Anyone who has witnessed a dysfunctional friend make one bad decision after another knows it's not an entertaining spectacle. This is one reason Sandra Block's latest thriller, The Girl Without a Name, is less satisfying than it could be.

The book's protagonist, Dr. Zoe Goldman, who first appeared in Block's debut, Little Black Lies, which was released earlier this year, is a medical resident specializing in psychiatry. Zoe also happens to suffer from ADHD, a trait presumably intended to give the doctor special insight into her patients and their problems.

The stakes are high for Zoe, and for the people around her. Following the events of Little Black Lies, she is on probation at her hospital, scared stiff of making an error, and anxious to impress her supervisor, the handsome Dr. Tad Berringer. Zoe's personal life likewise treads the edge of disaster, as she juggles a lost family fortune, an up-in-the-air relationship with her current boyfriend, and the ambiguous friendship of her engaged former lover.

Into the midst of Zoe's fragile functionality, Block drops a big, ugly, thrashing mystery. It involves the nameless girl of the book's title, dubbed Jane Doe as the story opens, who has suffered a terrible but unknown trauma. Zoe enlists some characters who also appeared in Little Black Lies — including the kindly, bear-like Detective Adams, and her brother Scotty, a computer genius — to help her find clues to the girl's identity.

At the same time, she seeks an effective medical treatment that will unlock information within Jane's memory. Her efforts bring her into frequent contention with Dr. Berringer and other authorities at the hospital.

Though Zoe knows her aggressive investigation of Jane's background is jeopardizing her career, she presses on impetuously, committing some fairly egregious ethical violations along the way. Progress is slow, and it eventually becomes clear Jane is not only traumatized, but is in immediate danger from an unknown source.

The story's erratic pacing makes all of this activity less engaging than it should be. Zoe's search for answers sometimes feels more like a string of stumbling blocks than a trail of clues, and even the smallest obstacles are treated as insurmountable.

"The picture's rotten," Detective Adams tells Zoe when she points out a possible connection between Jane and a suspected drug thief the police have caught on surveillance camera. Apparently no one in the entire police department has the ability to enhance or enlarge a blurry photograph.

When another authority figure barks, "Listen, Dr. Goldman, I don't need to get into all the nitty-gritty details," just as Zoe is about to share some crucial information, the supposedly strong-willed heroine promptly shuts up. As minor obstacles cause endless delays, the atmosphere by mid-novel moves from suspense to something more closely resembling tedium.

Block is a practicing neurologist, so the medical setbacks Zoe encounters ought to seem plausible, but the barrage of symptoms and drugs thrown at the reader makes it hard to tell. Encephalopathy, diaphoretic, sweat artifact, serotonin syndrome, Risperdal, and Effexor are all supposedly key pieces of the mystery, yet they are bandied about with little or no explanation for the average reader.

The book's descriptions of medical residency do ring true, though the details seem chosen for their blandness — paperwork is tedious, cafeteria food is unappetizing — which creates an atmosphere more mundane than mysterious. Yet the author makes Zoe’s world feel fully realized, with the hospital an authentic setting for drama and tragedy. The resolution of Jane Doe's story involves a skin-crawling level of betrayal, and mystery fans who crave nuance in their villains will appreciate the way Block plays stock concepts of good and evil against the science of modern psychology.

Zoe, despite the bumpy personal road she has traveled, seems ready to take on fresh mysteries at the story's end, and Block is evidently already planning them. In the final scenes of The Girl Without a Name, a skeptical policewoman, who plays bad cop to the friendly detective Adams, tries to bully Zoe into making a false confession.

She fails, but her unreasonable suspicion could well provide complications in the next phase of Zoe's tumultuous life. With any luck, by Zoe's next outing, she'll have gained enough confidence to provide the nitty-gritty details even if her supervisor tries to stop her.

Susan Schorn writes Bitchslap, a column on women and fighting, for McSweeney's Internet Tendency, and is the author of the memoir Smile at Strangers, and Other Lessons in the Art of Living Fearlessly (Houghton Mifflin Harcourt) as well as the short-story collection Small Heroes.

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