Charlatans, by Robin Cook

Robin Cook is a doctor and author of a dozen or so medical thrillers such as Coma and Contagion. In this latest book we watch a few weeks in the life of resident Noah Rothauser. Rothauser has been awarded an extended year of residency at Boston Memorial Hospital. He is now the chief resident, responsible for scheduling and supervising residents. It’s a job that can lead to a teaching position at the hospital.

Unfortunately for him, the job also involves doing the weekly mortality review in which deaths in the hospital are investigated and reported on. Just a short time before his new job Rothauser was involved in one of those deaths when a routine hernia operation ended in the patient’s death. The surgeon was the hospital’s leading surgeon doing a favor for a hospital employee. Even with Rothauser responding to a code and having to open the patient’s chest to massage the heart the man dies.

There is a suspicion that some of the cause was a system allowing surgeons to tightly schedule surgeries. They can send an order ahead to have anaesthesia started so that they can enter the surgical theater and begin without having to wait for the anaesthesia to take effect. Unfortunately, the patient expected a spinal block and ate before surgery. The surgeon’s previous surgery took longer than expected, requiring the anaesthesiologist to switch to inhaled anaesthesia drugs. He vomits the food which fills his lungs.

Rothauser is already being pressured to leave the fast track procedure alone. It helps to increase the income of surgeons. Soon after there are two more deaths, and all three deaths directly or indirectly involve a beautiful and highly-regarded anaesthesiologist. She and Rothauser become romantically involved and the pressure on him turns into threats for his livelihood and insinuations that the relationship is clouding his judgment.

As the relationship deepens Rothauser learns that his doctor lover has a second career as a lobbyist, and seems to have a past that doesn’t match her resumé.

Once the reader starts rooting for Rothauser, which happens pretty quickly with his sharp interventions and ethical code, the book draws one in with the intense pressure on him, the fairly creepy attitudes of the leading physicians, and a secondary storyline blossoming that follows two killers posing as FBI agents.

I don’t think you can say Cook doesn’t have a regard for medical practice in the US, but his objections show clearly through the narrative. Powerful and well-paid surgeons are willing to put patients’ lives at risk to increase their personal income. Office politics reach a horrifying level as those surgeons target others for their own failings. Cook also slams a medical education system that was founded in 1910 and has only been modified enough to keep from destroying the health of residents (or putting their patients’ lives in danger) by beginning to allow the residents more reasonable schedules to avoid sleep deprivation.

It’s both an exciting and eye-opening book about the inner workings of a medical training hospital and it pits one dedicated resident against both the political system and some pretty horrifying people who are willing to cover up one person’s past.