A Particularly Nasty Case

by Adam Kay

Genres: Amateur Sleuth; Medical Thrillers; Mystery

Synopsis

A chaotic young doctor might be the only one who can catch a killer seemingly targeting hospital officials—if his investigation doesn’t cost him his career first—in this deathly funny and brilliantly original debut mystery from Adam Kay, former doctor and BAFTA-winning author of the international bestseller and AMC+ hit show This is Going to Hurt.

When his toxic medical director dies of a heart attack, fellow doctor Eitan Rose smells foul play. Nobody else does, though, including some quite crucial players like the police and the medical examiner. So when another senior doctor dies, Eitan vows to uncover the truth himself.

But having recently returned to work after time off for his mental health, Eitan's personal file is far from spotless. Despite his budding relationship with Cole, a handsome hospital porter, and reluctant comradery with his office mate, Margaret-with-the-cats, Eitan is quickly in over his head. And as his investigation spirals into pandemonium, his colleagues begin to question his judgement. Could a killer really be roaming the halls? Or is Eitan making a catastrophic mistake?

This clever and fiendishly funny debut is filled with unforgettable wit, lovable characters, and plenty of twists—alongside texts, transcripts, medical reports, and all the evidence you’ll need to help solve this particularly nasty case.

Release date: September 2, 2025

Publisher: Little, Brown and Company

Print pages: 288

Sample

This wasn’t Cheers. Eitan wasn’t looking for the kind of bar where everybody knows your name. He wanted the sort of anonymity you’d normally only achieve by soldering off your fingerprints and buying a Bolivian passport on the dark web. Shelf was one of South London’s most airless caves—the walls bled sweat, the floor was sticky for what could have been any number of unsavory reasons and the thudding tech house synchronized with the pounding in his temples.

Eitan felt profoundly overdressed from the moment he stumbled in. He was, for example, the only person who seemed to be wearing a T-shirt. He tugged and fussed at it, suddenly conscious of how it clung to his body—a creaking oak tree in a field of daisies. He had university degrees older than most of the boys in here. Nobody looked like they’d manage to spell their own name, let alone know anyone else’s.

Eitan pummeled his way through the shoal of human protein shakes to reach the bar. “Double whisky, thanks. On the rocks.”

“Sorry, we don’t have ice,” said the fetus behind the counter. “Or whisky. I can do a vodka and tonic?”

“Sure.”

Eitan necked his tepid vodka tonic, a browning sliver of lemon floating on top like a corpse in a swimming pool. It was hard to gauge the boundaries of personal space in what was essentially a crowd crush with a PA system, but he became increasingly aware of someone standing closer than social norms dictated. He was either about to be pickpocketed, assaulted or engaged in conversation and couldn’t quite decide which he’d rather. The man edged gradually in front of him, as if he was on casters. The deep furrows in his forehead said mid-fifties but, judging by his backward baseball cap, his mouth presumably liked to say he was in his late thirties.

“Yo,” said the man.

“Yo,” replied Eitan, unsure what the correct response was, having never spent any quality time with Flavor Flav.

“I’m Chester.” American, which presumably explained the “yo.” And the Chester. Why were Americans so fond of naming their offspring after miserable English towns?

“I’m heading to Purgatory if you fancy it? Might be more our scene?”

Purgatory? Who named these clubs? Also, our scene? Eitan was vaguely offended at being lumped into the same category of the drop-down menu as this star-spangled simpleton. But not too offended to say no. The longer the night lasted and the more he anesthetized himself, the further away the next day would be. Besides, the crowd seemed to be getting younger and twinkier with every thump of the awful music, and the bar probably wasn’t about to recruit an award-winning mixologist.

Chester talked animatedly the entire way, listing London’s various failings, from its overcrowding and treacherous pollution to its lack of air-con and poor portion sizes. When he’d left Shelf, Eitan hadn’t felt any particular allegiance to his city, but by the end of this roast he had the loyalty of a beefeater. That said, he couldn’t be bothered with an argument, so he just nodded along like a dashboard dog.

As they rounded a corner, Chester dug a key into a small bag of something gray and powdery and held it up to Eitan’s nose. “A little pick-me-up, guvnor?” he said, in a mock English accent that would have lost Dick Van Dyke the Mary Poppins gig.

