death.

Through his skillful prose and keen insight, Lam creates a world that is both vividly real and charged with emotional intensity. The intricate web of relationships and the moral quandaries that unfold in "On the Ravine" captivate the reader, inviting reflection on the nature of healing, sacrifice, and the pursuit of redemption.

Overall, "On the Ravine" is a gripping and emotionally charged novel that showcases Lam's talent as both a physician and a storyteller. With its profound emotional force and compelling narrative, this book is a remarkable achievement that cements Lam's place as a distinctive voice in Canadian fiction.

This book was a poignant look at the opioid crisis. Very well done. Highly recommended. Characters were anything but cliche.

This is a brutally honest telling of the current addiction situation in Canada. It was honest and brutal and I really enjoyed reading it. The MC came across a little creepy in a few sections. I felt some of the interactions with students were a little inappropriate.

I enjoyed reading this and would try this author again.

On the Ravine considers the lives of two doctors--one who is known as the "dealing doctor", a doctor who would prescribe opioids to try to stop the addicts in his care from taking potentially dangerous street drugs, the second who is working on a new medicine to help cure addiction. Their stories are interwoven with that of a gifted violinist who becomes addicted to opioids after hurting her shoulder before an important show. This is a beautiful book, well-written and emotional, and humanizes those struggling with addiction well.

I did not finish this one, it was not for me, I couldn't relate to the characters, and just did not care for the story.

Unfortunately, I did not write my review while still fresh in my mind. Several months after reading it, I am unable to recall ANYTHING about this book. Sadly, I'm of the opinion that if I no recollection it did not make enough of any impact on me; good or bad. Perhaps, it was my disinterest topic?

This novel focuses on the experiences of Dr. Chen, who specializes in addictions medicine, and his patient Claire. I rooted for both characters throughout, and enjoyed reading about the complexities of addictions treatment/research and substance use issues. Another strength was reading about the differences in Dr. Chen and Fitzgerald's approaches to helping.

The book didn't quite ever feel like a "gripping novel of profound emotional force" as the blurb suggests. Often, the writing felt dry, overly clinical, and emotionally detached. Although I appreciated Dr. Chen's compassionate and analytical perspective and approach, it would have been interesting to see Dr. Chen consult and collaborate with other professionals (e.g., psychotherapists, peer support workers) and integrate psychodynamic models/interventions into his practice.

More insight into how the past (e.g., childhood/family experiences, the role of trauma...etc.) may have informed Dr. Chen and Claire's patterns and behaviors would have been helpful. On one hand, Dr. Chen is generally portrayed as a disciplined doctor who takes a by the book approach to medicine and clinical research, and other times he struggles with doctor-patient boundary issues in significant (and detrimental) ways - why not take some time to go deeper and reflect on what might have shaped some of his core patterns and struggles?

*Many thanks to NetGalley and Penguin Random House Canada for the ARC in exchange for an honest review.

Brilliant and impactful. An examination of the choices and consequences of following impulse versus trying to maintain control and the desperation in either path. The story of a doctor trying so hard to make positive change in the most challenging circumstances and a young artist trying to find the elusive magic of perfection. Thought provoking read.

This book is not my usual genre and maybe (hopefully) that’s why I couldn’t get passed the first 100 pages.

I absolutely loved this book!! I couldn’t put it down.
I just loved all the characters. I highly recommend this book.

This excellent book disturbed me, a lot! It was well written, moved along quite quickly, and yet was filled with anguish. The anguish of a drug addiction physician who cares deeply for his patients, the anguish of those addicted to drugs and the toll it takes on their lives, the anguish of family members, the anguish of those involved in drug addiction research and its effects (both positive and negative). Too many lives are ended, ruined, or dramatically changed with drugs. Physicians lose their licenses, with cause; researches lose their funding, again with cause; people lose hope for themselves and/or their loved ones, also with cause. The author paints a depressingly true picture of the changes that people addicted to drugs and those associated with drugs undergo, and the deep and too often overwhelming ditch that they try and fail to crawl out of. It left me with the belief that no one should touch/begin using drugs, and that working with those who are addicts takes a very special kind of person, one much more optimistic than myself. This is undoubtedly the best work of Lam, and certainly the most contemporary.

I’ve been a fan of Vincent Lam’s work since Blood Letting & Miraculous Cures. The author’s writing is always breathtaking, and in On the Ravine, it’s just as so.

A big thank you to the publisher and NetGalley for the ARC!

I'm a fan of Vincent Lam. Loved Bloodletting and Miraculous Cures! Despite not being a physician, I enjoy reading books from this perspective. This is a powerful book on an important topic that all Canadians need to know more about and understand more deeply. Lam provides intimate insight into drug addition and complicated lives and is beautifully written. A tough, heart wrenching read due to the subject but so worth it!

On the Ravine explores different approaches to the opioid crises and as a result the problem with the unsafe drug supply in Toronto. The main characters are a addiction doctor that works at a clinic, his former partner that lost his license for being the "dealing doctor" and one the addiction doctor's patients that crosses both of their paths.

