MORE ABOUT MEDICAL THRILLERS

Around the beginning of every year, I usually set a few vague reading goals for myself and then, almost invariably, never fulfill them. In 2024, for instance, I wanted to read a lot of crime novels set in Santa Barbara, California, and then write a long essay about them. Santa Barbara has always struck me as an odd place to set any sort of gritty crime novel because it is one of the most upscale counties in the country. It includes such high-end townships as Montecito (home to Jeff Bridges, Gwyneth Paltrow, Rob Lowe, Steve Martin, and numerous other celebrities), and Hope Ranch (home to Snoop Dogg, Dr. Laura Schlessinger, and others). Santa Barbara is probably one of the least crime-ridden areas of California, and most of the crime that occurs there probably involves the theft of expensive automobiles or valuable art and jewelry from multi-million-dollar mansions. The murder rate is probably very low. Nonetheless, Santa Barbara (or some fictional stand-in for it) is the setting of many popular series of crime novels, including Sue Grafton’s Kinsey Milhone mystery series, Meg Gardiner’s Evan Delaney series, and Ross Macdonald’s Lew Archer tales. Margaret Millar (Macdonald’s wife) and Newton Thornburg also set some memorable murder mysteries in Santa Barbara. In the beginning of 2024, I read a couple of great Santa Barbara crime novels (To Die In California and Cutter and Bone, both by Thornburg) but then I pretty much drifted away from the project entirely. My encounter with Richard Preston’s bio-medical thriller, The Cobra Event, whetted my appetite for more medical thrillers. As a result, I spent much of the year reading thrillers (both medical and non-medical) by Tess Gerritsen and a few other novelists. As 2025 rolled around, my appetite for medical thrills remained unsated, so I made it my goal to make 2025 my Year of Reading Medical Thrillers. I expected this goal to last until mid-January at which point I would probably swerve and devote myself to reading British spy novels or historical novels set in Asia or ghost stories or…you name it. But May is now upon us and, curiously, I am still reading medical thrillers. For once, I appear to be sticking to a reading plan, something I almost never do.

To be sure, I’ve read a few non-medical thrillers and other books as well this year. But my goal of making 2025 the Year of the Medical Thriller remains on track. In part, this happened because of a snide comment I made about Robin Cook and Michael Palmer in a review of Kelly Parson’s novel Under the Knife. Specifically, I wrote that Parsons would probably never produce a great thriller but, if he learned how to cut all the dead wood out of his novels, “he might at least join the ranks of Robin Cook and Michael Palmer, neither of whom ever wrote a masterpiece but both of whom were/are writers of above average medical thrillers.” After publishing that essay, I immediately started to feel guilty about flatly stating that two guys whose works I hadn’t read in years had never produced a pop fiction masterpiece between them. So I decided to read at least a few novels by both Cook and Palmer and see if I was right about that. By April 7, I had read enough old Michael Palmer thrillers to publish an essay about the man and his work, which I called “A Master of the Medical Thriller,” in which I happily conceded that, though he never produced a novel that became a household name like Jaws or The Firm or Jurassic Park, Palmer did, indeed, produce some novels smart enough and thrilling enough to earn them the status of minor masterpieces of American pop fiction, which may sound somewhat dismissive but isn’t meant to be. None of his books is as groundbreaking as, say, The Day of the Jackal or The Silence of the Lambs, but the best of his medical novels strike me as being more intelligent than the legal thrillers of John Grisham and more entertaining than the legal thrillers of Scott Turow. Forced to spend a year on a desert island with the collected novels of only one of those three writers, I would choose Palmer’s. (The legal info in the works of Turow and Grisham would be unlikely to prove helpful to me while stranded on a desert island; but I might be able to glean some medical info from Palmer’s books that could save my life).

But comparing Palmer to Turow and Grisham is kind of a cheat. The real question is: how does he stack up against other writers of medical thrillers, authors such as Michael Crichton, Robin Cook, Tess Gerritsen, Alex Kava, F. Paul Wilson, Patricia Cornwell, Kathy Reichs, and so forth? To answer that question, I have recently been catching up on the work of Robin Cook, whose books I quit reading in the late 1980s or early 1990s. I have also been seeking out books by many of the other novelists who specialize in medical thrillers. And, even since publishing my April 7^th essay on Palmer, I have read more of his novels and gained a greater appreciation of his work. Right now, it’s probably easiest for me to compare and contrast his work with the work of Tess Gerritsen, because I have read a great deal by both of these authors in the last year and a half.

