Last Patient of the Night

Last Patient of the Night (2023) is a medical thriller by Gary Gerlacher. AJ Docker, known as Doc, works in an ER in Houston. When a patient dies after being viciously tortured by an unknown assailant, Doc works to unravel the mystery of her death with his friend and police officer, Tom Nocal, and his police dog, Banshee. The novel explores The Moral Duties Associated With Medical Work, Trust and Mistrust in Systems of Care, and Heroism and Vulnerability in Frontline Professions.

This guide uses the 2023 Black Rose edition.

Content Warning: The source text and guide feature depictions of substance use, graphic violence/torture, physical abuse, cursing, sexual violence, and death.

Plot Summary

AJ Docker, or “Doc,” is skiing in Wyoming. A man crashes into a tree. Doc performs an emergency tracheotomy to save his life. Doc then returns to Houston, where he works in the ER of Ben Taub Hospital. Vice-President Lou Gallagher visits the ER to complain about the lower ER patient numbers and raises the thermostat to 74 degrees Fahrenheit, which is far too hot. Doc bribes the maintenance worker with NFL tickets to switch the thermostat of the ER and the executive floor of the hospital, so Lou unknowingly makes the executive floor hot while keeping the ER cool.

Police officer Tom Nocal, Doc’s friend, arrives with his K-9 dog Banshee and an injured man he has arrested. Doc then sees a 22-year-old woman named Tracy Palmer for a broken wrist. Doc suspects she’s being physically abused, but she claims she fell. Doc notices a tattoo of a sorceress with a random assortment of letters and numbers on her arm, and Tracy claims the sorceress will grant her freedom and happiness when the spell is unscrambled. Doc discharges her, though he feels unsettled.

As Doc finishes up his shift, a badly beaten woman is dropped off at the ER by a man claiming to be her husband, though the man quickly drives away. She dies shortly afterwards. When Doc looks at her arm, he sees the same tattoo from earlier and realizes it is Tracy. Tracy was clearly tortured, with several of her fingers severed. Doc and the charge nurse, Jean, can’t find any trace of Tracy Palmer in the system, so her name and address are fake. Tom calls Skinny Jeans, the colloquial nickname for two detectives named Jane and Lenny who work on murder cases. Doc tells Tom about the tattoo shop, and the two of them decide to visit the next day to try to find out more about Tracy. Skinny Jeans interviews Doc about Tracy, and he shares all he knows, with the exception of the tattoo shop.

Doc goes home after his shift and finds his nosy neighbor Carl standing outside. Doc barely talks to him before going inside, grieving Tracy. Doc and Tom visit Tracy’s tattoo parlor the next day. The tattoo artist, Anne, tells them that Tracy’s real name was Jen/Jenny. Anne doesn’t know much about Jen/Jenny, other than she’s a dancer at an adult entertainment venue called the U that is run by a notable Ukrainian gang. Tom advises Doc not to tell Skinny Jeans about the U so that they can investigate under the radar.

Doc goes for a late dinner at IHOP and talks with his friends, the chef Little D, and the waitress Gladys. When Doc leaves, a group of knife-wielding teenagers tries to mug Doc and steal his car, but he fights them off and takes their knives. The next day, Doc attends Jenny’s autopsy, and the autopsy tech determines that she died because of torture. Skinny Jeans hasn’t found out who dropped Jenny off at the ER, and Doc doesn’t tell them about the U.

That night, Tom and Doc arm themselves and go to the U. Doc poses as a customer and finds a dancer, who takes him upstairs. The woman introduces herself as Linda, and Doc tells her what happened to Jenny. Linda is horrified; she tells Doc that Jenny’s real name is Jenny Smithton and that she moved to Houston from a smaller town. Like all the women working at the U, Jenny was desperate for money to survive. Linda tells Doc that a mysterious man named Dyyavola is in charge of the club, and the women fear his violent brutality. Doc gives Linda his card in case she needs his help to escape, though she’s too afraid of what Dyyavola would do if she did. After Doc and Tom leave, Dyyavola calls Linda to his office. She’s honest and gives him Doc’s card. He sexually assaults her. Afterwards, Dyyavola tells the bouncer Bohdan to kill Doc.

Doc calls the charge nurse, Jean, and asks her to make an anonymous tip to Skinny Jeans about the intel he got from Linda. Skinny Jeans searches Jenny’s apartment but learns little. They visit the U, but without a warrant, they can’t enter.

Tom drops Banshee off to spend a few days with Doc. As Doc takes the dog for a run, Bohdan and his assistant park a white van on Doc’s street and plan to shoot him. As Doc returns fire and manages to kill one of them, one of them shoots Banshee as he defends Doc. Carl shoots the other man, defending Doc and Banshee. Skinny Jeans arrives at the scene and interviews Doc before he joins Tom at the emergency vet. The vet says Banshee will live because of Doc’s emergency care.

