Fifth Vial

Fifth Vial

by Michael Palmer


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From the blockbuster, eleven-time New York Times bestselling author comes a novel of medical suspense that begins with these chilling questions: Who ends up with the blood samples you routinely give for tests? What else are they being used for? Why don’t you know?..

Take a Deep Breath...
In Boston, a disgraced medical student is sent to deliver a research paper that could save her career. . . . Four thousand miles away, in a jungle hospital in Cameroon, a brilliant, reclusive scientist, dying from an incurable disease that threatens to make each tortured breath his last, is on the verge of perfecting a serum that could save millions of lives, and bring others inestimable wealth. . . . In Chicago, a disillusioned private detective, on the way to his third career, is hired to determine the identify of a John Doe, killed on a Florida highway, with mysterious marks on his body.

Three seemingly disconnected lives, surging unrelentingly toward one another. Three lives becoming irrevocably intertwined. Three lives in mounting peril, moving ever closer to the ultimate confrontation against a deadly secret society with godlike aspirations and roots in antiquity.
Medical student. Scientist. Private eye. Three people who will learn the deeper meanings of brilliance and madness, truth and deception, trust and betrayal.
Three lives linked forever by a single vial of blood - the fifth vial.

Product Details

ISBN-13: 9781250230485
Publisher: St. Martins Press-3PL
Publication date: 11/27/2007
Pages: 530
Product dimensions: 5.00(w) x 8.00(h) x 1.18(d)

About the Author

Michael Palmer (1942-2013) wrote internationally bestselling novels of medical suspense, including The First Patient, The Second Opinion, The Last Surgeon, A Heartbeat Away, Oath of Office and Political Suicide. His book Extreme Measures was adapted into a movie starring Hugh Grant and Gene Hackman. His books have been translated into thirty-five languages. Palmer earned his bachelor's degree at Wesleyan University, and he attended medical school at Case Western Reserve University. He trained in internal medicine at Boston City and Massachusetts General Hospitals. He spent twenty years as a full-time practitioner of internal and emergency medicine. In addition to his writing, Palmer was an associate director of the Massachusetts Medical Society Physician Health Services, devoted to helping physicians troubled by mental illness, physical illness, behavioral issues, and chemical dependency. He lived in eastern Massachusetts.

Read an Excerpt

The Fifth Vial

By Michael Palmer

St. Martin's Press

Copyright © 2007 Michael Palmer
All rights reserved.
ISBN: 978-0-312-93774-4


The partisan, when he is engaged in a dispute, cares nothing about the rights of the question, but is anxious only to convince his hearers of his own assertions.

— PLATO, Phaedo

"Go ahead and sew him up, Ms. Reyes."

Natalie stared at the slice down Darren Jones's forehead, across his eyebrow, and down his cheek. Until this moment, the largest knife wound she had ever seen was one she had accidentally inflicted on her own finger. Treatment then had been a couple of Band-Aids. She forced herself not to make eye contact with Cliff Renfro, the surgical senior resident in charge of the ER, and followed him out to the hallway.

In her three years and one month as a medical student, she had sutured countless pillows, several varieties of fruit, some ragged stuffed animals, and recently, at what she considered great peril, the seat of a pair of her favorite jeans. Renfro's order didn't make much sense. She was only two hours into her second day on the ER rotation at Metropolitan Hospital of Boston, and although Renfro had checked her diagnostic skills out on several patients, he had yet to see her sew.

"Dr. Renfro, I ... um ... think maybe I should go over things with you before —"

"Not necessary. When you're finished, write a scrip for him for some antibiotic — any one. I'll sign it."

The resident turned and was gone before she could respond. Her classmate and good friend, Veronica Kelly, who had already finished her surgical rotation at Metropolitan, had told her that Renfro was in his final year before taking over as chief surgical resident at White Memorial, the flagship of the medical school's many famous teaching hospitals. After years of training, he had the air of one who had seen it all and was burnt out on what he considered the lowlife patient population of Metro.

"Renfro's smart and damn competent," Veronica had said, "and he'll take the really messy trauma cases. But he couldn't care less about the routine stuff."

Apparently he considered a black teenage loser in a gang fight to be routine. Natalie hesitated outside the boy's room, wondering what the fallout would be if she chased Renfro down and asked for a demonstration of his skill.

