Last Patient of the Night

“A heavy dose of antiseptic cleansing fluids mixed with a hint of sweat, fear, frustration, blood and guts so strong you didn’t just smell it, you could taste it. Eau d’ hospital was never gonna make it as a cologne or candle scent, but it was home to me.”

Gerlacher uses olfactory sensory details to craft the setting of the ER. In describing the ER as “home,” Gerlacher further illustrates Doc’s emotional connection to the ER and the people who work within it, whom he later refers to as his “family.”

“My sorceress is gonna cast her spell today, and everything will be fine. Thanks for your help, Doc.”

Jenny truly believes that she’s going to be able to use the money she’s stolen from Dyyavola to escape Houston and find a better life. However, the sorceress fails to cast her spell, and Dyyavola murders Jenny. Despite Jenny’s death, the sorceress remains significant in the text as the symbol of the truth of what happened to Jenny.

“At the chance to tell them who did the tattoo, I held off for the moment. I soothed my guilt by quietly assuring myself that I would tell them right after I visited that tattoo artist myself.”

Doc’s moral code is complex within the novel. He has a strict ethical code that he follows at work, reflecting The Moral Duties Associated With Medical Work, and he feels a strong moral obligation to provide as much care for his patients as he can. However, once he begins investigating, he flouts the rule of law and hides things from law enforcement since he thinks his civilian status lets him fly under the radar.

“She was really particular about the sorceress. She wanted her powerful and vibrant and casting a spell, but she left the spell up to me…She said that when the sorceress unscrambled the letters, the spell would be cast, and everything would be okay. Seemed to mean a lot to her.”

Anne, Jenny’s tattoo artist, describes Jenny’s tattoo request to Doc and Tom, highlighting the strangeness of Jenny’s request. The random spell seems odd outside the context of Jenny’s Bitcoin account, and the lingering questions about the tattoo remain throughout the novel until Doc discovers the truth about the blackmail.

“I was in and out in under ten minutes. Other days, I took my time shooting the shit with Gladys and Little D, but I am a firm believer that friendship is based on quality of time, not quantity.”

Doc has a wide community of friends throughout Houston, including Gladys and Little D at IHOP. This demonstrates both Doc’s integral role in the community around him and how Doc doesn’t discriminate about whom he befriends, from drug dealers like Squirrel to waitresses to doctors and cops.

“Dancing is pretty easy money, although not the most rewarding work, but once these assholes get a hold of you, there is no quitting or leaving. The only way out of here is in a body bag.”

Linda explains how dangerous working at the U can be, and though she doesn’t specifically use the term, she describes how “working” at the U is essentially the same as being trafficked. Linda grieves Jenny, but she’s not shocked that Jenny was killed, as she tried to escape the trafficking of the violent Ukrainian gang.

“She had been here for eight months, paid rent on time. Apartment shows no evidence of blood, so wherever she was killed, it wasn’t here. Place was torn apart, obviously looking for something. Either they didn’t find it, or they found it in the last place they looked.”

Jenny’s apartment is seemingly not the crime scene, hinting at the existence of Dyyavola’s office as the location of his brutality. The statement that whoever destroyed her apartment found what they were looking for “in the last place they looked” is tragically ironic, as the last place Dyyavola was looking was at Jenny as he killed her, and the password to her account was tattooed on her body.

“He was affectionately known as Captain BS, never said to his face. Whilst his nickname suggested otherwise, Captain Shriver was, in fact, a hard man who did not accept bullshit from anyone and always made his thoughts clear.”

Captain Shriver’s nickname is symbolic of the distance he keeps from his police officers, reflecting the motif of nicknames in the novel. The term "affectionately" is ironic, as he’s a difficult and intimidating boss, so his nickname doesn’t represent friendship, but instead the emotional distance between him and others.

“A lot of bad things happened to good people over there, and I lost a lot of friends along the way. Easier to move forward with my new life without looking back. I work from home now on my computer, and life is simpler.”

Carl simplifies his tours of Afghanistan into a few sentences, invoking Heroism and Vulnerability in Frontline Professions. Though Carl now works from home, he still patrols the residential area in which he lives, demonstrating the emotional vulnerability he’s left with after his career as a frontline professional in the armed forces.

“Doc is a complicated character. He grew up with a mom who was drunk all the time, and he learned to fend for himself early on. Because of that, he doesn’t trust many people and relies on himself to get by. He is book smart, like most doctors, but he’s also streetwise. Doc notices everything and misses nothing going on around him.”

Jean describes Doc to Skinny Jeans in a complimentary way that further demonstrates the depth of their relationship. Jean understands Doc fundamentally, from his childhood wounds to his professional capabilities, demonstrating how much friendly intimacy Doc builds with his friends.

“Working with her every day on violent crime, Lenny often forgot that she was a mom to two young daughters.”

Jane is a talented and tough detective, which sometimes causes even her partner, Lenny, to forget the multifaceted elements of her personality. She likes fashion and martial arts in equal measure, and she has a family. Gerlacher includes small background elements of Jane’s character to make her more vivid on the page as one half of Skinny Jeans.

“Normally, that wouldn’t be a problem, but someone in administration has said ER billing is off-limits to everyone except for two new girls who work the accounts. We aren’t supposed to touch those ER records.”

