The Last Surgeon by Michael Palmer — Sneak Preview

About The Last Surgeon

Michael Palmer’s latest novel pits a flawed doctor against a ruthless psychopath, who has made murder his art form. Dr. Nick Garrity, a vet suffering from PTSD—post traumatic stress disorder—spends his days and nights dispensing medical treatment from a mobile clinic to the homeless and disenfranchised in D.C. and Baltimore. In addition, he is constantly on the lookout for his war buddy Umberto Vasquez, who was plucked from the streets by the military four years ago for a secret mission and has not been seen since.

Psych nurse Jillian Coates wants to find her sister’s killer. She does not believe that Belle Coates, an ICU nurse, took her own life, even though every bit of evidence indicates that she did—every bit save one. Belle has left Jillian a subtle clue that connects her with Nick Garrity.

Together, Nick and Gillian determine that one-by-one, each of those in the operating room for a fatally botched case is dying. Their discoveries pit them against genius Franz Koller–the highly-paid master of the “non-kill”—the art of murder that does not look like murder. As Doctor and nurse move closer to finding the terrifying secret behind these killings, Koller has been given a new directive: his mission will not be complete until Gillian Coates and Garrity, the last surgeon, are dead.

This sneak preview of The Last Surgeon is a thank you gift from Michael to all of his faithful readers. The Last Surgeon is coming to bookstores everywhere February 16, 2010. Released by St. Martin’s Press.

About the Author

MICHAEL PALMER is the author of fourteen previous novels of medical suspense, all international bestsellers. In addition to his writing, Palmer is 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 lives in eastern Massachusetts.

The Last Surgeon — Prologue

“I know you can’t believe this is happening, Ms. Coates, but I assure you it is. I have been paid and paid very well to kill you.”

Belle Coates looked up at the intruder through a glaze of tears. “Please. Just tell me what you want,” she said. “Just tell me what you want and you can have it. Anything. Anything at all.”

The man sighed. “You’re not paying attention, Ms. Coates,” he said with the accentuated patience of a third grade teacher. “I am not here to bargain. I told you that. I’m here because this is what I get paid to do.”

“But why? Why me?”

Belle made yet another futile attempt to stand. Her wrists and ankles were lashed to her kitchen chair by the sort of Velcro restraints she and other hospital nurses used so often on difficult patients.

“Those restraints look amazingly simple,” the intruder said, “but I tell you they are a marvel of engineering and ergonomics. No pain, no marks. None at all. That’s why I have a dozen or so sets of them in the drawer at home.”

The man, six feet tall and wiry, had been hidden inside Belle’s apartment, probably behind the couch in the living room, when she arrived home at nearly midnight. Her nursing shift—three-to-eleven in the cardiac surgery ICU at the Central Charlotte Medical Center–had been a tough one, and she had relished every stair of the trudge that brought her closer to her apartment, a cup of tea, and a steamy shower.

She was just choosing a tea when he appeared in the doorway of her kitchen, an apparition in sky blue surgical hair and feet covers, and latex gloves, black jeans, black long-sleeved T. She was so fixated on his appearance that it was several seconds before she noticed the huge, gleaming knife dangling at his side. Her hesitation was more than enough. In two quick strides he was beside her, seizing a handful of her hair, snapping her head back, and pressing the blade against her throat. With just enough restraint to keep from drawing blood, he forced her down onto one of the oak chairs she had recently refinished, and in moments, the restraints were on her. It had happened that fast.

A dozen or so sets in my drawer.

The statement was as terrifying as the knife.

Was he a serial rapist? A psychotic killer? Desperately, searching for even the smallest inroad to understanding the intruder, Belle tried to remain calm and remember if she had read about such a man in the papers, or heard about him on the news.

“What do you want?” she said. “My fiancé will be home any minute.”

He fixed her with pale, translucent blue eyes, that were devoid of even the slightest spark of humanity.

“I don’t think so. We both know about your failed engagement. Celebrate Belle and Doug’s love. I’m very sorry about that,”

Belle froze at the words, quoted from her wedding invitation.

“Who are you?” she managed again. “What do you want from me?”

“Now we’re getting someplace.” The man produced a vial from his pocket and set it on the table. “I want you to swallow these sleeping pills I found in your medicine cabinet the last time I was here. I have augmented what was there with some that I brought with me tonight, so there will be more than enough to achieve our goal. But before you take these pills, I want you to copy and sign a brief note I have composed explaining your despondency and your desire not to live anymore. And finally, I want you to undress, step into your tub, and go to sleep. See? Simple and absolutely painless.”

