As the emergency room fills up with trauma patients, the author rapidly introduces a substantial cast of characters with minimal hints regarding individual importance. Rita Donniger is an older than average, third-year medical student. As her pregnancy approaches term, she begins to express concern regarding hospitalization. She and her classmate Georgia (Jordan) Parker-Ross attend a class party complete with a recreational substance formulary and a lecherous professor. Jordan is knocked unconscious, and her friend Rita collapses while waiting at the ER.

The Chief Resident in Emergency Medicine is Dr. Todd Langford. He is clearly the prototypic ER Doc; he's bright, decisive, and an exemplary healer. As the story transpires, the reader also realizes that insidious events seem to shadow Langford.

While Jordan remains unconscious, Rita's medical condition rapidly becomes a nightmare. The author, a physician, adroitly presents the disastrous clinical situation and includes the life versus life ethical dilemma well known to obstetricians.

With three characters in critical condition, the novel quickturns to the home of the local, demented Mafioso Don. After a sharp return to the ER, there is another quick jump to the cafeteria where Dr. Langford encounters a character who earlier passed through the story.

After 100 pages of circular story action, the "real" plot surfaces. Terminal patients seem to magically improve; indolent lab animals perform as manic geniuses; characters who are not patients begin to die. Eventually, the majority of the earlier elements are drawn together around a very interesting premise. The crux – like so many contemporary medical novels – is the conflict of altruistic science with individual human rights. Crass profit motives are also relevant.

This is a violent suspense novel. It has bloody medical scenes, guns, and hand-to-hand combat. The action sequences of the hospital and on the streets are very well constructed. After the interminable opening chapters, the book becomes less choppy and moves at a better pace with crescendoing action. Its plot holds enough twists and turns to provide challenge to detective fans.

The author clearly knows his way around a hospital. The medical details and interplay of medical students, junior residents, senior residents, and staff are nicely accomplished. The medical characters fill their roles quite well, but are not extensively developed. The underworld figures seem a bit too pathetic to be convincing.

Medical professionals, or those who can speed read past the clinical details, will enjoy parts of this book. Impatient readers may be disappointed.

--Steve Nemmers