Fantastic period medical horror read. Difficult to read at times (including due to transphobia, misogyny, ableism, and and secondhand dread; the author supplies a helpful disclaimer at the beginning), but it is clear this book was written with intentionality, which shines through in the characterization. I loved how the author delved into the difficulties of untangling the edges of one's intersectional identity (Silas navigates being both trans and autistic in a world that severely punishes being either, let some both). The audiobook narrator,  Raphael Corkhill, was excellent.