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In his most high-concept thriller yet: 12-time New York Times bestselling author Michael Palmer delivers a novel at the crossroads of presidential politics and cutting-edge medicine.

Gabe Singleton and Andrew Stoddard were roommates at the Naval Academy in Annapolis years ago. Nowadays, Gabe is a country doctor and his friend Andrew has gone from war hero to governor to President of the United States. One quiet, rural day, helicopters land on Gabe’s front lawn and out from one of them strides his old friend. The president’s physician has suddenly and mysteriously disappeared, and he needs Gabe to take the man’s place. Gabe reluctantly agrees, but not until he is ensconced in the White House does he realize that strong evidence has been kept from him that the president is going insane. Facing a crisis of conscience surrounding presidential illness and the Twenty-fifth Amendment, Gabe discovers that his friend’s condition may not be of natural causes. Who? Why? And How? The president’s life is at stake. The safety of the world is in jeopardy. Gabe must find the answers, and the clock is ticking.

THE FIRST PATIENT: Background Notes

I’ve tried, with each of my books, to give readers some insight as to how the book came to be. Certainly, with The First Patient, the route was an unusual one. I am not the sort of writer whose brain is just bursting at the seams with plot ideas. For me it’s been a struggle almost every time. As The Fifth Vial was winding down, and I was casting about for book next, my seventeen-year-old son, Luke suggested that I write about nanotechnology, which all of the kids in his class were talking about that day. I confessed I knew next to nothing of nanotechnology, but I also confessed I knew next to nothing of what my next book was going to be about. For weeks after, I researched the subject, and loved what I learned. Finally, I took the plunge and wrote a brief outline about the potential for intelligence of so-called nanobots. Proudly, I shared my proposal with son Daniel, a songwriter and fine, imaginative novelist.

There followed a protracted, pregnant silence. Then, “…um, Dad, I don’t know how to tell you this, but I just read that book. And to make matters worse, it was written by Michael Crichton.”

Glurp!!

I read the book, Prey, and it was darn close to what I was thinking about.

Stuck again.

Enter my brilliant editor, Jennifer Enderlin at St. Martin’s Press, who called me not knowing that I was in an idea crisis. She had had a dream—a dream that I wrote a thriller about the President’s doctor called The First Patient! Now, THAT’S an editor!! I tried arguing that I knew nothing of Washington or presidential medicine or presidential politics. But once again, I started reading – book after book on presidential morbidity, mortality, and the Twenty-fifth Amendment, which has to do with getting a president out of office when he (she) doesn’t want to go. Then, with my new awareness of the field, I turned to the Internet, and almost immediately hit gold in the form of Dr. Connie Mariano who, for more than ten years, was arguably the most powerful doctor in the world – the personal White House physician to H.W. Bush, the Clintons, and for a short while, George W. She was working in a new career and after asking around and reviewing my web site, agreed to be my advisor for this book. And so she was.

I decided to write about the president’s friend and physician, coming to believe that the president was going insane. But why? How? It was going to be a very short book if he just went crazy.

Think….think….think, and suddenly there the answer was, right in front of my nose – er, I mean right in my bookshelf. Nanotechnology!! The circle was complete, and all I had to do was add the words and maintain my contact with Dr. Mariano.

From The Sisterhood, Michael Palmer’s first New York Times bestseller, to The Patient, his ninth, reviewers have proclaimed him a master of medical suspense. Recognized around the world for original, topical, nail-biting suspense, emergency physician Palmer’swork has been translated into more than thirty-five languages. Now he reaches controversial and startling new heights in a terrifying tale of cutting-edge microbiology, unbridled greed, and murder, where either knowing too little or trusting too much can be FATAL.

In Chicago, a pregnant cafeteria worker suffering nothing more malevolent than flulike symptoms begins hemorrhaging from every part of her body. In Boston, a brilliant musician, her face disfigured by an unknown disease, rapidly descends into a lethal paranoia. In Belinda, West Virginia, a miner suddenly goes berserk, causing a cave-in that kills two of his co-workers. Finding the link between these events could prove FATAL.