"You okay, Nat?"

The nurse, a gravel-voiced veteran of years in the ER, had given a portion of yesterday's student orientation, including the tradition that in a hardscrabble place like Metro, almost all the staff used first names. Hers was Bev — Bev Richardson.

"I asked for this rotation because I heard the students got to do a lot of procedures, but sewing up a kid's face on my second day is a bit more than I had expected."

"Have you sutured before?"

"Nothing that was ever alive, except a few unfortunate oranges."

Bev sighed.

"Cliff's a darn good doc, but he's a little immature at times and can be hard on people. And the truth is, I don't think he cares all that much for our clientele."

"Well, I do," Natalie said, stopping short of a litany of the many times earlier in her life when she had been wheeled or carried or dragged into this very ER.

"We like having people working around here who care. The patients have it hard enough everyplace else. Their hospital ought to be something of a sanctuary."

"I second that. Well, Dean Goldenberg has told me that he's heard I'm going to be accepted into the White Memorial surgical residency. Maybe Dr. Renfro has heard the same thing and he's just testing me."

"Or maybe he senses that you're not like him and he wants to see if you'll back down from the challenge."

"He wouldn't be the first," Natalie replied, already setting her jaw and mentally ticking through the pages of the plastic surgery text she had reviewed during the week before this rotation.

"You're the runner, aren't you?"

The question didn't startle Natalie in the least. Her tragic accident during the Olympic trials was chronicled on the local and national news and the cover of Sports Illustrated. From the day she started med school as a thirty-two-year-old first-year student, people knew who she was.

"Past tense," she said, her terse response requesting a change in subject.

"Think you can do this boy's face?"

"At least he'll have someone working on him who gives a hoot, if that means anything."

"It means plenty," Bev said. "Go ahead in there. I'll get you set up with some six-oh nylon suture. Even though most of them aren't, we assume everyone down here who is bleeding is HIV-positive, so best wear a gown and plastic face shield. If I think you're going wrong in any way, I'll clear my throat and you can come away and we can talk. Keep your fingers away from the needle. Straight instrument ties, double overhand knots about an eighth of an inch apart. Don't pull them so tight that the skin edges bunch, and don't shave his eyebrow because they never grow back right."

"Thank you."

"Welcome to the ER," Bev said.

"You doin' a good job, doc?"

Natalie looked up at Bev Richardson, who nodded proudly that she was. From the moment Nat had numbed up the skin edges, Darren Jones had been talking nonstop. Nerves, she guessed. If he only knew that he was hardly the only one. The procedure had taken probably three times what it one day would, and Natalie was still just through the forehead and eyebrow, with the cheek yet to go, but the repair looked quite decent.

"Yes, I'm doing a good job," she replied matter-of-factly.

"'M I gonna have a scar?"

"Every time skin is cut there's a scar."

"Women like scars. They're mysterious. Besides, I'm tough, so why not announce it. Right, Doc?"

"You seem pretty smart. Smart is more important than tough."

"Tough men like me scare you?"

"The guy who cut you would probably scare me," Natalie said, smiling beneath her mask. "You still in school?"

"I have a year to go, but I quit."

"You should think about starting up again."

"Fat chance." Darren laughed. "You wouldn't know about such things, Doc, but where I come from, the only thing that matters is being tough."

Again, Natalie grinned. Matched up against this boy in almost any measure of toughness, she would win hands down. She reminded herself that it wasn't the first person who had suggested she get back into school that had led her to the Edith Newhouse Academy for Girls, or even the second. But somewhere along the line, thanks to those who had tried before, someone had finally been able to breach the ramparts of her own toughness.

"Tough is swimming against the stream and having the courage to be different," she said, tying off the last of the sutures. "Tough is realizing that this is the only life you're going to have, so you might as well do what you can to make the most of it."

"I'll keep that in mind, Doc," the teen said with little sincerity.

Natalie glanced over her shoulder at Bev, who gave her technique a thumbs-up and mouthed the words, "Steri-Strips," motioning at the packets of paper stitches she had placed on the instrument tray. After ineptly fumbling several of the strips into useless balls, Natalie figured out how to cut and place them across the incision to reduce scarring by taking the tension off of her suture line.

