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Sinister by Design: An Authentic Medical Thriller
A mysterious illness is attacking new mothers, its root cause unknown. It's fast. It's deadly. And it may not be random.An outbreak of a new illness involving women who are all one-month postpartum leads a colleague to call on Drs. Shaw and Wyatt. When the high-profile daughter of the Governor becomes a victim of this seemingly random ailment, their unique mystery-solving skills are caught in the spotlight.
In their race to save the women, they uncover odd similarities amongst the mothers that point to disturbing conclusions about its root cause. The more they learn, the more dangerous and involved the situation becomes. And when related parties are found murdered, they must race against time to uncover the truth.
But with an increasing number of lives on the line, can they unwind the twisted knot before it's too late?
Sinister by Design, the nail-biting fourth book in the Madison Shaw and Jack Wyatt medical mystery series by Gary Birken, M.D., is perfect for fans of intricate plots, surprising twists, and chillingly authentic medical content.
In their race to save the women, they uncover odd similarities amongst the mothers that point to disturbing conclusions about its root cause. The more they learn, the more dangerous and involved the situation becomes. And when related parties are found murdered, they must race against time to uncover the truth.
But with an increasing number of lives on the line, can they unwind the twisted knot before it's too late?
Sinister by Design, the nail-biting fourth book in the Madison Shaw and Jack Wyatt medical mystery series by Gary Birken, M.D., is perfect for fans of intricate plots, surprising twists, and chillingly authentic medical content.
419 pages, Kindle Edition
Published February 10, 2026
About the author
Gary Birken
15 books147 followersGary Birken is a full-time pediatric surgeon, medical thriller author, husband, father, grandfather, and more.
Born and raised in New York, Birken completed his undergraduate studies in Ohio, spent two years studying in Paris, before returning to complete his general and pediatric surgery training at the Ohio State University Hospital and Columbus Children’s. Upon completion of his fellowship in pediatric surgery, Birken moved to Hollywood, Florida where he has spent his entire professional career. Presently, Birken serves as the Surgeon-In-Chief of the Joe DiMaggio Children’s Hospital.
As an Author, Gary Birken approaches novel writing as a means not only to entertain, but to educate the reader in a particular area of medicine. Birken’s approach to each book is first selecting a timely or controversial topic in medicine and then, using it as a springboard, Birken weaves a story of suspense and conspiracy around it.
When Birken is not in the operating room or writing his next medical thriller, he plays tennis, basketball and holds a black belt in martial arts.
Born and raised in New York, Birken completed his undergraduate studies in Ohio, spent two years studying in Paris, before returning to complete his general and pediatric surgery training at the Ohio State University Hospital and Columbus Children’s. Upon completion of his fellowship in pediatric surgery, Birken moved to Hollywood, Florida where he has spent his entire professional career. Presently, Birken serves as the Surgeon-In-Chief of the Joe DiMaggio Children’s Hospital.
As an Author, Gary Birken approaches novel writing as a means not only to entertain, but to educate the reader in a particular area of medicine. Birken’s approach to each book is first selecting a timely or controversial topic in medicine and then, using it as a springboard, Birken weaves a story of suspense and conspiracy around it.
When Birken is not in the operating room or writing his next medical thriller, he plays tennis, basketball and holds a black belt in martial arts.
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Displaying 1 - 17 of 17 reviews
March 6, 2026
Sinister by Design by Gary Birken 2/15/2026 Kindle
Doctors Jack Wyatt and Madison Shaw are called in when the daughter of a Governor is one of several women suffering an unknown ailment shortly after giving birth. While the root cause of their sickness remains a mystery, each victim was attended by the same doctor. When other victims are located in a different hospital, it is learned that the same physician was also nearby. While the blame seems directed at him, it becomes apparent that there is a human cause behind the epidemic. The search for answers becomes imperative as the patients slip closer toward death.
Wyatt and Shaw must overcome hospital politics to convince the hierarchy of the proper direction to a cure while trying to determine the culprit behind the mayhem.
While there are too many similarities among the installments of this series, each is interesting and holds the reader’s attention. I recommend the book to anyone who likes a medical thriller.
