Dr. Iddi Nyabawe, 1st year Ophthalmology Resident MUK

Dr. Iddi Nyabawe, 1st year Ophthalmology Resident MUK

Medical thrillers, like any other literal works of fiction contribute a great deal in nurturing empathy amongst their readers. Medicine being a career that entails working with people, empathy is needed more in it than almost in any other profession known. Doctors work on patients in all conditions, critical and non-critical, emergencies and chronic conditions. It is imperative to note that doctors are the best story-tellers for all their job is bound by ‘clerking patients’ which involves ‘history-taking’. A doctor listens to the patient’s ‘story’ of the disease; coined as the History of Presenting Complaints. We, as medical students are trained to sift the relevant history from the whole narrative given by the patient, and we are obliged to be good listeners. ‘Good’ would be an understatement to this effect, for we must be the very best listeners to avoid any misdiagnosis due to ‘mishearing’ the patient. This could cost a life of a patient. 
After recording the history, we then do the physical examinations, investigations and start off with the designated treatment of the patient as per the findings. All these steps involve relaying ‘stories’ to the next medical handler at each stage. For example, the referring doctor will write a referral note to the hospital to which the patient is being referred. Documentation of the facts in the best chronologic narrative is of utmost importance in the management of the patient upon being received in the referral hospital. Specialist physicians also take history of patients even if the history is written in the files so as to remove any doubts of any missing history whatsoever. Even the most experienced physician who has worked for over 30 years on the same kind of patients continues to take history of patients and does not just treat them according to his presumed knowledge. This emphasizes the common adage in medicine; ‘No two patients can be the same’.
In line with all the recognition of medical history-taking and documentation, this article attempts to explore a very interesting field in medicine, the field of medical thrillers.
Dr. Robin Cook once said: I think of myself more as a doctor who writes, rather than a writer who happens to be a doctor." He explained the popularity of his works thus: "The main reason is, we all realize we are at risk. We're all going to be patients sometime," he says. "You can write about great white sharks or haunted houses, and you can say I'm not going into the ocean or I'm not going in haunted houses, but you can't say you're not going to go into a hospital. ( Dr. Robin Cook, 2007)
In general terms, medical thrillers are basically medical-related narratives relayed by a either a medical personnel or any other person familiar with the medical drama in the hospital settings or associated with disease conditions.  
Medical thrillers have been a mainstay of popular fiction since the late 1970s and still attract a wide readership today. (Jean Charpy, 2014)
Thriller is a broad genre of literature, film and television, having numerous subgenres. Thrillers are characterized and defined by the moods they elicit, giving viewers heightened feelings of suspense, excitement, surprise, anticipation and anxiety. (Bennett, Steve et al)
Medical thrillers are classed as a separate genre in literal fiction, sharing a platform with Science Fiction (SciFi), adventure amongst other genres. Unlike other genres that can be authored by anyone with almost any background, most authors of medical thrillers are people with a medical background because their medical touch is best sculpted by those in the medical field.
Medical thrillers are fact-based novels. Whichever medical condition they discuss is meant to be rightly discussed and not otherwise, for their audience is both a medical and non-medical population. They literally have fewer counts on the tough medical terminologies because their readers include the general public, but again they are not so ‘dilute’ in the medical sense that they could appear a usual literal text to the medical personnel. They are somewhat in the middle of these two realities. This adds to their appeal in the eyes and hearts of patients, doctors, medical students, nurses, and all masses alike.
The first step in writing a medical thriller is research. This type of research needs depth and breadth. Not surprisingly, many medical and scientific thrillers have been written by physicians or scientists like Robin Cook, Michael Crichton, Kathy Reichs, and myself. (Dr. J.L. Greger  et al.).
 Other physicians notable in the field of being prolific authors of medical thrillers are; Tess Gerritsen and the late Michael Palmer. (Jay McDonald 2007) 
Brief authorship biographies of some of the above notable authors have been included in this review so as to better appreciate their contributions to the genre.
