The End of October

The End of October is a medical thriller about a devastating virus that begins in Asia and soon thereafter goes global. This riveting story begins at in internment camp in Indonesia where forty seven people die from acute hemorrhagic fever. When microbiologist Henry Parsons travels there on behalf of the World Health Organization he suddenly learns that his driver is infected and is on his way to join millions of worshippers in the annual Hajj to Mecca. Henry joins with a Saudi prince and doctor in an attempt to quarantine all of the pilgrims in the holy city.  It doesn't work.  The deputy director of the U.S. Department of Homeland Security is a Russian immigrant who scrambles to mount a response to what she thinks may be an act of biowar. Some people believe that the virus was bioengineered by Putin because there are few cases of it in Russia. The Russian leader, of course, blames the Americans. As the disease travels throughout the U. S. it decimates the population and religious, scientific and governmental institutions are dismantled. 

Obviously, this  novel is timely.  It was published in April 2020 so I doubt that the author had any idea that we would be dealing with a pandemic when he wrote the story. It is interesting to note that the president in the novel wears orange pancake makeup and the vice president will not make any decisions without praying first. To add to this phenomenon the main character worries about the danger his family could face while camping in off grid sites in Grand Teton National Park.

The sense of emergency contributed to the fast pace.  The reader does not know what the virus is or how fast it will kill people. Henry goes through a mental checklist to help him identify the origin of the virus and when it was revealed in the last 3 pages, I was astonished. I was not expecting this ending. Given all of my newfound knowledge on pandemics, I knew where the plot was heading. It was still a fantastic read. 4 out of 5 stars.

Viral

Viral is Robin Cook's 38th medical thriller and it is my favorite from among all of his books. The ending was unexpected and extremely satisfying that I am tempted to begin rereading it ASAP.  

The main character, Brian Murphy, and his wife and child travel to Cape Cod for a two week vacation. When wife Emma begins to get flu-like symptoms, they cut their vacation short and return to New York City after one week. On the drive home, Emma begins to convulse. When the family reaches their local hospital Emma is given a room in the ICU area. She is diagnosed with eastern equine encephalitis, a/k/a EEE. It is a rare and highly lethal mosquito-borne viral disease that she probably caught during one of their barbeques on the coast. To make matters worse, Brian and Emma's daughter Juliette begins to exhibit alarming physical and behavioral symptoms too.  Emma's hospital stay is rather expensive. When Brian receives a $221,000 bill that his insurer refuses to pay, citing dubious clauses in their health insurance policy, he decides to get to the bottom of the hospital's predatory billing practices.  

My love of the story is based on my own experience with encephalitis when I was 8 years old and my 35 year history dealing with insurance companies after a catastrophic injury in a car accident. The author gives us the basics on encephalitis, the treatment and etiology of which has changed drastically since I had it 55 years ago. I ended up googling it and discovered even more information that was geared to my experiences over all these years.  Cook is known for writing the etiology of whatever disease he writes about in his books. It becomes part of the plot action. Naturally, I was drawn to this particular story.  

The writing was superb. The pace was super fast because Brian needed to save the lives of his wife and child. The reader doesn't know how things will turn out, just that there is a sense of urgency. Brian had to fight this battle on three fronts:  the disease, the insurer and the hospital. I believe this alone will connect with every reader. All Americans have been put through the ringer with medical matters. The ending was quite different from what we have seen from Cook in the past. I won't elaborate, but I loved it!

Another aspect to the plot is how asian mosquitos came to be located on the U. S. eastern coast. This mosquito has a distinct look: 2 white dots on its wings. Climate change is the reason that this type of mosquito traveled from the tropics, where it is normally located, to the eastern coast of the United States. Later on in the story, the reader sees that this particular mosquito is somewhere else on the planet. I don't want to be a spoiler so I will leave it at that.

The hospital setting was where much of the action took place. Cook shows us what we are all familiar with: hours long waits in the emergency room, seemingly uncaring staff, and, of course, the nasty billing department who call you nonstop trying to collect. The plot goes into hospital billing practices that I was not aware of. It has made me determined to check my bills in the future now that I know how this system works.

I thought the characters were sympathetic.  We don't know much about Emma because she becomes ill early in the story. Daughter Juliette is four-years-old and cries constantly. She is catered to quite a bit. I can certainly feel for Brian. Having been through his circumstances more than once in my life, I felt his pain. His emotions ran high throughout the entire story. Although Brian is a problem solver by nature, he just cannot penetrate the medical system to resolve his issues. His line of thinking is insightful for anyone new to this experience. There are 4 other characters of note. His mother, mother-in-law, business assistant and a new friend named Jeanne all help him steer through the mess that healthcare is today. Jeanne, in particular, becomes a major part of the story. She is a child psychologist who lost her husband a year ago via the same situation that Brian now finds himself in.

