On the Ravine
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- Create Date：2023-03-01 10:51:43
- Update Date：2025-09-07
- Status：finish
- Author：Vincent Lam
- ISBN：0735277710
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Summary
From the bestselling， Giller Prize-winning author of Bloodletting & Miraculous Cures comes an exquisitely crafted novel， piercing in its urgency and breathtaking in its intimacy， about the devastating experience of addiction。
In his downtown Toronto condo， Dr。 Chen awakens to the sound of streetcars below， but it is not the early morning traffic that keeps him from sleep。 News banners run across his phone: Fentanyl Crisis; Toxic Drug Supply; Record Number of Deaths。 From behind the headlines， on the same screen， glow the faces of his patients， the faces of the what-ifs: What if he had done more， or less; or something different？ Would they still be alive？
Claire is a violinist; she feels at one with her music， taking flight in its melody， free in its movement。 But now she rises and falls with the opioids in her system， becoming increasingly reckless。 After two overdoses in twenty-four hours， she sits in the blue light of her computer， searching a notice board for recommendations: my doctor saved my life; my doctor is just another dealer。 And then another message catches her attention， about Chen's clinic: be a guinea pig--why not get paid to take it？
When Claire's life intersects with Chen's， the doctor is drawn ever more deeply into the complexities of the doctor-patient relationship， the implication and meaning of his intention to treat。 Chen must confront just how far he would go to save a life。
Combining the depth of his experience as a physician with the brilliance of his literary talent， Vincent Lam creates a world electric in its precision， radiant in its detail。 On the Ravine is a gripping novel of profound emotional force， a soaring achievement from a singular voice in Canadian fiction。
In his downtown Toronto condo， Dr。 Chen awakens to the sound of streetcars below， but it is not the early morning traffic that keeps him from sleep。 News banners run across his phone: Fentanyl Crisis; Toxic Drug Supply; Record Number of Deaths。 From behind the headlines， on the same screen， glow the faces of his patients， the faces of the what-ifs: What if he had done more， or less; or something different？ Would they still be alive？
Claire is a violinist; she feels at one with her music， taking flight in its melody， free in its movement。 But now she rises and falls with the opioids in her system， becoming increasingly reckless。 After two overdoses in twenty-four hours， she sits in the blue light of her computer， searching a notice board for recommendations: my doctor saved my life; my doctor is just another dealer。 And then another message catches her attention， about Chen's clinic: be a guinea pig--why not get paid to take it？
When Claire's life intersects with Chen's， the doctor is drawn ever more deeply into the complexities of the doctor-patient relationship， the implication and meaning of his intention to treat。 Chen must confront just how far he would go to save a life。
Combining the depth of his experience as a physician with the brilliance of his literary talent， Vincent Lam creates a world electric in its precision， radiant in its detail。 On the Ravine is a gripping novel of profound emotional force， a soaring achievement from a singular voice in Canadian fiction。
Reviews
Carol
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AVAILABLE NOW！This story takes place in Toronto Canada where Dr。 Chen runs a clinic called The Swan。 His patients are drug addicts and Dr。 Chen prescribes methadone or buprenorphine to handle withdrawal symptoms。 He is also a consulting doctor for drug trials。 Claire is a violinist who got addicted to opiates after suffering a shoulder injury and eventually graduated to injecting heroin and fentanyl。 In the hopes of getting a handle on her addiction she attends Dr。 Chen's clinic。 There's also an AVAILABLE NOW！This story takes place in Toronto Canada where Dr。 Chen runs a clinic called The Swan。 His patients are drug addicts and Dr。 Chen prescribes methadone or buprenorphine to handle withdrawal symptoms。 He is also a consulting doctor for drug trials。 Claire is a violinist who got addicted to opiates after suffering a shoulder injury and eventually graduated to injecting heroin and fentanyl。 In the hopes of getting a handle on her addiction she attends Dr。 Chen's clinic。 There's also another storyline running which involves Dr。 Chen's colleague Dr。 Fitzgerald who has his own addiction to alcohol and can no longer practise medicine。 He seems to be running a safe injection site out of his large crumbling home on the ravine。 I guess it's necessary to read Dr。 Lam's previous book to get the entire background on these characters。I found myself much more immersed in this novel than I expected; as a matter of fact it had me more enthralled than almost anything else I've read recently。 