Sunday, April 17, 2011

The Alphabet in Crime Fiction: Robin Cook's Outbreak

“O,” my! The Alphabet in Crime Fiction community meme has reached Stop #15 on our treacherous tour through the alphabet. Thanks, as always, to our most capable tour guide Kerrie at Mysteries in Paradise, for leading us around all of the obstacles in our path as we travel along. Thus far, we are all out of harm’s way : - ). My contribution for this week’s stop is Robin Cook’s Outbreak, published in 1987.

The main action in the novel begins when Dr. Rudolph Richter, the Los Angeles-based co-owner of the Richter Clinic, is mugged on his way home from his office one evening. The attack is frightening, but Richter isn’t badly hurt and he tries to put it behind him. The next day, though, he becomes seriously ill and shortly thereafter, he suddenly dies. Then, seven of the clinic’s patients die. Now it looks as though there is an outbreak of a very serious illness, and Los Angeles authorities ask for help from Atlanta’s Centers for Disease Control (CDC). The CDC sends Dr. Marissa Blumenthal from its Department of Virology, Special Pathogens Divisions, to Los Angeles to help isolate the pathogen that’s responsible for the outbreak. Blumenthal is looking forward to the chance to prove herself, especially to her boss Dr. Cyrill Dubchek. The CDC team begins its investigation and it’s soon clear that the victims have died from the highly contagious Ebola virus. Blumenthal and the team contain the disease and return to Atlanta. Then, five weeks later, there’s another outbreak, this time in St. Louis. Then there’s an outbreak in Phoenix. The more Blumenthal investigates, the more certain she becomes that the Ebola virus is being deliberately spread. All of the outbreaks begin at medical clinics, and the only fatalities seem to be clinic doctors and their patients.

Blumenthal investigates the connections among the medical clinics and the victims and discovers a dangerous conspiracy that involves politics, medicine – and a great deal of money. She tries to alert her bosses and colleagues at the CDC, but no-one wants to cause a public panic. Besides, she has very little evidence that the deaths were deliberately planned. Now Blumenthal is up against a highly toxic virus, her bosses, and an extremely dangerous group of people who are not afraid to kill. As she slowly finds the evidence she needs to save lives and salvage her own reputation, Blumenthal discovers that the closer she gets to the truth, the more danger she’s in, especially when she finds out that her own employer was likely the source of the deadly virus.

Since this is a medical thriller, one of the important and interesting elements in it is the information we learn about the way that pathogens are spread and how the medical community reacts to it. Readers go “behind the scenes” beginning with the prologue, in which the Ebola virus passes from its animal host to humans. We follow as the doctors at the various clinics and hospitals struggle to cope with a virulent illness and keep it from spreading, too. Several parts of the action take place in hospitals and clinics and this, too, gives the reader an “inside look” at medicine. And yet, the reader isn’t overburdened with medical minutiae or terminology.

Just as interesting is the “inside look” we get at one of the U.S.A.’s less-well-known federal agencies, the CDC. Admittedly, this book was published 24 years ago, and times and procedures have changed drastically. The availability of information on pathogens is ever more instant, and the CDC has kept pace. Modern technology and communication have also changed the CDC’s response protocol. Still, it’s clear that Cook “did his homework” while writing this novel and the story provides a fascinating look at the way the CDC responds to, isolates and combats pathogens and how important an agency focused on the public health really is. We also get a look at how the CDC works with local medical and civic authorities when there is a dangerous risk to public health. This insight into the CDC also gives a sobering perspective on how easily a highly contagious pathogen can wreak havoc on a community.

Although this is a medical thriller, the focus is really on the crimes taking place. So there are clues, suspects and plot twists and turns. There is a discussion of medical ethics, particularly as it relates to the effects of money and political power in the medical community. However, the ethical questions really take second place to Marissa Blumenthal’s search for the solution to the mystery. This is one of Cook’s earlier novels, and you could argue that there is a stark difference in this respect between his earlier work and more recent novels. This is not a novel created to explore a question of medical ethics. It’s a crime fiction novel in which medical ethics plays a role.

Outbreak is also a thriller. So the pacing and timing are fast and there is little break in the action. There’s also solid suspense, which Cook heightens in several ways. For example, there’s the matter of point of view. Most of the story is told from the point of view of Marissa Blumenthal, and we feel her growing fear as she gets closer to the truth. But some of the story is told from the point of view of the killer. This gives the effect of a game of “cat and mouse” without making the story melodramatic. And as Blumenthal realises just what she’s up against, there’s even more suspense as it becomes clear that someone in the CDC is involved in the murders. Although we know who “the enemy” is well before the end of the novel, there’s a strong thread of suspense as Blumenthal tries to convince her bosses of what’s going on and as she tries to stay one step ahead of the “bad guys.” The plot is plausible; we can imagine an outbreak starting in the way that this one does, and that adds to the suspense. So does the fact that there is a believable motive for the murders, rather than just a group of evil people who just, well, want to be evil.