Dr. Robin Cook, the inventor (or father) of the medical thriller genre is considered to be the first to have written a medical thriller that attracted world attention. His first book was called ‘The Year of the Intern’ second book and the second one, which sold most was called ‘Coma’ and it is about a shortage of transplant organs.( Fabrikant, Geraldine, January 21, 1996). Robert Brian "Robin" Cook (born May 4, 1940, in New York City) is an American physician and novelist who writes about medicine and topics affecting public health. (Stookey, Laurena Laura 1996) Dr. Robin Cook, a graduate of the Columbia University medical school, finished his post graduate medical training at Harvard. He has also been a professional diver, and has served as an aquanaut for Sea Lab and an intern at Jacques Cousteau’s oceanographic institute in the South of France. 
  Dr. Robin Cook (2008)
He is best known for combining medical writing with the thriller genre. Many of his books have been bestsellers on The New York Times Best Seller List. Several of his books have also been featured in Reader's Digest. His books have sold nearly 400 million copies worldwide. (AEI Speakers 2012 et al) 
To date, Cook has explored issues such as organ donation, fertility treatment, genetic engineering, in vitro fertilization, research funding, managed care, medical malpractice, medical tourism, drug research, and organ transplantation. His books number to 33 as of today; all being medical thrillers. His main publisher is Macmillan Publishers of the U.K.
Some books of Dr. Robin Cook include: 
    Year of the Intern (1972), ISBN 978-0-451-16555-8
    Coma (1977), ISBN 978-0-451-20739-5
    Sphinx (1979), ISBN 978-0-451-15949-6
    Brain (1981), ISBN 978-0-451-15797-3
    Fever (1982), ISBN 978-0-425-17420-3
    Godplayer (1983), ISBN 978-0-425-17638-2
    Mindbend (1985), ISBN 978-0-451-14108-8
    Outbreak (1987), ISBN 978-0-425-10687-7
    Mortal Fear (1988), ISBN 978-0-425-11388-2
    Mutation (1989), ISBN 978-0-425-11965-5
    Harmful Intent (1990), ISBN 978-0-425-12546-5
    Vital Signs (1991), ISBN 978-0-425-13176-3
    Terminal (1993), ISBN 978-0-425-15506-6
    Fatal Cure (1993), ISBN 978-0-425-14563-0
    Acceptable Risk (1995), ISBN 978-0-425-15186-0
    Invasion (1997), ISBN 978-0-425-21957-7
    Toxin (1998), ISBN 978-0-425-16661-1
    Abduction (2000), ISBN 978-0-425-17736-5
    Shock (2001), ISBN 978-0-425-18286-4
    Seizure (2003), ISBN 978-0-425-19794-3
    Death Benefit (2011), ISBN 978-0-425-25036-5
    Nano (2013), ISBN 978-0-425-26134-7
    Cell (2014), ISBN 978-0-399-16630-3
    Host (2015), ISBN 978-0-399-17214-4
Many of Dr. Robin Cook’s books have been adapted into film scripts. 
For example, Coma (1977) has been adapted for both film and television:
    -Coma (1978), a feature film directed by author/doctor Michael Crichton and produced by Martin Erlichmann for Metro-Goldwyn-Mayer
    -Coma (airdates September 3–4, 2012) a four-hour A&E television mini-series based on the 1977 novel and subsequent 1978 film, directed by Mikael Salomon and produced by brothers Ridley and Tony Scott
-Sphinx (1979) was adapted into the feature film Sphinx (1981), directed by Franklin J. Schaffner, produced by Orion Pictures for Warner Bros., and starring Lesley-Anne Down and Frank Langella
-Harmful Intent (1990) was adapted as the CBS television movie Robin Cook's Harmful Intent (airdate January 1, 1993), directed by John Patterson and produced by David A. Rosemont[9]
-Mortal Fear (1988) was as an eponymous TV movie, airdate November 20, 1994, directed by Larry Shaw
Outbreak (1987) was adapted as the film Virus (Formula For Death) (airdate May 1995), directed by Armand Mastroianni
  (Cover of ‘Cell’; authored by Dr. Robin Cook)
A brief synopsis of ‘Cell’, one of the books written by Dr. Robin Cook;
The New York Times–bestselling author and master of the medical thriller returns with a top-notch fusion of groundbreaking medical science and edge-of-your-seat suspense.