Eitan didn’t ask what it contained—ketamine, weed killer or the cremated remains of a beloved Maine coon—but smiled and graciously declined. Then immediately changed his mind and sniffed gratefully. Anything that would help with this mini-break from his thoughts.

“Welcome to Purgatory!” said Chester as they approached a door to what looked more like a bookie’s than a nightclub—a high street unit with the windows blacked out in case the innocent public might be tempted into corruption.

“Are you paying together?” asked a man with a line-beard behind a reception desk. A reception desk? Chester nodded. “Fifty pounds, please.” Fifty pounds? Chester blipped his card and in return Line-beard stamped their hands, handed them a Rymans clipboard to sign and passed over a couple of towels. Oh, shit. This was a bathhouse situation. And not the kind with essential oils and a vitality pool.

“I should go,” said Eitan.

“You could have said that before I’d dropped twenty-five bucks on you,” tutted Chester.

“No refunds,” added Line-beard.

In retrospect, he should have probably taken Fiona up on her offer of an episode of Drag Race and a bowl of carbonara. Although her carbonara always tasted like wallpaper paste was a central ingredient, and she’d have only spent the evening giving him ninth-rate therapy about tomorrow, which… no thanks.

The three of them entered into a brief, wordless staring contest in Purgatory’s waiting room. Oh, for god’s sake. Was he about to find himself in the middle of an orgy out of sheer British awkwardness, like some X-rated Hugh Grant film? Frotting Hill.

“If it’s not your bag we can just get a drink,” said Chester, which felt like a sensible middle ground, and Eitan allowed himself to be led down a set of barely lit, bleach-stinking stairs. He wondered if the overpowering stench of Dettol could possibly be better than whatever it was disguising and decided it probably was.

Unfortunately, the dress code for the bar area also involved changing into an off-off-white towel. He looked back wistfully at the stairs, but there was enough Bacardi in his bloodstream to persuade him through into the locker room. He was glad of the lack of mirrors in this particular changing area—after a lifetime of fitting into medium T-shirts and 32-inch jeans, he’d recently bought his first pair of 34s, with no possible explanation as to what might have caused this. Unless, of course, you counted eating daily takeaways and never exercising. His body negativity was somewhat eased by the fact that the rest of Purgatory’s clientele had the aerodynamic qualities of the trilithons at Stonehenge.

“This way,” said Chester, once they were disrobed and betoweled, leading him down enough twists of wipe-clean corridors to disorientate a Minotaur before hitting a large and dimly lit red-filtered room that was most definitely not a bar. It took quite a lot to shock Eitan, but his internal organs lurched at the mass of six or seven pensionable bodies writhing away in the middle like a rat’s nest, the occasional strobe revealing hints of their complicated tessellations before plunging them back into darkness. He was preparing his excuse—either an early start or a gastrointestinal meltdown—when he saw the red baseball cap disappear into the geriatric several-some. A relief, but somehow also a further insult.

Much as he didn’t particularly want to confront the real world, it was emphatically time to go. Now, which way out? He hadn’t thought to leave a trail of condoms, and Dante’s ninth square of hell had dozens of doors coming off it. He felt detached and trippy as he wandered from door to door, slightly regretting not knowing which chemicals were now meddling with his brain.

Door one: a man in a puppy mask hanging off a hook by his harness. No, but all credit to whoever was responsible for its installation. He moved on. Door two: again, no—a couple of guys going at it like pigeons fighting over a box of KFC bones. How to escape from this adult advent calendar?

Door three: a bloke Eitan half recognized—a former children’s TV presenter maybe?—sitting on a bed, his towel open just enough to be blurred out on Google SafeSearch.

“Like what you see?” asked the man, as Eitan peered inside as if he was checking the hinges on a wardrobe.

“Sorry, no,” stuttered Eitan. “I mean, not ‘no, I don’t like it,’ no, I’m not after —”

With vampire speed, the man shot off the bed and maneuvered Eitan into the room. “I don’t bite.” Exactly what a vampire would say.

