69 pages • 2-hour read
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Content Warning: This section of the guide includes discussion of substance use, graphic violence, sexual content, illness, and death.
On the first day of medical school orientation, 26-year-old Sasha Zaleski surveys her classmates and finds them unimpressive. She is older than most students because she worked as a waitress and nanny to pay for college and help support her family after her father developed Parkinson’s disease. Diagnosed during her high school years, he needed care, and Sasha moved home during college to help him. Her Russian immigrant father came to America to provide opportunities for his children and encouraged her to pursue medicine despite his illness. After Sasha graduated from college, her father developed pneumonia, was hospitalized, and died. She remains angry at the doctors for their slow diagnosis and for prescribing the wrong antibiotics. Determined to honor her father’s memory, Sasha resolves to graduate at the top of her class.
At the hospital bookstore, Sasha buys Dr. Matt Conlon’s anatomy textbook. She considers buying all remaining copies to gain an edge, but cannot afford to. Instead, she hides the remaining stack of Dr. Conlon’s books behind a skeleton, covering them with a sweatshirt. Sasha informs another student entering the store that she has just purchased the last copy.
In the anatomy lab, Sasha evaluates her lab partners: Heather McKinley, whom she considers an “airhead”; Abe Kaufman, who is focused on Heather; Rachel Bingham, who talks confidently but struggles; and Mason Howard. Sasha instantly dislikes Mason for being handsome and charming, believing these assets give him an unfair advantage.
Sasha scores a 98 on the first anatomy quiz. However, another student with ID number 20205 achieves a perfect score of 100. On the second quiz, she again scores one point below perfect while 20205 posts another 100. Obsessed with identifying her competitor, Sasha observes Mason in the library. In the library, Sasha glimpses Mason’s latest quiz on his desk, showing a perfect score, and realizes he is 20205.
Sasha drives two hours to visit her mother in Brooklyn. She blames her mother for her father’s death, believing she killed him by authorizing the withdrawal of life support. Her mother speaks primarily Russian and suggests that Sasha quit medical school to come home and find a husband. Angry, Sasha escapes to her parents’ bedroom, where her father’s possessions remain untouched. In the bathroom, she discovers bottles of her father’s Parkinson’s medications. She remembers the carbidopa-levodopa pills caused him severe hallucinations—voices and visions that tortured him. As Sasha pockets the nearly full bottle, an idea forms.
A few days later, Sasha grudgingly reflects that Mason has become the closest thing she has to a friend at school. Finding him in the library, she offers to get him coffee. In the medical student lounge, Sasha dissolves the contents of one of her father’s carbidopa-levodopa capsules into Mason’s coffee. She rationalizes that the medication will likely distract Mason from studying or have no effect. She notes that despite the school’s drug problem, Mason would never voluntarily take drugs.
In the anatomy lab, Sasha notices both Mason and Dr. Conlon staring at Rachel’s braless chest. She has been drugging Mason daily for two weeks with no noticeable effect. Sasha becomes further irritated when Dr. Conlon praises only Mason’s work. Mason comments on the tattoo on their cadaver’s arm, and Sasha tells him the man was likely a police officer. Mason becomes unusually excited and animated, leading Sasha to briefly wonder if the medication is affecting him after all.
On Friday night in the library, Sasha brings Mason another drugged coffee. He asks to sit with her and begins flirting. When he asks why she wants to be a doctor, she shares her father’s story. Mason appears sympathetic, takes her hand, and kisses her passionately. They go to the locker room and have sex. Afterward, Mason suggests future study breaks together. Despite her professed hatred, Sasha acknowledges she is attracted to Mason.
After they begin hooking up, Sasha stops drugging Mason, and she accepts that he earned his high score on the first major anatomy exam. She admits she is starting to fall for him. However, Mason angers her by constantly boasting that he was the first student ever to achieve a perfect score on the anatomy practical and that Dr. Conlon offered him a teaching assistant position. Wanting the prestigious role herself, Sasha visits Dr. Conlon’s office to express interest. The professor struggles to remember her name and dismisses her inquiry, saying it is too early to consider candidates. Furious, Sasha resumes her plan the next day, putting two carbidopa-levodopa capsules in Mason’s coffee instead of one.
