In the future, climate change and other factors have led to water scarcity. The civil conflict surrounding that scarcity has led to significant societal collapse, though cities that crumbled have been largely rebuilt by the powers that be into “New” cities that are home to the remaining elite. Science has engineered a water substitute – dubbed H2.0 – that has an unexpected, but never examined consequence: infertility.

Those fertility issues lead to massive governmental control over the various aspects of reproduction, with draconian rules in place that are almost impossible for anyone but the wealthiest of the wealthy to appropriately follow. The implications for women are bleak, with those in control exerting that control over every aspect of these increasingly rare pregnancies.

Carter Quinn is a young soldier back from the decades-long wars that have been raging over water – wars being fought on battlefields you might not expect. They’re the same wars in which his father fought … and the same wars that the next generation will likely fight as well. Carter fights insurgents with “triggers,” deadly weapons whose full effect is not truly understood by the men who wield them.

Suffering from an unknown illness and PTSD, Carter comes home on leave. His sister Fred has become pregnant – completely naturally, no less – which is just short of a miracle; however, she’s leery of the regimented reality into which this event has placed her. Meanwhile, his other sister Gardner, who works as a Nurse Completionist – a medical professional who specializes in doing whatever it takes to ensure the carriage of healthy pregnancies to term – has disappeared following months of erratic behavior.

Despite his own issues – his dark memories, his creeping illness, his alcoholic tendencies – Carter undertakes to find Gardner at Fred’s behest. And the clock is ticking – Fred’s marriage to her baby’s father, scion of a wealthy health care family, is looming … and she refuses to go through with it without Gardner by her side.

What Carter discovers is that there is much more to everyone in his family – his sisters, his father – than he ever knew. Secrets are abundant, even in a world where the most intimate aspects of life have been quantified and commodified. Bringing those secrets into the light could be their salvation … or their doom.

Dystopian visions are seemingly a dime a dozen in the speculative realm these days, so finding something that stands apart is relatively rare. That’s what “The Completionist” does. The reader might capture tonal or thematic similarities to other works here – Margaret Atwood’s “The Handmaid’s Tale” is an obvious comp, though there are others – but one never gets that lazy writing vibe that springs from more derivative work.

Instead, Adcock has given us a tragic, flawed hero making his way through a tragic, flawed world. Part of what makes that world so effective is the feeling of possibility that infuses it; the America that Carter Quinn and his family inhabit is close enough to our own that we can see the paths that society would have to travel to get there from here. It’s bleak and painful and sad, rendered with a ferocity that makes the whole thing that much more immersive.

And the HOW of that world’s creation is interesting as well. I’m a fan of less is more in terms of expository development. World-building is always better when it happens contextually; the societal and social structures of this alternative America are teased out slowly, with bits and pieces coming out organically. This isn’t about hand-holding; we learn plenty about the world, but not through third-person narration or in-story info dumps. It’s a fascinating, engaging setting meticulously rendered.

“The Completionist” is the best kind of speculative fiction, smart and sharp. Its themes and ideas challenge readers while the narrative and characterizations capture and hold their imagination. There’s plenty of dystopian fiction out there, but very little of it is anywhere close to this good … and you’ll be hard-pressed to find any that’s outright better. Powerful and thoughtful, this is a book that will stick in your synapses long after the last page is turned.