Fatal Mass market paperbound - 2003

From the jacket flap

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. Massachusettscoroner 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.

"From the Hardcover edition.

Excerpt

CHAPTER 1

Belinda, West Virginia

Matt, this is Laura in the er. . . . Matt?"

"Yeah."

"Matt, you're still asleep."

"I'm not."

"You are. I can tell."

"Time zit?"

"Two-thirty. Matt, please turn on a light and wake up. There's been an accident at the mine."

Matt Rutledge groaned. "Friggin' mine," he muttered.

"Dr. Butler has activated the disaster protocol. Team B is it tonight. Matt, are you awake?"

"I'm awake, I'm awake," he pronounced hoarsely, fumbling with the switch on his bedside lamp. "Nine times seven is fifty-six. The Miami basketball team is the Heat. The fifth president--"

"Okay, okay. I believe you."

From college, through medical school and residency, and now into his life as an internist, it had always been a chore for Matt to shut his mind down enough to fall asleep--but not nearly the challenge of subsequently waking up. Laura Williams knew this trait of his as well as any nurse, having worked with him in the ER of Montgomery County Regional Hospital for two years before his decision to switch over to private practice. She and all the other nurses had adopted the policy that Dr. Matthew Rutledge wasn't definitely awake until he could prove it beyond a reasonable doubt.

"Light on? Feet on the floor?"

"I'm up, I'm up. Hold on for a second." Matt tossed the receiver onto the bed and pulled on a pair of worn jeans, a can aerosols now T-shirt, and a light sweater. "Was it a cave-in?" he asked, tucking the receiver beneath one ear. He sensed a tightening in his gut at even saying the words.

"I think so. Ambulances are out there, but no one's been brought in here yet. The man from the mine just got here, though. He says he thinks ten or twelve are injured."

"Man from the mine?" Matt pulled on a pair of gym socks. Two toes--the little one and the fourth--poked through a hole in the left one. He briefly considered a replacement, then pushed the toes back in and went for his boots instead.

"He called himself the safety officer, something like that," Laura said.

"Tall, black hair with a white streak up the front?" Sort of like a giant skunk, Matt wanted to add, but didn't.

"Exactly."

"That would be Blaine LeBlanc. He's a very important person in Mineville. Just ask him. Laura, thanks. I'm up and dressed and on my way."

"Great. The first rescue unit won't be here for a little while, so drive slowly."

"I know. I know. Motorcycle equals donorcycle." He pulled on his boots. "I won't go over five, I promise. The rest of the team on their way in?"

"All except Dr. Crook. So far he hasn't answered his phone or his pager."

Please let it stay that way, Matt thought. Robert ("Don't ever call me Bob") Crook was a carriage trade cardiologist. One of the senior medical citizens in the multispecialty Belinda Medical Group, he had been the most vocal in opposition to Matt's move from the ER into their practice. Ultimately, though, those who thought a well-liked, Belinda-born-and-raised, Harvard-trained internist and ER specialist might just help fill the desperate need for a primary care doc won out over Crook, whose main objection (spoken) was that Matt was an arrogant weirdo who didn't dress or look like a doctor, and (unspoken) that he had once turned down his daughter's invitation to the prom.

"Well, I should be there in ten minutes."

"Make it fifteen."

"Okay, okay."

"And Matt?"

"Yes?"

"Nine times seven is sixty-three, not fifty-six."

"I knew that."

Matt set the phone down, pulled his dark brown hair back into a ponytail, and secured it with a rubber band. For as long as he and Ginny had known each other, he had worn his hair short--not exactly a crewcut, but almost. And by her decree, she was the only one allowed to barber him. Since her death, he hadn't done more than trim his sideburns. The stud in his right earlobe had followed a year or so later, and the tattoo on his right deltoid a few months after that. It was a masterful rendering done from a photograph of the white-blossomed hawthorn tree in their yard--Ginny's favorite.

The five-room log cabin the two of them had designed together was perched on a bluff looking out across the Sutherland Valley at the Allegheny Mountains. Pulling on a denim windbreaker, Matt stepped out onto the broad porch where, toward the end, Ginny had spent most of her time. In fact, only the tattoo artist in Morgantown had kept him from having the porch etched permanently into his arm instead of the hawthorn tree. ("I can dig the sentiment, man, but believe me, the aesthetic is just bogus.")

Anytime Matt began doubting his decision to come back to West Virginia--and of late those times were increasingly frequent--he needed only to walk out the front door of the cabin. This was Ginny's kind of night. There wasn't a single cloud in the new-moon sky. Directly overhead, the eternal river of the Milky Way shimmered across the blackness. The chilly late-summer air was, as always, tinged with a hint of smoke from the huge coal processing plant adjacent to the mine. Nevertheless, it was still sweet and fragrant with the scents of lavender, linden, wild orchids, wild roses, St. John's Wort, and hundreds of other kinds of blossoms.