Mason invites Sasha to dinner at his parents’ house. She agrees and spends hours selecting an outfit. Mason compliments her appearance and holds her hand during the drive. When they arrive, Sasha is intimidated by the massive mansion. She meets Mason’s beautiful but protective mother, who gives her a tour. In Mason’s old bedroom, Sasha sees a framed photo of Mason with an ex-girlfriend named Sienna. Mrs. Howard claims Mason gave Sienna a ring before she left for Paris. Upset, Sasha realizes she has deeper feelings for Mason than she admitted. When Sasha confronts him about Sienna, he aggressively asks why she cares. Mason’s harsh tone makes her feel used, and she realizes their relationship is over.
After the second anatomy exam, Sasha checks the posted scores and finds she got 94. Scanning the list, she discovers Mason failed with a score of 37. She recalls seeing him disheveled on exam day and briefly wonders if the medication is responsible.
In the anatomy lab, Sasha observes Rachel complete a perfect dissection and concludes she is sleeping with Dr. Conlon. When the professor arrives and, with obvious concern, asks about Mason’s absence, Sasha is angry that he does not comment on her superior performance. Reflecting that Rachel has gained an unfair advantage through the affair, she resolves to “level the playing field” (394).
Sasha prepares an extortion note for Rachel. The note demands Rachel place the final exam answers in empty Locker 282 or face exposure of her affair with Dr. Conlon. After sliding the note under Rachel’s locker door, she encounters Mason, who looks pale and unkempt, and collapses against a wall. Mason claims that he is going to be murdered just like Frank. Sasha sees a frightening look in his bloodshot eyes and knows he needs help. However, fearing she will be implicated in his condition, she decides not to tell anyone.
Sasha arrives at the anatomy lab to find Rachel staring in horror at their cadaver. Someone has brutally mutilated it, shredding the arms and legs with a scalpel. Sasha immediately suspects Mason.
A few nights before the final exam, Sasha tries to study in the library but is distracted by guilt over Mason and the extortion plot. Just before midnight, a disheveled Mason appears. He kneels before her, takes her hand, and admits with tears in his eyes that he thinks he is losing his mind. He begs for help. Sasha thinks bitterly that no one ever helped her and dismisses his fears, telling him he is merely a stressed medical student experiencing typical anxiety. Mason seems to accept her explanation. He then weakly propositions her for a hookup in the locker room. Though tempted, Sasha refuses, overcome with self-loathing for what she has done to him.
Unable to study, Sasha drives to Mason’s dorm suite, worried about him. Abe answers the door, tells Sasha that Mason isn't there, and invites her to wait. As they sit together, Abe compliments her, saying everyone knows she is the top student in the class. He mentions Heather, then trails off, looking sad. Driven by guilt, Sasha uncharacteristically offers to listen if he wants to talk about Heather. Abe refuses.
In the anatomy lab, Sasha dissects the cadaver’s foot as Dr. Conlon approaches. Addressing her by name, he praises her dissection skills and calls her the best student in the class due to her consistently superb performance on exams, quizzes, and dissections. Thrilled, Sasha accepts when he officially offers her the anatomy teaching assistant position for the following year. Dr. Conlon then asks whether Rachel has a good grasp of the material. Feeling sorry for the professor, Sasha tells him honestly that Rachel does not know the anatomy. Dr. Conlon looks dejected and thanks her.
Sasha’s mother calls asking her to visit for Christmas. When her mother says she feels lonely, Sasha yells that her mother killed her father by authorizing his removal from the ventilator. Her mother reveals the truth: The doctors followed Sasha’s father’s advance directive to refuse life support. He made this decision for Sasha so she could pursue her dream without being burdened by his care. Sasha refuses to believe it and accuses her mother of preventing her father from seeing her graduate from medical school.
