Book Review: The Fifth Vial

My copy of the book. Rarely do I make suggestions for book titles, but I think The Organ Guard would’ve been cooler here.

The first duty of a book (or any form of entertainment, in my humble opinion) is to be … entertaining. Is to thrill, excite, horrify, and otherwise make us emote in however the author (or creator) intends. In that regard, Michael Palmer’s 2007 medical thriller, The Fifth Vial, more than exceeded at such a duty. It’s like the antithesis of the Hippocratic oath: Do all the harm, if it’s entertaining and makes sense for the story and the characters within it. The second duty, if one wants to have a second duty, is to inform and make one think differently, perhaps, about a subject. As someone already converted (I worked in the field), I can’t say Palmer succeeded with me, but I sure hope he planted a number of seeds in the heads of his readers who aren’t already part of the flock.

I’m speaking about organ, eye and tissue donation, which is at the heart (heh) of his book. Essentially, a cabal of renowned physicians and other medical personnel, who have taken to calling themselves The Guardians in the model of Plato and his idea of Philosopher Kings to rule over society, mainly the lower classes of the productive workers (sometimes called craftsman) and the auxiliaries (soldiers), have circumvented the organ allocation process through evil (but justified in their heads) means. It is from these lower classes organs are procured illegally through coercion, deception, and often, murder, for the Guardians of society, aka those this cabal think are people worth keeping alive for the betterment of society. It also doesn’t hurt when those Guardians pay them millions of dollars to do procure such organs.

Up against this cabal are the unlikeliest, yet loveliest, of heroes: Natalie Reyes, a medical student from Boston, who was on her way to the Olympics as a runner before she tore her Achilles and is a fierce, competitive type, as you might imagine; and Ben Callahan, a former teacher-turned-private detective, who wants to be in the mold of his favorite detectives from novels he’s read, but so far, he’s working suspected domestic affair cases. Both are downcast about their future prospects (Reyes nearly got kicked out of medical school for contradicting the resident in charge), and it is from that positioning they are thrust into the world of illegal organ trafficking and transplantation.

Ben is hired by a woman who works for the Organ Guard, an organization dedicated to tracking the illegal procurement and sale of organs. In fact, as Palmer notes at the end of the book, there is an actual organization like that, known as Organs Watch. I didn’t know that, although I’m not sure the organization still exists. The site at the University of California, Berkeley is not functional anymore. Nonetheless, Natalie is drawn into this affair when she is attacked after arriving in Rio de Janeiro, Brazil. She’s seemingly shot twice, left for dead (in nothing but her panties, which she weirdly never reckons with), and she later learns, they had to remove one of her lungs to save her life. An Olympic-level runner losing one of her lungs is devastating enough, but then she returns home and her mother’s house catches fire from an errant cigarette from the mother, causing damage to Natalie’s one good lung.

As it turns out, however, there is no record of any of that having occurred to Natalie in Rio, which leads Natalie back to Brazil, and through his detective work, Ben also ends up in Brazil, trying to track down the nefariousness to its source. All the while this is going on, we do have another “hero,” a genius doctor in Cameroon, Africa, who has developed a drug that could cure cancers. The Plato cabal wants the drug and the secrets behind it, but Dr. Joe Anson is guarded and paranoid about handing it over, for good reason as it turns out. He’s also suffering from pulmonary fibrosis, or in a phrase I hadn’t heard before, but paints the picture nicely, if horrifically, he’s “air hungry.” The Plato cabal force Dr. Anson’s hand at having a lung transplant to keep him alive and to get him to hand over the secrets. Being the genius he is, though, he learns of the deception and that his lung actually came not from a brain dead Indian man, but from … Natalie.

Now, one question I do have: Why was Anson so resistant to getting a lung transplant? And for her part, if it was necessary, Natalie, too? Obviously, it’s not ideal to be in a such a state of health to need a transplant, but if it was necessary, why were these two fearful of it? In any event, once Natalie and Ben learn of each other and their shared mission, and with the help of the locals in a Brazilian rain forest village, they are able to thwart the Plato cabal, and importantly, one of its signature figures, none other than Doug Berenger, Natalie’s longtime mentor. I figured he was dirty because at the beginning of the novel, he was the one who sent Natalie to Rio! Then helped her get back to Rio when she wanted answers! I would be remiss, if I didn’t point out, that the staging point of sorts for Natalie, Ben, and the locals helping them was a literal cave near the hospital in the rain forest. As in, Plato’s allegory of the cave, i.e., the juxtaposition between reality and our interpretation of it, perhaps Palmer’s way of saying, the reality of organ donation and our interpretation of it (the stubbornly persistent myths).

The book got a little too cute and hokey at the end for me when Dr. Anson, an incredibly righteous figure in his own right, took his own life so as to return his — Natalie’s — lung back to Natalie. That’s not right or ethical, either! But it’s a fictional story, so, I’ll grant the leeway. But I loved the Natalie and Ben characters; I always have fun with normal people thrust into high-stake situations and dealing with crap perpetually hitting the fan and rising to the occasion.

In the Author’s Note, Palmer makes the case for organ donation, with a few helpful points dispelling the myths around organ donation. He also provides links to sites with more information. I appreciated that. I should note as well, that throughout the book itself, given the illicit trade and transplantation of organs, the characters use the word “harvest.” In reality, organs, eyes (the corneas) and tissues are procured or recovered. They are not harvested.

Like I said, I hope people were as entertained by the book as I was (Palmer’s first duty), but that it also compelled them to become informed (his desired second duty) and even register as an organ, eye and tissue donor. You could save eight lives through organ donation, and upwards of 75 through cornea and tissue donation! If you’re in the United States, registering takes less than five minutes through

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