Viral will make you read your insurance policy and search for medical billing advocates.  I loved it and rate it 5 out of 5 stars.

Genesis

Genesis is Robin Cook's 37th medical mystery novel. This particular novel delves into the use of commercial ancestry DNA kits to determine the paternity of a fetus in a murdered mother. Yes. It can be done. All those men who kill their pregnant wives and girlfriends are in for a good shock!

The inside cover blurb summarizes the book as follows:  "When the body of twenty-eight-year-old social worker Kera Jacobsen shows up on Chief New York City Medical Examiner Laurie Montgomery's autopsy table, at first it appears she was the victim of a tragic yet routine drug overdose. But for Laurie and her new pathology resident, the brilliant but enigmatic Dr. Aria Nichols, little things aren't adding up. Kara's family and friends swear she never touched drugs. Administrators from the hospital where Kera worked are insisting the case be shrouded in silence. And although Kera was ten weeks pregnant, nobody seems to know who the father was - or whether he holds the key to Kera's final moments alive.

As a medical emergency temporarily sidelines Laurie, impulsive Aria turns to a controversial new technique: using genealogical DNA databases to track down those who don't want to be found. Collaborating with experts at a start-up ancestry website, she plans to trace the fetus's DNA back to likely male relatives in the Hope's of identifying the mystery father. But when Kera's closest friend and fellow social  worker is murdered, the need for answers becomes even more urgent. Because someone out there clearly doesn't want Kera's secrets to come to light. . . and I'd Aria gets any nearer the truth, she and Laurie might find themselves a killer's next targets."

Wow! This thriller was spectacular. Robin Cook always writes a good book but he hasn't written anything this great in awhile. I thought perhaps my excitement was due to the thrill at now being scientifically able to catch all those men who kill their girlfriends because they become pregnant. It was much more than that though. Many pages were spent with characters describing the genealogical DNA process in layman's terms. I found that to be intriguing. The author had more unexpected twists and turns to surprise the reader than he has used in more recent books. The awkwardness between the two main characters, Jack Stapleton and Laurie Montgomery, in recent books was absent. A new, obnoxious character was introduced to keep the characters fresh. Cook has written a perfect thriller in Genesis!

Way over 5 out of 5 stars.

Saving Meghan

Daniel Palmer has written another amazing medical mystery with Saving Meghan. With this novel he examines the illness called munchausen's by proxy.

The Gerard family is falling apart due to daughter Meghan's undiagnosed illness and her mother Becky's constant demand for her to see new doctors and have more tests. Husband Carl doesn't seem to believe that his daughter is really sick.  Meghan, a former high school athlete, is now homebound with nausea, cramping, fevers, fatigue and dizziness. However, every medical test keeps coming back normal until the family meets Dr. Zach Fisher who thinks she has a mitochondrial disease. She begins treatment but White Hospital is considering an intervention. They think Becky is intentionally making Meghan sick.

This novel was one heck of a page turner! I had to stay up until 2 am to finish it this morning. The plot moved very quickly and each chapter ended with a bang so I had to continue reading. I was familiar with Munchausen's so I knew what to expect from the mother's character. However, the daughter's character surprised me. By age 15 she had already learned what made her mother happy so Meghan was somewhat complicit in acting out her illness. I had no idea that was normal in these situations.

The plot had incredible twists and plenty of suspense but the final resolution of the story caught me off guard. I wasn't expecting it and I don't think it fit the story well. Still, it was a fun read and I am looking forward to Palmer's next novel. 

Pandemic

Pandemic is Robin Cook's 36th medical mystery novel. The plot was inspired by a 2012 article in Science magazine concerning bacterial immunity. In his Preface the author stated that the article also introduced the world to a biologically active chimeric molecule called CRISPR/CAS9.  This molecule can be custom-tailored to alter genes in plants and animals.  With CRISPR/CAS9, any gene whose sequence is known can be replaced, removed, turned on and turned off and this can be done by anyone, even a high schooler in his garage. You don't need to be a molecular biologist to know how to do this. Therein lies one of the dangers. Another danger is that this technology is unregulated.

