If you’re susceptible to vicarious (sympathetic?) hangovers, take care reading Adam Kay’s “A Particularly Nasty Case.”

“All-night Bender” is the first chapter, and that’s exactly what Dr. Eitan Rose goes on, bouncing from the techno thump of a London club to a bathhouse in the company of an American called Chester (“Why were Americans so fond of naming their offspring after miserable English towns?” Eitan wonders.

In the few hours before daylight, Eitan proceeds to drink, do drugs, save a person’s life while naked (both of them) and then fall asleep on a bus-stop bench — only to wake, his head feeling “like it was gestating twins,” at 7 a.m. with no time to go home before he has to be at the hospital.

Eitan is “not a stupid person – he had the exam results to prove it, if you ignored his D in German – he just did stupid things,” and going out the night before his first day back after an extended leave is definitely a stupid thing. He chastises himself, but he seems hellbent on self-destruction for the next 188 or so pages (there are 336). Even a meet-cute on the hospital roof with Cole, a stud muffin porter, doesn’t slow Eitan’s trajectory.

There’s a lot of self-loathing to wade through, even though it’s often tempered with Eitan’s caustic sense of humor – he calls Margaret Corcoran, his officemate and fellow consultant rheumatologist, a ”human cardigan,” for instance. Still, it gets tiresome, especially when his colleagues begin dying and he fancies himself the only person who can figure out how they were murdered. Unfortunately, Eitan’s also the only person who thinks they were.

Kay, who wrote the hilarious medical-training memoir “This is Going to Hurt,” the basis of a limited TV series of the same name starring Ben Whishaw, knows his way around the material (illustrated hypodermic needles used as page breaks in “Nasty Case” are an especially nice touch). But writing fiction is different from memoir, and a whodunit even more so.

That there is a bit of literary gear-grinding isn’t unexpected. We who are not fluent in Britain’s National Health Service, or Britishisms, for example, might be puzzled occasionally. Same for minor characters who are introduced and then dropped for long periods before being reinserted into the plot. I must admit, there was more than a little backtracking.

Because “Nasty Case” is a mystery on the order of whether we believe what the protagonist thinks is true, we have to follow Eitan out of necessity, despite the first half being bogged down with his struggles. Once the novel moves on to Part Two, written from Cole’s perspective, it gets a second wind and the pace quickens. Eitan is still circling the drain, but a fresh take makes his acting-out less tedious.

By the time Part Three, written from Margaret’s point of view, comes into play, “Nasty Case” is operating under a full head of steam and chugs along to a conclusion worth waiting for.

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A Particularly Nasty Case

By: Adam Kay.

Publisher: Mulholland Books, 323 pages.

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