It is a mark of consummate skill and delicious irony that P. D. James audaciously opens "The Private Patient," her 14th novel to feature Adam Dalgliesh of Scotland Yard, with this compelling sentence: "On November the 21st, the day of her forty-seventh birthday, and three weeks and two days before she was murdered, Rhoda Gradwyn went to Harley Street to keep a first appointment with her plastic surgeon, and there in a consulting room designed, so it appeared, to inspire confidence and allay apprehension, made the decision which would lead inexorably to her death."
Straightaway, the identity of the hapless victim is furnished, along with several salient details that alert the reader to the kind of closed environment that is so important an element in a classic English mystery, especially one crafted by the woman known to countless admirers around the world as the Queen of Crime, the 88-year-old one-time civil servant who in 1991 was designated Baroness James of Holland Park by Queen Elizabeth II.
The person who we immediately know is soon to join the ranks of the departed -- the "private patient" of the title -- is a London investigative journalist of some notoriety, a woman respected as a capable professional but not one without the baggage of having made a few enemies over the years. She's made several, in fact, who might delight in the news of her demise. Somewhat problematic also is the question as to why Gradwyn decides at this stage of her life to have a facial scar inflicted on her 34 years earlier by an abusive father removed by Dr. George Chandler-Powell; she tells the renowned surgeon enigmatically it is because "I no longer have need of it."
Instead of having the procedure performed in London, however, she has chosen instead to check into Cheverell Manor, a historic country residence of understated opulence converted by Chandler-Powell a few years earlier into a private clinic for the use of his wealthiest clients. The operation successfully completed, Gradwyn is found in her bed the following morning, dead by means of "manual asphyxiation." The manor's location in the coastal county of Dorset -- the setting, by the way, for the richly atmospheric novels of native son Thomas Hardy -- is ideally suited to the fiction of P. D. James, one where a tightly confined place of uncommon curiosity becomes as much a character in the unfolding drama as the human beings that emerge so fully from her imagination.