"Five days," Bev mouthed, holding up one open hand.

"These stitches will probably be ready to come out in five days," Natalie said, grateful for the hedge inherent in the word "probably," at least for the time being.

"You got soul, Doc," Darren said. "I can tell."

Natalie stripped off her face protector and gloves. Another milestone, she was thinking. It was a huge advantage to be thirty-five and a med student — especially one who had seen more than her share of life. Decisions came easier to her than to most of her classmates, many of whom were a decade younger or, in a few cases, even more. Her perspective was often more finely honed; confidence in her convictions was stronger.

"Don't sell yourself short, my man," she replied.

"Stick around, Darren," Bev said. "I have a tetanus shot, some instructions, and some medication for you."

"Pain meds?" Darren asked hopefully.

"Sorry, antibiotics."

"Hey, you claim you're tough," Natalie said, heading out the door. "Tough guys don't need no steenking pain medicine."

She wrote her note at the nurses' station, feeling very pleased with the way she had performed under pressure. Renfro had issued the challenge and then had walked away, but she had more than measured up. She had set high school, college, and national records on the track, and had made it to within one unfortunate step of being on the Olympic team. Along the way, she had dealt with any number of Cliff Renfros, bent on feeding their egos off the insecurity of others. Well, she was still the same woman who had run 1,500 meters in 4:08.3. Let this particular Cliff Renfro keep trying. She hadn't knuckled under to any of the others, and she wasn't going to be intimidated by him either.

Bev materialized at her elbow.

"Saralee just came over from room four. You know what that is?"

"Yes, for the alcoholics."

"And other street people," Bev added. "Patients are put there when they're particularly ... um ... grimy."

"I know. I worked in there for a while yesterday. It wasn't so bad."

"Well, apparently the ER got a little backed up while you were off suturing and a code was going on in the other wing. So, much to his chagrin, Cliff is holding down the fort in room four. He wants you to take over in there as soon as you're done."

"I'm done now."

"Good. You handled that kid well, Nat. I think White Memorial made a good choice. You're going to make a fine doctor."

"That hospital may be the best of the best, but they're still a decade or two behind when it comes to accepting women into their surgical programs."

"So I've heard. Well, like I said, you'll do great. Take it from one who's seen them all come and go."

At that moment, they turned toward the sound of a commotion coming from down the hallway.

"I'm telling you, Doc, you're wrong! There's something the matter with me. Something bad. Right here behind my eye! I can't stand the pain!"

A man was being escorted out of room 4 by an orderly. Even at some distance, there was no doubt that he qualified to have been there. Grizzled and worn, he was in his forties, Natalie guessed, or maybe even his fifties. He had on a tattered windbreaker, stained chinos, and sneakers without laces. An oily Red Sox cap with its brim pulled low still failed to hide the sad hollows of his eyes.

Hands on hips, Cliff Renfro appeared in the doorway and glanced to where Natalie and Bev stood before addressing the man.

"What's wrong with you, Charlie, is that you need to stop drinking. I would suggest you get yourself over to the Pine Street Inn and get them to show you to the shower. They'll probably have some clothes for you, too."

"Doc, please. This is serious. I've got lights flickering in this eye and the pain is killing me. Everything keeps going black."

Clearly irritated almost beyond words, Renfro ignored the man and stalked down the hallway past where the two women were standing.

"You've got to move faster down here, Dr. Reyes," he paused long enough to say. "Now, please take over in four. I'm going to get washed up and," he muttered, "maybe fumigated."

Natalie caught the briefest spark of anger and frustration in the patient's eyes before he turned and allowed the orderly to lead him toward the waiting room, and beyond that, the street.

"I'll bet Renfro didn't even examine him," Natalie whispered.

"Possibly, but he usually —"

"There's something seriously wrong with that man, I just know it. Horrible pain, flickering lights, lost vision. I just finished six weeks on neurology. That guy has a tumor, or maybe a leaking aneurysm, or even a brain abscess. These people deal with pain and discomfort every day. If his symptoms are bad enough to have him drag himself in here, something's the matter. Did Renfro order any tests?"

"I don't know, but I don't think —"

"Listen, Bev, I want to check that guy over and then get a CT scan. Can you arrange that?"