Belle felt her breathing stop. This couldn’t be happening. She wouldn’t do it. He wouldn’t be able to pry her jaws apart with a crowbar. She began to hyperventilate and shake, grabbing and releasing the arms of her chair.

“I won’t do it.”

“You will.”

“I won’t!” she began screaming. “I won’t! I won’t! Help! Someone help m–!“

Her words were cut off by exquisite pressure around her throat. A hard rubber ball was forced expertly between her teeth and into her mouth. The killer remained absolutely calm during the insertion.

“That was stupid, Ms. Coates. Do anything stupid again, and you will be responsible for causing both yourself and your sister a great deal of pain.”

Belle stared up at him, wide-eyed. The mention of her sister was a dagger. Hyperventilating through her nose, she still could not seem to get in enough air.

“That’s right,” the man said. “I know all about Jillian. Just like I know all about you. Now, refuse to do exactly as I say, try anything stupid again, and I promise, both you and Jillian will die prolonged and painful deaths. Understand? I said, do you understand?” Belle nodded vigorously. “I’m still not certain you do. Now listen, Ms. Coates, and for your sister’s sake, believe me. I have no contract to kill Jillian—only you. And with very rare exceptions, those I am not paid to kill, I don’t kill.”

He took out his mobile phone, made a gentle tap on the screen’s touch display, and held it up for Belle to see.

“I assume you recognize your sister’s condo in Virginia—Arlington, to be exact, four-eighty-nine Bristol Court to be even more exact. Nod if you agree that is the case. Good. I know how close you two are. You see, I read your journal, or diary, including entries from the trip to Nassau that Jillian took you on after you learned about Doug’s how shall I say, dalliance with your friend Margo. Surgeons. They are just so full of themselves, aren’t they. I see you are having a little trouble breathing. Okay, here’s the deal: I’ll remove that ball if I get your assurance you will stay quiet and still.”

Belle grunted her agreement and again nodded. The man pulled the ball out keeping his fingers clear of her teeth, and dropped it into his pocket.

“Now,” he said, “what you are about to watch is a live video feed—live, as in it’s happening in four-eighty-nine Bristol Court right this very instant.”

Belle stared in disbelief at the full-color projection. The footage was unquestionably taken from her sister’s tastefully and lovingly decorated condominium. She was certain that the woman sleeping alone in the queen-size bed, was Jillian, also a nurse, and one of the main reasons Belle, herself had chosen the profession. Upon the automobile deaths of their parents, Jillian had stepped in to raise her fourteen-year-old sister, often making major sacrifices in her personal life. Belle considered her to be the kindest, brightest, most centered person she had ever known. The camera had been placed above the valance in the bedroom. At the sight of Jillian, rolling languidly from her left side to her back, Belle began to hyperventilate again.

“Easy,” the man warned. “Slow down. That’s it. . . . That’s it.

“Please. Please don’t hurt her.”

The apparition holding the phone leaned forward. Belle cringed as his empty eyes came level with her own. His pale white skin was tinted blue, a ghoulish illusion cast by her ecologically friendly halogen lights.

“You must calm down your breathing and listen, Ms. Coates. To save your sister’s life, and yourself from a great deal of pain, it is essential that you believe I will do as I say.”

“I believe. I believe. Turn it off. Turn that camera off and leave her alone.”

“I’m going to make you a promise Ms. Coates,” he whispered, his lips brushing her ear. “I promise that if you fail to follow my instructions, Jillian will die, and die quite horribly. Do as I say and she lives. Want proof? Look here.”

He held the phone at eye-level.

“Enough,” Belle pleaded. “Don’t hurt her.”

“I’ve placed small canisters of a potent nerve gas above the door frame inside the closet. From this phone, I can control how much of the gas is released simply by tapping my finger. Incredible, yes? I am a virtuoso operating this setup. I put another camera in Jillian’s bathroom because I want you to see what happens when just a smidge of this gas is inhaled.”

“No, please. Please stop this. I believe you.”

The intruder paid no attention. It was as if he had planned this demonstration all along. Belle’s brain was spinning. How could she believe him? How could she not? What choice did she have? Would he really spare Jillian as he promised? Why would he? Why wouldn’t he? The unanswerable questions roiled on and on.

“If I wanted to,” he said as if reading her thoughts, “I could kill your sister—I could kill anyone–any time, any place, and in any way I wish. But the point is I don’t have to. I don’t even want to. She seems like a nice woman. And as I said, there is nothing in her death for me.”

He made two gentle taps on the phone’s display, and Jillian’s quaint bathroom came into focus, illuminated by a night light beside the sink, and small a diamond-shaped window above the tub.

