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The First Patient

The First Patient

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  About the Book

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.”


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.