“I have to go and… find my friend,” said Eitan, wondering quite how he’d got himself into this situation and hoping to convince Nosferatu that he had reinforcements. “We can be friends,” said the vampire. Elodie had told him decades ago—she’d read it in a magazine called something like Teen Riot or Hormones Weekly—that you should never trust a man who tells you he wants to be friends when you’re in the bedroom. Whether or not this counted as a bedroom, she was definitely on the money today.

Eitan reached backward for a door handle but the vampire snaked his hand around him and unfastened his towel. Eitan was calculating if it would be better to yell for help or kick the guy in the balls, when they were both distracted by a cry of ecstasy from the floor show outside. He wasn’t sure he’d heard anyone of that vintage orgasm before. A kind of strangled yelp—maybe that’s what happens to elderly vocal cords with age, they crinkle up like their back skin. Then it stopped, and the screaming started.

Eitan shoved Dracula away from him and crashed back into the main room. A human bath mat of salt-and-pepper hair was lying arse-up on the lino as the rest of his furry frat club stood naked over him, flapping their invisible wings in terror. Eitan heaved the bloke over—not breathing, no pulse. Shit. That’s zero out of two on the “pretty important” list.

“Do we know his name? Anything about him? Has he taken anything?”

A man old enough to remember the Festival of Britain said, “Viagra?”

Eitan looked down. Stand aside, Columbo. This bloke could do with some of that blood circulating round the rest of his body. “Can someone call a fucking ambulance? And ask if they keep a defibrillator here. Let’s get the lights on, too!”

Eitan was consumed by self-consciousness as the harsh emergency strip-lighting blinked on. He pumped his hands hard down on the man’s rib cage and wondered how many ribs were cracking unheard underneath “Call on Me.” 100–120 beats per minute, suggested the guidelines. It was impossible to do anything but compress along to the beat of Eric Prydz’s earworm—a bit fast he reckoned, but under the circumstances, it would have to do. He suddenly appreciated why CPR was a procedure normally carried out with trousers on as his penis slapped against the man’s mat of chest hair. Still, it’s what he would have wanted.

“Are you a doctor?” asked one of the pensioners.

“I am.”

There were general murmurings of relief, apart from some suspicious walrus who asked, “What kind?”

“A consultant rheumatologist,” said Eitan with a superiority that he hoped would shut down any insurrection, then stopped compressing and moved on to the breaths. Lips locked. One. Two. God knows what this guy had been eating, but he already tasted worse than dead. Probably best not to think about what he’d been eating. Back to compressions. That must have been two or three minutes now—if his brain wasn’t reintroduced to oxygen sometime extremely soon, then this bloke would be horizontal on a permanent basis.

“Any sign of that fucking defibrillator?”

Right on cue, Line-beard ran in carrying the magic briefcase—it looked box-fresh, which was a little surprising. Eitan assumed the combination of age, temperature and pulse-hastening activities in the bathhouse would have probably seen off a fair few hearts. He greeted it like a wartime sweetheart, then turned it on and placed the paddles across the bloke’s cold chest.

“Stand clear, shock advised.” Its clipped public-school tones were clearly intended to sound reassuring, but only served to remind Eitan of his more irritating colleagues. Zap and… nothing. Fuck—there wasn’t a plan B here.

“Stand clear, shock advised.” Zap again and… nothing again. Double fuck—Eitan really didn’t want to appear in a coroner’s court to talk through this particular evening with an audience of learned friends. “Sorry, could you spell ‘felching’ for me?”

He peered at the screen of the defibrillator—this thing was pussyfooting around with 200-joule blasts, barely enough for an electric flyswatter. No wonder the guy was still in the land of the lifeless. Shit. He seemed to vaguely remember from some distant, godforsaken course that these things had a manual override function. Now, where might that be? He wrenched off a flappy panel on the front.

“Are you sure that’s how you use this?” asked the walrus.

Not especially. He stabbed at the menu buttons, not feeling particularly hopeful: he still hadn’t managed to turn off the Spanish subtitles he’d accidentally activated on Netflix two years earlier. There it was! He cranked it up to 360 for a stronger roll of the dice.

