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Fiction Literary

On the Ravine

A Novel

by (author) Vincent Lam

Knopf Canada
Initial publish date
Jun 2024
Literary, Medical, City Life
  • Hardback

    Publish Date
    Feb 2023
    List Price
  • Paperback / softback

    Publish Date
    Jun 2024
    List Price

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NATIONAL BESTSELLER • From the bestselling, Giller Prize-winning author of Bloodletting & Miraculous Cures comes an exquisitely crafted novel, piercing in its urgency and breathtaking in its intimacy.
“One of Canada’s greatest writers. . . . On the Ravine is Vincent Lam’s third and best [book].” —Toronto Star
“[Lam’s] nuanced understanding, insight, and compassion for people caught in the coils of addiction I have long appreciated. As a fellow writer, I can only admire his creative imagination and literary flair.” —Gabor Maté, MD, bestselling author of In the Realm of Hungry Ghosts: Close Encounters with Addiction

Dr. Chen, a downtown Toronto addictions doctor, is on the devastating front line of the opioid crisis. Grappling with ever-more desperate cases that arrive in his waiting room, he walks a tightrope between the human desires of his patients and the scientific doctrines of his profession. Chen is haunted by a photo gallery of patients he has lost to overdose. He asks: What if he had done more, or less? Or something different? Would his patients still be alive?
Claire, a passionate and highly accomplished violinist, suffers two overdoses in twenty-four hours, leading her to Chen's clinic. She is convinced that her most beautiful music is played when she is high on opioids, but has realized that her survival depends upon being sober. Their worlds collide, drawing Chen deeper into the intricate web of the doctor-patient relationship: the implications and consequences of his intention to treat. Chen must decide just how far he would go to save a life. Can he find choices that make a difference, and can he help his patients to do the same?
Combining the depth of his experience as a physician with the brilliance of his literary talent, Vincent Lam creates a world electric in its precision, radiant in its detail. On the Ravine is a gripping novel of profound emotional force, a soaring achievement from a singular voice in Canadian fiction.

About the author

Born in London, Ontario, Vincent Lam is an emergency physician who also works in international air evacuation and on expeditions. His non-fiction has been widely published in Canada. He and his wife live in Toronto.

Vincent Lam's profile page


  • Long-listed, Toronto Book Award

Editorial Reviews

Longlisted for the 2023 Toronto Book Award

“A small miracle. . . . With sharp precision . . . [On the Ravine] offers a compelling narrative on the purgatory of addiction. . . . Lam recreates the entire roller coaster in intimate detail, and leaves his reader shivering.” —Ian Brown, The Globe and Mail
"The best writers are born this way. It comes from the brain and the body; we’ll never understand this level of talent; it can’t be taught.” —Heather Mallick, The Toronto Star

“[On the Ravine is] a thought-provoking, wise, and compassionate novel on a subject of philosophical, as well as medical, import.” —The Sydney Morning Herald
Praise for Vincent Lam:

"Emotionally complex and layered, with a preternaturally surefooted negotiation of the human mind and heart, Lam's insanely gripping book is also illuminated by shafts of radiant, beautiful prose. Like all great fiction, it is both the absolute truth and a vehicle for taking us to a place we've never been before. Read it." TIME on Bloodletting & Miraculous Cures

"It's that street-level view of a story we're more accustomed to viewing in panorama that ultimately makes Lam's novel so effective and affecting. In stages so subtle they're scarcely noticeable until he's got you fully in his grip, Lam combines elements of historical fiction, political thriller and domestic drama to present one of the twentieth century's defining stories in a whole new way." Montreal Gazette on The Headmaster's Wager