Duke University Alumni Magazine

Bad Medicine

By Paul S. Auerbach '73, M.D. '77. Specialized Publications Company, 1998. 349 pages. $16.95, paper.

mericans like their doctors. Patients may gripe about being kept waiting or complain about being addressed by their first names, but most of us like and trust the physicians who care for us. And we respect them too. Politics, journalism, and law have all suffered a kind of fall from grace in the public eye, but medicine is still considered a noble profession, and those who practice it basically good.

In his first novel, Bad Medicine, Paul Auerbach seems to suggest we should not hold our health-care professionals in such high regard. Auerbach, a physician and former professor and chief of emergency medicine at both Stanford and Vanderbilt medical schools, sets out to tweak academic medicine in the same way John Grisham so successfully tweaked the legal profession.

The novel opens in Kuwait during the Gulf War. Dr. Frank Klawitter is performing his patriotic duty by serving a tour in the military. Along the way, he helps and inspires Sam Anderson, an idealistic young corporal and future medical student who wants to know what doctors do when other doctors make mistakes. Dr. Klawitter's answer: It depends. Sometimes they discipline each other, sometimes they don't. Terrible mistakes occur every day in hospitals but nobody finds out, the good doctor says. That's the way it has to be.

"But why?" Sam asks.

"For lots of reasons. Mostly political. An unwritten code of honor. To avoid lawsuits. To preserve reputations. To keep the public from getting scared. To hold onto business. If people knew everything that went wrong, then the good doctors would suffer as well."

Frank's neatly arranged little world begins to rip apart a few months later when he returns home and takes up his position at the prestigious Branscomb teaching hospital. Frank's beloved cousin dies on the operating table, the result of spectacular incompetence by a smug, arrogant, has-been anesthesiologist, one of a half-dozen terrible doctors who nonetheless seem to be protected from on high in the medical school. Everyone knows how inadequate, out-of-date, and downright dangerous these physicians are. The nurses cry, the paramedics are bitter, the folks in the morgue stand over the mutilated bodies of the victims, shaking their heads.

Who keeps covering up for these guys and why? With the help of Sam Anderson, now a medical student, Frank learns the dean is not only protecting the bad doctors, but making them rich by skimming profits from the practice plan. But why? And what can be done?

Bad Medicine has all the necessary elements of a good thriller--murder, blackmail, sex, and general mayhem. The book has the added advantage of focusing on an issue about which no thinking person can afford to be complacent: the competence and integrity of our medical professionals.

Legal thrillers are enormously successful despite the fact most of us can hope to get through life without ever seeing the inside of a courtroom, except, possibly, from a jury box. But sooner or later everyone has to see a doctor. We all must place our health, our trust, and sometimes our lives, in the hands of this human being. How are we to know whether the doctor is truly dedicated to his or her "sacred trust" or just a greedy, incompetent quack? Bad Medicine successfully plays upon these fears.

The author does a good job of presenting complicated medical diagnoses and procedures without condescending to or confusing the lay reader. Take this example: "He deftly carved a vertical skin incision that began a few inches below her breastbone, curved around her umbilicus, and stopped at the top of her pubis. Because time was of the essence, he didn't bother to meticulously cauterize small residual 'bleeders,' the tiny arteries and veins that course through the fat and muscle layers overlying Eleanor's intra-abdominal contents."

Such paragraphs may not be for the squeamish, but neither do they require a medical degree to penetrate. Only every now and then does Auerbach slip into the kind of jargon doctors often can't seem to help. In one chapter, he writes, "The pre-syncopal lass sat in a chair near the sink." I know what syncopated means, but pre-syncopal?

The novel's major weakness lies with its characters. Although the author makes an admirable effort to round them out with hobbies and romantic lives, the characters nonetheless come across as flat. Perhaps the problem stems from the constantly shifting point of view. The reader is given a great amount of background information about a great many characters, but never comes to really believe, or empathize with, any one. Sam Anderson seems impossibly eager and resourceful, a real Boy Scout around whom people just happen to keep ending up dead. Frank Klawitter comes across less as the highly intelligent and moral surgeon clearly intended and more as a finicky, unstable hothead who only decides to act when the death toll includes one of his own. Even Dean Wiley Waterhouse, a promisingly evil character, ultimately disappoints.

Still, good thrillers are about plot, not characters, and the plotting of this book is swift and sure, racing toward the climactic scene in which the good-guy doctors have it out with the bad-guy doctors in an improbable but exciting free-for-all in the operating room. During the fight, the good guys come up with all kinds of interesting uses for the high-tech medical equipment surrounding them. Do they teach this in medical school?

