It's been a long time—maybe even as far back as the rat-a-tat release of Chuck Palahniuk's first three novels—since I've found a book this compulsively readable. And it's been exactly as long since I've read a book this actively disgusting. Beat the Reaper is narrated by a mafia hit man named Pietro "Bearclaw" Brnwa who, after a messy court case and with the assistance of the witness protection program, becomes a medical intern named Peter Brown. Of course, an old employer recognizes Brown from his old life, and half of the book is spent flashing back to his hit-man days.

Brown has got a head full of the weird facts that materialize when you shove a new intern into the cynical messiness of a hospital—"Most bottled water in hospitals has 5 percent dextrose. This is to prevent the phrase 'Liter of plain fucking water: $35' from appearing on your bill"—and those tossed-off asides about the realities of hospital work keep the generic thriller plot pushing ahead with a vibrant wiseass's energy. There are set pieces galore (a climactic confrontation in an aquarium's shark tank is at once implausible and compelling), and Bazell writes action competently and clearly.

The climactic battle is one of the grossest literary scenes I've ever read—it's difficult trying to read and squinch your eyes in disgust at the same time—but all that nauseating gore would be meaningless without appealing characters. The scene-setting factoids distinguish Beat the Reaper from the dozens of testosterone-ridden gun-battle thrillers released every month; Brown's exasperated rant about how every surgeon in the world listens to U2 in the operating room endears the reader to him more than any fistfight ever could. (It rings true, too; Bazell just completed an internship at a hospital in San Francisco before Beat the Reaper was published.)

You can't help but wonder where Bazell will go from here; during a recent trip to Seattle, he confirmed that a second thriller starring Brown is on the way. I hope Bazell doesn't fall into the same trap Palahniuk did, of trying to become the literary gross-out king. Beat the Reaper could be the debut of a great thriller writer if Bazell studies the work of Jim Thompson and learns that the thing that keeps readers coming back isn't becoming more outlandish with every new book. It's about making sure that every knife and bullet cuts into the flesh of a human being so well sketched that the reader winces with sympathy.