Country roads, take me home, to the place I belong. . . .

Matt looped around the cabin to his one-car garage and fired up his maroon Harley Electraglide. In addition to the hog, he had a 900cc Kawasaki roadster and a 250cc Honda dirt bike, all of which he could pretty much maintain himself. The Harley was his choice for cruising, and the jackrabbit-quick roadster for those days when he wanted to live a bit more on the edge. The Honda, in addition to being a thrill a second in the woods, was invaluable in making house calls to a large portion of his practice, inaccessible by any but the most primitive road.

As he rolled down the gravel drive to State Highway 6, Matt started feeling the first rush of adrenaline at what the next few hours might hold. This accident was hardly the first he had dealt with courtesy of the Belinda Mine, although at ten to twelve injured it would be the biggest. Over the years, there had been bruises, gashes, strains, sprains, and fractures too numerous to mention. There had also been a few deaths. But the only other time disaster team B had actually been called in proved to be a farce. An underground train known as a maintrip had derailed deep in the mine. Twenty members of team B had milled around the ER from two until three in the morning before word was received that instead of the thirty to forty casualties originally reported, there were none.

However, this new disaster, Matt sensed, was the real deal.

The six-mile ride to the hospital was along a serpentine road for which the motorcycle seemed expressly created. Matt leaned into the familiar turns with a rhythm that had become second nature. He wondered if this latest disaster was yet another monument to the Belinda Coal and Coke Company's cutting safety corners wherever possible. Despite the constant pressure for modernization and improved safety that he and a few other brave souls tried to keep on the mine owners, little had changed. BC&C was persistently unwilling to do anything but the basest minimum to ensure the well-being of the miners. It was that way with the massive conglomerate today just as it had been that April night twenty-two years ago when the ceiling of Tunnel C-9--the tunnel cutely nicknamed Peggy Sue--caved in, crushing to death three miners, including shift foreman Matthew Rutledge, Sr.

CHAPTER 2

The er at the modern, 120-bed Montgomery county Regional Hospital had a patient capacity of twelve, including rooms specially equipped for orthopedics and pediatrics, as well as room 10, the "crash" suite for major medical or surgical emergencies. Two surgeons and a GP were waiting by the nurses' station when Matt arrived, but he knew there were at least two or three more clinicians around, plus a radiologist. In addition, almost certainly poised over in the lab, was Hal Sawyer, the chief of pathology and Matt's uncle. Hal, part mountain man, part community activist, part playboy, all scholar, was Matt's mother's brother, his godfather, and the major reason he had decided on a career in medicine. Over the twenty-two years since the cave-in of Tunnel C-9, Hal had been as close to a father as Matt had.

Matt hadn't been in the ER more than a minute when a pickup screeched into the ambulance bay bearing the first casualty. He waved off the other docs and accompanied two nurses to the truck. If the miner, muddy from a mix of limestone, coal dust, dirt, and perspiration, was any indication of the carnage in the mine, it was going to be a long night. His bloodied leg, fairly effectively splinted between two boards, had an obvious compound fracture of the femur. A grotesque spike of bone protruded through a tear in his coveralls midway up his thigh.

Matt followed the litter to the ortho room. Out of the corner of his eye he saw mine safety officer Blaine LeBlanc, dressed in pressed chinos and a hundred-dollar shirt, speaking to the driver of the pickup while making notes on a clipboard. Too late for Matt to avoid eye contact, LeBlanc turned toward him. His face was pinched and pallid. Matt flashed on what the humorless mine officer might be thinking.

Oh, no, here we go again. Another goddamn crusade by Dr. Do Little. Well, go ahead and try causing us more trouble, asshole. No one pays any attention to you anyhow. . . .

LeBlanc shook his head derisively, and Matt responded with a cheery thumbs-up. As long as Matt continued his efforts to make BC&C own up to its safety shortcomings and corner-cutting, they would be enemies.

Brian O'Neil, the orthopedist on team B, reached the cast-room door simultaneously with Matt. At six-three, O'Neil was two inches taller than Matt was, and a couple of years older. He had added two- or three-dozen pounds to the hard-nosed linebacker he had been at WVU, but at forty he was still a hell of an athlete. He was also a top-notch surgeon and Matt's closest friend on the medical staff.

"You first," Matt said. "I take enough of a pounding from you under the hoop."

"Since when did Gunner Rutledge ever mix it up under the hoop? You'd need a map just to show you where under the hoop is. Get a line in please, Laura. Normal saline. Usual bloods. Type and cross-match for six units. Portable films of his chest and leg. As soon as Dr. Gunner here has finished examining him, give him seventy-five of Demerol and twenty-five of Vistaril I.M."