You may not walk away from Bad Medicine wondering if your HMO would accept a shaman as your primary-care provider, but you probably won't be completely reassured of the medical profession's ability to police itself either. As Dr. Frank himself says, there is far too much at stake.

The Blue Hour

By Julie Tetel Andresen '72. Madeira Books, 1998. 439 pages. $23.50

ulie Tetel Andresen wants it all. Not content with her national fame as a best-selling romance genre author of thirteen books and her academic credentials as an associate professor of English at Duke, Andresen has published a new novel, The Blue Hour, that defies niche labeling.

Not many writers could combine plot lines involving molecular biology, eroticism, Paris, and Cary, North Carolina. The Blue Hour reads like a romantic thriller set locally in the Research Triangle, from the sophisticated DNA labs to the college-town restaurant scene. Not to miss out on two of our driving subcultures, she adds humorous comments about the rush-hour freeways and Duke basketball. (Obviously a fan, Andresen gives her main character a Polish last name, Kaminski, and the lab office the nickname of "Coach K.")

What's most significant about The Blue Hour is the sheer determination of its launch into the publishing and book-selling worlds. Andresen founded Madeira Books, becoming both a print and Web publisher, retaining artistic control over all manner of significant details. Featuring a tipped-in title plate, a dark-blue, silk bookmark, and evocative, blue-toned illustration montages by artist David Terry A.M. '89, Ph.D. '95, The Blue Hour, the physical book, has a dramatic impact on the reader.

As a studio and online publisher, Madeira Books and Andresen will seek other novelists and book ideas for partnership affiliations. One benefit of Madeira's clean, fresh Web presence is the quickness and breadth with which books and authors can be promoted. Links and frequent website updates drive publicity and create the buzz. See for yourself at www.madeirabooks.com.

Alexandra Kaminski is The Blue Hour's heroine, cancer researcher by day, time traveler by alternate chapters! As mundane dialogue and the setting of a DNA science lab is scripted, Alexandra drifts to become a much more spirited, sensuous personality. All of a sudden we are backstage at a Paris cancan club, Le Chat Noir, discussing "art" and dangerous liaisons. These leaps are no surprise, really. Andresen writes in her biographical note that, growing up in the Chicago suburbs, she used to dress up as a cancan dancer for Halloween.

While scenes of overt bodice-ripping, over-played heavy breathing, and "significant" askance glances that might highlight pulp romances are nowhere to be found in The Blue Hour, erotic encounters do spice up Alexandra's story. Lure and intrigue are played out in her relationship with a jet-setting, businessman-of-the-world, Valery Dorsainville. Mais, oui! Of course, Val combines the good looks and athleticism of a former Grand Slam tennis player and the risk-taking willpower of a pharmaceutical company entrepreneur.

We are not surprised at the electricity of their meetings, in Research Triangle Park or Paris, at the Duke Medical Center or in Alexandra's Trinity Park living room. "Val's overall impression of the woman was of a ripe wheat field with a hint of green that flattered a woman of her coloring. The sun filtered in and glanced off her thick blond hair that was caught back from her temples and clouded around her shoulders." While day-to-day venues add local color to The Blue Hour, the reader knows these two star-crossed scientists won't be ending up at Krogers supermarket.

A favorite chapter of mine was Alexandra's return home to Chicago, filled with all the tensions and feared betrayals of high-school reunions. Leaving Duke Medical Center to take care of itself, Alexandra embraces the old-world styles of her extended family. The dinner scenes and the alert, affectionate asides of her grandmother read with a tender honesty. Back in Durham, Alexandra chats about the American Dance Festival, drops by the Bryan Center on Duke's campus, and gets contemplative in the Duke Gardens; all the while a plot of corporate jealousy, macho greed, and coveted cancer research secrets boils around her.

Filled with multi-syllable molecular biology jargon, French art history lessons, chase scenes, with knowledgeable nods to reincarnation and murder mysteries, The Blue Hour is Andresen's answer to some of her academic colleagues who've been challenging her to write "a real book." Responding to a comment that no one will ever give a Nobel Prize to a romance novel, Andresen bristles. "The 1928 Nobel Prize in literature went to Sigrid Undset for her historical romance Kristin Lavransdatter," she has said, "and it's about time for another one."

Andresen's heart is in the right place. Her heroine even wanders Paris in a Duke T-shirt. Andresen's passion is her writing, and who could ever fault her as she follows form in The Blue Hour's last chapter? American literature needs more of the girl-gets-the-guy, the guy-gets-the-girl, and-they-embrace final scenes. The fact that they're just a few blocks from East Campus makes it even sweeter.