"I can, but I don't think it's such a good —"

"And some bloods. A CBC and Chem-Twelve. I've got to catch him before he gets away. Believe me, if he were a well-dressed businessman at White Memorial, he'd be over having a CT scan right now."

"Maybe, but —"

Before Bev could finish the sentence, Natalie was off. She checked the waiting room, then hurried out the doors to Washington Avenue. The man was a dozen yards away, shuffling slowly toward downtown.

"Charlie, wait!"

The derelict turned. His eyes were bloodshot, but he held his head erect and met her gaze evenly, perhaps even with some defiance.

"What is it?" he growled.

"I'm ... Dr. Reyes. I want to check you over a little more and maybe order a test or two."

"Then you believe me?"

Natalie took his arm and gently led him back toward the ER.

"I believe you," she said.

Bev Richardson was waiting just inside the door with a wheelchair.

"Room six is empty," she said in a conspiratorial whisper. "Hurry. I have no idea where Renfro is. Lab is on the way. Hopefully we can get his blood drawn and get him over to CT without anyone seeing."

Natalie helped the man out of his clothes and into a blue johnny. Renfro was right about one thing, she was thinking, Charlie really did smell. She did a modest neurologic exam, which disclosed several definite abnormalities in strength, eye movements, hand-eye coordination, and gait, any and all of which could be due to a brain tumor, abscess, or leaking blood vessel.

A technician had just finished drawing blood when Bev backed into the room hauling a stretcher.

"I pulled some strings," she said. "They're ready for him in CT."

"He has some clear-cut neurologic abnormalities. I'll get him over there, and then get to work in room four."

"I'll clean up in here."

Natalie wheeled the stretcher into the hallway.

"Thanks, Bev, I'll be right b —"

"What in the hell is this?"

Cliff Renfro, livid, stormed toward her from the nurses' station.

"I believe there is something seriously wrong with this man," Natalie said. "Maybe a tumor or a leaking aneurysm."

"So you chased him down after I had discharged him?"

Renfro's voice was raised to the point where staff and patients alike stopped and stared. Several people emerged from the examining rooms, several more from the nurses' station.

Natalie held her ground.

"I wanted to do the right thing. He has some neurologic findings."

"Well, this isn't the right thing. The findings, like everything else about him, are the result of alcohol. You know, I had heard from a number of people that you were too arrogant and hard-edged to be a good doctor. Just because you had fifteen minutes of fame doesn't mean you can step in here and act as if you're in charge of the place."

"And just because you like to keep your clinic coat from getting soiled doesn't mean you can brush off patients like this man," Natalie shot back.

Bev Richardson quickly inserted herself between the two combatants.

"It was my fault, Cliff," she said. "I was worried about this man, and thought it would be a good learning experience for —"

"That's nonsense, and you know it. Don't protect her." He stepped to his left to get a clear line of sight at Natalie. "There is no place in medicine for anyone as self-absorbed and conceited as you are, Reyes."

Natalie's jaws clenched. She was furious at being rebuked so publicly, and anxious to have all the witnesses know why Renfro's prejudices had led him to do an inadequate job in evaluating this down-and- outer.

"At least I care enough about people like Charlie here to do a complete evaluation on him."

"Five years as a doctor have made me perfectly capable of deciding what is and is not a complete evaluation. I intend to make sure that anyone at the medical school who will listen learns about you and what's happened here."

"Well, I think before you do that, you should see what this man's CT scan shows."

Renfro's glare could have melted block ice. He looked as if he were going to say something else, then turned and stalked off toward X Ray. Two exquisitely tense minutes later, a CT tech came and wheeled Charlie away. Natalie sighed her relief.

"Whew. I was certain he was going to cancel the test out of spite," she said, as she and Bev walked back to the nurses' station.

The seasoned nurse looked at her and shook her head.

"I'm sorry I couldn't get him to calm down," she said. "There was probably a better way to have done this."