Doctors Jack Wyatt and Madison Shaw are called in when the daughter of a Governor is one of several women suffering an unknown ailment shortly after giving birth. While the root cause of their sickness remains a mystery, each victim was attended by the same doctor. When other victims are located in a different hospital, it is learned that the same physician was also nearby. While the blame seems directed at him, it becomes apparent that there is a human cause behind the epidemic. The search for answers becomes imperative as the patients slip closer toward death.
Wyatt and Shaw must overcome hospital politics to convince the hierarchy of the proper direction to a cure while trying to determine the culprit behind the mayhem.
While there are too many similarities among the installments of this series, each is interesting and holds the reader’s attention. I recommend the book to anyone who likes a medical thriller.
May 26, 2026
Interesting plots but stilted language
This writer comes up with some interesting plots for his stories, including this book. I do wish he would learn to give each character their own voices, though. He severely abuses the word "irrespective" in total for all his books... I have encountered that word more since starting his books than I have the rest of my entire life, and I'm in my late 50s. While the word is used correctly, it's less commonly used by people in general, who prefer "regardless," so he's giving so many characters his own quirky voice. I'm seeing this author, whose photo is in his bio, in all those roles in my head. Lol "Irrespective" of his stiff language, he's got a good imagination, so I do encourage him to keep going. Maybe share a little more medical detail in the process, too. I know there's danger in losing your audience by getting too technical, but I find parts of these stories too vague. It shouldn't be a medical mystery just because it's in a hospital and we don't know what's going on because there are gaps in the story.
This writer comes up with some interesting plots for his stories, including this book. I do wish he would learn to give each character their own voices, though. He severely abuses the word "irrespective" in total for all his books... I have encountered that word more since starting his books than I have the rest of my entire life, and I'm in my late 50s. While the word is used correctly, it's less commonly used by people in general, who prefer "regardless," so he's giving so many characters his own quirky voice. I'm seeing this author, whose photo is in his bio, in all those roles in my head. Lol "Irrespective" of his stiff language, he's got a good imagination, so I do encourage him to keep going. Maybe share a little more medical detail in the process, too. I know there's danger in losing your audience by getting too technical, but I find parts of these stories too vague. It shouldn't be a medical mystery just because it's in a hospital and we don't know what's going on because there are gaps in the story.
February 12, 2026
A masterful medical thriller!
Sinister By Design, book 5 in the Madison and Shaw series, brings the protagonists to Florida to investigate a mysterious illness afflicting women who gave birth a month ago..... at the same hospital. Madison and Shaw are a great team, with strengths and weaknesses that balance each other perfectly! The plot of Sinister By Design is very, very good, with pacing that is a perfect match. The illness is frightening and seemingly inexplicable. The writing is absolutely fantastic, with very real feeling medical environments. Overall, 5/5 well earned stars! Highly recommended to any fan of medical thrillers and thrillers in general!
Sinister By Design, book 5 in the Madison and Shaw series, brings the protagonists to Florida to investigate a mysterious illness afflicting women who gave birth a month ago..... at the same hospital. Madison and Shaw are a great team, with strengths and weaknesses that balance each other perfectly! The plot of Sinister By Design is very, very good, with pacing that is a perfect match. The illness is frightening and seemingly inexplicable. The writing is absolutely fantastic, with very real feeling medical environments. Overall, 5/5 well earned stars! Highly recommended to any fan of medical thrillers and thrillers in general!
May 6, 2026
Needs a better proofreader
I have read all four books in this series. Although I enjoyed the overall story lines. I was irritatingly distracted by missing punctuation marks, half sentences, and the occasional mixup of characters in mid-sentence. I’m sure it isn’t easy writing a book, but a proofreader is supposed to catch the stumbles that appear in a manuscript. Aside from my OCD complaints, I really enjoyed all four books.
I have read all four books in this series. Although I enjoyed the overall story lines. I was irritatingly distracted by missing punctuation marks, half sentences, and the occasional mixup of characters in mid-sentence. I’m sure it isn’t easy writing a book, but a proofreader is supposed to catch the stumbles that appear in a manuscript. Aside from my OCD complaints, I really enjoyed all four books.