As I was reading the first 25 pages or so I wondered what I had gotten myself into; the content was a bit dry。 But then we got into Claire's story and I was totally engrossed and had trouble putting it down。 The events are related by Dr。 Chen and Claire separately， interspersed with letters written by Dr。 Chen "to a student of medicine" who is never really identified but through these lettters we eventually learn her connection to the doctor。 This book is definitely timely what with the opioid crisis pretty much everywhere。 I don't have first-hand， or even second-hand， experience with drug users but the characters and stories seem very authentic and I'd assume Dr。 Lam is drawing on his professional experience。 Incredibly well written and heartbreaking。 The ending leaves you hanging but I think it's appropriate in this case; kind of hope for the best but suspect the worst。Trigger Warning: This story deals with intravenous drug use with graphic descriptions of the process and the consequences。 It might be difficult to read if you're squeamish or in recovery。This was an ARC and there wasn't a lot of formatting， not even chapter breaks， so I did get slightly confused at times。 Hopefully the published version will be a bit easier to follow。My wholehearted thanks to Penguin Random House Canada via Netgalley for the opportunity to read an advance copy of this excellent novel。 All opinions expressed are my own。Publication Date: February 28， 2023 。。。more
Crystal Rees
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A very raw look at the drug crisis that Toronto and Canada faces。 I loved that I could identify every location in the background but I also hated that I could so completely relate to the people in those places。 I see it every day and the story telling was very real and made me think of those people I see。 It makes me connect with the fact that this is a human problem and more help absolutely needs to be done。Thank you Netgalley for this arc
Susan Coulter
，
Thank you to NetGalley and Penguin Random House Canada for providing a copy of this book in exchange for an honest review。 On the Ravine by Vincent Lam follows Doctor Chen with appearances from Fitzgerald who readers may remember from the Giller Prize Winning， Bloodletting & Miraculous Cures。 This book can be difficult at times， but overall paints a compassionate picture of drug addiction and the helpers who work on the front-lines trying to help to spite all of the obstacles that the opioid cri Thank you to NetGalley and Penguin Random House Canada for providing a copy of this book in exchange for an honest review。 On the Ravine by Vincent Lam follows Doctor Chen with appearances from Fitzgerald who readers may remember from the Giller Prize Winning， Bloodletting & Miraculous Cures。 This book can be difficult at times， but overall paints a compassionate picture of drug addiction and the helpers who work on the front-lines trying to help to spite all of the obstacles that the opioid crisis poses。 The story centres around Dr。 Chen and his patient Claire， a gifted violinist， who becomes addicted to opiates through a series of events that sees her drug use and seeking escalate。 She is not the picture most will have of a “junkie” and that is what makes this story all the more compelling and important。 Though constantly trying to ride a precarious line of what she is willing and not willing to do for her next fix， Claire seeks out the help of Dr。 Chen at his Swan Clinic in hopes of a miraculous cure。 Dr。 Chen keeps a photo album on his phone of his lost patients who haunt him， those he last sees in the morgue as they lose their fight with addiction。 Throughout this story， he stays hopeful that Claire will not be added to his gallery。 Fitz has lost his medical licence and continues to “help” addicts at his house that backs onto a ravine in questionable ways to ensure their drug supply is as safe as possible。As Claire finds success with Dr。 Chen’s regimens and struggles with the constant pull of the high， she relapses in spite of her best efforts。 In the background， the drug scene is slowly infiltrated with the introduction of fentanyl and carfentanil resulting in increased deaths。 Chen constantly worries about Claire and goes to extreme lengths to help her blurring patient/doctor boundaries。 Dr。 Chen and Fitz are involved with medical trials paying addicts to participate and are responsible for recruiting patients。 Dr。 Chen questions the new research trials using psychedelics which has promising results， but risks seem to be ignored leading to deadly consequences。 This book is fascinating， informative， and helps provide perspectives of what brings people to addiction and the lengths helpers will go for a successful story。 This book has stayed with me， and has helped put both sides of the story of addiction into perspective。 。。。more
Sylvia Barker
