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Fatal

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From The Sisterhood, Michael Palmer's first New York Times bestseller, to The Patient, his ninth, reviewers have proclaimed him a master of medical suspense. Recognized around the world for original, topical, nail-biting suspense, emergency physician Palmer'swork has been translated into more than thirty-five languages. Now he reaches controversial and startling new heights in a terrifying tale of cutting-edge microbiology, unbridled greed, and murder, where either knowing too little or trusting too much can be FATAL.

In Chicago, a pregnant cafeteria worker suffering nothing more malevolent than flulike symptoms begins hemorrhaging from every part of her body. In Boston, a brilliant musician, her face disfigured by an unknown disease, rapidly descends into a lethal paranoia. In Belinda, West Virginia, a miner suddenly goes berserk, causing a cave-in that kills two of his co-workers. Finding the link between these events could prove FATAL.

Five years ago, internist and emergency specialist Matt Rutledge returned to his West Virginia home to marry his high-school sweetheart and open a practice. He also had a score to settle. His father died while working for the Belinda Coal and Coke Company, and Matt swore to expose the mine's health and safety violations.

When his beloved Ginny succumbed to an unusual cancer, his campaign became even more bitterly personal. Now Matt has identified two bizarre cases of what he has dubbed the Belinda Syndrome--caused, he is certain, by the mine's careless disposal of toxic chemicals. All he needs is proof.

Meanwhile, two women, unknown to one another, are drawn inexorably to Belinda, into Matt's life--and into mortal danger. Massachusetts coroner Nikki Solari comes to attend the funeral of her roommate, killed violently on a Boston street. Ellen Kroft, a retired schoolteacher from Maryland, seeks the remorseless killer who has threatened to destroy her and her family.Three strangers--Rutledge, Solari, and Kroft--each hold one piece of a puzzle they must solve, and solve quickly. If they don't, it will be far more than just their own lives that are at risk.

Michael Palmer has crafted a novel of breathtaking speed and medical intricacy where nothing is as it seems and one false step could be FATAL.

509 pages, Mass Market Paperback

First published March 27, 2002

621 people are currently reading
2718 people want to read

About the author

Michael Palmer

68 books242 followers
Michael Stephen Palmer, M.D., was an American physician and author. His novels are often referred to as medical thrillers. 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.

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5 stars
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3 stars
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65 (1%)
Displaying 1 - 30 of 286 reviews
Profile Image for Jim.
581 reviews118 followers
May 19, 2019
Two stars means that I found this book to be okay. It wasn't great and I am in no great hurry to read another book by Michael Palmer. I was looking for my next book to read and this had been on my TBR shelf for a while so I decided to go with it. It fit that need adequately. A book to read when you are looking for something. Definitely not a book that once I finished I would tell others "you have to read this book".

The protagonist is Matt Rutledge, an internist and emergency specialist who returned to his hometown of Belinda, West Virginia to marry his high-school sweetheart, Ginny, and open a practice. Then Ginny succumbed to an unusual cancer. Matt blamed Belinda Coal and Coke Company, the town's largest employer. He believes their safety violations with regards to the careless disposal of toxic chemicals are at fault. Matt's father had also died in the mine when he was a boy. Now he has identified two bizarre cases of what he has dubbed the Belinda Syndrome. Matt is on a mission to expose Belinda Coal and Coke Company.

Dr. Nikki Solari, a Boston pathologist, watched as her musically gifted roommate deteriorated mentally and strange growths appeared on her face. When her roommate dies Nikki travels to the roommates hometown for the funeral. Belinda, West Virginia. After the funeral Nikki is assaulted and almost killed. She meets Matt and of course they fall in love and team up to find out the truth.

Ellen Kroft, a retired schoolteacher, sits on a board that will be voting on the release of a super vaccine. She is the lone holdout and finds both herself and her family threatened. Her response? She tracks down the man that threatened her. To where? Belinda, West Virginia!

There is a lot of typecasting in my opinion. The residents of Belinda are toothless, uneducated, and their manner of speaking? Well like I said ... typecasting. This is not to say the people of Belinda are not smart. There are four brothers who Matt relies on for help who are very smart and very colorful. They added a touch of humor to this story.

Together Matt, Nikki, and Ellen will take on the mine company and the pharmaceutical company that is developing the super vaccine. It is a story about money and ethics. Good and evil. The little guy standing up to the big guys. The bullies. Those who put money and profit over safety. It was interesting reading at this time due to the measles outbreaks happening, supposedly due to parents who did not get their child vaccinated. The premise of the story was interesting but there were too many different stories all converging in one place to make this believable. Entertaining? So so.
Profile Image for Jim C.
1,781 reviews35 followers
June 14, 2021
This is a medical thriller genre novel. In this one, Matt is a doctor who lives in a town where a coal mining company exists. He believes they are poisoning the area and infecting the town's residents. He is the only one who believes this and he has no evidence of the company doing this.