Five years ago, internist and emergency specialist Matt Rutledge returned to his West Virginia home to marry his high-school sweetheart and open a practice. He also had a score to settle. His father died while working for the Belinda Coal and Coke Company, and Matt swore to expose the mine’s health and safety violations. 

When his beloved Ginny succumbed to an unusual cancer, his campaign became even more bitterly personal. Now Matt has identified two bizarre cases of what he has dubbed the Belinda Syndrome–caused, he is certain, by the mine’s careless disposal of toxic chemicals. All he needs is proof.

Meanwhile, two women, unknown to one another, are drawn inexorably to Belinda, into Matt’s life–and into mortal danger. Massachusetts coroner Nikki Solari comes to attend the funeral of her roommate, killed violently on a Boston street. Ellen Kroft, a retired schoolteacher from Maryland, seeks the remorseless killer who has threatened to destroy her and her family.Three strangers–Rutledge, Solari, and Kroft–each hold one piece of a puzzle they must solve, and solve quickly. If they don’t, it will be far more than just their own lives that are at risk.

Michael Palmer has crafted a novel of breathtaking speed and medical intricacy where nothing is as it seems and one false step could be FATAL.

Author Notes

Fatal will, I hope, become the most controversial of my books. Five years ago, I began to think that I might want to write a thriller dealing with vaccinations. My interest in the field was the result of our efforts to diagnose and treat the developmental delay of our son, Luke.

As a physician and parent, my interest in vaccinations did not go beyond the perfunctory. If the pharmaceutical industry or the FDA or my family pediatrician said “vaccinate” I vaccinated, whether it was my patients or my children. No questions asked. In 1990 my son Luke was born. He received the standard vaccinations despite the fact that he was felt to have “allergies” including one to milk. At 8-months of age he began having ear infections–almost continuously until 19-months of age, when I insisted he have tubes put in. The procedure stopped the need for antibiotics, but I believe the damage to his nervous system was already done.

By the time Luke was 3 years old, he was diagnosed as having a form of autism. Years later, the diagnosis was honed down to “Asperger’s Syndrome,” also known as “right brain autism”, a condition on the spectrum between severe low-functioning autism and mild ADD. In making the rounds of various treatment centers, I became acquainted with many, many parents and their developmentally delayed children. The similarities from case to case were often striking, with chronic ear infections frequently preceding the onset of symptoms. More and more, the issue of vaccinations came up. Could our children’s immunizations have somehow compromised their immune systems, making them prone to ear infections and the subsequent dangers of excess antibiotics? Other parents believed that vaccinations directly caused their children’s autism.

I began reading and researching and found that while there are few answers in the area of vaccine-caused disease, there are many unanswered questions. Over the years, I became determined to write a thriller that raised these issues, just as others of my books have dealt with euthanasia (The Sisterhood), corporate medicine (Flashback), infertility (Side Effects), managed care (Silent Treatment), alternative medicine (Natural Causes) and academic research cheating (Miracle Cure). Over countless hours of research for Fatal, I examined the literature and spoke to parents, vaccine advocates, proponents of vaccine caution, and my academic friends. It was my hope as always in my writing, to craft a riveting story that raised questions rather than answered them. In the case of Fatal, the plea is made for a renewed look at vaccinations, extended clinical research, tighter controls on the studies necessary before a vaccine is released, and a review of those vaccinations which should be made mandatory. I am grateful to many for their teachings, but especially Barbara Loe Fisher and Kathi Williams of the National Vaccine Information Center, Gratefully, through hard work and concerned professionals, Luke is overcoming the obstacles of his condition and is thriving. I hope someday soon, we learn what is behind his diagnosis, and that of so many others. As with The Patient, there is an author’s note at the end ofFatal which will help direct those interested in learning more about environmental medicine or vaccines.

Neurosurgeon Jessie Copeland works at the very frontier of neurosurgery, developing technology that could revolutionize the treatment of brain tumors. But her work brings her to the attention of an infinitely dangerous man.

Claude Malloche is brilliant, remorseless—a terrorist without regard for human life. He is also ill with a brain tumor considered to be inoperable. Nothing can stop Malloche from getting to the woman he believes can cure him. For those caught in his path, the nightmare has just begun…and no one is more aware of the stakes than Jessie Copeland.

