** spoiler alert ** 
 I enjoyed the book, though thought it dragged a bit and there was little surprise in how the story unfolded. Not every story has to keep me on the edge of my seat, but if what happens is going to be fairly obvious, the story could at least move along faster! This one seemed to be both slow and predictable. That said, the topic and the dilemmas faced by the characters were interesting enough to keep me engaged. 
 The story focuses on choices and rules, and on not only understanding those of other people but also one's own. What is right and wrong, and what conditions may cause a person to change his/her mind? How can we judge others when we all make compromises along the way in life? How can we help others - how can we be useful? 
 I found Dr. Larch very compelling - he saw a certain hard reality and didn't sugar-coat it; instead he responded. He did things that he wasn't necessarily happy about, but that were needed. He understood the nuance of people's lives and their opportunities and their options, which were often minimal. He didn't judge the women who came to him He did sometimes judge those who had more options and had greater power in certain situations. I admired the fact that he made an effort to focus on the important things and not get too caught up in the nonsense - at least until toward the end of his life, when crankiness became more prominent! 
 The rules part was interesting as well, as most of the characters had their own sets of rules, in addition to some of the more general/common ones. These rules informed the choices, so it was important to see what people were thinking and which elements/rules were given priority. 
 I give the book a 4/5.