When I read a medical thriller I want it to be believable that it could happen but hopefully it doesn't. This one achieved that aspect for me. The idea of huge companies dumping toxic waste wherever and not caring about the effects on the surrounding environment is not new. I had no problem with how the author handled this conspiracy. There is also a sub plot about vaccinations that all ties in at the end. I was more engaged with this sub plot and I believe the reason is the state of the world at the moment. Even though this was written years ago the vaccination plot is easily identifiable with the Covid vaccine. I love when books that were written in the past remain topical with the world of today. As for the characters there is nothing special here besides a rural family of brothers. They stole every scene they were in and I would not have minded if we see more of them.

This book kept my interest throughout. There were times when the actions or story took a leap of faith but nothing to deter my enjoyment of the novel. This was one of the times when the sub plot was more enjoyable that the main plot. Michael Palmer usually delivers a taut medical thriller that makes you wonder and he has done so again with this book.
Profile Image for Helen Power.
Author 10 books632 followers
December 14, 2020
TLDR: While slow to start, this book is fast-paced and full of action, conspiracies, and just a hint of romance.

I read this book for the category of “Medical Thriller” for the PopSugar reading challenge. I’ve read a handful of medical thrillers in the past (many more than a handful if you can count books where the protagonist is a medical examiner), but this was my first by Michael Palmer. I’m so glad I decided to read this.
The book starts off somewhat slow paced, and Palmer spends many pages letting us get to know the characters. That said, the characters are well-rounded and have backstories that fuel who they are today. I loved the characters and the little snippets of romance in two of the storylines.
There’s a lot of action and intrigue in this book! There’s also a little bit of science, but not so much that it might be confusing or overwhelming to non-sciencey people. (I have a science background, so it can be hard for me to judge this sometimes, but it seemed well-explained).

Profile Image for Jacqueline.
158 reviews
February 4, 2017
I didn't care for the vaccine angle. I found it hard to enjoy the story because I was so irritated by the conspiracy theory plot of the anti-vaccers.
Profile Image for (NurseLisa) Square Granny from Ohio.
876 reviews50 followers
July 15, 2015
4.5/5 stars.

I truly adored this book overall!

As a very seasoned & experienced RN (20+ yrs already!), I tend to really pick apart any story written in or about any type of healthcare situation. Obviously, the fact that Michael Palmer is a physician himself lends a whole entire level of credibility and "realness" to his writings; there isn't a bunch of silly or exaggerated medical situations that are glaringly unbelievable or just not accurate (which makes me CRAZY! Lol). Instead, the things he writes about are generally based in truth (for example: performing the emergency tracheotomy with a 2 or 3 ml plastic syringe after thinking "an ink pen cap would be perfect". This is indeed a correct procedure performed thousands of times across the world & often a plain 'ole Bic ink pen does the job! See? I eat these details up & they increase my enjoyment of the novel overall.

I did not just appreciate the accuracy of the medical details though; I found the entire story RIVETING. Both of them. Controversy about vaccinating our babies & children as a requirement is a hot button issue for many, many people-medical & non-medical, still today. Also, I grew up in a town where coal mining was THE profession for the folks if my grandparents generation (before the local mine finally closed) & also lost my beloved grandpa to a BRUTAL case of environmentally based lung cancer. I wonder CONSTANTLY about "what's in the water & soil" in my hometown dude to the old mine.

Alright, I've rambled more than enough! If you're still reading this, I'm impressed by your patience! Lol.

Michael Palmer writes a good book again. If you're an experienced reader if his, you'll likely enjoy this as much as any other of his writings. First time reader? My advice: Keep an open mind & remember, while much if the storyline is very accurate, it is still a FICTIONAL novel so read it in that spirit! ^_^

More than enough said! Thanks again for stopping by for my pontificating! :D

ENJOY! Cheers, NurseLisainOhio
Profile Image for Ladyslott.
382 reviews19 followers
November 29, 2010
Well what can I say? I had heard a lot about Michael Palmer’s books over the years, so when I found this one in my stacks I picked it up. I was extremely disappointed in this book.

