Tammy Euliano. Fatal Intent. Oceanview, 2021.

We have noted that Oceanview publishing seems to pick some truly entertaining and suspenseful novels, including the Koa Kāne novels we have reviewed here. Fatal Intent is no different. Readers who get involved in the story will find their heart rates increasing. I use the medical language because our narrator here does as well.

This is medical mystery told from a surgical anesthetist’s point of view. We read about a number of patients sedated or stimulated. And some of them die. It gets complicated because our narrator, Dr. Kate Downey, is accused of malpractice when one of her patients dies, though normally it would be the responsibility of the surgeon first.

Soon we begin to see a pattern. Dr. Downey herself had had an uncle who died in a similar manner. Other apparent victims began to show up as well. In each case there was some kind of complication with the patient’s breathing after being given anesthetic gas. In each case also there were what we euphemistically call quality of life issues. Terminal cancer. A mentally retarded child. Long-term coma. Dementia.

It seems unusual to Dr. Downey that the surgeon who blamed her was not hired by the hospital in the usual manner. There also appeared to be a CRA (clinical research associate, I had to look it up) involved in these cases as well. A CRA is like a medical temporary hire. Another term sometimes used for this type of person is a locum, short for locum tenens, a placeholder. In this case the CRA is a nurse anesthetist who does not seem to stay in one place for very long. In fact, Dr. Downey recognizes the name but cannot recall what he looks like. When she legally tries to get access to his personnel files, she finds out there are none.

The accusations build up against Dr. Downey. Fortunately for her, a lawyer named Charles whose father died in a hospital under similar circumstances wants to get to the bottom of things as well.

The CRA leaves the hospital shortly after Dr. Downey is charged, but not before charging her with sexual harassment. Similar deaths start happening at two other hospitals where the CRA works after leaving Downey’s. At this point the doctor is taking some radical action. She tries to warn a patient who seems to be have been in line for questionable surgery, but she is too late. He and his wife have died of carbon monoxide asphyxiation in their home.

One very effective technique of the story is that we rarely see this allegedly homicidal CRA. No one is even sure of his name, though every name he chooses has the same initials. She and the lawyer start calling him BJ for that reason. While there is nothing supernatural in this tale, it almost reads like a horror story because we get the sense that BJ is pulling strings in the background like an unseen specter. (Fans of The Mentalist might think of Red John…)

This BJ character becomes something like Sherlock Holmes’ Professor Moriarty, the “Napoleon of crime.” He is there, lurking in the background. Sinister things seem to happen when he is around, but he always manages to move on. And why does he seem to have no problem getting hired? Are there any eminences grises behind BJ?

Police and the FBI get involved. Downey feels even greater pressure. As a kind of counterpoint, her own husband Greg has himself been comatose after a war injury for months. She wants to wait a year before making a decision because some people do recover from his type of trauma. But Greg’s brother insists that she is being foolish and that her hope is fruitless. When her house is broken into and one of her associates at the hospital is murdered, it seems like things are going out of control.

There is more, of course. There are good doctors and ones whose interpretation of the Hippocratic oath is pretty loose. There are professionals fearful losing their positions. And why was the CRA hired anyhow? What about the hiring of that other doctor? It seems too organized. Dr. Downey’s administrator is pretty hostile towards her, but how much of that is due to plain old money? Hospitals need generous donors to keep things going. No one wants to kill the proverbial golden goose.

Complicated and suspenseful, Fatal Intent is a true thriller. I would not be surprised to hear film rights have been sold for it. If you like suspense, you will like Fatal Intent.