I will concede right away that I am biased in favor of Gerritsen. She is a native of my home state, California, and she is a baby boomer who was born just three years before I was. What’s more she is still alive and very active as a writer. Palmer, who died in 2013, was born in Massachusetts and died in New York and appears to have spent most of his career in the East. He was born in 1943 and was closer in age to my parents than to me. None of these are bad traits. But I just find myself identifying with Gerritsen more than I do with Palmer. Gerritsen has spent a lot of time in Northern California, having gotten her undergraduate degree at Stanford and her medical training at the University of San Francisco. Although I lack the brainpower to ever matriculate at Stanford University, my wife and I have visited the Palo Alto campus dozens of times to attend sporting events, literary events, and so forth. Gerritsen was born in San Diego, where my stepdaughter Mary Ann and her family currently live. Curiously, though, much, if not most, of Gerritsen’s fiction is set in either Massachusetts (the primary setting of her Rizzoli and Isles series) or Maine (the setting of her Martini Club series). So far (as yet it comprises only two books) I’m kind of lukewarm on the Martini Club series, which is set in the world of retired (but not inactive) CIA agents and has little or nothing to do with medicine and, thus, isn’t germane to this essay. I like the Rizzoli and Isles novels a great deal and, because Maura Isles is a pathologist, that series is often steeped in medical detail. But my favorite Gerritsen novels are her five standalone medical thrillers: Harvest (1996), Life Support (1997), Bloodstream (1998), Gravity (1999), and The Bone Garden (2007). I actually think that her novel The Surgeon (2001) belongs on the list of her standalone medical thrillers. Although it introduced the character of Jane Rizzoli, it was the first book in the series and can be enjoyed on its own merits whether or not the reader goes on to sample any of its numerous sequels. The title alone announces that this book is a medical thriller, and it is a very good one indeed.

Palmer mostly wrote standalone medical thrillers. Seventeen of these were published during his lifetime. Three others were completed after his death by his son Daniel and published posthumously. Late in his career (and life) Michael Palmer began writing a series of books about a character named Dr. Lou Welcome. But that series comprises just three novels and a novella.

If you read a lot of medical thrillers, you might notice that a certain depressing formula turns up in them again and again. These novels often start out grippingly with all sorts of fascinating facts about contemporary medicine, pharmacology, hospitals, managed-care corporations, medical schools, and so forth. Experienced doctors like Cook and Palmer and Gerritsen possess a wealth of arcane knowledge about the care and treatment of the human body, information that a writer who lacks a medical degree might never come across despite doing tons of research. For instance, Palmer’s specialty as a doctor was the treatment of drug addiction. He knew a lot about oxycontin, heroin, cocaine, and other addictive drugs. At one point in his 2004 novel, The Society, Palmer’s surgeon protagonist passes out in an operating room while operating on a patient. He is rushed off to the emergency room where, among other things, a sample of his blood is collected for testing. It turns out that the doctor’s bloodstream had a high level of fentanyl in it. But the doctor is not a drug abuser. He’s never intentionally taken fentanyl. Someone, he believes, is trying to discredit him as a surgeon. The police don’t believe that theory. Neither do the hospital authorities, who put the doctor on suspension. The doctor can’t think of how the fentanyl could have gotten into his system. Only later does a clever sleuth/lawyer figure it out. It is well-known among hospital staffers that the doctor always wears his red Converse All-Star hightop shoes when he is in an operating room. The sleuth deduces that someone filled the insoles of the shoes with liquid fentanyl and allowed it to dry there. Later, when the doctor was in the operating room performing a long and challenging bit of surgery, the warmth of his feet reactivated the fentanyl, which was then absorbed into his system through the soles of his feet. Whether this is actually possible or not, I can’t say. But because Palmer specialized in drug addiction, I am willing to take his word for it. Weird medical twists like that are what make medical thrillers so much fun to read. But all too often, as a medical thriller reaches its third act, our doctor-protagonist quits behaving like a doctor and suddenly turns into a combination of James Bond, Jack Reacher, and Jim Rockford. He will often arm himself with a handgun and then go breaking into places – pharmaceutical warehouses, medical research facilities, meat-packing plants – in search of the solution to some dreadful medical crime. At this point many a medical thriller leaves the world of medicine far behind and becomes a series of chases, fist fights, shoot-outs, break-ins, break-outs, and other clichés of the thriller genre. Sometimes these clichés are handled well enough to keep the book from becoming pure drivel. Other times, they read like synopses of bad Netflix dramas. At any rate, if this kind of hokey derring-do doesn’t show up until the final twenty-five pages or so, I consider it a win. If it begins at the halfway point of the novel, I’ll often skim my way to the end or put the novel aside for good. For me, the ideal medical thriller is Richard Preston’s The Cobra Event, which, even though it involves the FBI and a search for a madman who possesses a bio-weapon with the potential to kill millions of people, remains focused almost exclusively on its medical-expert characters and their various scientific exploits and investigations. The plot includes a bit of derring-do, but it probably comprises less than five percent of the book’s length.