The story starts out with a good premise, the possibility that toxic waste in a mine is causing serious illness in a number of people. Dr. Matt Ruttledge has an axe to grind with the mine owner’s and is bound and determined to prove his theory. When a doctor from Boston comes to town for a friend’s funeral an attempt is made on her life. At this point Dr. Rutledge and the beautiful Dr. Nikki Solari team up against the mining company. At the same time Ellen Kroft is getting ready to vote on the release of a new vaccine that may or may not be dangerous. When someone threatens the life of Ms. Kroft she decides to find out if her suspicions are correct. Somehow all three of these people end up together to fight really, really bad guys.

The problem with this book is that there were too many threads that had to come together in a believable fashion. The good people were all candidates for sainthood, and the bad guys were all so cartoonishly bad that I found myself laughing out loud. The love scenes were clunky at best with eye rolling dialogue and just when everything would seem to be coming to a head Mr. Palmer jerks the rug out from under us. Not once or twice but what feels like an endless string of really bad luck and timing. I was groaning out loud at the preposterous twists and turns. A few surprises are expected but I was getting whiplash for it all, and I am sure my insurance company wasn’t going to pay damages.

Obviously I don’t recommend the book, unless you are a masochist and enjoy inflicting the pain of cliché after cliché; the bad news for you is that there is a happy ending after all.
Profile Image for Rebe.
343 reviews10 followers
October 13, 2022
This is an average thriller for the most part, but the subject of the plot ruins it. The protagonists are two doctors and an anti-vax advocate who believes vaccines caused her granddaughter’s autism. A running theme of the book is that vaccines can’t be trusted because they haven’t been tested thoroughly enough. In the end (keeping it vague for spoiler reasons), evidence comes to light to prove that a certain vaccine is going to kill people and that the big bad people behind the vaccine are pretty much all evil and just in it for money. The doctor protagonists come to agree with the anti-vax woman, and the parents of the baby who was supposed to receive the vaccine first also express doubts that vaccines are safe.

It’s amazing that this was written by a doctor because it reads like something a conspiracy theorist came up with. I know it’s just a story, but it turned me off big time. I can’t recommend it to anyone.
6 reviews
April 18, 2012
I had to read this book for one of my classes. It was my first time reading anything by Michael Palmer, and at first, I really enjoyed it. How the entire mystery started off with an accident, and the way it could possibly be related to the protagonist's wife's death a few years back... But I started having a few problems with the book as I read it.


One thing was the million of characters that appear, and disappear into thin air. I had to write down every name that came up in the story, just in case they were to come up again later. At the end of the book, only about 1/3rd of them were regular characters. Palmer gives a name to every insignificant person who is mentioned only once or twice, it's extremely unnecessary. It also doesn't help that the book switches to a different point of view every few chapters, when there's already enough characters to memorise in one POV. However, I did like that the three POVs that seemed completely separate at first, eventually came together and connected.


I liked two of the main protagonists in this book. Their humour and sarcastic remarks were entertaining. And then... they decided to get together. The man still thinks about his deceased wife in the beginning of the book, so it showed that he was finally able to move on. That was sweet. Or, so I thought. These two have a mystery to solve ASAP, criminals they need to stop, and escape from other wrong-doers. But after having their kiss and confirming their relationship, they decide to flirt and make out instead. They basically do this throughout the second half of the book.


The ending and solution of the mystery wasn't very mind-blowing, either. Although I have to admit I didn't expect the antagonist to be who it was.


In conclusion, it was ok. It wasn't so bad that I couldn't go on, but I can't say that I liked it.

This entire review has been hidden because of spoilers.
Profile Image for Suzie.
17 reviews
August 23, 2013
Only half way thru & it is very tough to keep reading... bought this book as it got so many good reviews, however, I find it boring... there are too many stories going on at the same time & he goes into detail with all the medical & scientific terms... hoping it gets better soon, but doubt I will be reading any other books by him
Profile Image for Barbara Nutting.
3,205 reviews163 followers
January 27, 2022
To vaccinate or not to vaccinate - that is the question. This book was written 20 years ago, but that was the dilemma it exposed. It asked the same questions I wondered about with the Covid-19 shots. How safe? It was available very quickly, minimal testing, how many long term effects may result? I got all three shots and just hope they prevent me from contracting the virus. Big Pharma is not to be trusted nor the government, as was shown in this novel. Money and greed run both. I have a son with asthma and a grandson with ADHD - could a vaccine be the cause? We’ll never know.