"We're on it," Laura Williams replied, unflappable as always.

"You know, pal, Laura and some of the other nurses were betting that you'd sleep through this one."

"They may still be right. Seeing you here on time makes me think I might be dreaming."

Together, they moved to the bedside and assisted the nurse in cutting away the young miner's clothes. He might have been nineteen or twenty, with reddish hair and wide, feline eyes. His narrow face was etched with pain, but he forced his lips tightly together and took the jostling to his shattered leg without a sound.

"I'm Dr. O'Neil, the orthopedist," Brian said. "This is Dr. Rutledge. He's a veterinarian, but he's a damn fine one. We're going to take good care of you."

"Th-thanks, sir," the young man managed. "I'm Fenton. Robby Fenton."

"What in the heck happened down there, Robby?" O'Neil asked as Matt began a rapid physical assessment.

"It was Darryl Teague, sir. He . . . he went berserk. He's been actin' a little tetched for a while, but tonight he was operatin' the C.M. an' he jes went off. You know what a C.M. is--a continuous miner?"

"That monster machine that scoops up coal and puts it onto the conveyor belt?" Matt said.

"Exactly. Twelve ton or more every minute."

"You never cease to amaze me, Dr. Rutledge," O'Neil said. "No wonder you don't date even though people tell me you're the prime catch in the region. You scare all the women away with your vast knowledge."

"Don't pay any attention to him, Robby. He's lucky he's a darn good bone doctor, or no one would even talk to him. Go on."

"Well, early on in the shift Teague got into a shovin' match with one of the guys, Alan Riggs. I don't know what it was about. Teague's been like that for a while--pickin' fights, complainin' that people were out to get him, that sort of thing. Well, a bunch of us broke it up between him and Riggs. Then, a little while later, Teague goes after Riggs with the C.M. He runs right over him, I mean right over him. Then he goes on an' takes out maybe half a dozen supports. That's when the roof caved in. How are the rest of the guys?"

"We don't know yet, Robby. You're the first arrival."

"Alan's got to be dead. You shoulda seen it. Blasted Darryl Teague. I don't usually wish nobody no harm, but I hope he got hurt but good."

"Dr. Rutledge, we need you," Laura Williams said from the doorway.

Matt had been so mesmerized by Robby Fenton's account that he had completely forgotten about the deluge that was about to hit. Now the ER was in beehive mode. Six of the beds were occupied by miners in varying degrees of distress and pain. Technicians, nurses, and physicians were in constant movement, but the chaos seemed organized and nothing looked out of control.

"We don't need your internist skills right now," Laura said, "but we sure could use your ER talent. There's a lac in three. A beauty. I've ordered skull films, but they're going to take a while. He's low on the triage totem pole."

Matt stopped in the on-call room and quickly changed into scrubs. He was on his way to room 3 when Blaine LeBlanc intercepted him. A New Yorker with a dense accent, LeBlanc was a fit fifty, just an inch or so shorter than Matt, and broader across the shoulders. His thick, jet hair was slicked straight back and held in place with something from a tube. His trademark white stripe, an inch and a half across, glistened beneath the fluorescent overheads.

"What did that kid in there tell you?" he asked.

"Nice of you to inquire after the lad, Blaine. He has a compound fracture of his femur. That's when the ol' thighbone is sticking out through the skin. He won't be pushing coal for you for a while."


From the Hardcover edition.

Media reviews

Raves for Michael Palmer's

THE PATIENT
“The Patient might be [Palmer’s] most riveting book yet, leaving hardly enough time to take a breath.”
—The Denver Post

“The Patient is what Die Hard movies are made of: brilliantly nasty terrorists hectoring innocent folks, with only a wisecracking lone wolf to forestall.”
—Milwaukee Journal Sentinel

MIRACLE CURE
“A highly entertaining tale of greed and medicine run amok.”
—Chicago Tribune

“Packs plenty of heart-stopping action.”
—Associated Press

CRITICAL JUDGMENT
“Wrenchingly scary...Palmer is reaching the top of a demanding craft.”
—Publishers Weekly (starred review)

“Palmer [brings] his fascinating ER procedural knowledge to a fast-paced...narrative.”
—San Francisco Chronicle

SILENT TREATMENT
“Guaranteed to terrify anyone who...has reason to step inside the doors of a hospital....Dynamite plot...fast-paced and engrossing.”
—The Washington Post

“Palmer owes this reviewer about three hours of sleep spent reading this can’t-put-it-downer. You are cautioned...don’t start this one at 10 at night.”
—The Washington Times




From the Hardcover edition.