Diagnosis: Hypertension

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Reviewed by Ron Charles
Sunday, January 11, 2009


By Josh Bazell

Little, Brown. 310 pp. $24.99

Beat the Reaper is a hypochondriac's nightmare but a reader's dream. Josh Bazell concocted this comic thriller while working as a medical resident at the University of California, San Francisco, and if anything he describes here is true, we should all become Christian Scientists. After I gulped down the doctor's story, my pulse was racing so fast I didn't know whether to recommend his outrageous first novel or sue for malpractice.

Bazell's narrator is known to his patients and colleagues at New York's run-down Manhattan Catholic hospital as Dr. Peter Brown, but his old mafia brothers knew him as Pietro "Bearclaw" Brnwa. He hasn't seen any of those thugs for years, since he fled into the Federal Witness Protection Program and was reborn as a cynical emergency room physician who just happens to look "like an Easter Island sculpture of a longshoreman."

Beat the Reaper opens with a mugging, followed by sex in a hospital elevator with a cute drug rep, and then it races along for eight manic hours in what looks like the last day of Peter's career -- and perhaps his life. On early morning rounds, he has to tell a wealthy businessman named Nicholas LoBrutto that he probably has cancer, but when Peter steps into the room, LoBrutto instantly recognizes him as Bearclaw, the mafia assassin who turned state's evidence and vanished. LoBrutto offers him a deal: So long as he stays alive, he won't blow the doctor's cover, but if he dies, the mafia will pounce on their AWOL killer. As if that deadline weren't nerve-wracking enough, Peter accidentally gets stuck by a syringe full of fluid from a patient with a mysterious fever. It's that kind of book: constantly working its butt off to keep our attention, from fights to sex to medical gore, all told at a breakneck pace in the comic voice of a killer-turned-healer.

Early on, the novel splits into two storylines. While Peter tries to keep his medical staff from losing LoBrutto to neglect or incompetence, he tells us how he fell in with the mafia during high school to find out who murdered his grandparents. He became a kind of Robin Hood executioner who specialized in the lucrative work of rubbing out the most loathsome criminals, the "truly evil." There's enough male fantasy packed into these pages to temporarily relieve the worst case of mid-life crisis. The flashback scenes are full of hand-to-hand combat and bull's-eye shooting on the fly, along with lots of ironic macho talk of guns and stake-outs. And there are some Nazis, too, of course.

What's more, Bazell has the advantage of bringing a physician's knowledge to the mechanics of mayhem: While taking down a guy with a knife, Peter stops momentarily to explain the trajectory of his left hand: "If it hits, it will crush the fragile rings of cartilage that keep his trachea open against the vacuum of breathing in. Next time he tries, his windpipe will clench shut like an anus, leaving him at ReaperTime minus maybe six minutes. Even if I ruin my Propulsatil pen trying to trache him."

Bazell's gangster-turned-doctor makes Daniel Craig's James Bond look wussy in comparison. And the female characters in Beat the Reaper -- particularly Peter's sultry European girlfriend -- are about as complex as those traipsing through "Octopussy." Toward the end of the book, there's a love scene so ludicrous that Ian Fleming must be turning gangrene with envy: Flying bullets! Vicious sharks! Oral sex! (Teenage boys and jurors for the Bad Sex in Fiction Award, turn directly to p. 268.)

The mafia killings are brutal, but Peter's portrait of the hospital culture is even more alarming (and hilarious). Turn your head and cough -- nervously -- but you can't help wondering how much of this Bazell learned on the job. (Ironic footnotes fill in additional morbid details.) Doctors' paranoia about possible legal action rules all their medical decisions, especially how quickly to move barely stabilized patients out of the hospital to meet weekly quotas. When a surgeon tells a patient, "You have a chance," he really means, "I need a slightly longer Chriscraft." A desperate shortage of nurses leads the hospital to hire "mostly bitter and demented" women who seem to have emerged from "the white supremacist cult Nietzsche's sister founded in Paraguay." And all these so-called professionals are always so exhausted and pumped up on narcotics that they work in a mental state no different from extreme inebriation. Not surprisingly, Peter notes, physician-caused and hospital-caused illnesses "are the eighth leading cause of death in the United States."

Of course, this is the doctor hero we've adored for years: the cynical iconoclast with a heart of gold who breaks all the rules but saves the patients no one else can. Bazell has sutured together Alan Alda's Capt. Hawkeye and James Gandolfini's Tony Soprano, and so long as he keeps everything operating fast enough, it's too much fun and too much gore to take your eyes off the page. Beware the risk of dependency: This is the first of a planned series, and movie versions aren't far behind. ยท

Ron Charles is a senior editor of Book World. He can be reached at

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