George Wilson, M.D., a radiology resident in Los Angeles, is about to enter a profession on the brink of an enormous paradigm shift, foreshadowing a vastly different role for doctors everywhere. The smartphone is poised to take on a new role in medicine, no longer as a mere medical app but rather as a fully customizable personal physician capable of diagnosing and treating even better than the real thing. It is called iDoc.
George's initial collision with this incredible innovation is devastating. He awakens one morning to find his fiancée dead in bed alongside him, not long after she participated in an iDoc beta test. Then several of his patients die after undergoing imaging procedures. All of them had been part of the same beta test.
Is it possible that iDoc is being subverted by hackers—and that the U.S. government is involved in a cover-up? Despite threats to both his career and his freedom, George relentlessly seeks the truth, knowing that if he's right, the consequences could be lethal.
(An excerpt of ‘Cell’)
Praise for Cell:
"Medicine is about to go through its biggest shakeup in history. Who could better capture this in the form of a medical techno-thriller than Dr. Robin Cook? CELL presents an enthralling, balanced look at the imminent future of digital medicine, with the smartphone center stage."
— Eric Topol, MD, author, The Creative Destruction of Medicine, Editor-in-Chief of MEDSCAPE, Chief Academic Officer, Scripps Health, and Professor of Genomics, The Scripps Research Institute
"Rare is the writer who can take us into the fast-paced, miraculous, often bewildering world, of modern medicine the way Robin Cook can. CELL is a superbly crafted, full-steam thriller, to be sure, but also a vivid lesson in just how momentous are the advances being made in medicine almost by the day—and how highly unsettling are some of the possible consequences."
— David McCullough 
"CELL might be Robin Cook's best book . . . a page-turner par excellence with potential impact on health policy. It's a fun, thought provoking story and, like his book COMA, cries out to be an engrossing movie."
— Senator Orrin Hatch, ranking member of the Senate Finance Committee and a member of the Subcommittee on Health Care.
"Medicine is undergoing a major change as it is pulled into the information age. Robin Cook's brilliant new creation iDoc, the physician smartphone app, may soon become a reality. Cook's latest, iconic, paradigm-shifting thriller, CELL, demonstrates the chilling implications of the electronic transformation of medicine today."
— Peter Black, MD, PhD. Emeritus Professor of Neurosurgery, Harvard Medical School and President, World Federation of Neurosurgical Societies, 2009-2013. (ibid)
The above glimpse on Dr. Robin Cook would suffice as an attempt on an exegesis of his contributions to the medical thriller genre. As a medical student, he is my medical mentor by default. Whilst reading his books, I feel like a child being cuddled by a dad and listening to his best refined stories that take you to the realms of a medical reverie! It’s literally kind of a medical epic! This is not presented as an advertisement or nominal praise of one author but an unbiased recognition of Dr. Robin Cook in the medical thriller genre. (Iddi et al, 2017)
As this review is a general review on the subject of medical thrillers and not specifically about one author, it’s inevitable to discuss some other contemporaries of Dr. Robin Cook.
The late Dr. Michael Stephen Palmer, M.D. (October 9, 1942 – October 30, 2013), was an American physician and author. His novels are often referred to as medical thrillers. (The Miami Herald, 2013). Some of his novels have made the New York Times Best Seller List and have been translated into 35 languages. One, Extreme Measures (1991), was adopted into a 1996 film of the same name starring Hugh Grant, Sarah Jessica Parker, and Gene Hackman. 
In 1978, he read Robin Cook's medical thriller Coma (1977). Palmer thought if Cook, also a Wesleyan graduate, could write a novel, then he could too. When not writing, he worked part-time at Massachusetts Medical Society. (Palmer, Michael 2014)
  The late Dr. Michael Palmer.