Skinny Jeans gets a warrant for Bohdan’s apartment and the U because Bohdan shot at Doc with an unregistered machine gun. Dyyavola appoints a man named Fedir to replace Bohdan and commands that he hide all incriminating things in the U. Skinny Jeans goes to Bohdan’s apartment first, but they find nothing besides a little cocaine and an illegal gun.

Doc returns home and talks with Carl, who reveals himself to be a former Army E7 Sergeant First Class who received the Congressional Medal of Honor for saving his fellow servicemen after their car was blown up with an IED. Carl asks Doc not to tell anyone, as the memories are traumatic for Carl. Carl also likes people underestimating him, and he is frequently outside his house patrolling the neighborhood.

Skinny Jeans raids the U, but they find nothing significant. Fedir is unhelpful, and the other employees are too scared to talk. Afterwards, Dyyavola tells Fedir to have two other men kill Doc in a drive-by shooting. Doc has a meeting with the hospital executives. Lou claims that ER profitability is up, which confuses Doc. He visits a romantic interest, Lana, in billing to ask for ER documentation. Lana promises to try to smuggle them to Doc.

When Doc leaves the hospital, two Ukrainians follow him, leading to a car chase. Doc parks in the police station parking lot, and the police descend upon the following car, shooting the Ukrainian man.

Skinny Jeans interviews Doc, and he tells them the truth about his investigation so far. They tell him to lie low, and Doc decides to stay with Gina, another love interest and respiratory therapist at the hospital. Dyyavola beats Fedir to death and replaces him with Kyrylo, whom Skinny Jeans meets when they search the U again. This time, Jane finds a hidden financial document detailing an account with over $300,000. Tom and Doc talk to Linda again, and she tells them that Jenny sometimes went on outside missions for Dyyavola, including meeting a man called Giovanni at the Four Seasons hotel. Doc meets Giovanni, who says he used Jenny as an escort, but she hacked his laptop and installed a virus that blackmailed his entire company for two million dollars, lest the virus release all of the company’s private information. The company paid in Bitcoin.

Meanwhile, a financial crimes officer meets with Skinny Jeans to inform them that the newly discovered account is linked to a Bitcoin account worth over 1.2 billion dollars. Doc meets with Skinny Jeans and tells them about Giovanni’s blackmail, and they tell him about the Bitcoin account, but they warn him to stop investigating. Skinny Jeans keeps the U under surveillance. Doc and Tom visit the surveillance team, and Doc sees a faint light coming from the warehouse next door to the U. VP Lou asks Doc why he’s asking about ER billing numbers, but Doc lies his way out.

Later, Doc visits the U and tries to break into the adjoining warehouse. He sees Dyyavola emerge from a secret tunnel connecting the U and the warehouse before going to his upstairs office in the warehouse. More men come through the tunnel, and Doc mimics their movements to open the tunnel. He makes it through to the U, but the men discover the tunnel open behind him. Doc hides in the U while they search for him, but when he later sneaks out to his car, the Ukrainians find him and bring him to Dyyavola’s office. Doc calls Tom and loudly announces that he’s being taken to the office in the warehouse. Tom calls Skinny Jeans and alerts them.

Dyyavola punches Doc his men tie Doc up. Doc wants to keep Dyyavola talking to buy time for the police to arrive, so he offers to tell Dyyavola everything he’s discovered about his blackmail scheme. Dyyavola is enraged and admits he tortured Jenny to death because she stole half his Bitcoin, worth almost $600 million. He plans to torture Doc and cut off his fingers the same way he did to Jenny, but Doc manages to free himself and kills Dyyavola. Doc then cuts off Dyyavola’s thumb and uses it to access Dyyavola’s secure Bitcoin account, transferring the remaining funds to himself. Tom, Skinny Jeans, and the SWAT team arrive, along with two special agents from the FBI. Doc sends the Bitcoin to the FBI.

Doc continues to investigate the ER, and Lana smuggles him the billing documentation: Someone has been fraudulently adding fictional procedures onto patients’ bills. He asks the BT to send him Lou’s financial records.

Later, Doc realizes that Jenny’s tattoo was the password to her Bitcoin account after talking with Gladys and Little D. He accesses it and transfers the money to himself. He gives it back to the FBI in return for a favor. Doc visits VP Lou on his boat and tells him that he knows that Lou is inventing fake medical procedures to inflate profits. Lou says that he put some of the money in an account in Doc’s name, implicating him. Doc’s wearing a wire, so the FBI boards the boat and arrests Lou.

Doc receives over $80 million as a reward for recovering the Bitcoin blackmail money. He gives some of it to Little D, Gladys, and Tom. He also creates a foundation to support endangered women, which he names after Jenny and announces at her funeral. Doc keeps $40 million and plans to leave Houston. Tom gets a new K-9 puppy to train, giving Banshee to Doc. Doc plans to move to Montana with Banshee and start over.