The story opens with a woman suddenly dying on a New York subway. Medical Examiner Jack Stapleton performs her autopsy and is astonished to find that she had a recent heart transplant but was not on any immunosuppressive drugs to prevent rejection of the heart. Her DNA also matched the DNA of the transplanted heart which would be impossible unless it came from a twin. A lung virus is the expected cause of death and the woman's short period of illness is reminiscent of the 1918 flu epidemic.

With troubles at home that he wants to avoid, Stapleton throws himself into this case. He tries to identify the woman by visiting a  tattoo parlor to determine the origin of her unusual tattoo of a puzzle piece with the name Helen on it. He locates the hospital that performed her transplant and is led to a Chinese billionaire who owns a hospital and research facility that uses CRISPR/CAS9. Then, a second woman ends up in his morgue with a puzzle piece tattoo with the name Carol in the middle.

I loved this book. It was fast paced and the search to identify the cause of death was interesting. When the plot came to what the Chinese billionaire was doing with his transplant business, I was astonished that anyone would even think about doing what he was doing. I won't be a spoiler here but it was shocking.

The relationship between the two main characters, Jack Stapleton and his wife Laurie Montgomery, was quite different from prior novels. Laurie is now Jack's boss. She has no problem yelling at him. He cannot handle it though. Jack is usually the dominant person in this relationship and this mixup feels awkward. To make things worse, they have a new child who was just diagnosed as being autistic. I am not sure where these two characters go from here. Is this 11th book featuring them the last one?

4 out of 5 stars.

Deadly Cure

Deadly Cure is the first book by Lawrence Goldstone that I have read. It is both a historical mystery and a medical mystery novel.  It takes place in 1893 in New York City.

Physician Noah Whitestone is called to a rich neighbor's home to urgently care for their 5 year old son, Willard Anschutz, as his regular physician, Dr. Frias, was not available.  Noah finds the boy exhibiting the symptoms of morphia toxicity, with leg tremors, a rancid odor, extreme perspiration and dilated pupils.  Noah asked the boy's mother, Mildred Anzchutz, if he had taken any patent medications which were not regulated and were known to have morphine as an ingredient.  She said that he hadn't taken any but that he had been taking a blue pill prescribed by Dr. Frias for a cough. Noah doesn't believe that Willard was not on any patent medications but has to take her word so he gives the boy 2 drops of laudanum and leaves to see 2 more patients. When he returned to the house later that night, the boy had died. However, he was able to get 2 of the blue pills that Willard was taking.

The next day Noah stops by the Anschutz home to pay his respects to the family. Here he finds himself accused of wrongdoing in the boy's death.  After leaving the house he goes to the local hospital lab to do tests on the blue pill to determine what it is made of. Dr. Frias finds out he is testing the pill and threatens to yank his license.  Noah later meets a radical working for a newspaper who tells him the paper is trying to break the Patent Medicine Trust. This radical/reporter knew about Willard's death and the death of other children from patent medications. Noah wants to get involved with research for the publication in order to clear his name but knows there is a risk with being associated with communists.  He does it anyway.

Deadly Cure was spellbinding!  I was hooked from the first page and could not put this book down.  The book had a fast pace, fascinating characters and an intricate plot. However, what I found most interesting was how aspirin and heroin were initially introduced in the U. S. as patent medications. In their beginning forms these drugs killed people. Various German companies worked on what eventually became known as aspirin and heroin and while their products were not healthy they were marketed to the public by physicians who became wealthy by prescribing them.  This history was expertly woven into the story by the author.

5 out of 5 stars!

The First Family

The First Family was written by Daniel Palmer but he used his famous father's name on the front cover too.  Michael Palmer wrote 21 medical mysteries before his death 5 years ago.  The First Family is a medical mystery.

The front cover book summary:
"The White House is not an easy place to grow up, so when the president's son Cam Hilliard, a sixteen-year-old chess champion, experienced fatigue, moodiness, and an uncharacteristic violent outburst, doctors are quick to dismiss his troubles as teen angst.  But Secret Service agent Karen Ray, whose job it is to guard the president's family with her life, is convinced Cam's issues are serious-serious enough for her to summon her physician ex-husband for a second opinion.

Dr. Lee Blackwell's concerns are dismissed by the president's team-until Cam gets sicker.  Lee must make a diagnosis from a puzzling array of symptoms he's never seen before.  His only clue is a patient named Susie Banks, a young musical prodigy who seems to be suffering from the same baffling condition as Cam. Hospitalized after an attempt on her live by a determined killer, Susie faces increased jeopardy as Cam's condition takes on a terrifying new dinension.

Is someone trying to kill the president's son?

As Lee and Karen raced for a cure to Cam's mysterious and deadly disease, they begin to uncover betrayals that breach the highest levels of national security.

