Customer Reviews

Critical

5 star:		(11)
4 star:		(12)
3 star:		(11)
2 star:		(17)
1 star:		(15)

 

 

Corporate fraud has not involved an attractive female doctor turned CEO until now, with Robin Cook's "Critical." This is a great book...a fast, page-turning ride of intrigue involving the health care system, a development stage company going IPO (an Initial Public Offering), organized crime, and Washington lobbyists.

Angela Dawson, MD/MBA, a divorced single parent, doctor turned CEO is facing the challenge of a lifetime for any CEO. The company she founded, Angels Healthcare, LLC, is about to go public but is experiencing a mini-epidemic of nosocomial methicillin-resistant staphylococcus aureus (MRSA) infections. A number of patients have died at three of their New York City based hospitals resulting in the shutdown of their surgical suites, a cash crunch and the potential delay of the IPO. This delay may mean insolvency and the loss of millions not only to the founders but also to key investors, one of NYC's crime bosses.

Key figures include Jack Stapleton, forensic pathologist in NYC Office of Chief Medical Examiner who is scheduled for knee surgery at Angels Orthopedic Hospital; Stapleton's wife, Laurie Montgomery, who is also a forensic pathologist at OCME; Walter Osgood, MD, Department Head of Clinical Pathology for Angels Healthcare; Michael Calabrese, Dawson's ex-husband who helped raise the start-up capital for Angels from childhood friend and crime boss, Vinnie Dominick; Adam Williamson, a killing machine who worked for healthcare lobbyists in Washington, DC; and Angelo Facciolo, hitman for Dominick.

Montgomery who becomes increasingly concerned with her husband's scheduled surgery as a result of post-mortems on a stream of patients operated at Angels' facilities initiates an unofficial investigation of the cause. Dawson, Dominick, and the DC lobbyists, concerned with "overenthusiastic medical examiner" take matters into their own hands to silence Montgomery. Dominick had already murdered Paul Yang, Angels' Chief Accountant, and Amy Lucas, Yang's administrative assistant.

"Critical" bobs and weaves between stories of the key figures then lurches to an unexpected and satisfying outcome. The book also raises and details some issues of the day, including:

* The rise and shortcomings of specialty hospitals in the US - They "don't have the resources for serious problems and have to outsource them, are interested in the cream of patients (healthy, well insured), like quick procedures that require no overnight stay (in and out), and have no ER or ICU. They are money making machines."

* Conflicts of doctors and the business of medicine - "Success from business as measured by wealth and its trappings had trumped altruism, charity, and the pleasures of interpersonal intimacy.

* Hospital infection rates - Hospital acquired infections affect about two million patients per year resulting in 90,000 deaths per year in the US alone.

* Nosocomial methicillin-resistant staphylococcus aureus (MRSA) infections - one of the greatest healthcare concerns we have today as bacteria mutate and become resistant to available antibiotics.

As one who is not a big reader of fiction, I found "Critical" to be an excellent book. It is a great story that also outlines some critical issues of the day, raising questions about today's morality. As someone who has worked in healthcare for more than thirty years, I agree with Cook's final assessment, "In politics, power corrupts and absolute power corrupts absolutely. In medicine, its money, not power." We - doctors, the delivery system, the regulatory system and payors, which includes the federal government - have lost sight of the patient.

The delivery of medical care in the United States is a subject of great public and private debate. The economics of medicine are quite unlike other economic models because neither pure competition nor governmental regulation will ever produce affordable quality health care uniformly. Coupled with the fact that health care is controlled not by physicians but by corporations the opportunity to exploit niche markets creates both risk and reward.

So here we examine, in the context of a medical thriller, the issue of specialty hospitals. Specialty hospitals are apparently organized in such a way relative to government set reimbursement rates for procedures. Because they do not have emergency rooms, ICU units, etc like general hospitals they can be very profitable. This creates a class of winners-specialy hospitals and losers general hospitals. And in all business situations the winners want to maintain their advantage and the losers want to "level the playing field."

So a business war breaks out and unlike most business wars this one produces real casualties. When Assistant Medical Examiner Laurie Montgomery starts noting strange fatal nosocomial infections (hospital acquired) plaguing three corporately related specialty hospitals she launches an investigation. Her motives are a bit personal since her husband, also a medical examiner is scheduled for surgery at one of them.

Now someone has decided to make this really a thriller something more than a bunch of deaths caused by pneumonia is needed. Here Critical strays. Cook is not content with a mysterious virus and possible serial killer on the loose. He enlists not just the Mafia to bump off executives and Laurie, he also gets a ex-Delta Force mercenary into the same act.

When you go from Quincy, MD to Don Corleone and Rambo in a book, you can be assured that it will lose credibility. This is a shame since the original premise has enough tension to sustain it as a medical thriller.

Hopefully, Robin Cook will find a new editor who knows how to properly utilize his great talent.

Author Robin Cook continues to pound out his brand of medical thrillers. In Critical, a struggling private medical surgical company, Angels Healthcare, has financial problems compounded by a mysterious series of lethal infections occurring in patients throughout Angels Healthcare's system of clinics. Involved are investors, the Medical Examiner's office, the police, the mob, and others. Bad guys are really bad, and folk at the ME's office work hard to understand what's going on, for a variety of personal reasons.

Being "critical" myself, Critical probably moved slower than what I expect from a Robin Cook novel. The twist at the end is so unexpected that it almost reads as an afterthought, as in "I don't want the reader to have any chance at all to guess who's doing this, so I better throw another person in." At least Cook had an explanation for this person's involvement.

