69 pages • 2-hour read
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Content Warning: This section of the guide includes discussion of mental illness, substance use, graphic violence, sexual content, and death.
Mason Howard sits through Dean Bushnell’s orientation speech with contempt. He predicts many classmates will drop out or turn to drugs, but resolves to graduate with top honors and secure the best residency. Mason’s father is Dr. Walter Howard, head of cardiothoracic surgery at Yale and one of the most respected surgeons in the country. Despite being valedictorian and earning a perfect MCAT score, Mason chose DeWitt over Yale to escape his father’s shadow. His ultimate goal is to surpass his father in success and status.
Mason has studied anatomy all summer to prepare. His roommate, Abe Kaufman, asks him to be lab partners and suggests inviting Heather McKinley, a classmate Abe has a crush on, to join their group. In the lab, Heather struggles and manages only with Abe’s patient help. Mason enjoys antagonizing Heather’s roommate, Rachel, by calling their cadaver Frank. The fifth lab partner is Sasha Zaleski, quiet but knowledgeable. When examining Frank’s arm, Sasha notes that his faded tattoo indicates he was a police officer.
Mason spends nearly every night studying in the hospital library. Sasha studies in the same corner and brings him coffee each night. One evening, Mason asks why she wants to be a doctor. She reveals her father died of Parkinson’s disease after receiving mismanaged care, and she wants to become the physician who could have helped him. When she begins to cry, Mason kisses her. They have sex in the deserted medical student locker room.
Abe complains to Mason that, despite his feelings for Heather, he stands no chance with her. Mason advises his roommate to be assertive and kiss her, insisting that “[n]ice guys finish last” (284). Abe hesitates, worried about violating her boundaries. Later, classmate Brogan Scott flirts with Mason and invites him to a party. When Mason asks if he can bring Sasha, Brogan refuses. Mason declines the invitation.
Dr. Matt Conlon summons Mason to his office and subjects him to difficult anatomy questions. Satisfied with his answers, Dr. Conlon explains he was testing Mason to make sure he hadn’t cheated, as he scored perfectly on the practical exam: an unprecedented achievement. When Mason reveals he wants to go into plastic surgery, Dr. Conlon offers to use his connections at UCSF’s top-ranked plastics program if Mason maintains his performance.
At two o’clock in the morning, in the library, Mason watches Sasha study. He and Sasha have developed an ongoing sexual relationship, using a system of tapping a yellow highlighter to signal their interest. Sasha and Mason discuss Frank, wondering how he died. Both have noticed that, unlike most of the cadavers, Frank’s organs appear healthy. At home, Mason finds Abe distraught, convinced he will lose Heather. Abe vows to keep Heather, no matter what it takes.
During the anatomy lab, Mason asks Dr. Conlon about Frank’s cause of death. Dr. Conlon snaps that the information is confidential and angrily limps away. Mason begins to suspect Dr. Conlon is hiding something.
Mason’s mother invites him home for dinner and suggests bringing his girlfriend. Mason invites Sasha, planning to ask her to be his girlfriend afterward. At his parents’ massive house, Sasha is intimidated by their wealth. Mason’s imposing father questions whether his son is at the top of his class. Left alone in the den, Mason unlocks his father’s desk and finds a .357 Magnum. A male voice commands him to take the gun. Though he sees no one, the voice speaks his name clearly. Convinced the auditory hallucination is real, Mason takes the gun and bullets, hiding them in his coat pocket.
During dinner, Mason views Sasha through his parents’ critical eyes. He becomes embarrassed, realizing she does not fit into his world. After a tense meal, Mason’s mother is visibly relieved when he confirms Sasha is not his girlfriend. On the drive home, Sasha comments on the family’s wealth and asks Mason if he has ever worked. Mason becomes defensive.
Mason visits a bookstore to buy anatomy texts. In line, he meets Erin, an art history major. They flirt, and Erin writes her number in one of Mason’s books. Erin is the kind of girl his parents would approve of, but Mason cannot stop thinking about Sasha.
A surgery resident named Norm approaches Mason in the library. Norm suggests that Dr. Conlon could be responsible for the school’s drug problem, noting the issue seemed to start when Dr. Conlon began teaching. Mason hyperventilates, imagining Dr. Conlon obtaining cadavers to hide evidence of his involvement in their deaths. The mysterious voice returns, agreeing with Mason’s suspicions.
Mason visits Anita, Dr. Conlon’s secretary, and asks her to look up Frank’s cause of death. As she is about to help, Dr. Conlon walks in. When Anita explains Mason’s request, Dr. Conlon angrily repeats his earlier warning that all cadaver information is strictly confidential. This confirms Mason’s suspicion that Dr. Conlon knows he is onto him.
During anatomy lab, Mason observes Dr. Conlon and becomes certain the professor is faking his disability. When Sasha asks Dr. Conlon a question, Mason grows anxious watching the professor stand close to her. He thinks that if Dr. Conlon harms Sasha, he will kill him.
Mason oversleeps and arrives late and disheveled to his lunch date with Erin. His mind wanders, and he becomes convinced Frank was heading a police investigation of Dr. Conlon, and the anatomy professor had him murdered. He accidentally speaks these thoughts aloud. When Erin tells him he looks like he is on drugs, Mason develops a new paranoia that Dr. Conlon is drugging him. Fed up with his behavior, Erin leaves.