“There are four levels of gas I can administer. The first three will cause increasing pain and the symptoms you are about to see. The fourth will kill . . . slowly. This is level one.”

Within seconds, Jillian, wearing flannel pajamas Belle had bought for her, burst into the frame, fell onto her knees, and began retching violently into the toilet. Between bouts, she lay clenched in a fetal position on the tiled floor, shivering uncontrollably.

“Can you believe that’s only level one?” the man asked. “I think I should patent this delivery system.”

“Stop it! Stop doing this to her,” Belle cried.

“Keep it down or I’ll cut your larynx out and set it on the table. I’m sensing you need a bit more motivation Ms. Coates. Allow me to oblige by upping Jillian’s misery to level two. I’ll keep it on level two until you start copying this note. Audio is really a must to get the full effect.”

He tapped his phone’s display again and now Belle could hear Jillian’s grunting, labored breathing, interrupted by fits of gut-wrenching vomiting and sobs of pain.

“Please…stop…I believe you. I believe you.”

He loosened her left hand and pushed the note she was to copy in front of her.

“Start writing your farewell letter, Ms. Coates. When you do, I’ll stop killing your sister,” he said.

Belle’s face contorted in agony at the sound of Jillian’s unrelenting anguish.


“Do you need more volume? Write the damn note!” the monster barked, pounding the table with each word. “You’re dead regardless. But you can still save your sister’s life, that is if you have the courage to do the right thing.”

The man shut off the gas as soon as Belle began to write. In just a minute, Jillian’s moaning stopped. Belle managed to pen the first four words before she began to sob.

“Finish,” he said, “or, I’ll fire it up again.”

“Why me? I haven’t done anything wrong. I don’t even know you. Why do you want me to die?”

“Not my call. Somebody in this great big world of ours has decided you have to go. And that somebody is paying me to make it happen. I can do it to you alone or to both of you.”

“This is insane,” she said, as much to herself as to the man who was about to murder her. “This is absolutely insane.”

“I guess you enjoy listening to your sister scream. Allow me to show you level three.”

The tormented retching Belle heard could scarcely be described as human. On the tiny video display, Jillian’s body convulsed more violently than before. Soon as Belle lifted up the pen again, the man pressed a button on his phone and her sister’s screaming stopped. Belle found the strength to finish copying the note.

“I’m a man of my word, Ms. Coates. I’m also very good with handwriting and I have a large sample of yours from your journal. Mess with this and I’ll dismember you joint by joint with that ball stuck back in your mouth. You’ll still be alive to watch when I finally jack up the gas in Jillian’s pad to level four.”

“I did as you asked. Let her go.”

“Sign it.” The man studied the note with great care. “Okay, now the pills.”

He shook the pills onto the table, motioning her to take one.

“Please,” Belle begged, still trying to make inroads into the utter helplessness she was feeling. “Who’s paying you? Why do they want to kill me?”

“I’m running out of time and patience.”

The man pressed a button on his phone like a puppet master pulling on invisible strings. Jillian’s body again twitched with violent spasms.

“No! You promised!” Belle cried.

“You have the power to make this easier on Jillian. Think of all your sister has done for you. You owe it to her, don’t you? Make me stop. I want you to stop me, Ms. Coates.”

She could not listen to her sister’s cries anymore. Her only thought was of the man’s chilling proclamation.

You’re dead regardless.

As though in a trance, her hand shakily reached out. Jillian’s moaning abated soon as Belle swallowed the first pill.

“Please…don’t. No more.”

“Keep swallowing and that’s the last time you have to hear that nasty

sound, Ms. Coates.

Belle tightened her jaw and nodded that she understood.

“Promise?” Her voice sounded like a child’s. “I said, do you promise?”

“Ms. Coates, I might be a killer, but I’m a professional. You have my word. But I’m going to resume torturing your beloved sister unless all these pills are down the hatch.”

It was too much to take. Belle raced to swallow the pills.

What else can I do? her mind kept asking. What else can I do? . . . What else can I do?

The action, in a way, was liberating. Her heart rate slowed and her tears stopped. In minutes, she no longer felt agitated or even frightened. The man’s eyes, once haunting, now made her feel nothing at all.

“Good girl. You are simply going to close your eyes and go to sleep.”

Her tongue already felt heavy. “You promised,” Belle managed.

“You have my word.”

After a while, he filled the tub, then undid her restraints.

“Clothes,” he said.

Feeling the wooziness of the drug take further hold, Belle stepped out of her scrubs and dropped her bra and panties onto the floor.

Then she stepped into the tub.

“I love you Jillian,” she murmured. “I love you.”

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