Robin Cook's Fatal Cure is a bestseller that sustains a loyal fan base by following a successful formula. This essay discusses three specific categories of bestsellers into which this novel falls: Fatal Cure was written by an author who practices the profession he writes about; it is an example of a David vs. Goliath tale; and it uses stock characters, in particular the "sympathetic doctor" character.
Authors who practice the profession they write about
Fatal Cure belongs to the category of bestsellers written by authors who are members of another profession and write novels about that second profession. Membership in typical second professions is restricted to a small subset of the population, but these novels allow lay readers to live vicariously through the author and his or her characters. For example, doctors have the power to save lives, something the average American can only dream about. While reading a Robin Cook medical thriller, a reader can imagine himself treating patients (without four years of medical school and a six-year residency). These authors focus on the most glamorous and exciting aspects of their respective occupations. A television show about doctors performing routine physical examinations would hardly match the Nielsen ratings of "ER." Lawyer-authors who write legal novels focus on baffling investigations and nailbiting courtroom drama in the same vein as television's "Law & Order."
Robin Cook is an ophthalmic surgeon, and nineteen of his twenty-one novels published before May 1, 2000 are medical murder mysteries. The main characters in Fatal Cure are Dr. David Wilson, who practices internal medicine (Cook 38) and his wife, pathologist Dr. Angela Wilson (Cook 35). In the novel, a series of mysterious deaths of patients at Bartlet Community Hospital arouses the Wilsons' suspicion. Using his experience in the medical field, Dr. Cook provides an insider's view of the financial arrangements between physicians, hospitals and managed care organizations that may affect readers' health care.
Scott Turow has written several best-selling courtroom dramas, including 1987's Presumed Innocent (Osborn, Bibliographic Description) and 1993's Pleading Guilty (Russell, Bibliographic Description). Turow attended Harvard Law School, and has worked for the U.S. Attorney's office and as a private criminal lawyer (Russell, Brief Biography). In a striking parallel to Robin Cook, Turow wrote One L: An Inside Account of Life in the First Year at Harvard about his law school experiences (Russell, Brief Biography). Cook wrote The Year of the Intern about his own experiences during his medical training, also at Harvard (Contemporary Authors Online).
John Grisham, author of several mega-blockbuster legal thrillers in the 1990s, attended the University of Mississippi Law School (Braintwain, Brief Biography). The fact that Grisham practiced both criminal law and civil law has influenced his writing; some of his books focus on criminal cases while others discuss civil cases. A representative novel from Grisham's opus, The Client, tells the story of a young boy who witnesses a Mafia assassination and retains a tough lawyer to help see that justice is done (Grisham, The Client).
This "authentic author" category of bestsellers was not created in the 1990s by doctors and lawyers. Ian Fleming, author of the James Bond spy novels, reached the American bestseller list in 1964 with You Only Live Twice (Maloney, Bibliographic Description) and again in 1965 with The Man with the Golden Gun (Johnson, Bibliographic Description). Fleming was no stranger to the international espionage he wrote about; Britain's Foreign Office sent him to Russia before World War II to evaluate a potential Russo-British war alliance (Maloney, Brief Biography). During World War II, Fleming worked with the Director of Naval Intelligence and was trained as a spy (Maloney, Brief Biography).
Joseph Maloney suggests that Ian Fleming used his image as an intelligence agent to promote sales of his spy novels (Maloney, Critical Essay); Robin Cook and other similar authors also use their professional personas to sell books about their professions. The book jacket on an American edition of You Only Live Twice mentions Fleming's intelligence background and shows Fleming blowing smoke from the barrel of a gun (Maloney, Critical Essay). The Fatal Cure book jacket shows Robin Cook decked out in white coat, with a stethoscope draped around his neck. In reality, an ophthalmic surgeon like Cook is much more likely to wear scrubs than a white coat, and he has very little need for a stethoscope. Cook is clearly trying to conform to the public's mental image of a typical doctor. After picking up a novel with an obviously occupation-specific title and seeing a photograph of the author in full professional garb on the back cover, a consumer's natural reaction is, "He/she knows what he/she is talking about (i.e. he/she knows more about this profession than I do). This could be a good book." In constrast, a non-physician author who was photographed in a white coat would be ridiculed and labeled as an impostor.