There are, of course, plenty of excellent non-thriller medical novels that don’t include any clichéd derring-do, books like W.C. Heinz’s The Surgeon, or Alice Hoffman’s At Risk, or Peter DeVries The Blood of the Lamb. But we are concerned here with medical thrillers, not mainstream medical novels. In my biased opinion, the standalone medical thrillers of Tess Gerritsen are very good at avoiding the trap of morphing into James Bond thrillers. Her medical thrillers do include some gunplay and fisticuffs, some chases and some moustache-twirling villains, but these things usually come very late in the novel and don’t overwhelm the medical aspects of the plot. She tends to stay relentlessly focused on scientific matters. If she has a weakness, it may be that, because she began her career by writing novels of romantic suspense, she seems obliged to throw a fairly generic romance into every one of her thrillers. But people falling in love, going out on dates, having sex, breaking up – these are the stuff of everyday human life, and thus they don’t seem as ridiculous as when a meek medical student suddenly morphs into Jack Reacher.

The six Michael Palmer novels that I’ve read so far this year – The Sisterhood, Flashback, Extreme Measures, The Patient, The Society, and The Fifth Vial – vary in the amount of fairly generic action sequences they contain. The Fifth Vial often feels more like a routine detective novel than a top-notch medical thriller. The Sisterhood, his first novel, remains largely focused on medicine and medical issues (specifically euthanasia), with generic detective elements comprising only about five or ten percent of the book’s length and not really doing it any harm (it is, after all, a thriller and not a mainstream medical story). The Patient, one of my favorites, remains mostly a very intriguing medical mystery until about page 265, when terrorists take over an upper floor of a Boston hospital and threaten to kill everyone there unless their demands are met. As it turns out, the terrorists have also planted bio-weapons in various locations around Boston and are planning to explode them and kill thousands of people should the authorities try to impede their escape from the hospital after their “business” there has been completed. The book is 435 pages long and those final 170 pages consist largely of shootouts, hairsbreadth escapes, helicopter chases, bombs going off, a horrible nerve-gas killing, and so forth. Palmer is better than the average physician-novelist at writing non-medical action sequences (Gerritsen is even better, and her 2005 novel involves a similar terrorist takeover of a hospital), but he is certainly no Frederick Forsyth or Stephen Hunter. The final 170 pages of The Patient fly by quickly and enjoyably but not very memorably. Which is a shame, because the first 265 pages of the book, which focus rather tightly on cutting edge medical procedures circa the year 2000 are excellent.

Flashback is another of my favorite Palmer novels. Whereas The Patient deals with the treatment of largely inoperable brain tumors, Flashback deals with anesthesiology and its potential abuses. The villain in Flashback is far too much of a moustache twirler; and the hero (the villain’s brother) is far too much of a goody two shoes. Nonetheless, the medical info about anesthesiology and its potential risks and misuses is fascinating. For most of its length, the book remains largely focused on a medical mystery, and that’s a good thing. The ending is a bit over-the-top, but not unbelievably so by thriller standards. And pretty much the entire story unfolds in a hospital setting, which is also generally a plus in a medical mystery.

