I just finished reading Jonathan Lethem's Motherless Brooklyn, which won a bunch of awards back in 1999, and I loved it. It's a sort of post-modern cross between a 40s tough guy detective novel and an 80s wise guy movie, California Noir retold with a Brooklyn accent.
Our narrator is Lionel Essrog, who grows up in a Brooklyn orphanage and then with three orphanage friends joins the crew of a small-time gangster named Frank Minna. Essrog has tourette's syndrome, and growing up they call him Freakshow. He tries all the available drugs but they make him feel terrible and he decides he'd rather be Freakshow than feel like that. So he goes through life ticcing and touching and bursting out with pet sayings like "Eatmebailey!" at exactly the wrong time. Sometimes he gets going on rolls of echolalia: Lexluthor, Lunchylooper, Laughyluck, Loopylip, Lockystuff. At first this is cute, and then it gets annoying, and just when it was getting so annoying I thought I might have to stop reading Lethem dials it back to an acceptable level. Point made, I guess. Essrog is basically a sweetheart, which given a flavor to the tale different from what a more hard-boiled detective would give us.
The plot is classic tough guy, right out of Raymond Chandler or Ross MacDonald. It drags a bit early on because Lethem sets the stage very carefully, but once it gets going it's terrific. Highly recommended if you're into that sort of thing.