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Despite reading the trigger warnings (very kindly) included in the book and being very uncomfortable with the first few chapters, I decided to finish this book because I really wanted to know what happened. Unfortunately, the unending medical gore made me so viscerally uncomfortable that I had to keep pausing because I was having physical reactions to it. I can't do gross-surgery-goes-wrong stuff, and our main character is always thinking about or performing it. I can read so many horrible things in books, but this one type of thing is the only one to physically upset me. Because of this, I won't be rating the book. If you're like me, I'd avoid this book. If that's something you can take, I do recommend this!
Now my otherwise thoughts on the book. I really enjoyed Silas as a main character. He was well characterized and I deeply wanted everything to be okay with him. The author is also trans and autistic, so those aspects are Own Voices. While it's great to be reading about trans, queer, and autistic characters in a historical setting, this is a more realistic book that depicts the horrible ways such people were treated in the past (and in some places, today). There is deep tragedy in the way that these children are treated and experimented on. I also appreciated that the author acknowledged the history of Black people particularly having horrifying medical experiments done on them. In terms of this being a speculative fiction book, I thought the magic and spirit stuff left some to be desired. I wanted to know more about how this world was affected by spirits being a part of life. I wasn't 100% on the relationship because they don't know each other well and have basically one thing in common, but for the sake of a HEA, I'll take it. I also am unsure that this should be categorized as YA; yes, it follows teen characters, but the content is so very adult.
Overall, I should have DNFed because of the medical gore, but otherwise I think it's a high quality book.
Graphic: Adult/minor relationship, Animal death, Body horror, Child abuse, Child death, Confinement, Deadnaming, Death, Emotional abuse, Gore, Hate crime, Homophobia, Miscarriage, Misogyny, Pedophilia, Physical abuse, Rape, Sexism, Sexual violence, Torture, Transphobia, Forced institutionalization, Blood, Medical content, Medical trauma, Murder, Pregnancy, Lesbophobia, Outing, Sexual harassment, Dysphoria
Graphic: Ableism, Deadnaming, Misogyny, Sexual violence, Transphobia, Violence, Forced institutionalization, Blood, Medical content, Abortion
Moderate: Adult/minor relationship, Miscarriage, Rape, Suicidal thoughts, Death of parent, Pregnancy, Dysphoria
Minor: Self harm, Cannibalism, Suicide attempt
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cover artist: niky motekallem
Graphic: Transphobia, Violence, Medical trauma