This is a literary novel with science fictional, fantastical, and horrific elements. It’s a novel with overt religious themes that’s filled with black humor, curse words, sexual situations, bleakness, and just a sprinkle of hope. It is dark and funny. The writing is top notch. Some characters are chillingly true-to-life while others are wonderfully over-the-top. The author creates a true microcosm of the world in his children’s hospital afloat on God’s second great flood. He’s smashed a little bit of everything inside and let everything loose to wreak havoc. Is it a bit much? A bit overlong? Perhaps. But the more I think on it, I can’t think of anything that I’d cut. I liked every scene, and especially those featuring Jemma’s big brother, the young psychopath who wants to be undone. This character is so well drawn that his chapters alone are worth the read. Folks seem to be evenly divided on this work. I’m on the side that thinks this is one hell of a literary accomplishment.