Five Patients: The Hospital Explained

Most of Crichton's work is fiction. However, he did write a few nonfiction, and Five Patients is the first of those. It is basically five case studies of patients at Massachusetts General Hospital that Crichton uses as a vehicle to introduce the reader to what actually goes on at a hospital and to make a few points regarding the state of medicine, health care and even insurance. It is not, in my opinion, a great read. But it is an important work to examine when looking at the evolution of Crichton's style.

Prior to this book, Crichton was writing primarily in the detective genre under the pen name of John Lange. A Case of Need written under the pen name of Jeffrey Hudson was a transition novel that combined a mystery with commentary on the medical profession as well as public policy issue. If Crichton had continued to write detective fiction, following in the trajectory established by his novels prior to Five Patients, he almost certainly would still have been a major author. His books were promising and he was beginning to take on larger social issues such as the issue of abortion in A Case of Need.

It is also interesting to note that if you consider the emerging trajectory which included A Case of New and Five patients  and later went on to include the long running TV series ER, we can see another path to success. The roots of ER show clearly in Five Patients where Crichton exposes the reader to the raw human dynamic side of life in the ER along with a heavy does of technical medicine.

At this point we see several themes emerging. Crichton offers a healthy dose of nonfiction science to inform the reader and bolster the credibility of what he is saying. And, he comments on public policy issues. In five patients, he takes on health insurance and the rising cost of health care. In fact, in the Afterward, he states "Hospitals are becoming so expensive that financial considerations will soon become the paramount determination of function." Yes, that was nearly forty year ago and rings eerily true considering our recent debates on health care.

So, at this point there are two competing trajectories: detective fiction and medical fiction. Which way will he go? Well, since we already know about the success of the TV series ER it  appears that the detective fiction died out in favor of the medical fiction. But in reality a new trajectory would emerge beginning with a book published a year earlier. The book was his first major best seller and set the course for much of his later work. It was The Andromeda Strain and that is the book we will look at next.