“Stand clear, shock advised.” And… bingo. The man spluttered back to life, just in time for a couple of paramedics to run in. One or two onlookers became rather more excited about this scenario than they should have been. Maybe it was the uniforms.

“Fuck’s sake, gents!” Eitan yelled. “There’s a time and a place!” Admittedly, this was the place, although very much not the time.

“You saved his life, you know,” said one of the paramedics, as they scooped the patient up to continue his care in a more traditional environment. Eitan knew. He felt the familiar, mildly messianic rush that no amount of booze or nondescript gray powder had ever managed to replicate, the reason he went to medical school in the first place.

“They said you’re a doctor. What’s your name?”

He wasn’t sure about the medical board’s position on treating a patient in the middle of a bathhouse, under the influence of god-knows-what. “I have to go,” he said, striding off with as much pride as his sweating arse cheeks would allow. “It’s Moran,” he said, trying not to catch their eyes, in case a smile betrayed him. “Douglas Moran.”

“You signed in as Robert?” said Line-beard.

“I thought you said it was Eitan!” cried Chester.

Eitan stumbled up the stairs and out into the night, feeling significantly more sober than he’d ordinarily expect to at 3 a.m. It was definitely time to go home, but he needed a little sit-down first. He lowered his aching body into the perforated metal of a bus-stop bench, leaned backward and sighed at the towers looming above him. “Just one minute,” he whispered to the air, and was asleep within seconds.

Eitan knew it wasn’t possible to wake up dead. Years of expensive and exhausting medical education had seen to that. But this felt pretty close. He lifted his head, which weighed a good hundred pounds more than he remembered. Ideally, a headache like this would be nursed away in an alpine clinic’s sensory deprivation tank rather than… he heaved himself onto his elbows to take in his surroundings: a bus stop with half the cars in London belching their way past.

Still, he’d made his bench and he had to lie on it. And as painful as this hangover was, he had to give alcohol credit where it was due—it always rewarded him with a decent fog of retrograde amnesia. Had he performed sex-club CPR last night or was that a bus-shelter dream? His wrists certainly hurt, and not for the fun reason. He braved a look at his watch, which, given he’d spent the night in a coma in South London, was surprisingly still wrapped round his wrist. Shit—7 a.m. No time to go home. It was really happening, then—his first day back.

“Just you wait,” Mo had said. “When it finally comes around, you’ll be itching to get those gloves back on.” Well, it finally had and he definitely, empirically wasn’t.

His ring hadn’t been stolen either, which was even more of a relief than the watch. That said, the diameter of his little finger had expanded sufficiently since medical school that any potential thief would have had to lop it off with bolt cutters.

He attempted to peel himself out of his seat and his legs buckled beneath him, like Bambi with a career-ending cruciate ligament injury. He steadied himself against the metal frame of the bus shelter, then launched himself onto the number 36, wobbling like he was between carriages on a train before homing in on a quiet corner. Priority seat: somebody may need it more than you, said the sticker on the window, now pressed against his left cheek, but Eitan was pretty sure that nobody on the bus needed this seat more than he did. His throat was flammable, his eyes unfocused and his head felt like it was gestating twins. A woman across the aisle clutched her Mulberry bag a bit tighter and shot him a sharp stare, somewhere between disgust and pity. He hated that feeling of being watched, judged—as if a TV crew in some darkened studio was laughing away.

Eitan was not a stupid person—he had the exam results to prove it, if you ignored his D in German—he just did stupid things. Going out on a catastrophic bender the night before his first day back was clearly a mistake. He could have stopped after he pulled on his Spider-Man T-shirt, which had felt fun and kitsch at the time, but now looked like he’d stolen it from a ten-year-old. He could have bailed after Shelf and still woken up in his own bed, feeling at least half-human. But, as always with him, it was all or nothing. And in retrospect, “nothing” would have been the correct answer.

Mrs. Mulberry gave him a full-body scan, from his mousy mop of hair the color of a forgotten teabag, past his washing-machine-white complexion, down to his ripped jeans, which seemed less like a fashion choice and more like he’d had a fall. She turned away and began typing on her phone. Shit, she didn’t work at the hospital, did she?

