The Prognosis Is Good

By Patrick Anderson,
whose e-mail address is
Monday, March 13, 2006


A Novel of Medical Suspense

By Joshua Spanogle

Delacorte. 391 pp. $22

Joshua Spanogle's first novel is a smart, fast-paced medical thriller that is also a case study in how a young writer can make the conventions of the genre work to his advantage. Spanogle started with two considerable assets. First, he's a 35-year-old medical student at Stanford who knows all about the physical vulnerabilities of our bodies and the moral uncertainties of his profession. Second -- and they don't teach this in medical school -- he's a first-rate writer. To know a profession cold and to be a born writer is a rare blessing. Scott Turow also comes to mind.

In "Isolation Ward," a mysterious disease has struck residents of several homes for the mentally handicapped in Baltimore. Nate McCormick, a 33-year-old investigator for the Centers for Disease Control and Prevention -- a medical detective -- is sent there and soon gives us graphic accounts of the patients' symptoms: "The mouth was alive with little hemorrhages. The tonsils, nearly the size of golf balls, were slicked in a thick gray-yellow pus, like they had been coated with mortar." Because the patients had been enjoying active sex lives, McCormick fears some new variant of AIDS, and he also has to wonder if bioterrorism is involved. His search for a suspect takes him to the San Francisco area, where he and we begin to suspect that the mysterious disease -- as in John le Carre's "The Constant Gardener" and many medical thrillers -- may have its roots in corporate greed.

McCormick, our hero-narrator, follows one venerable convention of the genre in that he is a wise guy, endlessly battling with his bosses, the police and the women in his life, but, fortunately, he's more complex than that. He's intelligent and has a core of idealism. He's also ambitious. After fudging the facts on a research project, he was kicked out of medical school. But after two years' penance in the Peace Corps, he earned his degree and was hired by the CDC.

His medical skills impress us while his quips amuse us. "Why the hell didn't I go into plastic surgery?" he asks. "Work three days a week and drive a Porsche." When his ex-girlfriend turns up with an arrogant billionaire, he comments, "I thought I caught a whiff of Choate and Harvard, though it could have been his cologne." At a funeral, he reflects that his chances of getting into bed with the gorgeous woman at his side are "something less than the odds of Harriet Tobel sitting up in her casket and asking for lunch." He's also capable of this, when his girlfriend comforts him with kisses: "A hundred tiny contacts covering my face like raindrops."

People start dying, not from the disease but in possible murders, and the police are clueless -- a tradition that goes back to the first-ever detective story, Poe's "The Murders in the Rue Morgue." McCormick and his ex-girlfriend Brooke, herself a doctor, set out to solve the mystery on their own -- another convention -- and soon are being chased from pillar to post by various villains and hit men, like the couple in "The Da Vinci Code" and many other thrillers. They begin to suspect that the answer to the medical mystery lies in a high-minded scientific experiment that went wrong -- a device we first saw in Mary Shelley's "Frankenstein."

One of the most basic elements of the thriller is that the hero's courage and stubbornness will lead him into a seemingly hopeless situation. Thus, in "The Big Sleep," Raymond Chandler has Philip Marlowe handcuffed and bound by ropes -- "trussed up like a turkey" -- with a gunman coming to kill him. Not to worry -- Marlowe manages a miraculous escape, just as McCormick and Brooke elude a professional killer who has them handcuffed and marked for death, after which Spanogle gives his novel an exciting, largely unexpected ending.

Spanogle lets us know that he knows what he's doing. He has McCormick note that the dialogue of a fellow who's about to kill him is "getting very Chandleresque." Another time, he says of a very scary and beautiful woman, "I wonder if she wondered," which sounds a lot like "I wonder if you wonder," a line Fred MacMurray speaks to the very scary and beautiful Barbara Stanwyck in "Double Indemnity."

I intend no criticism of Spanogle for hewing to conventions. They are basic to genre fiction, and most readers (unlike certain pedantic reviewers) will take them for granted. If the writer is skillful, he's driving the car, shifting gears, watching the road signs, doing his job, while the reader has only to hold on tight and enjoy the thrill of rounding curves at 90 miles an hour. Of course, the best writers find ways to ignore or subvert conventions. For them, they're just training wheels -- Exhibit A is Dennis Lehane's leap from his Kenzie-Gennaro series to "Mystic River." Spanogle is not there yet, but he's good. To his publisher, he's a hot new writer -- with, it appears, a sequel in the works. But in terms of American crime fiction, which I date to the appearance of "The Maltese Falcon" in 1930, his roots are firmly, admirably rooted in the past.

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