This isn’t a character-driven novel; it’s a plot-and-suspense-driven novel. That said, though, the character of Marissa Blumenthal is appealing. She’s bright, clever and skilled. Yet, she’s also human. She’s not always right, and she makes some mistakes in judgement. She’s up against a dangerous enemy and she’s quite naturally afraid. She doesn’t take comic-book-hero-type risks, and she feels the panic anyone might feel being so close to such a deadly murder weapon. And although Blumenthal ends up risking her own life, the novel doesn’t come overly close to the “persecuted heroine” trap into which so many recent novels have fallen (at least, in my own personal opinion it doesn’t). It’s not hard to cheer for her as she searches for the truth.

The story’s plausibility, combined with a likeable main character and solid pacing and time make this mystery a solid example of the medical thriller. But what’s your view? Have you read Outbreak? If you have, what elements do you see in it?

ps I have to admit I like this cover – there’s something “retro” about it…

An Interesting Factoid…

Don’t confuse this novel with the 1995 film of the same name starring Dustin Hoffman and Rene Russo. The film is (very, very) loosely based on the novel, and bears some similarities, but it’s a different story altogether. If you experience the novel and movie as separate stories, it’s certainly possible to enjoy both. But if you expect the two to tell the same story, you’ll be disappointed.


  1. Margot: In the mid-1990's Canada had a federal public inquiry into how and why AIDS got into the Canadian blood system. I represented a group of hemophiliacs at the inquiry. There was a great deal of evidence on how the CDC investigated the outbreak unusual conditions starting in San Francisco and solved the mystery. It was fascinating and terrifying. A Canadian air line attendant was called Patient Zero. While working on the inquiry I read a book called "The Coming Plague" which made clear other unidentified diseases are going to suddenly turn up around the world. Thank you for an interesting review of Cook's book.

  2. Bill - ...and thank you so much for that absolutely fascinating look at the reality - not the fiction - of how disease can spread. I remember reading about that inquiry but it didn't make the news where I lived at the time the way I'm certain it did in Canada. I appreciate your perspective. It really is as terrifying as it is fascinating isn't it? Today's global world makes it so easy to imagine how something contagious can turn up just about anywhere.

  3. There was a time when I read a lot of Robin Cook Margot. I think he made us think about some of those "medical-related" issues in ways that had not occurred to us before. Many thanks for this contribution to this week's CFA

  4. I've not read OUTBREAK, but I have seen the movie several times. Knowing now that the book and movie are different, I think I would enjoy the book as much as I have the movie. I agree with Kerrie that Robin Cook's books make us think about 'medical-related' issues like never before.

    Thoughts in Progress

  5. Kerrie - You are quite right. Robin Cook really brought medical issues and lots of larger ethical ones, too, to the forefront, and I used to read those earlier novels quite a lot.

  6. Mason - I'm so glad you enjoyed the move; I did, too. I think it was actually a well-done film (of course, I happen to be a Dustin Hoffman fan, but still... ;-) ). I think you would like the book. It really does raise some interesting question, and the sense of suspense is as strong there - just different - as it is in the movie.

  7. Cook used to be one of my 'must read' authors as I think he did combine story-telling and an exploration of interesting themes like this really well (I think he went a bit 'preachy' later on but have tried not let that affect how I think of his earlier books). Outbreak is a terrific novel, full of suspense but with a quite credible plot. Great choice for O

  8. Bernadette - Thanks :-) That's precisely how I feel about Cook's work. The early novels have a nice dose of suspense and credible plots, but they also do explore deeper themes. I really did enjoy them. I agree about the "preachiness," too, of the more recent novels. Those early ones, though, are really worth the read.

  9. Great post, Margot. I read this book ages ago when I still read Robin Cook (before he spread himself too thin), and enjoyed it.
    Re. the AIDS epidemic, there is a book by Randy Shiltz called And The Band Played On which makes great play on the Patient Zero theory. Although the book is an excellent account of what it was like to be in SF in those times, the presentation of the Patient Zero theory was not accurate, as it turned out (and he did not correct it in the subsequent edition when this was known).

  10. Maxine - Thank you :-). And agreed about Robin Cook. Thanks, too, for mentioning Randy Shilz' book. That book was later made into a made-for-television movie that also did not correct the Patient Zero theory. Still, as you say, it's a terrific account of life in San Francisco at that time, and it drew attention to a major public health issue.

  11. Sorry I haven't been around for the last few days. I missed reading your blog.

    I read this novel a long time ago. It was the first Cook book that I read and I loved it so much that I went and read all the others. It was also the first time I was introduced to Ebola and outbreaks in a novel and it had fascinated me ever since.

    Perhaps I will include an outbreak in one of my future novels.

  12. Clarissa - I'm glad you're here :-). Funny you'd mention this was your introduction to Cook. It was mine, too, although I later went back and read some of his even earlier stuff. It's a fairly compelling story and yes, it's a good introduction to Ebola and outbreaks.

    If you do decide to use an outbreak in one of your novels, I'm sure it'll be a great story....

  13. I have to say the movie Outbreak was one of the worst I have ever seen. In fact, I had to turn it off. A real stinker it was. Hope the book is better.

  14. Stephen - Isn't it interesting how movies have different effects on different people? The same movie that some folks rave about, others have to walk out on or turn off. The novel is different enough from the book that you might find it enjoyable.