Excerpted from The Fifth Vial by Michael Palmer. Copyright © 2007 Michael Palmer. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Fifth Vial 4.2 out of 5 based on 0 ratings. 86 reviews.
Starluv9227 More than 1 year ago
This book keeps you on your toes. The book is so good I had chills down my spine the whole time. I couldn't put this one down! I would recommend this one to anyone out there that likes medical inspired thrillers!!!
Guest More than 1 year ago
This is a scary sort of thriller because it is the thing that could happen. We hear about people being kidnapped and their body parts stolen. What if someone specifically targeted you because they know you are a match for someone else? The author brings a very realistic approach to this frightening thought and uses three main characters to battle the bad guys. There is Natalie, the former world class runner who is trying to get through medical school, Ben the private detective hired by a foundation that suspects that someone is stealing body parts and Anson a researcher who has perfected the next wonder drug but is in need of a new lung. The story winds to an exciting conclusion with a lot of action.
almosthere More than 1 year ago
the fifth vial hits a little to close to home and takes the reader down pathways they might never think of or admit are possible. The suspense mounts as the characters progress in their quest toward an inevitable mix. Excellent THINK book ... shakes your views on organ donation and moral judgement with a unique twist at the end ...
BookieMa More than 1 year ago
but I hope not probable. Good story line that makes you think. The "bad guys" were a bit psycho and some of the physical antics of the main character, "Natalie" were a little far fetched; but all-in-all, a good read.
Anonymous More than 1 year ago
A fast paced, well-written book that will make you think twice every time you get your blood drawn. Definately a worth-while read.
Guest More than 1 year ago
This is the first Palmer novel I have read. What I liked about this book was the union of simultaneous stories. Each story is excellent and all build to conclude an excellent story that grabs you from the very first page.
Judes316 on LibraryThing More than 1 year ago
A friend gave me this book and I had never read Michael Palmer. I was so hooked I could not put it down and when I was done I bought more of his books. I would recommend this book to anyone that likes medical thrillers
vanedow on LibraryThing More than 1 year ago
gifted medical student gets on a plane to South America and becomes the victim of a terrible and mysterious crime... In Africa, a scientist on the verge of medical breakthrough is in need of medical intervention himself... A private detective answers a help wanted ad that changes his life. In The Fifth Vial, these three completely different people are woven together in a way none of them could have imagined. This chilling book uses the example of a fictional company to explore the frightening possibilities of black-market organ trafficking.This book gave me chills up my spine. Not necessarily because it is frightening in itself, but because it all seems so very plausible. In the story, a secret society of doctors has taken it into their own hands to decide who should receive donor organs. Usually whoever has the most money or power to pay for it. And they don't really care if the donor of the organs is finished with them yet. A business tycoon will make better use of that heart than a waitress from Tennessee. That lung would be put to better use in a doctor than a mentally handicapped man. Where do you draw the line? I had guessed a lot of what was going to happen in this book by the time I was one third into it, but I still really enjoyed it. The story jumps around between the different characters, which is not a style I typically enjoy, but it was very well done here and I found each story line kept feeding into the others effectively. There was enough action to really keep me flying through, but the best part of this book was the creepy way it kept me wondering... I'm definitely going to be paying attention to how many vials of my blood get taken the next time I go in for tests =o) My final word: 4 out of 5. A great thriller which will be especially enjoyed by the conspiracy theorists among us. I'm taking away a point because the characters and dialogue seemed a little plastic from time to time.
JeanneMarkert on LibraryThing More than 1 year ago
In Boston, a disgraced medical student is sent to deliver a research paper that could save her career...In a hospital 1000 miles away a reclusive scientist dying from an incurable disease is on the verge of perfecting a serum that could save millons of lives. In Chicago, a disillusioned detective is hire to determine the identity of a Jody Doe , killed on a Floride highway wit mysterious marks on his body.. There seems to be a link between them
WeeziesBooks on LibraryThing More than 1 year ago
