The publication of The Year of the Intern in 1972 signaled the beginning of Dr. Robin Cook's long and successful career as a premonitory voice in popular culture. Writing from the authority of his position within the medical profession, Cook has secured a reputation as today's foremost practitioner of the contemporary fiction genre known as the medical thriller. To date, Cook has written seventeen novels. Fifteen of these books, most of them best-sellers, offer cautionary and suspenseful tales of conspiracy and intrigue set within the worlds of medicine or medical research. While Cook's fiction is written primarily to entertain his many avid readers, his novels, as a review of Vital Signs in Publishers Weekly aptly noted, are also “designed, in part, to keep the public aware of both the technological possibilities of modern medicine and the ensuing ethical problems” (Steinberg, 1990, 55).

Cook's career as writer of the medical thriller runs parallel to the recent growth of public interest in the field of medicine itself. For Cook's readers, a friendly and familiar figure once known as “Doc” (the bearer of the ubiquitous black bag) has faded into legend. The black bag has long since given way to medical technology, and the ancient art of healing has been broadly named—with obvious significance—the “health care industry.” An industry indeed, incorporating private insurance plans and Medicare and Medicaid, emergency rooms, specialty clinics, for-profit hospitals, and medical teaching facilities. Pharmaceutical companies are part of the health care industry, as are the laboratories where medical research is conducted. Preventive medicine is an important concern within the burgeoning industry, and numerous varieties of alternative medicine have also attracted public attention. In one form or another, the health care industry commands a significant portion of the nation's economy and work force. With the high costs of medicine ever continuing to rise, the industry itself has become the subject of a national debate.

It is in the context of this general debate that Cook's literary contributions have assumed a special relevance. Other physicians, notably William Carlos Williams, Oliver Sacks, and Richard Selzer, have written insightfully about the medical profession; in both stories and essays, these writing doctors have shared poignant moments—triumphant ones or painful ones—garnered from their wisdom and experience. This literature offers laypersons an opportunity to see a side of medicine that is otherwise not generally available to them. The same can be said for Robin Cook's suspense fiction, though it is written from a different angle. In setting out to surprise, shock, and entertain his reading audience, Cook makes use of the popular narrative genres to draw the attention of an exceedingly broad reading audience. The platform of the thriller novel lets him engage ideological issues in a highly dramatic fashion. He, too, reveals dimensions of the world of medicine that lie beyond most readers' direct experience—with the express intention of encouraging them to become involved in the debates being carried out in Congress and in the press. As he stated in a 1983 interview for Health magazine: “The public is more powerful now. We've lived through an age of consumerism. I believe that medicine is just as amenable to that kind of approach. I would like to see more consumerism in medicine. I think it's perhaps the only way to goad this enormous inertial mass known as medicine into changing itself” (Grossmann, 57). In choosing the medium of popular literature, Cook strives to democratize an interest that many people have hitherto thought to be arcane. His timely fiction appeals to a reading audience that has grown increasingly conscious of the major role that health care issues have come to play in public life.

Cook is deeply committed to situating his interest in medical policies and practices within the larger context of contemporary culture. He is, for example, especially concerned about the effects of marketplace motivations on the health care industry. Many of his novels therefore explore, from one perspective or another, questions of the economy of medicine. When medicine's economy intersects with that of the law, as it clearly does in instances of personal injury claims or malpractice litigation, Cook focuses his social critique on the law. His overviews of the workings of social institutions such as medicine and law dramatically reveal many of the ways in which the self-interests of these professions impinge upon the public welfare.

In addition to matters of economic interest, the novels consider numerous current social problems. Cook is attentive to women's issues: to women's positions in the health science workplace and to their treatment by the medical profession. He is concerned about society's widespread use of drugs and about the health threats posed by industrial pollution. He enjoys engaging the ethical problems that medicine's new technologies have inevitably raised—questions about genetic engineering, for example, or in vitro fertilization or experiments with fetal tissue. His first best-seller, Coma, raises the problematic issue of organ transplants, suggesting by means of its startling plot that clearly time has come for a drastic revision of social attitudes about the collection and use of human organs. Always carefully researched, the subjects of Cook's medical thrillers offer his readers much to ponder. Because he characteristically uses the technical terminology employed by members of the medical profession, his books are also instructive, providing his reading audience with an authentic vision of the world of contemporary medicine.