"David vs. Goliath" tales
Fatal Cure also falls into the category of American bestsellers that describe a "David vs. Goliath" conflict (Conaty 150). Americans waged the Revolutionary War because they felt they were being oppressed and unfairly taxed by the British Empire. This spirit of independence and fighting for one's beliefs remains popular among Americans, since they continue to buy books about one good man struggling against an evil organization. In modern examples of this category, the evil organizations usually have an immense amount of money and resources, and have no respect for the law. The organization threatens the lives of the individual and his or her family. By the end of the novel, the idealistic individual has overcome enormous odds to bring down the organization.
The protagonist in Fatal Cure, a representative "David vs. Goliath" story, is actually named David. In the novel, the idealistic Dr. David Wilson, fresh out of his residency, discovers the harsh reality of working for Comprehensive Medical of Vermont (CMV), a modern health maintenance organization. CMV and David's hospital, linked by financial agreements, form the novel's Goliath. David Wilson has several run-ins with Charles Kelley, a CMV administrator, and hospital administrators; these moneymen continually berate David for ordering expensive treatments and consults for several terminal patients who are suffering from an unidentified illness. Kelley continually second-guesses David; after the death of a patient with cancer, Kelley uses hindsight to call David's consultations with specialists wasteful because the consults did not save the patient's life (Cook 161). Kelley warns David to reduce his patient care costs or risk being fired. These repeated conflicts culminate in a physical confrontation between David and Kelley:
"Just a minute!" David snapped, cutting off Kelley. "I've got a sick patient in the ICU and I don't have time to waste with you. So for now stay out of my way." . . . (David) spun around and started out of the room.
"Just a minute, Dr. Wilson," Kelley called. "Not so fast."
David whirled around and stormed back. Without warning he reached out and grabbed Kelley by the tie and the front of his shirt and roughly pushed him back. Kelley collapsed into the club chair behind him. David shook a clenched fist in Kelley's face.
"I want you to get the hell out of here," David snarled. "If you don't, I don't take responsibility for the consequences. It's as simple as that" (Cook 315-316).
By the end of Fatal Cure, both of the Wilsons have been fired from their jobs. The Wilsons' detective efforts have exposed seven hospital administrators who murdered patients by strapping a radioactive cobalt cylinder to the patients' hospital beds. This evil conspiracy was felled when the administrators were killed by their own radioactive source. After getting new jobs, the Wilsons tell their story to Ed Bradley in a 60 Minutes interview.
In John Grisham's 1991 novel The Firm, the young lawyer Mitch McDeere, fresh from law school at (where else?) Harvard, is offered the job of a lifetime at the prestigious law firm of Bendini, Lambert & Locke. Unbeknownst to McDeere, "the firm" is actually owned by the Morolto crime family (Grisham 198). The FBI approaches McDeere, asking him to gather evidence against his associates. The task of mole is not to be taken lightly; the firm has already murdered two associates for speaking to the FBI. The powerful firm has wiretaps and bugs in McDeere's house and men monitoring McDeere's every move. At the end of the novel, McDeere provides the FBI with enough incriminating documents to bring down the firm and the Morolto family. With Goliath slain, McDeere and his wife escape to a yacht in the Caribbean with 8 million dollars.
Tom Clancy's Jack Ryan is another odds-against David character. Ryan appears in Patriot Games, the #2 fiction bestseller in 1987, and in Clear and Present Danger, the #1 fiction bestseller in 1989 (Cader Books website). Ryan is a ranking CIA official; he is also an ex-Marine, ex-history professor, and ex-stockbroker (Bosler, Brief Biography). In Patriot Games, Ryan battles a group of Irish Republican Army radicals after he thwarts their attempt to assassinate British royals. The IRA sprays his wife's car with machine-gun fire, nearly killing the pregnant Mrs. Ryan (who is a caring physician character) and her daughter. Ryan works with the CIA to destroy an IRA outpost in Africa, and he eventually wins a battle against his chief tormentor on a flaming boat in the Chesapeake Bay. Ryan returns in Clear and Present Danger to battle double-crossing cabinet officials and a duplicitous president who deployed an American commando unit to attack drug dealers in Colombia. The officials gave the unit's position to a drug dealer who promised to let the U.S. make token drug busts in exchange for massacring the unit. At the end of the novel, Ryan rescues the surviving members of the unit and lets the conspirators know that their plot has been discovered.