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This is a very thought-provoking and insightful book。 Lam's writing is captivating and the subject matter could not be more timely。 I expect this book will be a Giller contender。Thank you to NetGalley and the publisher for this RAC in exchange for an honest review。 This is a very thought-provoking and insightful book。 Lam's writing is captivating and the subject matter could not be more timely。 I expect this book will be a Giller contender。Thank you to NetGalley and the publisher for this RAC in exchange for an honest review。 。。。more
Yolanda | yolandaannmarie。reads
，
[arc review]Thank you to NetGalley， Penguin Random House Canada， and Knopf Canada for providing an arc in exchange for an honest review。On the Ravine releases February 28， 2023“Even if we make the withdrawal go away， we can’t take away the memory of the high。”This title features two characters from Vincent Lam’s Bloodletting & Miraculous Cures — Chen and Fitzgerald。 These are both standalone novels， and while it’s not necessary to read Bloodletting & Miraculous Cures in order to understand On th [arc review]Thank you to NetGalley， Penguin Random House Canada， and Knopf Canada for providing an arc in exchange for an honest review。On the Ravine releases February 28， 2023“Even if we make the withdrawal go away， we can’t take away the memory of the high。”This title features two characters from Vincent Lam’s Bloodletting & Miraculous Cures — Chen and Fitzgerald。 These are both standalone novels， and while it’s not necessary to read Bloodletting & Miraculous Cures in order to understand On the Ravine， it would provide more character background。CW: opioid addiction， racial slursThis entire novel is heavily centered around opioids， addiction， addiction clinics， and drug trials。 There are many descriptive in-depth scenes about drug use， including needle injections， pill use， highs， withdrawal symptoms， and overdoses。 Please keep this in mind to gauge whether or not you’re in the proper headspace to handle content surrounding these topics。The two main characters here are Claire and Chen， with some sparse input from Fitzgerald （but he mainly takes a backseat here）。Claire is a violinist who has a serious opioid addiction that originally stemmed from an injury。 Chen often frequents the restaurant that Claire plays at， and eventually progresses to being her doctor。 He tries so adamantly to help her with her addiction but there is an endless cycle for seeking a high。There are also letters scattered throughout between Chen and a former student of his， although the student is never named。I’m no stranger to the adverse struggles of addiction， and I’ve seen it first hand for years in the DTES （Vancouver）。 I think Lam definitely used his experience and knowledge in the medical field to his advantage。 However， with that being said， I did find it difficult to focus solely on this book， and often times found myself reaching for my phone or literally anything else。 The narrative was a bit lengthy in the beginning and maybe could have cut down on some repetition。I’m also so confused， because having read Bloodletting & Miraculous Cures， I was expecting to see a mention of Ming （who Chen apparently married）， but there was zero instances of this。 Instead， he was comingling with some woman named Bella？！ It’s like I went from A to C， and B got lost in a blackhole。 。。。more
Linda
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This book will stay with me for a long time。 I live in an area with several safe use houses。 Almost every day I see someone who chose not to use under supervision。 It is sad to watch as they show signs of withdrawl， or perhaps something else as they don't want to use under supervision。This drug epidemic is certainly a human issue， but it is so easy sometimes to forget that these are people who made bad decisions。 Who are addicted and no longer have a choice to make decisions。 Vincent Lam breaks This book will stay with me for a long time。 I live in an area with several safe use houses。 Almost every day I see someone who chose not to use under supervision。 It is sad to watch as they show signs of withdrawl， or perhaps something else as they don't want to use under supervision。This drug epidemic is certainly a human issue， but it is so easy sometimes to forget that these are people who made bad decisions。 Who are addicted and no longer have a choice to make decisions。 Vincent Lam breaks that barrier and forces us to see addicts as the people they were before addiction。 The people they could be without addiction。And that is a powerful message。 。。。more
Chuk
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This was very well done， very engaging with lots of detail about the current toxic drug crisis and a main character working in an addiction clinic and another viewpoint character who is having troubles with her substance abuse disorder。 There's also some suspense in it and a set of interspersed letters to a former student。。。the prose and the shape of the novel are great。 Good local colour for Toronto too。 I thought this one was even better than Bloodletting & Miraculous Cures。 This was very well done， very engaging with lots of detail about the current toxic drug crisis and a main character working in an addiction clinic and another viewpoint character who is having troubles with her substance abuse disorder。 There's also some suspense in it and a set of interspersed letters to a former student。。。the prose and the shape of the novel are great。 Good local colour for Toronto too。 I thought this one was even better than Bloodletting & Miraculous Cures。 。。。more
