Emerita T. Gueson. 213 pages. Bristol, Indiana: Wyndham Hall; 1992. $29.95.

In this tale of fiction, two resident physicians unceasingly work in an overwhelmingly busy city hospital. Drs. Laura and Michael give tireless, selfless, empathetic care to the urban poor, but they confront a "profit-motivated and cruel healthcare system," which conspires to deprive their patients of critical medical services. For their efforts, they are mugged, robbed, sued for malpractice, and, in Michael's case, infected fatally by AIDS acquired from a patient's blood. In the story's background, reading like the entry log of a large emergency room, is the constant din of urban mayhem, a relentless series of vignettes of murder, rape, abuse, suicides, and auto accidents. A climax is reached in a grisly scene where a serial killer guns down judges and bystanders in a courtroom shootout.

For such outrages of society and organized medicine, the story's author does not hide her scapegoats: HMO (her term for institutions of prepaid care), malpractice lawyers, and pharmaceutical companies that manufacture generic drugs. Behind these is big government, cutting payments for medical care to trim the federal deficit. Several fatal or near-fatal mishaps are caused by HMO—delays in diagnosis of appendicitis, brain tumor, epiglottitis, among others—because it purposely delays consultation of specialists. Proper lengths of hospital stays are not permitted by HMO, which causes other disastrous outcomes, as in the case of one pregnant woman being forcibly discharged from the hospital and then exsanguinated at home from a placenta previa. Another woman had an advanced breast cancer because HMO would not pay for mammograms. These crimes are abetted by penurious physician-gatekeepers, greedily hoarding HMO payments. Besides HMO, other betes noire are malpractice lawyers—in this story, they are also crime lords—who drive good physicians to suicide and pharmaceutical companies that make dangerously fraudulent generic drugs. One patient with asthma nearly dies after receiving a theophylline preparation with a reduced theophylline content. Virtually all institutions involved in modern medical care, however, are to blame for a far-reaching conspiracy against patients.

Often the story's characters step out of the action to lecture us about the malfeasance of health maintenance organizations, hospitals, insurance companies, business, and government. "HMO does not cut healthcare cost," Laura tells us. "It does, though, cut lives". The author herself argues in the preface for repealing the Federal HMO Act of 1973, repealing Medicare diagnostic related groups, and ending support for the use of generic drugs.

Evil medicine in an evil society—underneath it all is the author's apocalyptic vision of the city as hell, to which the hospital is a witness. "God," says one character, "punished the Russians by giving them Chernobyl; He is only beginning to punish us for our warped moral and spiritual values". Only prayer can save us. Such doomsday prophecy is the spiritual core of this book, the source of its libelous polemic against modern medicine. I do not recommend it to anyone who does not share this particular religious perspective.