In brain surgery there are no guarantees—but that’s exactly what Malloche demands. With disaster just one cut away, Jessie faces the most harrowing case of her life—and the price of failure may be thousands of lives….

Author Notes

Unlike any of my other stories, The Patient started with a “What if?” (see Writing Tips) that didn’t involve any particular issue in medicine. “What if the most mysterious, ruthless, brilliant assassin in the world had a brain tumor and needed surgery?” I believe it is, along with The Sisterhood, the strongest premise I have concocted. In order to make the story work, I spent much of three months following my friend, Dr. Eben Alexander, around. Alex is a brilliant scientist and neurosurgeon, in addition to being a compassionate and involved physician. I watched as he told patients their operation had succeeded, and told others that, unfortunately, their cancer had regrown. I stood in the operating room for many hours watching him operate incredibly complex machinery while he was painstakingly dissecting out a tumor from a patient’s brain. Much of who Jessie Copeland is in this novel, she owes to Alex. The notion to delve into robotics is what ultimately pulled this book together. I want to take total credit for the idea, but I think the initial germ of it came from Dr. Alexander. I read as much as I could to find out about medical robotics, and spent hours sketching the electronic beastie that would become ARTIE in the book.

For more than a year, it looked as if Noah Wyle and his production company were going to make a film of this book. Then, alas, the project fell through, in part I think because of the post 9/11 reluctance of Hollywood to produce movies about terrorists.

This is the first of my books with an author’s note at the end, dealing primarily with robotics. Ironically, the day The Patient first hit the stores,The New York Times featured the report of a cardiac bypass operation done robotically (and successfully) via three pencil-sized holes placed in the patient’s chest.

The master of medical suspense takes you to prestigious Boston Heart Institute, where some patients are dying to get well….

After a troubled past, Dr.  Brian Holbrook has been given a second chance to prove himself.  At state-of-the-art Boston Heart Institute, he’s been chosen to join the medical team testing a new miracle drug.  The initial results are so promising that Brian pushes to get his father–who suffers from a dangerous heart condition–accepted into the study.

But Brian is beginning to suspect his superiors are hiding something.  Why are crucial records disappearing? Why did a patient making startling progress suddenly die? Is the miracle drug a prescription for death? The answers could cost Brian more than his career.  For at Boston Heart Institute, knowing too much is the quickest way to the morgue.

Author Notes

Miracle Cure was inspired by several highly publicized cases of cheating in academic research, one of them in the lab of a Nobel Prize winner here in Boston.

This is perhaps the most autobiographical of all of my books, although there are certainly large chunks of my life in every one of them. Brian Holbrook’s life parallels my own in that I tore up a knee playing football (in my case touch football in med school against the law school) and required surgery (a total of 5 operations so far.) With time, I became addicted to the pain medicine, just as Brian did, and ultimately got into serious trouble. Gratefully, 23 years ago, concerned doctors came to my aid. Since then, I have devoted my life to helping docs with problems similar to mine, initially as a volunteer, and now as an associate director of the Massachusetts Medical Society’s Physician Health Services. Brian’s trials and tribulations were modeled after those faced by many of “my” doctors. Characters in The Sisterhood, Extreme Measures (he was framed) andSilent Treatment also had to deal with alcohol and drug problems. Write about what you know about, I am always telling would-be novelists. Another aspect of Miracle Cure that hits close to my life is Brian’s father’s cardiac disease. While I was writing the novel, I was also helping to care for my father who had terminal cardiac disease and prostate cancer, which took his life a few months before the first draft of the book was finished. Many of our interactions and exchanges found their way onto the pages.

In preparation for the writing of this book, I spent many hours observing in the cardiac catheterization lab at the Massachusetts General Hospital where I trained. Drs. Michael Fifer and Igor Palacios were indispensable in this regard.

In his five bestselling novels, from The Sisterhood to Natural Causes, physician Michael Palmer has drawn on years of firsthand emergency-room experience to create the drama of a frighteningly authentic world–a world where the line between medicine and murder is scalpel-thin.  Now, in his most harrowing suspense novel yet, Palmer reveals how the power to heal can become a license to kill….