Returning to the same Washington, D.C., setting of The First Patient, which former president Bill Clinton said "captured the intense atmosphere of the White House," The First Family is a riveting new medical drama from acclaimed novelist Daniel Palmer, in the tradition of his late father, New York Times bestselling novelist Michael Palmer."

First, let me say that Daniel Palmer has all of the talent his father had. He published several suspense novels before this one and I would categorize The First Family as a medical thriller, not a medical mystery.  He used the thriller formula. Since the medical mystery is my favorite mystery sub-genre, I hope this author continues to write them.  There are not many authors who write them but there are many who write suspense, albeit not at the high level he was writing at.

I read this book in one sitting.  It was that gripping. The characters were sympathetic even though they were the first family and I am sick of reading about current events in today's political climate. That was quite an achievement in itself. The first family was portrayed as any family would be with a teenager. This author used the emotional bonds of the family but the setting of the White House did advance the plot significantly. 

One of the main plot thrusts not mentioned in the blurb is that the 2, really 4, kids affected with the condition all attended a private institution after school that helped them achieve prodigy status in their chosen interest.  The TPI dispensed non-FDA regulated supplements to its students to help them achieve greatness. The CEO of TPI is a strange man and he makes a great villain but he is not the only one, of course.

The First Family is an action packed thriller with medical and legal issues about pushing kids to high performance.  I highly recommend it!

Mercy

Mercy was written by Dan Palmer, the son of medical mystery author Michael Palmer who died a year or two ago.  I don't know if Mercy was an unfinished manuscript by Michael or whether his son is going to continue to write medical mysteries in his memory.  Either way, I am glad that there is someone still interested in writing medical mysteries. It is my favorite mystery sub-genre. With the death of Michael Palmer and Robin Cook no longer writing there currently isn't anyone specializing in this sub-genre.

The topic of Mercy is the critically ill patient's right to die with dignity.  In the novel's White Memorial Hospital expensive, critically ill patients mysteriously die of heart attacks even though none of them have heart disease. It saves the hospital a bundle of money but how is it happening and who is involved?

ICU doctor Julie Devereaux is an outspoken advocate for a patient's right to die until her fiance becomes a paraplegic from a motorcycle accident. He dies of an unexpected heart attack. His autopsy reveals an unusual heart defect, one that is only seen in people under extreme stress.  Since the defect disappears when the stress is alleviated it is not seen as a fatal disease.  Julie investigates similar cases and finds herself the target of threats, even to the point of being accused of a mercy killing herself.

I thoroughly enjoyed reading this book. It was quite relaxing to read a book that I knew I would like because of its genre.  I also knew that any book written by the Palmers will have great characters, excellent pacing, and suspense.  They have the writing gene.  Mercy was somewhat bittersweet due to personal circumstances that have put me in the hospital several times over the past 2 months.  I have been subjected to nurses yelling at me for not having a living will and they let it be known that they wanted me to sign a DNR (do not rescesitate order).  Being stubborn I refused.  But the beginning of the book was too real for me and made me a little paranoid.  However, it has a compelling plot and excellent writing and I highly recommend it.

A Change of Heart

This is the first book of Sonali Dev's that I have read. Unfortunately, I was disappointed with the book.  I just could not get into it.

The back cover blurb summarizes the story "Dr. Nikhil 'Nic' Joshi had it all - marriage, career, purpose.  Until, while working with Doctors Without Borders, in a Mumbai slum with his wife, Jen, discovers a black market organ transplant ring.  Before she could expose the truth, Jen was killed.

Two years after the tragedy Nic is a cruise ship doctor who spends his days treating seasickness and sunburn and his nights in a boozy haze.  On one of those blurry evenings on deck, Nic meets a woman who makes a startling claim:  she received Jen's heart in a transplant and has a message for him.  Nic wants to discount Jess Koirala's story as absurd, but there's something about her reckless desperation that resonates despite his doubts.

Jess has spent years working her way out if a nightmarish life in Calcutta and into a respectable Bollywood dance troupe. Now she faces losing the one thing that matters - her young son Joy.  She needs to uncover the secrets Jen risked everything for; but the unforeseen bond that results between her and Nic is both a lifeline and a perilous complication"

After reading 100 pages I did not know any of the above other than that Nic was an alcoholic cruise ship doctor.  So, I stopped reading.  My rule is that if I cannot get hooked after reading 50-100 pages, I put it down.  Alot of verbage was wasted on descriptions of Nic's alcoholic state which did not interest me and I did not see anything developing in the story. Better luck with the next book.