The Society is a 2004 novel that took on a sudden horrible new relevance twenty years later in 2024. It concerns the hunt for a killer who is assassinating the CEOs of various managed-care corporations. These corporations make life-and-death decisions about medical care based, in part, upon financial considerations, occasionally denying life-saving procedures to patients because of, say, a pre-existing medical condition or improperly filled out paperwork, resulting in catastrophic outcomes for some patients. The story resonates in many ways with the December, 2024, murder of Brian Thompson, who was CEO of UnitedHealthcare, a major American health-insurance company. The novel reminds us that health-care executives were perceived by many Americans as villains long before Luigi Mangione became notorious. In an author’s note at the beginning of The Society, Palmer states that all of the nightmarish encounters between patients and managed-care companies detailed in the novel are based on real-life cases. It’s clear that Palmer disliked the rise of the managed-care middlemen who changed the face of American medicine late in the twentieth century. He wasn’t alone. Robin Cook has written a few anti-managed-care thrillers of his own (about which, more in a moment).

The hero of The Society is an honorable surgeon, Dr. Will Grant (old Fentanyl Feet, mentioned above), whose public statements about the harm caused by managed-care corporations has made him a target of the industry and, as a result, a suspect in the various CEO murders. Dr. Grant’s dislike of managed care, shared by many of his colleagues, offers Palmer a mouthpiece for some of his own opinions on managed-care corporations. Often these opinions are not subtly expressed. Here is one of Dr. Grant’s colleagues talking about managed care: “Never in our history have our medical students and residents been better prepared for the rigors of taking care of patients. But ironically, never has the care their patients are receiving been poorer. Hospitals are no longer safe, accessible havens for the ill and injured. Getting admitted to one is often more difficult than getting into an Ivy League college. Cost of care has become our standard of care. The stethoscope and careful physician exam have been replaced by paperwork and excessive documentation. And all of this for only one and a half trillion dollars a year – many, many times what the very effective and accessible Canadian health-care system costs. Health care in America, the most affluent and resource-blessed nation in the history of the world, is a disgrace, and expecting change to come from insurance executives, who are the oilmen of medicine, is just not going to cut it. That is like asking the fox to build improvements in the chicken coop.”

Screeds like that tend to muck up the flow of the novel a bit, but they also illustrate just how passionate the author was about the subject of his fiction. The Society seems to have been written in the white heat of anger and frustration, and that fact lends it an appealing immediacy. It isn’t gracefully done, but it is compelling and stirring in the way of old muckraking novels such as Upton Sinclair’s The Jungle or David Graham Phillips’s Susan Lenox: Her Fall and Rise. The novel also possesses an agreeable blend of medical fiction with action sequences, with the latter making up only about a quarter of the story (primarily in the novel’s climactic chapters).

Palmer’s best-known novel is probably 1991’s Extreme Measures, mainly because it was the source of a 1996 film starring Gene Hackman and Hugh Grant. Although it contains almost as much crime-fighting as it does medical machinations, it is nonetheless one of the best medical thrillers I have read. In other books, Palmer’s forays into straight detective-story territory can feel a bit rote. But here he really gives it the old college try, and the effort pays off. Occasionally he channels his inner pulp-fictioneer:

“The two men stood in silence for a time, gazing down at the ghostly remains. Then they turned and headed back to the plane. As the engine roared to life, a scorpion crept out of Marilyn Colson’s skull and scampered across to the safety of a nearby pile of rocks.”

“The driver of the oncoming sixteen-wheeler, high on cocaine he had bought from a dealer in Cambridge, never saw the figure lurch out of the shadows and onto the road; nor did he feel the impact when the reinforced steel grille-guard of the truck slammed into the man full force. What remained of the genius biochemist’s right arm became entangled in the metal grate as the semi roared on through the rain. The young driver, immersed in a Guns and Roses [sic] tape, sang along as he drove, unaware of the huge, grotesque ornament suspended just below the Mack bull dog on his hood.”

I like Extreme Measures a lot, but I prefer novels such as The Society, The Patient, and Flashback, that remain, for the most part, more tightly focused on medical matters.