In these bestsellers, the author unambiguously differentiates between people and organizations that are good and those that are evil. Tom Clancy contrasts John Ryan, a sensitive family man, with ruthless terrorists and politicos. John Grisham's Mitch McDeere is no angel: he cheats on his wife, and he dupes both his firm and the FBI. However, McDeere is a choirboy when compared to his associates at the firm, who are involved in murder and organized crime. Robin Cook uses money to help Fatal Cure readers differentiate between sympathetic characters such as the Wilsons and the contemptible characters associated with the CMV HMO. In keeping with the fact that physicians' salaries have declined due to managed care capitation plans and reduced Medicare reimbursements, Cook asks us to sympathize with the Wilsons' financial situation. The Wilsons drive a "blue, eleven-year-old Volvo station wagon" (Cook 30) while Charles Kelley, a CMV administrator, drives a Ferrari (Cook 87). Cook implies that money saved by inconveniencing patients and not providing them with expensive care is used to finance the plush lifestyle of CMV's bureaucrats. Witness the following lines: "With CMV's Learjet in its final stages of fueling, (the CEO of CMV) invited Kelley into the back of his limousine. He offered Kelley a drink from the limo's bar" (Cook 87). Readers are meant to demonize these CMV administrators and envy their opulent lifestyle.
Use of the stock character of the sympathetic doctor
Fatal Cure is a bestseller that relies on the stock character of the caring male doctor. This stereotypical doctor only has his patients' best interests at heart. He is sensitive and introspective. In addition, these characters may break the rules of "professional etiquette" (Porter 258) for their patients' benefit.
Dr. Thomas Chilton in Eleanor Porter's Pollyanna is another stock compassionate doctor character. After the title character loses the use of her legs, Pollyanna's Aunt Polly, still bitter years after an angry lover's quarrel with Chilton, refuses to let Chilton treat the child. Instead of feeling insulted, Chilton tries to follow Pollyanna's case from "a mile from her bedside" (Porter 257). Convinced that he can help Pollyanna walk again, Dr. Chilton begs his friend to help him see the patient. "'Pendleton, I want to see that child. I want to make an examination. I must make an examination . . . Pendleton, I've got to see that child! Think of what it may mean to her - if I do!'" (Porter 255-258). When not caring for patients, the sensitive doctor spends much of the novel contemplating his lonely existence and pining for Aunt Polly.
Dr. Matthew Swain is a stock doctor character in Grace Metalious' 1956 novel Peyton Place (Jones, Bibliographic Description). Dr. Swain hates death more than anything else (Metalious 2), but he puts his principles aside to perform an illegal abortion on Selena Cross, a young girl carrying her stepfather's child. Since Selena Cross (not her unborn child) is Swain's patient, he puts the young girl's interests first: "And to hell with you, he told the silent voice. I am protecting life, this life, the one already being lived by Selena Cross" (Metalious 145). After Selena killed her father and is on trial for his murder, Dr. Swain remains loyal to his patient. He takes the stand, testifying that he had performed Selena's abortion, that Selena's father was a monster, and that the murder was justifiable homicide. By testifying, Swain risked losing his medical license and being arrested himself, but he placed the needs of his former patient before his own.
Fatal Cure's Dr. David Wilson had "prided himself on always keeping the patient's needs to the fore" (Cook 142). David resists his HMO employers' attempts to force him to pledge allegiance to cost containment instead of patient care. During a performance review, David expects to hear about patient approval rates; instead, a CMV administrator rebukes David for spending too much time talking with each patient. An angry David resists the HMO's orders "'to avoid talking with patients and answering their questions,'" saying "'I don't like it. I wonder if the patients realize they are being shortchanged'" (Cook 232-233). At the end of the novel, David gets a new job in a new city, where "'now I have the freedom to spend more time with a patient when I think it's called for'" (Cook 438). Throughout the novel, David's foremost concern continues to be the welfare of his patients.
