The Decision

Salerno's dedication tells you exactly where this book's spine comes from — a father lost to Alzheimer's, a mother battling dementia — and that lived grief is the one thing in this opening that never feels manufactured. The lasagna dinner scene is the book's best sustained piece of writing: Nancy's four phone calls, the wine poured for everyone but Joe, the recliner lever pulled "returning his world to its normal position" the instant the diagnosis lands. That image is the strongest sentence in the excerpt, and it earns its place because the surrounding scene has actually built toward it — the reader knows, before Jonathan does, that something is wrong.

The braided structure is ambitious for a debut thriller: a mob boss counting down to a payoff, a biotech CEO racing an IPO against a hidden lawsuit, a general counsel answering to a voice on a burner phone, and a defense attorney whose recurring courtroom nightmare (that unforgettable prologue image of a judge producing a gun from beneath her robes) sits over all of it like a fuse. That prologue is a genuine hook — disorienting, violent, and specifically weird in a way that promises a payoff worth waiting for.

Where the book earns its Theme & Substance nod is in refusing to let the disease be wallpaper. Antsalemab isn't just a MacGuffin drug — it's explicitly the thing that might have saved Joe, and Jonathan's fury ("Stupid son of a bitch!") reads like someone processing real anger at watching a parent refuse help. The stakes of the corporate plot and the stakes of the family plot are the same stakes, dressed differently. That's a smart structural choice, and it's the throughline worth awarding.