Spasm

Robin Cook's latest medical thriller Spasm was recently published on December 9, 2025. It is his 42nd novel to date and the 15th novel featuring medical examiners Jack Stapleton and Laurie Montgomery. The medical mystery to be solved in this novel involves prions, ie, proteins and infections, that cause dementia symptoms and muscle spasms. 

The publisher's summary:

When Laurie Montgomery temporarily steps down from her position as Chief Medical Examiner, she and Jack find themselves uncharacteristically free for a couple of weeks. And the timing couldn’t be better when they receive a call from Jack’s former medical school classmate, Robert Neilson, who is the sole family practitioner in Essex Falls, an idyllic town tucked away in New York State’s Adirondack Mountains. Serving also as the Hamilton County coroner, Dr. Neilson is in over his head trying to explain the sudden death of a young, healthy pest control worker on top of an outbreak of rapidly progressive Alzheimer’s-like cases, and he pleads with Jack and Laurie to come lend a professional hand. Unable to resist a good mystery and a vacation in one, Laurie and Jack agree to help and head upstate.

Essex Falls is beautiful enough and their accommodations are even better than they imagined. But they soon learn the town has suffered a major economic and social setback, which has shaken its residents to their cores. When the body of the pest control worker disappears without a trace just prior to an autopsy, Jack’s penchant for solving forensic conundrums launches him into a full-scale investigation that uncovers the most frightening modus operandi of his career so far.

I am pleased that this novel does not involve Laurie being her husband Jack’s boss. I don't think that those stories were as successful as others. In Spasm, they are once again working together to solve a death investigation. It is nice that they are on a vacation of sorts, a working one. The usual stress of working at the New York Medical Examiner Office is removed. What the reader gets is just the mystery, which is all I am ever interested in. 

The investigation was different from earlier novels. In the past, Cook had his characters searching for a cause of death. In Spasm, Jack and his friend Bob Neilson know pretty quickly that prions are the reason two people died and several others developed alzheimer-related symptoms and died shortly thereafter. What Jack doesn't know is how the people of Essex Falls are getting prion infections. It's not an airborne infection. The investigation in this story is into how the prions were released in Essex Falls and how did the corpse of a pest control worker and local militiaman Ethan Jameson disappear from Dr. Neilson's morgue. While the intensity of the investigation is decreased, there is still a mystery to resolve. I read the book in one sitting. It was not any less riveting for me because the medical investigation was not a howdunnit but a whodunnit.

The story is timely. Ethan Jameson was the president of a local militia in Essex Falls. His group, the Diehard Patriots, are a ragtag group of seventeen men who mainly drink beer and shoot off their rifles in the early hours of the night when most people are asleep.  However, on this particular week Ethan hired four Russian men to train them in combat maneuvers. The Russians slipped into the U.S. from Canada fairly easily. They walked across the border. Two of these men were more interested in brewing beer than teaching the Diehard Patriots. Yes, it was not beer they were brewing but a biological weapon.

I enjoyed this book and am rating it 5 out of 5 stars.