Not typically a fan of first person narrative, I found this book to be exceptional. There aren't many heads I want to spend that much time inside. Patrick is a major exception. I never tired of walking with him. If you liked "Low Boy", please read this book, too. Other reviewers have criticized the author for not explaining why some of the characters in the novel seem to really like and support Patrick, the narrator, while others turn their backs on him. As a reader, I felt great sympathy for Patrick. I liked him, rooted for him, and wanted to stay with him through his slow but steady descent or devolution. Having just finished reading the book, I still care about him. I feel concerned about him. I assume that is how the characters who met him during the course of events in the book felt, too. At the same time, I can easily imagine why those who knew him best (or at least longest) are no longer able/willing to maintain their connection with him. I'm so glad that Hyland didn't explain these relationship choices. Readers who want to be entertained and prefer having everything spelled out for them should stick with something more formulaic and plot driven. This is not a British mystery or a suspense novel. Those who want to be engaged, who want to participate and bring their own experience/mind to the story will find this book quite rewarding. Perhaps that makes Hyland a writer's writer. I admire Hyland's restraint in not explaining everything. In other words, she trusts her readers to get it and to continue thinking about Patrick and lingering with thoughts of his life after the book ends.