The six medical thrillers I’ve read by Palmer this year can mostly hold their own with the six novels of Tess Gerritsen’s that I categorize as standalone medical thrillers (Harvest, Life Support, Bloodstream, Gravity, The Bone Garden, and The Surgeon). I have a slight preference for Gerritsen’s six books, because they are a bit more artistically adventurous. Much of Gravity takes place on board the International Space Station orbiting the earth. The Bone Garden weaves together two time lines, one set in the beginning of the twenty-first century and one set in 1833. Both Gravity and Bloodstream incorporate elements of science-fiction. Your mileage, of course, may vary. If you love medical thrillers, you ought to delve into the fiction of both Gerritsen and Palmer.

Often, the person credited with inventing or, at the very least, popularizing a fiction genre, isn’t necessarily the best writer in the field. Plenty of good legal thrillers were written before Scott Turow’s 1987 bestseller, Presumed Innocent, became a bestseller and was credited with initiating the legal thriller vogue. And plenty of better legal thrillers have been written since then as well. But Scott Turow and John Grisham are generally the first two names mentioned when people talk about legal thrillers. Likewise, Robin Cook’s 1977 novel Coma is often credited with kicking off the medical thriller genre, despite the fact that plenty of medical thrillers were published in earlier years, decades, and centuries. So be it. Coma was a massive bestseller in paperback and did, indeed, inspire American publishers to start seeking out more medical thrillers, especially ones written by actual doctors. Cook himself didn’t seem eager to be known primarily as a writer of medical thrillers. He followed up Coma with Sphinx, a mystery involving Egyptology but not much in the way of medical material. The book was nowhere near as well-received as Coma. Cook learned his lesson. Nearly every novel he has written since then has been a medical thriller of some sort.

I was a fan of Coma back when it was first published. I continued to read Cook’s novels throughout the eighties but with less and less enjoyment. A while ago I tried to re-read Coma but lost interest in the project. Last December (I think) I got hold of Cook’s 2005 medical thriller Marker, to see if I had possibly given up on him too early. Marker contains some of the most compelling early chapters I’ve ever encountered in the medical thriller genre. Alas, it is a massive book (nearly 700 pages in paperback) and by about the midway point it began to read more like a generic crime novel than a medical thriller. My bookmark sits between pages 378 and 379, and is likely to always remain there. Determined to give Cook more opportunities to prove himself a master of the medical thriller, last week I read his 1998 novel, Toxin. This one I actually finished. In fact, I rather enjoyed it. Curiously, like Palmer’s The Society, Cook’s novel is – in part, at least – an anti-managed-care tract. It is also as much of an indictment of America’s meat-packing industry as Upton Sinclair’s The Jungle is. Like The Society, it appears to have been written in haste under the spell of an intense urgency to expose several developments in Corporate America that Cook seemed to believe posed serious threats to the nation’s health. I kept being reminded of Robert F. Kennedy Jr.’s misguided anti-vaccine crusade while reading Cook’s anti-meat-industry novel. If Kennedy were a more skilled fictioneer, he might have given us a novel called Vaccine, which could rival the immediacy and fervor of Toxin.

Although I enjoyed reading Toxin, it can’t hold its own with the best of Palmer and Gerritsen. The first half of the book is by far the better part of it. The story concerns a cardiac surgeon named Dr. Kim Reggis, a divorced father of a daughter named Becky who is, I believe, about ten. The early chapters chronicle (often in disgusting detail) how a diseased cow carcass makes its way through, first, a slaughterhouse, then a meatpacking plant, and then finally, in the form of frozen hamburger patties, to a Midwestern fast-food restaurant called The Onion Ring. In alternating chapters we also see how Dr. Reggis is struggling, post-divorce, to maintain a healthy relationship with his daughter. One of the most admirable aspects of Cook’s novel is that he did not make his protagonist a very likeable person. Dr. Reggis is a violent hothead. Much of the hardship he endures over the course of the novel he brings on himself. Though a brilliant surgeon, he was a failure as a husband and isn’t much of a father either. He is determined to fix his relationship with Becky. So, one day, he decides to take her out for dinner to her favorite restaurant – The Onion Ring. Yup, Becky’s immune system is on a collision course with some E. coli-tainted beef.