Lana’s explanation of the billing records being hidden hints at VP Lou’s financial crimes, invoking Trust and Mistrust in Systems of Care. Doc doesn’t know for certain what Lou’s done yet, but the hidden records indicate something fraudulent is afoot and motivate Doc to keep investigating.

“The men got to work without question, relieved to obey their new leader.”

Like the women who work as dancers, the men who work at the U for Dyyavola lack agency and safety in their everyday lives. Few want to step up and lead, as the leaders either die or are murdered by Dyyavola. They work to survive, and obedience is the key to that survival.

“It all came down to Doc. If he couldn’t stop Dyyavola, she was going to end up like Jenny. She had run out of tears by the time she made it back to her apartment.”

Linda places all her faith in Doc, as she views him as the only solution to her and the other women’s problems. She assumes all the women at the club will end up dead because of Dyyavola, so unless Doc can kill him, she’ll leave in a “body bag,” too.

“You’ve been watching too many movies. We paid in Bitcoin, anonymous, instantaneous, and untraceable Bitcoin. Within fifteen minutes of payment, they erased the virus completely from our system, like the whole thing never happened.”

Giovanni explains how the Bitcoin blackmail scheme works technologically. Though Dyyavola utilizes simplistic language and violence to accomplish his goals, he is more technologically adept than he seems, or he at least hires someone who is.

“Time evaporated like steam in summer heat, and the door to the outside was chained shut.”

Doc uses evocative language to describe the slippage of time as he tries to find somewhere to hide from Dyyavola’s men, creating a vivid image on the page. The chained shut door is also an image that clearly evokes confinement, as Doc is trapped in the U with little time to hide.

“Turns out, if you are kidnapped, beaten, kill an international extortionist, desecrate his corpse and steal his money, everyone seems to have questions, but in the end, no charges were filed against me.”

Doc escapes any criminal charges for his actions during his personal investigation into Jenny’s death, illustrating that although he pushed the envelope of his moral boundaries, his pushing the boundaries of the law will not result in consequences. His friendships with Skinny Jeans and Tom help, illustrating the importance of forging bonds within a community.

“‘Good to know, but I’m always on patrol. Never know when the next crazy ends up on this street. You sleep tight, and I will keep watch.’ And I knew he would. I walked into my house feeling safe for the first time in a week.”

Carl’s promise to keep patrol of the neighborhood demonstrates two different expressions of vulnerability. Carl still feels vulnerable, even after leaving the battlefields of war behind, so he cannot stop patrolling, reflecting Heroism and Vulnerability in Frontline Professions. Doc feels vulnerable even after Dyyavola’s death, as the trauma lingers, but he manages to feel safe knowing that Carl is watching over the street.

“Most criminals are caught when they spend their money in a flashy way. They buy mansions or expensive cars and attract attention. People talk, and eventually, law enforcement looks into it. This guy never really spent his money. It sat there and kept growing in value. Even his own guys probably had no idea how much money he had. They would have killed him for it if they knew.”

Lenny explains how Dyyavola became a billionaire through Bitcoin without ever being found out for his crimes. Dyyavola hoarded his wealth for years, keeping it a secret like he keeps even his own identity a secret. His empire was built upon secrecy, and once Doc uncovers the truth, it topples.

“Good. Now go check in with Deb. There’s some intern rotating through this month who thinks he knows everything, but he’s dumber than that chair over there. The only question is whether I kill him before he kills a patient. Talk some sense into him.”

As soon as Doc promises Jean he’s okay after his run-in with Dyyavola, Jean returns to business as usual, telling Doc to help with a challenging medical student. The normalcy of the ER resumes, even after Doc’s trauma.

“Overjoyed at sharing their tears of joy, thank yous, and hugs, I savored the moment. Eventually, Little D and Gladys went to finish their shifts; money does not change good people.”

In his lecture to his medical students, Doc explains that money is neither good nor bad, but a source of power. When Doc gives Money to Little D and Gladys to thank them for their help in the case, they remain good people, demonstrating the goodness of their character and Doc’s strong ability to judge good people. Such statements also reflect the way the novel creates one-dimensional heroes and villains, reflecting a trope of the thriller genre.

“In the last few weeks, I have had an opportunity to meet many of her friends who were also going through difficult times with her. Every one of them stressed how Jenny was their rock, their foundation, that provided stability in a difficult situation. When many of them had lost hope, it was Jenny who gave them purpose again. When times were toughest, Jenny was strongest.”

Doc gives a eulogy at Jenny’s funeral, highlighting the good qualities in Jenny that her friends and fellow dancers described. Doc highlights Jenny’s strength, which is an integral part of her character. Despite the risks, she attempted to free herself from Dyyavola, a feat that required immense mental fortitude.

“He successfully begged for food from everyone, chewed on the furniture, and peed on the floor. Someone noted that if he was sober enough to pee on the floor, he was ready for discharge over the sound of laughter.”

The final chapter of Last Patient of the Night takes a notably lighter tone after Jenny’s funeral ends. Doc’s going-away party features pizza, friendly ribbing amongst his coworkers and friends, and even Tom’s new K-9 puppy peeing on the floor and chewing on things. Despite the high-stakes plot of the novel, Gerlacher ends with a typical happy ending scene.