The concept of this book is great, and really enticing for fans of Hogarth's other work: xenotherapists Jahir and Vasiht'h face the most difficult and serious task of their lives, meeting, treating, and escorting home Lisinthir, the Alliance ambassador to the Chatcaava, who has suffered physical, mental, and sexual abuse and torture for a year and a half in the Chatcaavan Court, much of it at the hands of the Chatcaavan Emperor who he claims to have converted and reformed to decency and also fallen in love with, and both of them with the Chatcaavan Slave Queen who has also suffered at the Emperor's hands her whole life. To add to the tension, Lisinthir's body is failing him and the courier ship that the Alliance sent to fetch him and the vital intelligence he carries was attacked at the rendezvous point, stranded in enemy territory a long, long way from proper medical facilities.
This book is about how, through the magic of Eldritch emphatic abilities, Lisinthir's perspective on his relationship with the Emperor and the change in the Emperor's nature is validated as true and correct without any doubt. Also through those same mysterious powers, in an extension of the ability to pull patients back from the brink of death as seen in Mindline, Jahir and Vasiht'h are able to block Lisinthir from feeling pain and stabilize his condition so that, despite the drug withdrawal, occasional seizures, blood vomiting, brushes with organ failure, and the complete destruction of his alimentary canal to the extent that he has to be fed by pump, Lisinthir is able to a. conduct self-defense training sessions that exhaust both Jahir and Vasith'h who are both in good health, b. act as a sex therapist to Jahir to help him come to terms with the unexpected discovery that he has a sexual response to violence (alongside the way he's somehow completely repressed his ability to feel sexual attraction at all because of his Forbidden Love for his female cousin, to the extent that Vasiht'h thought he was asexual until just recently- see the novella Family which has this unexpected reveal), and c. formulate and execute a plan to lure in a Chatcaavan ship and board it and kill dozens of Chatcaava on the crew so that they can all make it back home to the Alliance.
This book is, in short, something of a mess, unexpectedly and unfailingly pulling its punches when they could have had most impact and railroading the characters away from sensible responses onto the predefined relationship train full steam ahead: the obvious question of Stockholm syndrome only briefly comes up and is magicked away, and the elision of even the possibility of lasting trauma from the torture Lisinthir endured is even more remote, an acceptable choice in Even the Wingless where the narrative was stylized and abstracted to the point of a parable of suffering and redemption but one that clashes poorly with the more grounded (and later written) attempt at psychological detail in the Dreamhealers Quartet. The same goes for Lisinthir's physical condition, which is sometimes a source of angst and tension but mostly alternately ignored, magicked away, or elided because Jahir throws up his hands in helplessness, lacking the proper specialization- a far cry from the tense medical scenes of Mindline, and somewhat out of character for Jahir to boot.
I will note that there was one thing that worked for me, and that was Vasiht'h's arc. Vasiht'h had a good bit of anxiety about whether he was willing _or_ able to follow Jahir into the coming Alliance-Chatcaavan war because Jahir believes it is his duty to fight, this arc felt strongly in character and wasn't handled badly, though I wished it had been given a little more page time.
I remain disappointed with the author's handling of Jahir's sexual orientation as well. The Dreamhealers quartet- Mindtouch (2013), Mindline (2014), Dreamhearth (2017), and Dreamstorm (2018)- are billed as "an asexual romance" and tell the story of Jahir and Vasiht'h meeting, going to school together, and building a life and a practice together, a relationship that reads as a committed queerplatonic life partnership; parallels are drawn in the later books to the commitment and intimacy arcs in romance novels in-setting. The series is followed chronologically by the earlier and much weaker novella Family (2011, recently revised) in which the nature of their relationship is different, coworkers who cohabitate and think of themselves as siblings and become sworn siblings in truth in the course of the story, during which Vasiht'h also learns after years sharing a close mental bond to Jahir that Jahir is not asexual but allosexual and sexually repressed.
I've not read the revised edition of the novella, but reading the original one in order there was a... serious discontinuity between the quartet and the novella, and this novel, Some Things Transcend (2014), written after the novella between the two halves of the quartet, takes up with the Jahir and Vasiht'h we met in Family and goes from there, which is jarring if one reads these in chronological order because it means the closeness of their relationship (and the functionality of it with regard to hiding worries and needs from each other for fear of judgment) feels like it's taken several steps back. This kind of discontinuity might be inevitable for a series written so out far out of order over a period of years, but I can't help but feel like it could have been handled better- especially since Jahir's sexuality was a foregone conclusion, I would have liked more foreshadowing of that throughout the series, and it rather undermines his and Vasiht'h's relationship a bit to me that Jahir evidently never told Vasiht'h about his difficulties in that area through the quartet _and_ that Vasiht'h uncharacteristically never encouraged him to seek out therapy or help for it in the years between Family and this novel.
There was an opportunity for representation and exploration of what it's like to question one's sexuality here, but what we got was... I don't even really know. Over the course of a couple of days, things go from Jahir being extremely severely repressed and avoidant and the product of an extremely homophobic society to... joking about having sex that includes being the recipient deliberately inflicted pain with his male cousin? This happens in the first half or so of the book too, so it's really not even an "after all they've been through" situation at that point. It was another unrealistic profession and another huge missed opportunity in a book full of them. It doesn't help that the book's larger points about the Eldritch suffering as a civilization for eschewing having sex all the time don't fit at all with the romance we see in the Earthrise trilogy.
At this point, for readers who are interested in this series as a continuation of Jahir and Vasiht'h's story, I'm not sure I'd recommend it. For readers interested in the dark space opera series, I'd recommend starting with Family and then continuing to this book, skipping Even the Wingless because it's a weaker novel and doesn't really lead into this one well because of friction in characterization, but maybe reading that as a prequel; really, in all ways I'd recommend the Earthrise series over this, though the first book is weaker than the second two there as well and could possibly be skipped and gone back to as well.