Micheal Palmer was a doctor and he included way too much medical information that detracted from the story, so I knocked off a star. But He exposed the environmental problems with big busines and their lack of concern. He had very valid points in all he was trying to get across. It’s too bad he didn’t live to see the vaccination prophecy he wrote about come to fruition - or maybe not.
Profile Image for Fredrick Danysh.
6,844 reviews197 followers
November 11, 2020
In this medical thriller, people are dying horrible deaths. Dr. Matt Rutledge belieces thet are linked to the toxic dump of a coal mine. Then Dr, Nikki Solari arrives in Belenda, W.V. to inform her roommates parents of her death. Soon someone id trying to kill Solari and Rutledge. Is it due to the toxic chemicals or is there another reason? A read that keeps you guessing.


Profile Image for Judy.
1,987 reviews26 followers
April 17, 2021
Set aside some time when you begin this book. If you are like me, you won’t be able to stop reading. It starts off with three different storylines that come together with an exciting climax. Michael Palmer is a new author to me. Here he creates believable characters that I came to care about. I love Dr. Matt Rutledge and how he cares for the patients. Though I don’t understand the medical problems, I can appreciate the serious aspects. I am looking forward to another thriller from Palmer.
Profile Image for Rob Dinsmoor.
Author 9 books31 followers
January 23, 2011
I loved this books as I love all of Michael Palmer's books that I read. As Palmer trained as an ER physician and I'm a medical writer, I ate up all the medical detail, including his hero's performing dicey surgical procedures on the fly. This book follows the adventures of ER doctor Matt Rutledge, who returned to his hometown of Belinda, West Virginia, to marry his high school sweetheart and open a practice. After his wife Ginny dies from an unusual cancer, he starts to suspect that some unusual deaths are being caused by the Belinda Coal and Coke Company, which he suspects of illegally dumping toxic waste. He enlists the aid of four brothers who live in the hills. True to form, Palmer never looks down on his characters just because of their lack of education and station in life. The four brothers, with their knowledge of firearms and explosives, are some of the most colorful characters I've encountered recently in fiction. Very fun read!
Profile Image for Becky Spurlock.
24 reviews3 followers
September 19, 2023
DNF at 15%. I just couldn't keep reading. I love a medical thriller and I do not mind hearing repetitive medical situations and terms as I am a nurse. As a doctor writing this I was surprised at some of the situations and beliefs in this novel, especially the anti-vax plot. It is fiction so I won't go over the mercury/Thimerosal not contained in children's vaccines. I guess I should stick to medical thrillers that have more truth in them.
This novel dragged on in the beginning and I did not see this changing. I would not recommend this book.
67 reviews1 follower
November 17, 2018
The medical descriptions were so repetitive & boring. The flirting/joking around when they were in very dangerous situations was just stupid/silly. I am glad to be finished with this book - it took me forever to get through it.
Profile Image for Katie Sunsdahl.
669 reviews
March 27, 2021
could not finish this. I worked in the medical field for 40+ years, but this book had waaay too much "jargon" in it.
Profile Image for Stephanie Jenkins Ortiz Cerrillo.
373 reviews12 followers
November 10, 2018
Another great read by Michael Palmer and one that strikes close to home for me. My daughter and I both have auto-immune diseases that there has not been a discovery of what caused them. It could be from the enviroment, contamination of the environment, chemicals in the atmosphere, soil and our foods, vaccinations, or it could be a genetic factor in our bodies that just needed one of the previously mentioned factors or other trigger to bring about the onset of our chronic illnesses.

Doctor Matt Rutledge, an internist and emergency specialist has spent the last five years trying to prove that a coal mine in Belinda, West Virginia, is responsible for the deaths of his father and his wife. He believes the coal mine is releasing toxic chemicals into the environment and those chemicals are causing people in the area to become ill but he doesn't have the proof. This book has a double plot that comes together with a huge turn of events. There are two woman that show up in Belinda that believe there is yet another sinister health issue that's somehow connected to Belinda, West Virginia. Matt and the two woman set out to get to the bottom of the illnesses and deaths and there are people willing to kill them and anyone else that tries to get to the truth. Too what length will greedy individuals go to become wealthy? This book will leave you wondering if this type of thing really goes on in this world. I know it left me questioning even more than I already did.
205 reviews
May 9, 2023
A high octane medical thriller. It has, among other adrenaline producing events, high speed chases on Harleys - even in the deep woods of West Virginia - mine explosions, shoot- outs, kidnappings, assassinations, betrayals, a likable secluded backwoods mercenary family with a penchant for explosives, emergency surgery in rustic conditions, and races against time.

