With his debut novel, doctor Josh Bazell has combined two major tropes of American popular culture – the New Jersey mob and the medical drama – and managed to enrich both of them. Beat the Reaper is a powerful and compelling thriller, with a great narrative voice and some dark, driving prose.

Dr Peter Brown, aka Pietro Brnwa, aka The Bearclaw is on his way to his hospital shift when a would-be mugger discovers that there is more to him than meets the eye – because before he went in to Witness Protection and studied medicine, Peter was a hitter for the Mafia. Inspired initially by the need for revenge over the killers of his grandparents, Peter fell in with the offspring of a Mafia lawayer, a delightful article taking the nickname of Skinflick, and gradually became a reliable freelance killer, though (importantly for maintaining our sympathies, perhaps) only of people who were demonstrably immoral, people who the world was better off without.

When Peter, overworked and sleep deprived in the manner of junior doctors everywhere, comes across one of Skinflick’s Mafia buddies on a hospital ward, the old world and the new collide, and through a series of flashbacks we learn the story of Peter’s dark past, including how he acquired the name Bearclaw, and culminating in his entry in to Witness Protection, and thence to medicine. Back in the present, the fact that the Mafia now know where he is will clearly not end well for Peter – and when mob goons show up, it requires a gruesome combination of his medical knowledge and his facility for violence to save him.

Despite the obligatory disclaimer at the end, Bazell puts his medical knowledge to good use, with some fairly detailed footnotes that utilise his inside knowledge of medicine to great effect. As a narrator, cynical and hard-bitten, Peter is not afraid to teach his readers about the gory details of either of his worlds – medical or Mafia. With a plot that’s fast-paced and violent, and the central irony of a narrator skilled in both taking and saving lives driving it along, Beat the Reaper is a very cool debut indeed. Recommended.

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