The Fifth Vial written by Michael Palmer. I wasn't sure about this book when I started listening to it as an audiobook because I did not like the reader's female character voices and felt the twang in Ben¿s, a main characters voice was artificial. However, as I continued to listen, I began to get caught up in the plot and connected with the characters. The plot and action made the voices less important but I would have enjoyed it more with a different reader.Natalie Reyes a young medical resident has a terrible life threatening incident which changes her life and her aspirations to be an Olympic track star. She is pulled into a world of medical mystery and terror. From the sterile operating rooms in the United States to the green and lush jungles of Brazil, this novel is non-stop action and suspense. Ben Callahan is a private detective from Chicago who doubts his own worth and is not positive about his future. Natalie and Ben meet in a most unlikely way.This book deals with the delicate issues surrounding legal and illegal donors and recipients of transplanted organs. The story line is filled with self-important men and women, selfless medical staff and greedy and self-proclaimed rulers known as the ¿Guardians¿ as the plot speeds through narrow alleys, down steep and dangerous cliffs and into the lives of doctors, military police and into small unknown villages.I enjoyed this book and would have given it 3.5 stars, but it is closer to 4 and a worthwhile read.
Jarratt on LibraryThing More than 1 year ago
This is the first Michael Palmer book I've read. Knowing he wrote medical mysteries and being a huge fan of TV's "House," I figured I'd give him a try. The idea of black market organ transplants had potential, but got bogged down with the telling of the story, one-dimensional characters, and little mystery.¿The Fifth Vial¿ has three interrelated stories: med student Natalie Reyes is sent to a conference in Rio only to get abducted, shot, and have one of her lungs removed due to a bullet wound. Then there¿s Ben Callahan, a low-level PI who gets asked to look into the disappearance of someone suspected of being killed for his bone marrow. Finally, there¿s Joe Anson, a medical genius who¿s being paid by Whitestone Pharmaceuticals to develop a potentially life-saving drug. But he must undergo a life-saving lung transplant due to an illness so he can complete his work and divulge all of the drug information to Whitestone.Pretty early on, it¿s clear who¿s responsible for what happens to Natalie but we¿re supposed to be shocked at the end. Then Ben, who seems like a pretty decent guy, goes way out of character to get himself on a plane to the ¿hospital¿ in Brazil where these transplants take place. (SPOILER: He doesn¿t get in trouble for it either¿guess the guy he abducted and locked in a storage shed for several days/weeks didn¿t hold a grudge.)One really cool, pretty much left-alone idea that comes along, however, is the fact that what Nat thought happened to her (abduction, getting shot) were memories implanted via a 3D virtual reality system. I think had that been a bigger part of the story, things might have been more interesting. I also think a debate between more reasonable characters on organ transplants would have served the reader better. We have already made up our minds about the characters before they go off on why organ transplants are good/bad. This is something Michael Crichton did very well in ¿State of Fear.¿ Characters offered very differing views of global warming, but if memory serves, they weren¿t purely good/evil characters.Overall, ¿The Fifth Vial¿ was pretty disappointing.
amachiski on LibraryThing More than 1 year ago
This is pretty much in line with Michael Palmer's other books - pretty basic medical thriller with a twist at the end (not unexpected). A good, quick summer read. I like stories like this. It¿s fiction but you believe it could actually happen. The science in the midst of the story is interesting and current. Some of the stories were told from separate points of view but it all came together in the end. Books that increase your paranoia are always fun to read, and this book did exactly that. After reading this, you will always pay attention to the color on the top of the blood vials from now on (watch out for the green ones). I greatly enjoyed this book. It was an excellent mix of adventure, puzzle-solving, romance (there is a little) and, of course, paranoia. I would recommend this to anyone who likes to solve mysteries and is interested in medical thrillers.
bellmorejer on LibraryThing More than 1 year ago
Excellent! I couldn't put the book down. Now I have to read more books by this author.
mspolly on LibraryThing More than 1 year ago
The book takes a while to introduce the players, but about half way through the connections begin to be made and the excitement begins.
brendajanefrank on LibraryThing More than 1 year ago
Very engaging and entertaining. You meet characters from Boston, Chicago, Cameroon and Brazil. Palmer ties them all together in unexpected, interesting ways. Bad things happen but the good guys win, big. The ending is Great!
manyalibrarian on LibraryThing More than 1 year ago
Easy to read, fast-paced thriller about the underground world of organ theft. Follow a group of disconnected characters and watch their lives come together.
Anonymous More than 1 year ago
This is the first Michael Palmer book I have ever read and it definitely won't be the last. I could not put it down.
Anonymous More than 1 year ago
Anonymous More than 1 year ago
Good story, interesting issue. The sales pitch to donate your organs at the end was annoying and simplisic.
Anonymous More than 1 year ago
bll14 More than 1 year ago
Great Book, fast shipping
Anonymous More than 1 year ago
Anonymous More than 1 year ago
Can't wait for the movie
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