On Sunday night, before the final exam, the library is crowded with students studying. Sasha feels confident but has not yet checked Locker 282 for the blackmailed exam answers. Rachel approaches, revealing that she and the man she was seeing have broken up because she did something unforgivable.
Sasha goes to Locker 282 and opens it. As she holds the final exam paper, she remembers her father’s pride in her desire to become a doctor. Realizing her father would be ashamed of her for cheating, Sasha rips the paper into shreds and throws it in a trash bin.
After sobbing in the locker room, Sasha goes to the bathroom and wonders what made the large crack in the bathroom sink. At the vending machines, Sasha thinks about Mason when Rachel suddenly appears, running toward her with blood on her face and shirt. In a panic, Rachel reveals that Mason shot Dr. Conlon. Sasha realizes Rachel genuinely cared for Dr. Conlon and says they need to get help. She resolves that no one must ever discover what she has done.
Sasha’s narrative perspective provides a psychological study of how grief and socioeconomic resentment fuel a corrosive ambition. Her identity is inextricably linked to the memory of her father, whose death serves as the central trauma shaping her worldview. She constructs a narrative of blame, holding doctors and her mother accountable for his death. Sasha’s relentless drive to graduate “at the very top of my class” (355), initially framed as a tribute to her father’s dream, sours into a zero-sum competition where classmates are not peers but obstacles. Her early concealment of textbooks in the bookstore reveals a predisposition for seeking unfair advantages, stemming from a deeply ingrained sense that the world, particularly for people from her immigrant, working-class background, is inherently unfair. This initial transgression establishes a pattern of behavior that escalates in severity, demonstrating the dangers of pursuing a goal without moral restraint.
Sasha’s narrative arc explores The Destructive Power of Academic Pressure on Identity. The intense environment of medical school reduces individuals to their academic performance, and Sasha internalizes this value system. Stripping Mason of his humanity, she views him as a collection of unearned advantages—good looks, wealth, and charisma—that give him an unfair advantage she feels she must neutralize. Her identity becomes so enmeshed with being the top student that any challenge to this status is perceived as an existential threat. This pressure drives her to commit an ethical violation by drugging Mason, an act she rationalizes as leveling a “playing field” she believes is rigged against her. The author’s placement of Sasha’s perspective in the novel’s final section creates dramatic irony. The reader, already aware of the consequences of her actions on Mason’s psyche, sees her self-justifications as a reflection of deep self-deception.
Sasha’s internal monologue exemplifies The Corrupting Influence of Secrets and Deception, primarily through her reliance on rationalization. Each immoral act is accompanied by a justification that preserves her self-image as a devoted daughter honoring her father. She minimizes the act of drugging Mason, reflecting that the medication will likely only distract him, willfully ignoring the potential for severe harm. The recurrence of the drugs and pills motif in these chapters reinforces Sasha’s moral descent. By using the drug that caused her father’s hallucinations to induce them in Mason, Sasha perverts the memory of her father’s suffering, twisting a symbol of care into a malicious weapon. As Mason’s mental state visibly deteriorates, she chooses silence, consciously allowing his decline to continue because it serves her competitive goals. Her internal admission that she wants Mason to “sink deeper and deeper into the hole. So deep that he can never crawl out” (399) illustrates the theme of Ambition as a Catalyst for Moral Decay. Her actions create a devastating chain reaction, far removed from her lofty goal of honoring her father.
The introduction of Sasha’s perspective at this point in the narrative recontextualizes the entire preceding story. By presenting events through her eyes, the text forces the reader to inhabit a morally compromised viewpoint, revealing the distorted logic behind the progression of her choices. Sasha’s narration is fundamentally unreliable; she frames herself as a victim of circumstance and systemic unfairness while victimizing Mason and manipulating Rachel. The final revelation from her mother—that her father chose to end his life to unburden her—shatters the foundational grievance that justified all of Sasha’s actions, recasting her quest as a profoundly selfish endeavor. Her priority on learning of Dr. Conlon’s murder is self-preservation: “Nobody can ever know what I’ve done” (420). Sasha’s concluding statement cements her characterization as someone whose ambition has eclipsed her empathy.



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