After being awake all night searching obituaries for Frank’s identity, Mason receives an email from Dr. Conlon summoning him to his office. When Mason arrives, he finds Dr. Patrice Winters, a psychiatrist, also present. They gently ask about his well-being, and Dr. Conlon tells Mason he failed the last exam. Mason accuses the professor of tampering with his grade. When Dr. Winters touches Dr. Conlon’s arm and calls him Matt, Mason decides that they are couple, and are conspiring against him. He storms out.
Mason decides to confide in Abe about his suspicions, but the next morning, his roommate has already left for his job at the clinic. Their classmate Victor Pereira arrives and, learning Abe is at the clinic, excitedly says he’ll “get it there” (283). Mason realizes Victor intends to buy drugs at the clinic and concludes Abe is involved in the drug ring. Horrified, Mason decides he can trust no one.
After 40 hours without sleep, Mason suspects Abe has been drugging him. He discovers itchy rashes on his forearms and concludes they resulted from poison on Frank’s body. Near midnight, he drives to the hospital to examine Frank and obtain a blood sample. In the anatomy lab, he discovers Frank’s arms and legs have been mutilated and concludes that someone has destroyed the body to eliminate evidence. He hears a voice encouraging him not to give up and believes the cadaver is speaking to him. Terrified, he finds Sasha at the library and breaks down. She soothes him, attributing his state to exhaustion. It occurs to Mason that Sasha may also be involved in the conspiracy.
Mason realizes he has not attended class in some time and that the final anatomy exam is the next day. He decides to go to the hospital that night to break into Dr. Conlon’s office and search for evidence. As he prepares to leave, he feels his dad’s gun in his jacket pocket. He hesitates, but the voice in his head commands him to keep the gun with him and load it.
Just before midnight, Mason drives to the hospital and sees a light on under Dr. Conlon’s office door. He knocks, and Dr. Conlon lets him in. Mason confronts him, and when Dr. Conlon grows nervous, Mason pulls out the gun and demands to know how Dr. Conlon killed Frank. Dr. Conlon denies everything and pleads with Mason to calm down. Mason presses the gun to Dr. Conlon’s forehead. When Dr. Conlon says he is sorry, Mason interprets this as a confession and shoots the professor in the head, killing him instantly. In the hallway, he encounters Dr. Winters. She sees the gun, and, realizing she is a witness, Mason shoots her in the chest, killing her. With four bullets remaining, he resolves to eliminate any other witnesses.
These chapters establish Mason’s character through his formidable ambition, which is inextricably linked to the figure of his father, a renowned surgeon. Mason’s identity is constructed in reaction to his father’s legacy; his decision to attend DeWitt Medical School over Yale is a strategic calculation to escape his father’s “shadow” and become “number one in my class” (275). This ambition is motivated by a desire for status, wealth, and superiority—a reflection of the values he perceives in his father. Mason illustrates the theme of The Destructive Power of Academic Pressure on Identity as his determination to excel is rooted in a deep-seated insecurity and a desire for validation that can only be achieved by surpassing his father. This foundation of ambition, built on external validation rather than internal principle, leaves him psychologically vulnerable to the pressures of medical school and creates the conditions for his subsequent collapse.
The narrative structure, which confines the reader to Mason’s first-person perspective, chronicles his psychological disintegration and highlights the unreliability of his perception. His mental state shifts from academic arrogance to acute paranoia, insomnia, and auditory hallucinations. The author charts this decline through a series of escalating misinterpretations based on confirmation bias. Dr. Conlon’s insistence on confidentiality regarding a cadaver’s death is perceived by Mason as proof of a cover-up, demonstrating how he interprets events to support his delusions. As every interaction is filtered through a lens of suspicion, the narrative becomes a study in cognitive distortion. This descent culminates in Mason’s distrust of those around him, including his roommate, Abe. His paranoid belief that Abe is part of a conspiracy signals his isolation from possible help and support.
The symbolism of the cadaver, Frank, evolves in parallel with Mason’s mental decay. Initially, Frank is an object of academic conquest and a prop for Mason’s humor, used to antagonize his lab partner. As Mason’s paranoia grows, Frank is transformed into a symbol of a vast conspiracy—a murdered police officer whose case Mason believes he alone can solve. Frank becomes the focal point of Mason’s obsession, a silent victim whose voice Mason begins to hear in his hallucinations. This personification marks the erosion of the boundary between reality and delusion. The discovery of Frank’s mutilated limbs, which Mason interprets as the intentional destruction of evidence, further cements his conspiratorial beliefs. The cadaver, meant to be a tool for understanding the human body, becomes a catalyst for Mason’s psychological breakdown, representing the failure of objective, scientific observation in the face of mental illness.
Mason’s acquisition of his father’s .357 Magnum is a pivotal moment in the narrative, underscoring the burden of inherited expectations. The disembodied voice that commands Mason to “[t]ake the gun” (304) articulates the intimidating authority he sees in his father. Stealing the weapon represents a shortcut to the power and control he craves. Mason’s subsequent actions are all influenced by the gun’s potential as it becomes a tool to enforce his delusional reality upon others. After Mason kills Dr. Conlon and Dr. Winters, his resolve to kill “every single potential witness” (349) signals the complete erosion of his moral compass. Abandoning the notion that he is delivering justice, he becomes a danger to anyone who crosses his path. Later, when Abe disarms Mason, Abe’s sorrowful reflection that his roommate will “never be a doctor” (452) underscores how Mason’s mental decline ultimately thwarts his fierce ambition.



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