I knew from the premise that this would be dark, but there was a point where I was like "woah this just got extra f**ked up" and I had to put the book down for a bit. 

Overall, a very interesting and suspenseful story. It's fairly slow paced for the most part aside from some especially dramatic moments, but during the calmer parts of the story there are always looming threats and the sense that trouble is closing in on the main character. I still have some lingering questions now that the book is over. I did like the romance and the found family elements of the story, they were fairly uncomplicated considering everything else going on. I also enjoyed the the historical scientific elements, but this is not a story for the squeamish.

The audiobook narrator was excellent, I'd definitely like to listen to more of their work. 

Bit of a personal criticism, but I did feel a strong lack of women in this story. Up until around 25% into the book there is only a passing reference to the main character's mother and sister, otherwise the world is entirely inhabited by men. I understand that women were not allowed in the medical profession, but surely they did exist in Scotland. The first named woman that does show up is of course flawlessly gorgeous and saintly, which irritated me a bit. The sister mentioned in passing earlier also comes back for two scenes to be generally homophobic and snobby. Again, I understand that this was probably a side effect of the historical setting, but I did feel the absence.