Dr. Chen, the addiction doctor, delivers his care with empathy and understanding but has his own demons. His devotion to the clinic and his patients could be described as an addiction as well. The dealing doctor thinks of himself as an addiction specialist, even though his methods are unorthodox and he is no longer licensed. The other protagonist is Claire, a violinist, who believes that she is only capable of playing while high. Each of these characters lives intertwine as they search for the courage to redeem their pasts, to forge connections and to improve the lives of those around them.

This novel is at times heartbreaking and uplifting. Vincent Lam does not shy away from the realities of the opioid crises or the added harms of the unsafe drug supply on the streets. His insights as a physician give the reader access to what addiction is like and how it affects everyday people. On the Ravine is especially timely as we read more and more about the impacts of the unsafe drug supply on the streets and as overdoses are becoming more common; not just in Vancouver and Toronto but everywhere in Canada. On the Ravine was more of a special read to me since Vincent Lam is a local author and the locations had a familiarity to me.

I recommend that you read this book right away. It is timely. It is well paced. It has characters you will be thinking about and hoping the best for long after you finish reading this book.

Thank you to Net Galley for providing this arc to me.

Vincent Lam's follow-up to his 2006 Giller-winning Bloodletting and Other Miraculous Cures, ON THE RAVINE is a must-read about addictions, recovery, and all kinds of different harm.

Based in Toronto, we meet Dr. Chen, a committed addictions doc who runs a clinic and is forever hopeful, disappointed, full of regret, and deeply caring. He also co-founded a company that runs drug trials. His partner in both the clinic and company was Fitzgerald, the "dealing doctor" who lost his medical license for giving his patients medical-grade versions of drugs in an attempt to reduce harm and keep them away from street drugs.

We also meet Claire, a violinist who has been struggling with opioids since an injury who sees Dr. Chen at his clinic. 

At its core, it's a book about how we can know another person, what that means, and if it matters. It's about the kind of love that is sacrificial and hopeful, but not always well-placed. And it's about the compromises and promises we make to ourselves to be good, to live ethically, and with each other. 

It's also about the current deadly poisoned drug supply, about complex medical, moral and policy questions around the balance of harm reduction including safer supply, the limitations of current forms of treatments, and the potential for new ones. As public discussions ramp up across North America about forced treatment, addictions treatment in general, and the rights of people who use drugs, this is an absolute must-read. 

You don't need to have read his 2006 book (I haven't) and be ready for some density and richness in description and interior monologue. It's beautiful, compelling, and very important.

Lam is a doctor in Toronto and has written several books - award winners. This novel is about 2 doctors, one has lost his license to practice. They work with drug addicts. One of Dr. Chen’s patients, Claire, is a talented violinist. She became addicted to opioids when she injured her shoulder. This is a page-turner and a gritty depiction of drug use, treatments and drug trials. Not for me but I know many will find this a satisfying read.

I cannot even begin to describe the depth of the motion that I felt when reading this book, both from the addict's point of view but also most poignantly from a caring doctor's point of view. It is clear that the author's experience of true pain in caring for and tending to his patients' most desperately, shines in every page. Vincent Lam has given me a clearer insight as to the tremendous struggles an addict suffers every day of their tumultuous lives, with hopes of healing yet inability to escape their demons. I loved reading this book but more importantly I loved the skill involved in expression of the human side of the complex emotional issues. Thank you to NetGalley for an advanced copy of this most important book.

This book will be one of my top recommendations to my patrons this year. I was a fan of Lam's after Bloodletting and Miraculous Cures and find his writing beautiful to read, On the Ravine does not disappoint. I found the empathy and kindness with which he depicts the lives of people who use drugs really unique. I've never read a book that treats people living with addiction with such care and compassion. Lam also does an excellent job illustrating how our health care system has contributed to/created the opioid crisis, and how little the current state of health care is doing to manage this crisis. I always love a novel that I feel teaches me something while reading a compelling story.

Written by Vincent Lam, an addictions physician, comes an important piece about addiction. Treating it, living with it, big pharma's role, and the ultimate toll it takes. The novel explores not only the doctor patient relationship between Dr. Chen and Claire, and the medical ethics around treating addiction. But, also Claire's own relationship to her addiction, the way it affects decision making and the ability to function with and without drugs. This is a necessary piece for our current time when drug use and addiction are at an all time high. It's heartbreaking in its reality. I have a close family member who works at an addictions clinic with a detox facility, and this novel could easily be about any number of clients they see who desperately want to be out from under the hold addiction has on them. It is so important to know, as this book highlights, that it's nowhere near as simple as just choosing not to use, contrary to what society as a whole seems to believe.
Exceptionally written, and incredibly moving, with characters you can't help but feel for. I highly recommend it! ⭐⭐⭐⭐⭐

Thank you NetGalley and Knopf Canada for an advanced copy of this ebook.

In this book by Canadian Author Vincent Lam, we follow Chen, a doctor working in an addictions clinic, and Claire, a violinist who once suffered a shoulder injury and got hooked on opioids which led to addiction,

While this book has touching and heartbreaking moments and descriptions and gives real insight to a very real crisis that exists (I live just outside Toronto where the book takes place) it failed to draw me in. The pacing in the beginning was very slow with too much narrative and story building. It took me a very long time to get through this book as I didn’t feel a connection despite the heavy topics.

I will say Lam’s descriptions of places and situations and his character building are exceptional. If there had been less narrating and a quicker pace to the story I think I would have loved this book.