Sue
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I received an ARC of On the Ravine from NetGalley in return for a fair review。Vincent Lam's collection of stories about a group of medical students in Toronto， Bloodletting & Miraculous Cures was a Giller Prize winning and hugely popular book published in 2005。 I came to know it very well as I taught it in a grade 11 University English course a couple of years after its publication。On the Ravine picks up the story of two of the med students， Fitz and Chen， who have developed a practice in addict I received an ARC of On the Ravine from NetGalley in return for a fair review。Vincent Lam's collection of stories about a group of medical students in Toronto， Bloodletting & Miraculous Cures was a Giller Prize winning and hugely popular book published in 2005。 I came to know it very well as I taught it in a grade 11 University English course a couple of years after its publication。On the Ravine picks up the story of two of the med students， Fitz and Chen， who have developed a practice in addictions， a clinic to help those trying to get off heroin and opioids and a highly respected cooperation with pharmaceutical companies to develop new alternatives to the standard methadone and buprenorphine。 Chen works tirelessly to help all his patients， sometimes finding himself in situations that challenge his values and medical ethics。 His relationship with a very talented violinist addicted to opioids， first prescribed because of a shoulder injury， is a powerful thread throughout the story。 Fitz's less orthodox attitude to addicts is a foil to Chen's mostly 'by the book' methods and their continued friendship allows the reader to see how fine the lines are within an often hopeless quest to help and protect those with addiction illness。Lam's own professional involvement in the addiction community of Toronto is the authentic voice but the stories are all out in there in the media - the explosion of 'bad' adulterated heroin and cocaine and the rising death toll in opioid addiction。 Notwithstanding Chen's dark world， he is a believable light who is not deterred by the low success rate。 Lam does not create a medical saint in Chen but a caring， likeable physician whose life is governed by his Hippocratic oath to do "Do No Harm"， a strong sense of ethics and a desire to do better。 。。。more
Eva
，
I was so excited to read On the Ravine by Dr。 Vincent Lam after loving Bloodletting and Miraculous Cures many years ago。 I just finished it last night and am still in the process of formulating my thoughts so they may change a bit。 My early thoughts are that this was a very good book about a very difficult topic。In this story， which features two characters from his previous book （but it is not necessary to have read the other one to enjoy this one）， we are given a very deep look at drug addictio I was so excited to read On the Ravine by Dr。 Vincent Lam after loving Bloodletting and Miraculous Cures many years ago。 I just finished it last night and am still in the process of formulating my thoughts so they may change a bit。 My early thoughts are that this was a very good book about a very difficult topic。In this story， which features two characters from his previous book （but it is not necessary to have read the other one to enjoy this one）， we are given a very deep look at drug addiction。 Dr。 Chen runs a clinic called The Swan where he sees patients each day who are dealing with drug addiction。 In addition to putting patients on methadone or Buprenorphine to settle their withdrawal symptoms， he is also a consulting doctor for drug trials。 In comes Claire， an aspiring professional violinist。 Claire has been using Oxycodone and heroin as an IV drug user and needs assistance in coming off the drugs。 This is the beginning of a precarious doctor/patient relationship。 Addiction is a beast that many cannot reckon with。 The chemical dependency and increasing tolerance usually results in the person using more drugs， more dangerously and experiencing withdrawal more and more quickly。 Harm reduction is the current method used to stabilize patients but doesn’t offer freedom。 The role of the doctor in determining just how much of an opioid will have the patient become a functioning person is a difficult balance and it is tested by addicts who will manipulate and lie to obtain their high。 Please don’t take this as me judging addicts， this is not so simply the result of a chemical that has taken over the addict’s life。 In the story， Claire fights this battle and tells Dr。 Chen that what she wants most is to be able to play her violin and become the music。 