He had thought about asking for further time off—to live totally clean, then come back to work refreshed and ready and everything else he currently wasn’t. But he didn’t want to give them any more ammo. Besides, there was no point putting it off. Stay calm—that was the key. In through the mouth, out through the nose. In through the mouth, out through the nose. Hang on, that was the wrong way round—hopefully it hadn’t made him less calm. What would Elodie have said to him about today? She wasn’t one for empty platitudes. No “you’ve got this” or “you’ll smash it.” It would be, “It can’t be any worse than your first day at school when you shat in the pool.” He rubbed the ring on his little finger and smiled.

Stumbling off the bus at Paddington, Eitan shot Mulberry his best attempt at a winning smile, before tucking his head down and speeding up the stone steps and into the new wing at St. Jude’s. Well, “new” like the New Testament is new. He saw the crane-fly silhouette of Ciaran Bourke, a resident he definitely couldn’t face speaking to, lumbering toward the door, so he turned the other way, hoping he could make it to his office without anyone spotting him. Then he remembered why atheists don’t pray, immediately bumping into somebody significantly worse. Douglas Moran. Voldemoran, the students called him. The hospital’s medical director, beach-ball impersonator and part-time puppy strangler. In all likelihood.

“Rose,” he said. “Good to see you back,” the word “good” structurally unsound underneath the weight of his sarcasm. “You look like you need a run through a car wash. Are you sure you’re OK to be here?”

Of course he wasn’t.

“Of course I am, Dr. Moran. I’m excited to be back.”

“So excited you’ve torn a hole in your trousers?” That hideous amphibian smirk. “Everyone’s counting on you. Don’t fuck it up again.”

Eitan sped on, alternately cursing Moran and cursing his own luck for running into him. He liberated a pair of dark blue scrubs from a laundry cart and darted into the patient showers on the liver unit—the best bathroom for a quick freshen-up since the hospital had shuttered the staff showers as part of its commitment to ruining the lives of its employees. The shower had a fairly prostatic flow but a thoughtful fold-down seat, which he slumped onto gratefully. Maybe he should get one installed in his flat? He turned the water up as hot as he could in the vague hope it might scour off a thick layer of skin and memories to reveal a fresh-faced young doctor.

Moran might be a bastard but it didn’t mean he was wrong. Everyone would be counting on him—well, the patients would be. The staff would just be judging him; they all knew what he’d done. He shuffled through the ward, bile threatening the back of his throat at the thought of it all. He chucked yesterday’s clothes in the bin—opting, probably correctly, for the yellow medical waste one. Or maybe Mo was right: today might not be so bad. Apart from the endless meetings. And the crap computers. And the smell. And the Kafkaesque bureaucracy—he’d never read any Kafka, but other people always said it about hospitals, so it presumably made sense. But as long as he was helping people, he had a reason to stick around. He was rather looking forward to sitting in his knackered old chair and spending ten minutes in quiet contemplation. Albeit an enforced ten minutes while his decrepit computer booted up.

He opened the door. Something was up. Well, two main things. His desk had been relegated to the edge of the room. Still covered in the same mountain of paperwork, Twix wrappers and scribbled notes he’d left, but sat in the corner, like a naughty child. Secondly, the lion’s share of the room was taken up by another, bigger desk, occupied by Margaret Corcoran, human cardigan and one of the other consultant rheumatologists. In fact, the only other consultant rheumatologist now that Eleanor Gibney had retrained as a nail technician—earning twice as much, apparently.

Margaret was sobbing gently, the kind of controlled crying you get in the wake of an apocalyptic bawl. About what he could only guess. Actually, he wasn’t even sure that he could. He ran through everything he knew about her: late fifties, from the Scottish Borders—neither quite enough of a reason to burst into tears—sang in a choir, had three cats called… something or other. The cats were clearly a huge part of her life; there were grotesque paintings of them and their predecessors now displayed on all four of his walls. Maybe this was what she did every morning before clinic: sat in her office and cried her eyes out. He could see the appeal.

He was tempted to say, “What the terrible fuck are you doing in my office?” but that’s not the correct form of address for someone who’s actively weeping.

“Eitan! Welcome back!” She began wiping away her tears.

“What’s going on, Margaret?”

“I’m fine, just had a b. . .