With his wife, Evie, scheduled for surgery the next day, Dr.  Harry Corbett goes to the hospital for what he hopes will be a quiet evening of reconciliation.  In recent weeks Evie, never quick to share her feelings, has been more closed and distant than ever.

But when Harry reaches Evie’s room, it is too late for reconciliation.  Shockingly, without warning, Evie is dead.  The police suspect homicide.  And their only suspect is Dr.  Harry Corbett.

Harry is not prepared for the stunning revelations that follow: His bright, beautiful, highly ambitious wife was leading a double life; she may have had dangerous secrets.  But what secret could have been explosive enough to die for?

Then the killer strikes again, boldly, tauntingly murdering one of Harry’s favorite patients in such a way that only Harry knows the death was not natural.  This time Harry is certain: The killer, medically sophisticated, coolly arrogant, moving undetected through a busy urban hospital, could only be a doctor.  And he wonders–how many more will die?

Desperately Harry probes deeper, following the only clue Evie left.  What he finds is a sinister pattern that threatens patients in every hospital in the city.  Harry is engaged in a life-and-death battle of wits with a chillingly efficient monster.  And until the doctor is unmasked, no patient is safe from his lethal silent treatment.

Michael Palmer has done it again, delivering a no-holds-barred novel of medical intrigue– a gripping thriller that features the most terrifying physician since Hannibal Lecter.  Silent Treatment will keep your pulse racing from beginning to end.

Author Notes

People are always asking me which of my books is my favorite. And the truth is, just like children, I like each one of them for different reasons. Harry Corbett in Silent Treatment is my favorite protagonist, and The Doctor (Anton Perchek) is my favorite villain. I also like this cover the most of all of my books. I started this book wondering about managed care and what unscrupulous insurance companies might do if they could predict how much your illness would cost them over its entire course. Beyond a certain threshold, it seemed, it would not be cost-effective for them to allow that illness to run its full and natural history.

Harry, forty-nine and in denial about increasing chest pain when he exerts himself, is drawn into danger and conflict with a genius killer, when all he wants to do is show up every day at his gritty inner-city office and take care of people, many of whom have no insurance at all. He is not only juxtaposed against The Doctor, but also against his brother Phil, who, without even a high school diploma, has become a mogul in car dealerships. Ultimately, Harry’s survival will depend on Phil. Silent Treatment features a grand chase along the New Jersey Palisades between a sedan full of heavily armed killers and a 36-foot customized Winnebago motor home. It ends in the massive boiler plant of a huge New York hospital. What more can I say? A script for Silent Treatment was written to be a four-hour mini-series, but for whatever reason, the project just waned. Right now we are trying to resurrect it. I recently learned that the audio of this book will be part of Jiffy Lube’s summer promotion in 2002. Get a lube and be given a copy of Adam Arkin reading Silent Treatment. Sounds goofy, but the truth is, I’m flattered.

In the tiny town of Patience, California, newcomer Dr. Abby Dolan has noticed a frightening syndrome among her emergency room patients.  It begins with a baffling, seemingly minor set of symptoms, but builds relentlessly until it plunges its victims into insane, murderous rages.  As she searches for clues to this deadly mystery, Abby’s superiors make it clear her probing is unwelcome.

Soon Abby will learn just how high the cost of the truth may be–and how far someone will go to keep a lethal secret.  But she may not find the answer until it’s too late to save her patients, her career…her life.

Author Notes

The impetus for this book, as with some others, came from the news–this time, two very disturbing events in California. In one, a gunman in San Diego opened fire inside a crowded McDonalds, killing many. Not long after, in northern California, a man with a semi-automatic weapon opened fire on a playground of children, killing a number of them. Inconceivable! I began to wonder how such events could happen, and I decided (obviously) that the gunmen were insane. Then my storyteller’s imagination began to rumble. What if the two of them, plus some others, were together at the same place and moment when some sort of toxic exposure occurred, poisoning their brains, and rendering them homicidally disturbed, with none of them realizing what had happened. Critical Judgment started there and just kind of evolved. Abby Dolan, a junk-food addict must make a major decision. She loves her ER job in San Francisco, but her engineer fiancé has taken a position in the small mountain town of Patience, a hundred and fifty miles away. She decides her love is more important than her career, and accepts an ER position in Patience, not knowing that the man who awaits her is hardly the man who left the city to move there.