February 15, 2026
OUTSTANDING UNEXPECTED CHALLENGES!
I liked the feeling about the care the patients were given as the story evolved. The communication between characters felt real and honest. I was honestly surprised by the ending and that was a pleasant surprise because I read so many books I often figure out the ending! I HIGHLY RECOMMEND THIS BOOK!
I liked the feeling about the care the patients were given as the story evolved. The communication between characters felt real and honest. I was honestly surprised by the ending and that was a pleasant surprise because I read so many books I often figure out the ending! I HIGHLY RECOMMEND THIS BOOK!
February 24, 2026
Great read
I’ve read all the books in this series and they all have been spine tingling. You’ll want to get to the end quickly. Don’t do it! I truly enjoyed the characters in this book. Don’t forget to read all the books in the series. You’ll love them all.
I’ve read all the books in this series and they all have been spine tingling. You’ll want to get to the end quickly. Don’t do it! I truly enjoyed the characters in this book. Don’t forget to read all the books in the series. You’ll love them all.
March 24, 2026
Very good read
Such a complicated virus. I didn't know if it was curable. Jack and Madison were awesome in finding a cure. The part about the case against Joseph Church being the cause of the virus was a shock. A must read.
Such a complicated virus. I didn't know if it was curable. Jack and Madison were awesome in finding a cure. The part about the case against Joseph Church being the cause of the virus was a shock. A must read.
March 27, 2026
I’ve read books by this author before and really enjoyed them. I found this book to really drag along. After awhile I was asking myself when something was going to happen. Too tedious and not much fun:(
April 15, 2026
Novel Virus
Great book! Learned a lot! I knew the unsub the minute he entered the picture. Then felt my faith in my intuition fading as book continued. Kept the faith and I was correct. Ending just fantastic!
Great book! Learned a lot! I knew the unsub the minute he entered the picture. Then felt my faith in my intuition fading as book continued. Kept the faith and I was correct. Ending just fantastic!
April 17, 2026
Another great story
Another wonderful book by this fine author...I am grateful to have found his books and like to share and recommend them to people I know who like these types of stories thanks for creating another fascinating novel
Another wonderful book by this fine author...I am grateful to have found his books and like to share and recommend them to people I know who like these types of stories thanks for creating another fascinating novel
February 23, 2026
The best
You are the best So talented I have read all the books When is the next I am afraid of flying but not with you
You are the best So talented I have read all the books When is the next I am afraid of flying but not with you
March 26, 2026
Another Compelling Story
Lots of twists and turns in this page turner. Keeps you guessing right to the end. Birken is a great storyteller.
Lots of twists and turns in this page turner. Keeps you guessing right to the end. Birken is a great storyteller.
April 2, 2026
Another Good Story!
I always enjoy Birken's medical mysteries. The mystery part is always page-turning, and the medical part is intriguing. Settle in for a good read!
I always enjoy Birken's medical mysteries. The mystery part is always page-turning, and the medical part is intriguing. Settle in for a good read!
April 3, 2026
great spellbinder!
Another great medical mystery by Gary. He keeps u guessing until the end! You will not be disappointed with this read!
Another great medical mystery by Gary. He keeps u guessing until the end! You will not be disappointed with this read!
April 5, 2026
jack and Madison’s adventures continue
This one definitely has a twist that keeps you wondering. Wasn’t my favorite of Gary’s but still a nice read.
This one definitely has a twist that keeps you wondering. Wasn’t my favorite of Gary’s but still a nice read.
April 16, 2026
A twisty thriller, the plot fast moving and a hard book to put down. I didn't see the ending coming, a complete surprise. Sorry this is the last in this series, hoping for more in the future.
May 8, 2026
I was a long, boring read.
I read three quarters of the book before it got somewhat interesting. I kept reading because I wanted to find out how the story ended.
I read three quarters of the book before it got somewhat interesting. I kept reading because I wanted to find out how the story ended.
Displaying 1 - 17 of 17 reviews