The Only One Left

The Only One Left is a 2023 gothic horror novel by Riley Sager, one of the noms de plume of Todd Ritter. Sager is know for his thriller novels, including The House Across the Lake (2022) and Final Girls (2017). The Only One Left follows home-health aide Kit McDeere, who becomes the caregiver for Lenora Hope—the woman believed to be responsible for the grisly murders of her family when she was a teenager.

This guide uses the 2023 hardcover edition by Dutton Books.

Content Warning: The Only One Left includes depictions of violence, gore, emotional abuse, opiate addiction, overdose, suicide, teen pregnancy, traumatic birth, forced familial separation, financial abuse, classism, misogyny, and elder abuse.

Plot Summary

In the fall of 1983, Kit McDeere, professional home caregiver with 12 years of experience, accepts her first assignment after six months suspension without pay. For the past six months, Kit has been grieving the death of her mother, Kathleen, who was also Kit’s last patient. Kathleen overdosed on fentanyl prescribed to ease the excruciating pain caused by her aggressive terminal cancer.

Though found not responsible for her last patient’s death by the state health board and never formally charged with a crime, Kit is expected to be grateful for the opportunity to return to work.