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Book Review: The Last Surgeon by Michael Palmer

Fiction Reviews

Book Review: The Last Surgeon by Michael Palmer

The Last Surgeon by Michael Palmer
The Last Surgeon
by Michael Palmer
St. Martin’s Press, 384 pp.
CLR [rating:5]

A Writer at the Pinnacle of the Medical Thriller Genre

“I know you can’t believe this is happening, Ms. Coates, but I assure you it is. I have been paid and paid very well to kill you.” With these chilling words, Michael Palmer’s newest novel, The Last Surgeon, begins. In this agonizing initial scene, Belle Coates, an ICU nurse bound to a chair in her apartment, has no idea why she is about to die.

Central to this engaging tale is Dr. Nick Garrity. A surgeon, Garrity, suffers from Post Traumatic Stress Syndrome due to injuries suffered while an army surgeon in Afghanistan. A traitorous, previously trusted suicidal bomber detonates his explosive-laden truck after ramming through the front of the canvas field hospital at FOB Savannah. A total of twenty eight die in the blast including Nick Garrity’s fiancée, army surgeon Sarah Berman. Garrity witnesses her death as she is “nearly cut in half” by the truck before the explosives are detonated. Garrity, sheltered by a steel industrial sized medical refrigerator, is unconscious for 24 hours.

After his army service, Garrity practices medicine from a mobile clinic van for destitute people in both D.C. and Baltimore, all the while engaging in a search for a homeless military buddy, Umberto Vasquez. The missing person, a onetime U.S. Marine staff sergeant, never reappeared after allegedly being plucked from the streets by the military four years previously for a secret mission.

If Julie, the mobile medical clinic R.N. and Garrity’s tireless assistant, is almost too perfect, resourceful and perceptive, it is also true that all of the nurses who are part of this suspense filled drama are particularly well drawn. They are shown as the highly competent, knowledgeable and crucial members of medical team they typically are.

The mysterious hired killer, Franz Koller, is superbly characterized; a brilliant and malevolent master of his trade. He exhibits the conscience of a crocodile and obviously relishes his life’s calling; committing murders that don’t appear to be murders. Koller terminates a number of physicians who work in the same hospital as did the unfortunate Belle. He also has a day job, working as a substitute high school chemistry teacher. Teaching provides cover for his more lucrative and less demanding task of serial murder.

A secondary villain, Phillip MacCandliss, is an employee of the Veteran’s Administration, a claims adjudicator who finds joy in disallowing the valid claims of veterans suffering from PTSD. Who cannot rejoice at the eventual miserable death of such a miscreant?

Then there is Reggie, something of a benign and brilliant juvenile delinquent with an uncanny mastery of computer skills so that he is able to hack into the V.A. computer system to help obtain information pertaining to the missing Vasquez.

Deft characterizations continue with,”The Mole,” a certain Mr. Mollender, the reclusive and misanthropic medical records clerk who finally, in a rare act of benevolence, locates vital evidence. In a confirmation of Oscar Wilde’s aphorism that no good deed goes unpunished, Mollender pays dearly for what is apparently the solitary good deed of his misspent life.

Garrity’s Post Traumatic Stress disorder serves as the leitmotif that binds the story‘s disparate characters and incidents together. The several distressed veterans involved are portrayed with appropriate sympathy and a professional depth of understanding. PTSD also provides a fine contemporary resonance for this tale.

Nurse Jillian Coates, the older sister of the R.N. who died in the opening scene, locates Nick Garrity after she finds out that “Dr. Nick Fury,” a name found in her dead sister’s apartment, was his military nickname. This further arouses her suspicion that her sister’s death had some tie to him and to his concern over Vasquez.

As well as being a superb psychiatric nurse, Jillian is, as they say in the vernacular, smokin’ hot. Jillian, fortuitously enough, as she searches for clues to help deciphering the mystery of her sister’s death, turns up in Garrity’s medical van. It is more a matter of literary inevitability than predictability that Dr. Nick Garrity, lonely and bereft, and lovely grief-stricken Jillian Coates, R.N., meet. The two join forces in their pursuits—Jillian in the cause of proving her younger sister Ellen’s death was a homicide, and Nick in the pursuit of the elusive Umberto Vasquez as well as escaping his personal demons.

The amount of good luck—and bad—Nick and Jillian encounter in unraveling the mysteries confronting them sometimes stretch suspension of disbelief to the utmost limits of elasticity (e.g. When Garrity, fleeing the assassin Koller, leaps in desperation from a cliff face, it is his great good fortune that there is a river of sufficient depth at the bottom to receive his flailing body and preserve life). Similarly, the scene in which Garrity chases down a homeless and terrified drug addicted patient through rush hour traffic without becoming road kill is quite remarkable. In a similar vein, on his first visit to Jillian’s place of employment, he spots an unconscious alcoholic, a street person on a gurney in the hallway.

“Dunno for certain,” Nick said, ‘but I think his right pupil is slightly larger than the left.’

“Subdural?” Jillian asked referring to the life–threatening collection of blood expanding between the skull and brain that often followed head trauma.

Diagnostic tests confirm his near instantaneous life-saving diagnosis. Such acumen and perceptiveness is the medical equivalent of a hole-in-one, a performance to die for, for any male physician in the presence of his lovely nurse gal pal.

Yet if such is hyperbole, it is also indigenous to the genre, and no more of a concern than the endless love and loss of country music or the elaborate costumery and melodrama of grand opera. Garrity is an archetype, an ill-understood and imperiled hero who after overcoming every obstacle, exits hand-in-hand with the alluring heroine. It is part of the fun for our heroes to be bigger, somehow, than life, and for villains to be so brilliantly inventive and evil as to rival Satan himself. This fictional world of good and bad provides the reader with a comforting temporary escape from the real world with all its pesky shades of gray.

The plot winds its way through the 384 pages with more twists and turns than a sociopath’s psyche. The denouement, which reveals ties to the highest levels of government, is both inventive and effective.

Michael Palmer is a writer at the pinnacle of the medical thriller genre. He is an M.D. who has practiced internal medicine as well as emergency medicine and is currently an associate director of the Massachusetts Medical Society Physician Health Services, a unit that seeks to assist impaired physicians. His background as physician provides a depth and verity to the medical aspects of his stories. The Last Surgeon is an entertaining and engaging read, one that is likely to join the previous fourteen of Michael Palmer’s well-constructed medical mysteries on the international best seller lists.

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John R. Guthrie is a former Marine infantry rifleman. He later studied medicine and became the commanding officer of a U.S. Navy Reserve Shock Surgical Group. He practiced family medicine in the Smoky Mountain foothills of Appalachia. His fiction, poetry, and nonfiction has been published widely. He is the editor and publisher of the monthly webzine "The Chickasaw Plum: Politics and the Arts Online." Tianjin Grand Bridge

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