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. Told that her new patient is Lenora Hope, Kit is unable to refuse, even though she recognizes the name as that of a notorious local legend whose reputation has haunted Kit’s hometown for decades. The entire Hope family was murdered in October of 1929; echoing in Kit’s mind is a playground rhyme about Lenora Hope’s presumed guilt.

When she arrives at Hope’s End, the once impressive but now rapidly deteriorating 36-room estate on one of Maine’s picturesque cliff sides, Kit tries to make the best of her new position. She is determined to look past what her 70-year-old patient is accused of and fulfill the role of caregiver to the exemplary standard she has set for herself.

Amidst strange noises and the sense that her patient isn’t being honest, Kit becomes curious about Lenora, an astute, passionate writer who does not allow her physical limitations—the inability to speak or be mobile—to prevent her from slowly typing an account of what happened the night her family was murdered. Her curiosity piqued, Kit looks into the circumstances of the murders, exchanging notes with groundskeeper Carter and house cleaner Jessie, and cautiously pursuing the truth under the radar of the estate’s long-term staff, housekeeper Mrs. Baker and chef Archie.

As new information emerges about the Hope family and those employed at the house at the time of the murders, Kit finds more questions than answers. When Kit discovers the body of her predecessor—Lenora’s previous caregiver Mary—Kit worries that she may be in danger from someone eager to prevent her investigation at all costs. The discovery that her patient was pregnant at the time of the murders cracks open the mystery. Kit eventually tracks down a former employee whose recollections become the catalyst for Kit’s ultimate confrontation with the so-called “Mrs. Baker,” who is, in fact, Lenora Hope.

Lenora confesses everything. Her sister Virginia (the woman Kit has been caring for) had her newborn son taken away from her minutes after his birth. Virginia then confronted their father for bribing the child’s father to abandon Virginia. In a rage, Virginia tried to kill their father. She was stopped by their mother, who took the knife and stabbed her husband and herself, but was unsuccessful in her attempt to cause a fatal wound. Virginia’s mother then goaded Virginia’s lover, who stabbed Virginia’s mother on the stairs, leaving her to bleed to death. Virginia, distraught at the loss of her son, attempted to hang herself, but survived. Everyone assumed that Virginia died six months later, when Lenora had her sister declared dead. Lenora then took on the identity of their former governess, Miss Baker, leaving Virginia at Hope’s End and spending several years in Europe. Virginia then returned as “Mrs. Baker” and no one remained who had any inkling that the woman now known as Lenora was actually Virginia.

Kit is devastated to learn that Virginia’s lover Patrick was actually Kit’s father, Ricky. Ricky was also a teenager in 1929. He and Virginia never saw their son, Kit’s half-brother, again. Kit feels an even deeper sense of betrayal when she discovers that Ricky killed the previous nurse, Mary, and who allowed Kit’s mother Kathleen to take the entire bottle of fentanyl. Ricky claims that he had always intended to turn himself in if Kit had been arrested and criminally charged. After his confession, as Ricky attacks Virginia and Lenora, the ancient house of Hope’s End crumbles, falling apart around them. Ricky helps Kit bring Virginia to safety on the front lawn, and then goes back inside. He sits beside Lenora on the steps of Hope’s End, choosing to die alongside her. Both are consumed by the rubble and cast into the sea.

Kit brings Virginia back to her childhood home, where they live happily for a while. One day, Kit finds Virginia gone and a letter waiting. The letter is Virginia’s apology and confession: Virginia has actually been able to speak and move on her own the whole time. Virginia invites Kit, her best friend Archie, and Jessie—actually Virginia’s granddaughter—to travel the world together. The group spends the rest of Virginia’s life at her Italian villa until Virginia dies at the age of 101.