An American doctor in London finds peace and happiness with a beautiful plastic surgeon's assistant who has a predilection for gruesome torture; a perfectly dreadful novel, Tessier's fifth. Tom Sutherland, a 28-year-old M.D., has just finished his residency in New Haven and finds himself at a crossroads: should he open up his own practice and settle down, or use some inherited money and see the world? The world wins out, and he heads to London for a six-month stay. Despite much pretentious twaddle about satisfying his ""wanderlust,"" all Sutherland seems to do is get sloshed in pubs, and in one of them he meets Dr. Roger Nordhagen, alcoholic plastic surgeon to the stars who is on a downward slide into a terminal vat of gin. Nordhagen introduces Tom to his mysterious and beautiful assistant, Lina Ravachol, a budding dominatrix who talks like a print ad for a Bob Guccionne film: ""The ultimate fantasy is also the only reality,"" she tells a slavering Sutherland, who, after ""thirty-six hours of almost nonstop sex, drinking, and more sex,"" is feeling like a ""whipped kitten."" Lina's ultimate fantasy is, of course, death, and Tom obliges her by killing a young prostitute hired for the occasion. The two of them begin what is generally described as a downward spiral into madness, joined by Nordhagen, no slouch himself when it comes to the ultimate fantasy game: he has a basement filled with cubicles containing human beings (mainly tramps and street people) whose arms and legs he's cut off--he keeps them going with elaborate life-sustaining equipment and forces them to listen to his insane drunken ravings. While Tom and Lina agree with the doctor in principle, they think the whole operation is, well, uncool, so they off Nordhagen, dump the torsos, and set up a little free-lancing business of their own--when last seen, they are pulling in strangers off the street, drugging them, and performing impromptu lobotomies with wire egg-whisks, before sending them--coals to Newcastle, from Tom's point of view--back into the madding crowd. Wire egg-whisks, indeed. Well, it's the thought that counts.