Still, I've enjoyed every "Cook Book" I've read, beginning with Toxin. I hope his next one is back on track.

You'll be running for the antibacterial soap after this one. Not for the squeamish, this is up close and personal in the autopsy suites. More information on virulent staph infections than you might want to know, but on the other hand, maybe this is something we should all be aware of, especially if one of you is headed for knee surgery.
I love getting the inside dope on the medical profession and hospitals--and Robin Cook is full of tips. They're always up to something--usually something that's in the interest of money and not the patient. This book gives a very revealing picture of the "cash cows" of medicine; the invasive tests that are favored because of quick reimbursement, and the specialty hospitals that are partially owned by physician/investors, draining resources of the health care industry in general because they skim the cream of the patients (the well-insured, the wealthy). Full service hospitals are left with chaff--emergency rooms, the uninsured, the chronically ill; anchors around their financial neck.
As a sort of side story woven into the action (which I found slightly less engaging) the mob is attracted to the windfall of money from specialty hospitals like flies to garbage. Hard to write about wiseguys and be original.
Cook has crafted a medical thriller that cuts the shenanigans wide open like a can of worms, reaching all the way to Washington lobbyists. His knowledge and research are astounding, and he puts it to good use, concocting a riveting story that when it gets in gear, races from page to page. It does take awhile for the story to develop, but the time investment is worth it. The final chapter will have you completely engrossed and transfixed, delivering the maximum amount of tension, adventure and unbearable suspense, leading to a great ending.

One can hardly think of the "medical thriller" genre without acknowledging the contributions of Michael Palmer and Robin Cook. In recent years, Cook has traded all-out suspense and intrigue for books that strive to not only entertain with a decent plot but also lecture the reader on a medical topic of concern, if not pet peeve, of the author's. While we are spared an outright after-word essay in "Critical", nonetheless we get a heavy dose of explanation about what a specialty hospital is (one that only takes referred surgery patients) and the evils associated with doctors themselves owning such hospitals.

In the storyline, a series of very unusual hospital deaths, occurring within 12 hours or less of minor to major surgery, from a particularly nasty strain of staph infection, leads one of Cook's favorite heroines, Medical Examiner Laurie Montgomery, to eventually establish the connection between the untimely deaths and three specific hospitals all owned by Angels Healthcare. Angels is in the process of going public with an IPO, sure to make a fortune for all its owners - but the unsettling nature of the deaths, and the need to suspend operations to clean operating rooms and so forth, engages the business in a cash flow crisis just weeks shy of the IPO. The gist of the plot is to discover both what's happening and why. Adding to the intrigue is Laurie's fears for hubby and fellow med examiner Jack Stapleton, who is scheduled for imminent knee surgery at Angels.

When all the dust settles, we find out, to no surprise, that the deaths are the result of a merciless tyrant trying to interfere with the IPO. That outcome not only strains credibility given the three dozen or so murders involved, but other than keeping Jack out of harm's way, there was very little to care about in this whole book. The CEO of Angels, and her dating a colleague of Laurie's was nothing short of boring; and why the hospitals involved hadn't long before just plain been barred shut by the authorities made no sense. Meanwhile, the lecture on specialty hospitals, with pages and pages devoted to something hard to care about but easy to understand, got old fast.

In short, despite a now lengthy booklist of best sellers, Cook's ability to thrill and chill is at best on the wane - it seemed to us that even he took little delight in this particular novel. Maybe he's running out of messages, er -- make that, good ideas !!

I have been reading Robin Cook since his book 'Coma', which came out over 30 years ago. This was was such a disappointment. I started reading it and it was so boring that I put it down, read 4 or 5 other books, then came back to it because I had paid for it and wanted not to waste my money. The book features Jack and Laurie Montgomery, who have been in previous books and are always fun. This time around they were still fun to see in the book, but the rest of the book was like plodding through thick mud. It got a little exciting almost at the end , but then the end itself was such a letdown, I was totally aggravated. Maybe Robin Cook has lost his touch after so many wonderful books. I have never hesitated to buy his books, but next time I will check it out at the library and not spend my money on it. I was so disappointed because he is such a favorite author.

Having read Robin Cook's several books, I was extremely disappointed. It was boring and predictable.

Readers know that the accountant of Angels Health Care is murdered in the first few pages of the book. Cook bores us writing several pages about the discussions that ensues about his whereabouts by the executives of Angels Healthcare. There are 14 pages of small talk between Angela Dawson the founder of the company and Chet McGovern, a Medical Examiner, before anything substantial that adds to the story happens.

It is truly boring and if you have not bought it, don't.

I've always read Robin Cook's books, but this one was just a bit too ordinary. I was tempted not to finish it, but ploughed through to the end. The plot was fairly predicatable this time and even the ending was a bit of an anti-climax. Michael Palmer's The Fifth Vial and Ken McClure's The Lazarus Strain are better medical thrillers! Better read next book I think.

Medical mystery, high finance, organized crime - sounded interesting, but the writing is so bad that I could not even finish reading it. Here is the description of someone drunk:

"Amy was now evincing slight intermittent jerky motions just to keep herself sitting upright."

'Evincing'? 'Intermittent jerky motions'? That are 'slight' to booth!

And the real pain are the dialogs:

"I am beginning to wonder...", "Yet my real concern...", "We have mandated..."

Who would ever use such expression while speaking? Any character becomes immediately unreal the moment she (or he) starts saying things like that.

Predictable characters, uninspiring and plodding plot. There are better ways to invite a thoughtful consideration of medicine today.