The chapters chronicling the way that tainted beef makes its way first into America’s food-supply system and then into a young girl’s body are fascinating and terrifying. These are followed by chapters detailing Dr. Reggis’s struggles to get help for Becky. Despite his stature as one of the country’s top cardiac surgeons, when Reggis takes Becky to the hospital where he is employed, he is given no special treatment. Quite early on he begins to suspect that Becky may have acquired a food-borne toxin at The Onion Ring, but he has no actual proof of this. He demands that the hospital emergency-room employees run a series of tests on her to see if she might be suffering from salmonella or some other food-related illness. Alas, the managed-care company that runs the hospital refuses to order tests that Dr. Reggis wants. As far as the hospital’s emergency-room doctors are concerned, Becky is suffering from nothing more than a stomachache. They send her home with some non-prescription antacid, or something equally unequal to the challenge of battling E. coli.

Naturally, Becky’s condition quickly worsens. And Dr. Reggis, never a very psychologically healthy person, begins to, as they say in the medical field, lose his friggin’ mind. He becomes convinced that Becky is the victim of a vast conspiracy among various deep-pocketed players in America’s meat-packing industry. Sadly (for the reader, that is) it turns out that he is right and, about midway through the novel, Dr. Reggis becomes an angrier version of Jack Reacher. He breaks into meat-packing plants. He dies his hair blond and gets a job in a slaughterhouse. He beats up an employee of The Onion Ring. He punches an emergency-room doctor. He gets a kindly employee of the USDA killed. He fights off a knife-wielding assassin not once but several times. A gun-wielding assassin is sent to kill him, but that effort fizzles out. In its second half, the book becomes a rather generic action thriller, and its medical elements sit mostly on the back burner, simmering like bad hamburger on a under-heated grill. The pace is fast and some of the action sequences are moderately enjoyable. But, considering how compelling and well done the first half of the book was, the second half cannot be seen as anything but a major disappointment.

Also, it must be said, Cook is not much of prosesmith. To be sure, Gerritsen’s isn’t exactly Raymond Chandler. Her prose tends to be fairly workmanlike, but that is a quality I like in a pop-fiction writer. Palmer’s prose is less consistent than Gerritsen’s. For the most part it is workmanlike. But every now and then he seems to be striving for a more literary style that always remains well out of reach. He’s most enjoyable when he lets his freak flag fly and writes about scorpions crawling out of eye sockets.

Cook, however, is often an appallingly bad writer. He suffers from the condition known as “said bookism,” wherein a writer goes to embarrassing lengths to avoid using the perfectly suitable word “said.” At least a dozen times in Toxin he writes a line of dialog and concludes it with “he spat.” At one point he writes:

“Bull,” Kim spat.

Can you really spit a word has no sibilants?

Several times characters in Toxin “laugh mirthlessly,” as if they are characters from a 1920s British comedy of manners.

The knife-wielding assassin is, sadly, a Mexican who is as subtly drawn as the Frito Bandito.

“No problem!” Carlos said with emphasis. “Tonight I keeelll him!”

Why bother with an exclamation mark if you’re going to follow it up with, “Carlos said with emphasis”?

Many of the characters are given descriptions so generic that I couldn’t understand why Cook even bothered describing them at all:

Mrs. English was a diminutive, silver-haired lady who looked like the quintessential grandmother.

Thanks a lot. Why not just say “little old lady” and spare us the wordiness.

As a pop-fiction fan, I have a fairly high tolerance for crappy writing. Sometimes I even enjoy the crappiness. It can add to the pulpiness of a good piece of pulp. But I’m not sure how much more of Robin Cook’s godawful writing I can subject myself to. The man has written something like forty novels, almost all of them medical thrillers. Despite my recent disappointments with his work, I will probably give a few more of his novels a try. He is regarded as the father of the modern American medical thriller, so I feel I owe him a chance to prove that he is also the master of the modern American medical thriller. I suspect that more disappointment lies ahead. I doubt that he has written any medical thrillers as good as the best of Palmer and Gerritsen. And he almost certainly hasn’t written anything as good as Richard Preston’s lone solo novel, The Cobra Event. But, in my review of Kelly Parson’s Under the Knife, I unjustly dismissed Michael Palmer’s medical thrillers as second rate. I don’t want to make the same mistake with Cook. I feel I owe him a few more chances to prove himself worthy of being mentioned in the same breath as Gerritsen and Palmer. But I have a feeling that, by exposing myself to more of Cook’s prose, I will be setting myself up for a lot of mirthless laughter.