Before he began work on his first published novel, The Sisterhood, about euthanasia, Palmer was practicing treatment of drug addiction.
Side Effects (1985), his second published work, was about the testing of unapproved drugs on a patient in Nazi Germany, but his most famous novel proved to be Extreme Measures (1991), in which a promising young doctor is threatened by a hospital elite after discovering the body's criminal acts. A selection of his other books include: Natural Causes (1994), about an holistic doctor who prescribes medicine that actually kills patients; Miracle Cure (1998), about a drug for heart disease that actually is very dangerous because of its side effects; and Extreme Measures (1991), on which the eponymous 1996 thriller film starring Hugh Grant, Sarah Jessica Parker, and Gene Hackman is based.
A list of medical thrillers authored by Dr. Michael Palmer;

    The Sisterhood (1982)
    Side Effects (1985)
    Flashback (book) (1988)
    Extreme Measures (1991)
    Natural Causes (1994)
    Silent Treatment (1995)
    Critical Judgment (1996)
    Miracle Cure (1998)
    The Patient (2000)
    Fatal (2002)
    The Society (2004)
    The Fifth Vial (2007)
    The First Patient (2008)
    The Second Opinion (2009)
    The Last Surgeon (2010)
    A Heartbeat Away (2011)
    Oath of Office (2012)
    Political Suicide (2013)
    Resistant (2014)
    Trauma (2015)
    Mercy with Daniel Palmer (2016)
Dr. Tess Gerritsen (born June 12, 1953) is an American novelist and retired physician. In 1975, Gerritsen graduated from Stanford University with a BA in anthropology, intrigued by the ranges of human behavior. (CASA, January 2009) She went on to study medicine at the University of California, San Francisco. (High Chris, 2007) She received her medical degree in 1979 and started work as a physician in Honolulu, Hawaii. (Karm, Ali; September 2002)
  Dr. Tess Gerritsen
Gerritsen wrote a stand-alone medical- historical thriller titled The Bone Garden. A tale of gruesome murders, the book is set primarily in 1830s Boston and includes a character based on Dr. Oliver Wendell Holmes. (Sege, Irene ; November 14, 2007) In this book, she discusses that the high demand for bodies to be used for dissections in medical schools at that time instigated the murders and even exhuming of bodies by some characters in the storyline. These bodies would then be sold to the Boston Medical School.
Some  medical thrillers authored by Dr. Tess Gerritsen include; Harvest (1996), Life Support (1997) Bloodstream (1998), Gravity (1999), The Bone Garden (2007) medical examiner Dr. Maura Isles is a secondary character, Girl Missing (2009).
Unlike Dr. Robin Cook who writes only medical thrillers, Dr. Tess Gerritsen has also written a number of books out of the medical thriller genre including some romance and standalone books.
The above brief glimpses at three prominent authors of medical thrillers would suffice to indicate that they are a current trend amongst both medical personnel and the general public; for the authors would not have written those many books if the readers did not exist within the masses and amongst health workers as well.
The captivating nature of medical thrillers is affirmed by those that read them. This is because the hospital is a centre that almost all people must entre. We are born in hospitals and most critically and terminally ill patients die in hospital. Every hospital tries to treat patients and most get cured by still a number also die. Death is inevitable; otherwise, what would be the need of the mortuary? What would be the need for a post mortem and pathology departments for that matter?  A suitable book to read on this is ‘Brain’ written by Dr. Robin Cook.  
Realizing all these facts, whoever reads a medical thriller knows that what is being discussed is a reality! Any subject held in a medical thriller ought not to be neglected for it is part of the daily medical dilemmas seen in hospital. 