One of the characters who drives the story and about whom I received many letters, is Ives, a hermit and master archer (read Zen and the Art of Archery) who was not even a character in my original outline. I developed him simply because I needed a particular type of patient for Abby to care for in the ER. Almost before I knew it, he had taken over much of the book. That’s when this writing business is really fun!

Of all my books, I see this one and The Patient as being the most cinematic. So far, no go, although The Patient was optioned for a while. Sometimes I look at what comes out of Hollywood and just shake my head. Sometimes I get rankled that an author is not considered to have truly arrived unless some cigar-chomping producer in Hollywood decides to film his book. What’s that? Your second cousin once removed knows someone at Dreamworks? Well, now, let’s talk!

Dr. Eric Najarian. He’s young, talented, and ambitious. He has all the qualities they’re looking for at White Memorial Hospital. He doesn’t know he’s being watched. Judged. An elite clique of medical professionals thinks he has what it takes to join their secret club. All the young doctor has to do is agree to play by their rules.

But Eric has already seen too much. A missing corpse. An unspeakable mutilation. A brutal abduction. It’s only the beginning of a plot of terrifying evil. A sinister plan the group will stop at nothing to hide. And if Eric refuses to become their colleague–he will be their next victim.

Author Notes

This project started when my friend, Eric Radack gave me the book, The Serpent and The Rainbow by Harvard ethnobotanist, Dr. Wade Davis. The book (subsequently made into a pretty good movie by Wes Craven) was about voodoo and Davis’s search in Haiti for the “Zombi Poison,” a drug that could slow metabolism so much that a person could appear dead even to a trained eye when they weren’t. At Wesleyan University in Connecticut where I went to college, I took a seminar on Edgar Allan Poe. Poe wrote so effectively about people being buried alive that for years wills demanded that a bell-and-chain set-up be rigged in the deceased’s casket just in case they awoke underground.

So, my “What if?” (see writing tips) was born. What if there was a drug that could make a person look dead when they weren’t? At last, even though my productivity hadn’t increased all that much, Bantam felt my first three books had built up enough of a following to take the risk of coming out in hardcover. The hardcover book did great as did the paperback that followed, and that was that.

Many of my books have been optioned for films, but so far only this one has been made. An option is where the producers pay a sum for rights to a book for a stated length of time. Extreme Measures was optioned by Castlerock Pictures for almost four years before it was finally made. The 1996 movie starred Hugh Grant, Gene Hackman, and Sarah Jessica Parker, and was produced by Elizabeth Hurley. I was on the set for a time as a “script consultant” but really had nothing to do with the making of the film. Much was changed from the book to the screenplay, but some of the critical story points were not. The credits read “Based on the Book By . . . ” and based on the book it was. I enjoyed the film, and wasn’t the least put out with the choices they made although, of course, I think it would have been a much better movie if they had stayed closer to the novel I wrote.

Dr. Sarah Baldwin races to a Boston hospital with a young woman whose normal labor has suddenly become a matter of life and death. As she struggles to save both mother and baby, she doesn’t know that two other women have already died under horrifying identical circumstances. And so begins Sarah’s own nightmare, as she learns that the prenatal herbal vitamins she prescribed are the only thing these women have in common. Soon Sarah is fighting to save her career, her reputation–her life. For she’s certain there must be some unknown factor linking these women, and as she gets closer to the truth, it becomes clear that someone will do anything–even murder–to keep a devastating secret.

Author Notes

I have been interested in alternative medicine since the day I started medical school. My school, Case Western Reserve University, was very psychiatrically oriented, and spent more time than most schools looking at the mind-body connection. During those years, I once witnessed a hypnotist do a C-section on a woman with no anesthesia save his voice. The operation took only minutes, and the joyful mother walked back to her room. Another time, a hypnotist told a woman she was going to be touched by a hot poker, and touched her arm instead with a pencil eraser. The skin beneath the eraser became red and blistered! That event spoke to me.

Sarah Baldwin, the heroine of the book, says many of the things that I believe about mind-body medicine. “Our microscopes keep getting bigger, and the things we can look at keep getting smaller, but we still don’t know why person “A” got a strep throat and person “B” standing right next to them didn’t.”