She wants to reach beyond the formulaic playing of her violin and become immersed in the music。 In addition to desperately wanting relief from her addiction， she has a sister who comes to stay with her who is also an addict。 As someone who has worked as a youth worker with street addicted youth， we often say “people， places， and things” need to change in order for success。 When Dr。 Chen contacts Claire after she has had two overdoses and tells her that he believes she may be suitable for a new drug trial， Claire jumps in with both feet。 Lam has written a story that one must finish to appreciate。 The beginning third of the book takes its time in setting up what a drug trial looks like， the decline in an addict-especially with fentanyl out there， and the push and pull of a doctor who works in the field。 I am concerned some will find this part of the book a little dry and not continue but I urge you to trust the process。 Dr。 Chen is an interesting character on his own with his big heart and wanting to do the best for his patients。 He is a hero character with faults and hindsight。 Big pharma and the interests of the players in the field was a little less dramatic and at times a bit lengthy but played a role in the crux of the story。Thinking about the audience for this book has been with me during the night。 This book could be highly triggering for anyone in recovery， or an active user。 The processes and terms are very detailed and even the descriptions of dealers， users， drugs， places， and equipment has the potential to activate an addict’s brain to want to use。 For those that are interested in the field of addiction or who can manage difficult stories， then I would feel comfortable in recommending this book。 With more and more deadly drugs on the street， this could also be a call to action。 I live in Vancouver， Canada and we are currently experiencing overdoses at alarming rates。 One of the pushes is to legalize drugs and offer a safe supply。 Recent legislation passed has allowed small amounts of drugs to be carried without penalty but that doesn’t stop those drugs from being laced with fentanyl or carfentanil。 Safe injection sites are available and drug testing kits and more people are being trained on how to use Nalaxone kits。 I would be interested in revisiting this book in ten years and seeing how it fits into reality then。Thank you to @netgalley and @penguinrandomca for an ARC of On the Ravine。 It publishes February 28， 2023。 。。。more
Terri （BooklyMatters）
，
A compassionate accounting of a complex and seemingly unsolvable problem， this book takes a fictionalized look at a real-life physician’s perspective of drug addiction， focusing on fentanyl， heroin and opiates， and the depths of despair such an addiction cannot help but reveal。 As Dr Chen， who runs a Toronto-based addiction clinic and research center， our fictional third person POV narrator， tries to do his very best for his patients， he inevitably faces moral dilemmas and must rely on the judic A compassionate accounting of a complex and seemingly unsolvable problem， this book takes a fictionalized look at a real-life physician’s perspective of drug addiction， focusing on fentanyl， heroin and opiates， and the depths of despair such an addiction cannot help but reveal。 As Dr Chen， who runs a Toronto-based addiction clinic and research center， our fictional third person POV narrator， tries to do his very best for his patients， he inevitably faces moral dilemmas and must rely on the judiciousness of his experience， as he encounters desperate and manipulative patients， suffering and out-of-control， in situations as bleak as they are heartrending。 Addictions for which， although somewhat alleviated by the tools modern medicine can provide， may be seen as merely transferred through treatment from one drug to another perhaps more manageable alternative。 As Dr Chen becomes ever more intertwined in the particularly heartbreaking world of Claire， a heroin-addicted violinist with talent and a seemingly broad world of opportunity， and Bella， a romantically-charged pharmaceutical rep with a vested interest in involving him in a new addiction-treatment modality， Dr Chen may or may not be in danger of losing some of his professional objectivity。 Hard to read in its unflinching and doubtlessly realistic portrayal of suffering， this is a book that will open your eyes to the depths experienced by those in the grips of this terrible problem， and the incredible strength and sensitivity of those who care for them。A great big thank you to Netgalley， the author， and the publisher for an ARC of this book。 All thoughts presented are my own。 。。。more
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Reference
google book https://www.google.com/search?tbm=bks&q=On the Ravine
hathitrust digital library https://babel.hathitrust.org/cgi/ls?q1=On the Ravine&field1=ocr&a=srchls&ft=ft&lmt=ft
The British Library https://bll01.primo.exlibrisgroup.com/discovery/search?query=any,contains,On the Ravine&tab=LibraryCatalog&search_scope=Not_BL_Suppress&vid=44BL_INST:BLL01&lang=en&offset=0