This book is set in Romania following World War II. Spanning over fifty years, the novel begins with a young couple, and follows their life. Prior to the war, Kostea and Clara met and fell in love. Both doctor’s, they are limited under the confines of communism. While Kostea focuses on his career, Clara raises their son while working in a lab.

I found this novel to be well written and engaging. The characters were lively and well developed. The plot moved along nicely and did not seem to brush over and skip time. Set in Romania, I enjoyed reading about their way of life, culture, and struggles under communism. Overall, 4 out of 5 stars.

The Last Patient by Tudor Alexander. Kostea and Clara are the wrong side of the iron curtain and this is a long story about their long life and how long communism went on for. I liked all the people in the book and it did feel like they were normal people doing normal things but it was so long. I felt like I aged about 50 years reading it. Obviously it’s not full of sunshine and rainbows for a lot of it.

In The Last Patient, we follow the Bardu family from 1950 to 1975 with flashbacks to 1935 and WWII, wrapping up in the 1990s. Kostea and Clara meet in Kishinev and go to medical school in Bucharest. Their studies are interrupted by WWII, but after the war they continue their lives together and marry. The communist government takes over, and the Romanian king is exiled.

It is 1950, and they are living in Kostea’s small Bucharest apartment. A knock on the door, and they are told another family will be sharing their space. Clara is ready to give birth to their only child, Toddy, and the Ionescu family of three and their cat move in the next day – add in Clara’s mother, who has also moved in to watch Toddy while Clara works. Kostea becomes more prominent in his medical research, writing papers and presenting them at conferences. He is gradually given more travel privileges outside Romania as he proves he will not defect – his family left behind guarantees his return. Eventually Clara is allowed to travel with Kostea, a privilege very few have.

Ceaușescu’s Securitate keeps everyone under constant surveillance with tapped phones, censored letters, and watchers, but Kostea becomes bolder, breaking more rules and taking chances. He cleverly talks his way out of tight situations and has learned to play the system. Kostea is a remarkably layered and nuanced character with more imperfections than strengths and can be unlikable, but we understand him. Like any family, the Bardus have their joyful times and their conflicts. In this excellent novel of humanity, the author shows that Romanians under totalitarian rule are like people anywhere. Yes, they must navigate the political pitfalls of their jobs and the “maze-like system of favors and bribes and connections and traps” to survive, but they are resilient and resourceful, and able to find happiness and fulfillment.
-- The Historical Novels Review, May 2025

A sweeping, heart-breaking, wonderful ode to love - familial, romantic, unexpected, and everything in between. There's something uniquely moving about books that chart a person's whole life. I quickly grew very attached to Kostea, Clara, and their family and friends, and felt their losses and frustrations and heartache. This is the work of a very wise writer, with a keen capacity for feeling and complexity. And the attention to detail in the evocation of Cold War Romania was fascinating. I'd highly recommend this to anyone. A future classic for sure.

"The Last Patient" is a story of family dynamics and relationships with love, loss, and the likes featuring a surgeon and his family in communist Romania. It also explores why some people decide to leave their country, despite their deep attachment and devotion to it. The characters were well-developed, with admirable qualities along with some flaws, that made them feel real and human. I think the narrative was very realistic and honest, and depicted the struggles of the characters as well as their strength during this regime, all while going about their day-to-day lives and experiencing the joys, sorrows, and difficult decisions that come with it.

Kostea is a surgeon, and even in post WWII communist Romania, that amounts to something. He and his wife Clara are forced to maneuvre an oppressive regime - Bucharest’s rampant food & housing shortages, Romania’s Cold War and all its political upheavals, all while building a family, raising children and their careers.

I found Kostea’s character interesting but flawed & insufferable at times – the patriarch of the family; he angered me. Clara was lovable, but even she struggles with Kostea at times. This is like another version of Pachinko, a historical family saga but with a stronger emphasis on the regime & politics than familial relations; and a larger extended family. I felt sad reading this throughout. For some reason, I found I couldn’t connect with the characters in the book.

This is a historical fiction that’s equal parts painful, insufferable & endearing.

I’d give this 3/5.

My thanks to Victory Editing NetGalley Co-op for the e-book.

Wonderful historical novel set in Romania during Communist times. Kostea and his friends and family navigate through difficult times trying to adapt to the new rules. Is defection the way out?

Though immensely interesting as to living conditions in Romania behind the Iron Curtain, this novel focuses on family relationships. This overwhelmed the storyline because of Kostea's powerful personality. I really disliked this egocentric, selfish and know-it-all man! His behaviour was totally unacceptable and it greatly saddened and angered me to see all the damage he caused his family in the name of love. I found it interesting to read about the social conditions (though Kostea's family had money, so it probably didn't reflect the general population). I never knew about bribery being the expected currency (what happened if you didn't have money and needed medical care?). I particularly enjoyed the descriptions of the Romanian countryside. It did sound lovely. A good novel about family dynamics.
I received a digital copy of this novel from NetGalley and I have voluntarily written an honest review.