It is Sarah’s belief, and mine, that whatever helps a patient is worth doing, provided there is minimum downside, and also that he is not kept from finding the therapy that will do the most good. Ultimately, I believe that emotional state and the immune system will prove at least as important as genetics in determining who gets sick and who doesn’t.

Natural Causes was a breakthrough book for me in that it was the first of my novels to make it into the top five of The New York Times Best-Seller List. Also, although I generally steer away from listening to the audio abridgment of my books, I did enjoy Natasha Richardson’s reading of this one.

Toby is eight years old. He had a routine operation. It was fine. Now he’s gone home to terror. Months have passed. But Toby still bursts into tortured screams. Because something is very wrong. Toby can remember evey moment of the operation. All the trauma. All the pain. He relives evrey horrifying detail of surgery while he’s awake. Now someone must expose the unspeakable truth about this hospital. Or else an innocent child will die. And he won’t be the last. The next victim is being wheeled into surgery right now.

Author Notes

One of my favorites. “What if corporations started taking over hospitals and running them with a corporate mentality as for-profit businesses?” The idea was a natural and very prophetic as it turns out. The trick with this book was to find a specific, scary example of what could evolve from my “What if?” (see writing tips) Enter Serenyl. I got the idea from a newspaper article about a woman who awoke from her surgery remembering very clearly the surgeon making disparaging remarks about her weight as he operated on her. The nurses in the OR corroborated her statements, and she ended up with huge settlements from both the surgeon and the anesthesiologist.

So my initial “What if?” was augmented by another–what if there was an anesthetic agent that made a patient look like she was asleep, and she woke up thinking she was asleep, but at some level of her brain, she was wide awake and experiencing her surgery. From that point on the writing was painless.

Ironically, after the book was published, I received dozens of letters and newspaper articles describing episodes where there was incomplete (or NO!!) anesthesia during surgery. For this book, I was assigned to editor Beverly Lewis. From 1984 until her untimely and tragic death in 1999, we worked closely together on six novels. I loved her as a person, a friend, and a professional, and I miss her every day. Once again (this time against my wishes), Bantam decided to publish the book as a mass market original. Again, the exchange: “Write faster.” “I can’t without compromising the book and giving up something I love doing.” Finally, after completing this book, I did cut back to about half time in the ER. In 1990, after my son Luke was born, I left the ER and began work in the field of physician health, helping doctors with mental illness, physical illness, and substance abuse problems. I continue with that job today.

Kate Bennet. A bright hospital pathologist with a loving husband and a solid future. Until one day her world turns dark. A strange, puzzling illness has killed two women. Now it endangers Kate’s closest friend. Soon it will threaten Kate’s marriage. Her sanity. Her life. Kate has uncovered a horrifying secret. Important people will stop at nothing to protect it. It is a terrifying medical discovery. And its roots lie in one of the greatest evils in the history of humankind.

Author Notes:

To my mind this was the hardest to write of all my books. Every published novelist has one book in him. The trick is to have two or more. The “What if?” (see writing tips) that got this ball rolling was, “What if there was a drug that could sterilize a woman without her knowing it?” The idea evolved from the angst of one of my cousins and several friends, all of whom were having trouble conceiving a child.

Whereas the story for The Sisterhood seemed to flow, this story was agony to put together. The success of The Sisterhood meant that now there was a contract before I even began working on my outline. And with the contract and the success came expectations. Linda Grey started as the editor of this book, then became the publisher of Bantam and turned the job over to Jeanne Bernkopf, who also edited James Clavelle. Once again, my willingness to rewrite and rewrite made it possible for me to learn on the job, so to speak.

Working full time in a busy ER saw to it that Side Effects didn’t get written quickly. Once again (with my blessing) the book was published as a paperback (mass market) original. “The public has a short memory,” I was told, “and you are not writing fast enough to take the hardcover gamble yet.” The publishers felt that if the book didn’t succeed in hardcover, the numbers ordered for the reprint (paperback) would plummet. “Write faster,” they suggested. “I don’t want to stop working as an ER doc,” I replied.