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In Foster’s intense hospital thriller, a hard-pressed emergency room doctor copes with medical crises, malevolent bureaucrats and vicious gangbangers.

There’s so much excitement in the ordinary workings of a hospital emergency room that a plot is hardly necessary to hold readers' interest in the doings of Dr. Alex Randolph, chief of emergency medicine at the for-profit Mason-Dixon Regional Medical Center in rural Maryland. Confronting him every day are strokes, heart attacks and trauma cases where a minute’s delay in treatment can spell the difference between life and death. There are floods of school children with colds—but hidden among them could be a kid whose lethargy and runny nose signal a deadly case of meningitis. There are scammers faking back pain to score a Percocet scrip and, more ominously, a sudden rash of heroin overdoses. Then into the ER walks Julio, a wounded chieftain of the Mara Salvatrucha gang, accompanied by three stony, snarling thugs; their arrival heralds a drug war that will put the ER staff in the crossfire. Alex has an off-duty life and a tepid romance with a nurse, but the hospital is the novel’s magnetic center. Foster, himself an ER doctor, writes with a lucid, supple prose that illuminates the physician’s art while bringing out the human drama that entwines it. He skillfully evokes the barely controlled chaos and high-wire camaraderie of the ER and regales readers with intricate, absorbing accounts of the struggle to stabilize, diagnose and treat patients under extreme pressure. Alex is an engaging guide to this scene; outwardly he’s a Dr. Jekyll oozing polite concern, inwardly he’s a Mr. Hyde seething at slackers, addicts, parents who neglect their kids and the corporate executives at Mason-Dixon who care more about pushing paper and fighting turf battles than they do about patients. On its way to a riveting climax, Alex’s saga gives us a vivid dispatch from the front lines of American medicine.

Enthralling medical procedural with real depth and pathos.

Pub Date: Aug. 3rd, 2011
ISBN: 978-0615493886
Page count: 380pp
Publisher: Macdougall
Program: Kirkus Indie
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