To the patients, medical thrillers are a way in which to discover the feelings of other patients who had succumbed to a similar condition. Fate, being undetermined, is an undeniable fact in the eyes of all patients, and more so to those with chronic illnesses. Mental patients who had been of high profile class initially see it as a big shame to be institutionalized in a mental or psychiatric hospital. The only way they can rediscover themselves is by reading about similar people who were in the same condition they find themselves in. A relevant boo k to recommend on this is ‘Veronika Decides To Die’, a somewhat medical thriller authored by a non-doctor, but prolific author Paul Coelho. In this book, he clearly depicts the thoughts of a suicidal patient and the lives of psychiatric patients in a mental hospital. This is of great value to students studying psychiatry for they wouldn’t easily delve into the minds of a psychopath unless helped by the marvel of a medical thriller.
When a terminally ill patient reads the book called ‘Terminal’ also authored by Dr. Robin Cook, he/she will bond with the protagonists in their endless and demanding search or discovery of a cure for medulloblastoma.  Even if the book also shows the money-laundering aspect in medical research, it still communicates to terminally ill patients as a relevant narrative to answer some of their questions on how a terminally ill patient feels. Although a work of fiction, this book makes the patients realize that they aren’t the first ones to get a certain terminal illness, and therefore not the last ones. Another book to this effect is ‘Fever’ by the same author.  As the patient continues to read this book, the events behind medical research are opened up and unveiled for the patient to know that the doctors try to do their best to find a cure for their ailment. ‘Acceptable Risk’, also by Dr. Robin Cook shows how much doctors give in towards the almost unbearable search for a new drug. In this book, he spoke about ‘Prozac’, whose generic is Fluoxetine. I am of the view that research should be done on the role of medical thrillers in the management of chronically ill and terminal patients. 
To the general public inquisitive on new developments in the medical world, their curiosity is satisfied when they read a storyline of a fact-based medical novel in connection with their field of interest. For example, when I was studying management of infertility for the first time in my fourth year, I found a unique connection of the applied theory with the text in ‘Shock’, written by Dr. Robin Cook. I recommended this to friends of mine in the general public who were asking about infertility and the related aspects of Invitro Fertilization (IVF). They commented that they appreciated the message and enjoyed the narrative as the author speaks in a language they best understood; storytelling.
To the medical doctors, medical thrillers inspire them to have empathy for their patients. This is also well experienced whilst reading ‘Terminal’ by Dr. Robin Cook, as medical personnel.  Another added benefit to doctors who read medical thrillers is that they get to develop empathy, which is uniquely acquired more in reading fiction than in reading textbooks. Besides, they also improve their clinical acumen as they read more marveling clinical judgments by other doctors in the thriller narratives.
To the medical students, medical thrillers are a means of a ‘virtual clinical exposure’ before the wards and also to disease conditions that might not be common in their area. Having read ‘Fever’ by Robin Cook in my 3rd year of medical school was a means of learning more about Aplastic Anemia, a rather rare condition in Uganda. This helps in integrating the theoretical medical knowledge in medical textbooks with the practical bit in the clinical sphere. Through reading medical thrillers, I got the opportunity to glimpse at the lives of doctors in different clinical specialties or those of medical academia, and even those that are not yet available here in Uganda, East Africa. It is an opportunity to listen to the thoughts some prominent doctors who are the main characters of the thrillers; a rather rare opportunity to students. Reading medical thrillers also improves both the medical and English vocabulary of the readers, especially medical students who are rarely interested in the literal disciplines. It’s of critical importance to note that medical thrillers can never and should not be assumed to substitute medical textbooks however detailed they might be, for the former are written for medical entertainment and the latter for medical education. The role of medical thrillers in medical education ought to be investigated further by more research projects to this effect. 
To the social aspect, medical thrillers are an effective way to bond with people of all walks of life. I have gained a wide range of friends and connections due to writing a series of medical thriller articles in ‘The Daily Post Uganda’. Besides, I have made many other friends through lending them some medical thriller books, mainly those by Dr. Robin Cook, Dr. Tess Gerritsen and the late Dr. Michael Palmer.