Cook does not write about selfless, caring doctors to imply that as a doctor he is also selfless and caring; he is hoping to single-handedly prevent American readers from losing faith in their managed-care physicians. Fatal Cure publicizes several of the questionable financial arrangements made "behind the scenes" between doctors, hospitals, and managed care organizations. For example, physicians employed by CMV are paid a bonus for reducing the number of days his patients stay in the hospital. The fewer patients one admits to the hospital, the larger the bonus one receives (Cook 85). Faced with this compelling financial incentive, the CMV "gatekeeper" physicians will think twice before admitting any patient to the hospital. After explaining the backroom deals made by managed care players, Cook realizes that patients/readers will need to blame someone for the divided loyalties and conflicts of interest inherent in modern-day managed care. To prevent readers from becoming suspicious of their doctors and undermining the physician-patient relationship, Cook shows David Wilson making his patients' welfare his only priority. Cook encourages readers to blame HMO administrators, people who are invariably described as not physicians, for these conflicts of interest.
By stating that "everyone knows that doctor-patient relationships are the cornerstone of good medical care" in Fatal Cure, Cook anticipates the concerns of the entire medical community. One year after Fatal Cure was published, the American Medical Association published a position paper entitled "Ethical Issues in Managed Care" that expressed doctors' concern that harsh financial incentives to limit the cost of health care would undermine the physician-patient relationship. The AMA argued that incentives like the one offered by CMV might result in doctors with a dual allegiance to their pocketbooks and their patients, as opposed to a sole goal of improving their patient's welfare (AMA 333). In addition, when patients learned of these incentive agreements, they would begin to suspect that their doctors might be withholding potentially beneficial treatments because of financial concerns (AMA 333). The AMA did not know that Dr. Cook had already taken steps to shape the attitudes of the reading public.
Fatal Cure falls into the categories of bestsellers written by an author who practices the profession he writes about, David vs. Goliath tales, and bestsellers featuring a stock sympathetic doctor character. These three categories are elements of the more general category of formulaic bestsellers. Robin Cook follows a proven formula, just like other best-selling authors such as John Grisham (legal thrillers), Tom Clancy (espionage thrillers), and Danielle Steel (romance novels). By repetition of a successful formula, each of these authors builds a loyal fan base of readers who enjoyed the author's previous books and want to read more of the same. Amazon.com reader reviews by readers who have read several books by these authors show that it is this "loyal fan base" that makes the authors' successive books bestsellers. Many American readers seek the predictable and the familiar, and these authors do not disappoint.
In addition to sharing aspects of other formulaic bestsellers, Cook also repeats his proven formula within his own body of works (Stookey 127). His 1988 novel Mortal Fear is a previous product of the same formula Cook used to create Fatal Cure six years later (Goudar, Brief Biography). Both novels are medical murder mysteries written by a medical doctor. Both of these novels describe a David vs. Goliath conflict between a sympathetic doctor and evil HMO administrators who are murdering patients with costly illnesses (Stookey 127-128). In the same vein as Fatal Cure's Dr. David Wilson, Mortal Fear's main character Dr. Jason Howard "is a physician who makes extra time for his patients, who worries about them after hours, and who mourns for them after they are gone" (Stookey 128). The U.S. book-buying public is voicing their increasing desire for Cook's formulaic medical thriller novels: 1988's Mortal Fear sold over 150,000 copies in its first eleven months (Simora 549), while 1994's Fatal Cure sold more than twice as many copies during a similar period of time (Barr 589).
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Contemporary Authors Online database, The Gale Group, 1999. Go to the Biography Resource Center (Web) database (http://www.galenet.com/servlet/BioRC), search for Robin Cook, and click on "Narrative Biographies."
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Cook, Robin. Mortal Fear. New York: G.P. Putnam's Sons, 1988.
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Maloney, Joseph. Database entry on You Only Live Twice by Ian Fleming. (http://www.engl.virginia.edu:8000/courses/bestsellers/picked.books.cgi)
Metalious, Grace. Peyton Place. Boston: Northeastern University Press, 1999.
Osborn, Stephanie. Database entry on Presumed Innocent by Scott Turow. (http://www.engl.virginia.edu:8000/courses/bestsellers/picked.books.cgi)
Porter, Eleanor H. Pollyanna. New York: Puffin Books, 1994.
Russell, Brandis. Database entry on Pleading Guilty by Scott Turow. (http://www.engl.virginia.edu:8000/courses/bestsellers/picked.books.cgi)
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