This story has three main plots: One takes place in the coal mining region of West Virginia and has a medical doctor in arms against a local mining company, believing the company is severely violating safety standards at the mines and subsequently endangering the lives not only of its employees but also the lives of others in the local community; Another plot has a medical doctor become aware of an unusual and heretofore previously unknown and fatal disease; The third plot has a 60+ grandmother volunteering in a non-profit “watchdog” organization that monitors the release of new vaccines to the public and provides education on vaccines and support for those whose children became sick after receiving a mandated vaccine. These three plots are connected and do eventually merge into one major story.

While reading the story it was intriguing trying to piece together the three storylines and it was very surprising to eventually find out how they were connected. This is my first book by this author and it won’t be my last.
Profile Image for Susan.
359 reviews32 followers
June 11, 2018
I give this book 3.5 stars. Started slow for me, fairly unbelievable premise, but I loved some of the characters (the Slocumb brothers were strangely my favorites!) This was really not great medical thriller material but it moved along and had enough side plots to keep it humming. If this wasn’t on my iPad, I could picture finding at one of my aunt’s homes, all dog-eared and I’d start reading it just because it was there. And that’s not a bad thing! I have numerous fond memories of those “pick up” novels. But I think this may be my only Michael Palmer book - just too not believable (and I am very good at suspending disbelief!)
Profile Image for Tonya Lucas.
1,266 reviews19 followers
September 24, 2018
An awesome book, 2 different plots that come together.
People are dying, not only in West Virginia but in other places. Is it from a coal mine what’s dumping toxic waste or something more sinister?
As the nation is preparing for a new vaccine for children, is it really safe for the children or a fate towards death?
Just wait until it all comes together.
1,922 reviews2 followers
May 2, 2018
Thoroughly enjoyed my first Michael Palmer ..... don't know why it took me so long to find this author....I'm a big fan of robin cook and now too Michael palmer
58 reviews
June 29, 2019
3.5 out of 5 stars. Good read. Slow at first. The story jumps around, especially in the beginning, but it all comes together in the end. Some of the dialogue is a little cheesy, but the plot makes up for it.
Profile Image for David Walley.
315 reviews
April 20, 2024
This was not one of Michael palmers better books. There were far too many coincidences in this book for it to be even remotely possible. Also, I thought it just went on too long and as usual I thought he over played the part of doctors making them far too God like. I have been an emergency physician myself, and trust me. Things do not go that easily no matter what one’s skill level. Life is far too fragile to be able to do some of the things that were done in this book.
Profile Image for Lauren Stoolfire.
4,778 reviews297 followers
November 12, 2012
It took me quite a while to really get into this novel - probably somewhere around the 100 page mark. There is a possibility that what kind of through me off in the prologue was the bit about "explosive diarrhea"... I had dinner shortly before I began the story. Anyways, of the three lead characters I particularly enjoyed reading Matt and Nikki; I found that I wasn't really all that interested in Ellen; she did grow on me to some extent near the end. However, one thing that irked me about Matt and Nikki was that they had to fall in love. I would have been just as happy if they didn't. I also liked the fact that there was a good deal more to the "mountain folk" than I originally expected since they started off as stereotypes. On a side note, if this would ever go the big screen (or small screen) Chris Bauer should definitely portray Chief Grimes.
Profile Image for Amy.
622 reviews6 followers
July 10, 2018
I wondered if he wrote this with someone else?
The beginning was fascinating but it deteriorated into too many threads and too many stereotypes. The good people were very good and the bad people were very bad. No nuance. The older woman is sole protester of a new multi vaccine from the bad pharmaceutical company. The young femme fatale is a young doctor who despite being attacked and thrown into water and kidnapped and shot at? is appealing and works to solve the mystery of a disease reminiscent of Ebola with the hero young widowed pony tailed Harley riding dr..
There are 2 love stories further mucking up details and allowing pages to be filled with that while the reader awaits results of plane passengers, autopsies, slides, coal production, and the vaccine vote. Its really a 2.5. Not his best.
Profile Image for Anthony Previte.
3 reviews
May 20, 2021
“What I’ve just read is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.”
Profile Image for Lou.
242 reviews3 followers
May 4, 2018
This took me 3 tries and an absolute age to get through. It started out ok but I just kept losing interest as it seemed too all over the place. I usually enjoy this sort of book but this one just didn't cut it for me.
Profile Image for Becca.
1 review1 follower
February 12, 2019
I would have given another star, but it takes a long time to get to the point. I know there are a lot of parts and pieces to get there, but I think there’s a few chapters that we could have done without.
Profile Image for Cynthia Edge.
1,472 reviews9 followers
March 19, 2020
The premise of this book was really intriguing, but there was too much going on and it was way too unbelievable. I am fine with suspending disbelief up to a point, but it just got to be too much for me. I enjoyed the medical aspects.
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