In Uganda, we need more medical thrillers to be authored especially as related to the practice of medicine in developing countries. It would be of great value if doctors in different specialties contribute to this interesting and educative field. 
In conclusion, this would help much in the realization of the role of literal texts in nurturing empathy.
Researchers at The New School in New York City have found evidence that literary fiction improves a reader’s capacity to understand what others are thinking and feeling.
Emanuele Castano, a social psychologist, along with PhD candidate David Kidd conducted five studies in which they divided a varying number of participants (ranging from 86 to 356) and gave them different reading assignments: excerpts from genre (or popular) fiction, literary fiction, nonfiction or nothing. After they finished the excerpts the participants took a test that measured their ability to infer and understand other people’s thoughts and emotions. The researchers found, to their surprise, a significant difference between the literary- and genre-fiction readers.
When study participants read non-fiction or nothing, their results were unimpressive. When they read excerpts of genre fiction, such as Danielle Steel’s the Sins of the Mother, their test results were dually insignificant. However, when they read literary fiction, such as The Round House by Louise Erdrich, their test results improved markedly—and, by implication, so did their capacity for empathy. The study was published October 4 in Science. (Julianne Chiaet, 2013)
Humans love to listen to stories, to tell them and to write them. It is by default that all cultures have narratives as part of their folk traditions. It would be really thrilling to embrace medical thrillers as a tradition in medicine!

References:
- Jay McDonald. "What a shock: Robin Cook fuses stem cells with a suspenseful tale". Retrieved 2007-10-08.
-Bennett, Steve. "Thriller Fiction Genre definition". Findmeanauthor.com. Retrieved June 22, 2010
-J. L. Greger, author of ‘Malignancy’; a former professor in the biological sciences at the University of Wisconsin-Madison
-Fabrikant, Geraldine (January 21, 1996). "TALKING MONEY WITH: DR. ROBIN COOK". The New York Times. Retrieved February 22, 2017
-Stookey, Lorena Laura (1996). Robin Cook: A Critical Companion, Westport, Connecticut, London: Greenwood Press. ISBN 0-313-29578-6
-AEI Speakers, American Entertainment International Speakers Bureau. "Robin Cook Biography". Second and fifth paragraphs. Retrieved April 8, 2012.
-Jay McDonald. "Workaholic doctor-author says money never a goal". Retrieved 2007-10-08.
-http://robincook.com/book-display.php?isbn13=9780425273852
- BIO from the Tess Gerritsen Official Blog
- CASA Newsletter" (PDF). Cultural and Social Anthropology Department, Stanford University. 1999. Retrieved January 20, 2009.
- High, Chris (2007). "Interview with Tess Gerristen 2007". Chris High. Retrieved January 19, 2009.
- Karm, Ali (September 2002). "Shots Magazine Interview: Tess Gerritsen". Shots Magazine. Archived from the original on May 1, 2003. Retrieved January 19, 2009.
-Sege, Irene (November 14, 2007). "Medical mysteries add twists to historical thriller". Boston Globe. Retrieved January 19, 2009.
-Jean Pierre Charpy, Journal of Medical Humanities, December 2014, Volume 35, Issue 4, pp 423–434,Medical Thrillers: Doctored Fiction for Future Doctors?
-Novel Finding: Reading Literary Fiction Improves Empathy types of books we read may affect how we relate to others, By Julianne Chiaet on October 4, 2013 
-https://www.scientificamerican.com/article/novel-finding-reading-literar...
-Iddi Ndyabawe, 2017; Could Time Be Health? http://thedailypost.ug/health-wealth-time-money-obviously-money-wealth-t...

Dr. Iddi Nyabawe, 1st year Ophthalmology Resident MUK. 30/06/2020.

Comments

Well written Dr Iddi. Indeed inspires and provokes one to write and share the wealth of experience we encounter on a daily. Thank you for sharing. Kind regards

Mansha-Allah... Wow, Great work, indeed its time to embrace medical thrillers...

Educative & good packaging of scientific information. Keep it up my Eye Dr .waiting for more

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