Born May 4, 1940, in New York City, Robert Brian (shortened to Robin) Cook spent his childhood years in Leonia, New Jersey, a community that receives mention in a couple of his books. His father, Edgar Lee Cook, was a commercial artist and businessman. His mother, Audrey (Koons) Cook, has apparently been a particularly significant figure in Cook's life—he appreciatively dedicated both Outbreak and Harmful Intent to her. Robin Cook has an older brother, Lee, and a younger sister, Laurie. (Mortal Fear is dedicated to Cook's siblings with a heartfelt expression of his esteem and affection.)

As a young child, the winsome Robin Cook modeled toddler's fashions, but his first great enthusiasm was for archaeology, the subject he knowledgeably explores in his third work of fiction, Sphinx. As its title indicates, he was especially fascinated by the wonders of ancient Egypt, and as a youth regularly visited the mummy rooms of Manhattan's Metropolitan Museum—where he was, in fact, inspired to commit to memory the names of the rulers of all the Egyptian dynasties. This early interest in the lore of Egypt has remained a lifelong passion, one that indeed received expression in the only one of Cook's seventeen novels to date that is not set within the world of medicine.

Readers of his books will readily note that Robin Cook's first and third novels are anomalous in respect to the rest of his fiction. The largely autobiographical first book, The Year of the Intern, is not a thriller, and Sphinx, which is unquestionably a suspense novel (one that even features a double conspiracy plot), is not a medical thriller. Appearing in the wake of the popular success and critical acclaim that attended the publication of his second novel, Coma, Sphinx spent seven weeks on the best-seller list and was also adapted for the screen. The movie, in whose production Cook took no part at all, was not the success that the movie version of Coma had been, and reviews of the novel itself were decidedly mixed. It is quite apparent that, after writing Coma, Cook used his newly acquired facility with the suspense genre to write a novel that paid homage to his fascination with mysteries of the past. After experimenting, however, with a thriller that featured black market intrigue in the smuggling of Egyptian antiquities, Cook chose to return to his fictional exploration of a variety of medical issues, and it is this specialized focus that has come to distinguish his work within the body of contemporary suspense literature.

Sphinx's plot is an intricate one, providing room for Cook to play with standard conventions of the suspense novel, and the book is of general interest to his readers in two other noteworthy respects. In the figure of its central character, Erica Baron, it offers an example of a strong female protagonist, and in its “lovingly detailed and sensuous descriptions of Cairo, Luxor, and Egypt's holy places” (Aldridge, 36), it captures an atmosphere of place that can be favorably compared with the realistic effects that the writer characteristically achieves in his representations of hospital settings. Sphinx's ingenious plot, based on the notion that the undisturbed tomb of another Egyptian ruler, Seti I, actually lies hidden beneath the familiar tomb of King Tutankhamen, proved to be of timely interest to many readers, for the book was published around the time artifacts from Tutankhamen's tomb were on exhibition in the United States.

Although his obsession with archaeology predated his interest in medicine, the latter passion also emerged early in Robin Cook's life. Indeed, it was at age fifteen, after he had witnessed a football injury at Leonia High School, that he determined that he would become a doctor. Cook graduated from Connecticut's Wesleyan University with a B.A. in premed in 1962. He then attended Columbia University's College of Physicians and Surgeons, receiving an M.D. in 1966. (Cook's summer job during his years at Columbia was a particularly interesting one: traveling each summer to Monaco, he served as a lab assistant to Jacques Cousteau; readers can see a reference to Cook's scuba diving experiences in Vital Signs, where one character is devoured by an immense white shark while diving off Australia's Great Barrier Reef.) While Cook found his university experiences at Wesleyan immensely stimulating, he has frequently criticized the ways advanced medical education is organized, believing that medical schools have “a tendency to stay in the past” (Grossmann, 56). The critique of medicine that is sounded throughout his literary career therefore first began to take shape while he was still a medical student.

In 1966 Cook became a surgical resident at Queen's Hospital in Honolulu, Hawaii; he remained at this post until 1968, later using his own experiences there as the inspiration for his first book, the insightful study of the institution of medical residency entitled The Year of the Intern. Deeply disturbed by the exhausting regimen of residency (or internship, as it was then called), and thoughtfully concerned about the ways this form of apprenticeship might in fact be counterproductive as a tool for training doctors, Cook felt compelled to find a way to express his thoughts on the subject. The opportunity arose during his stint in the U.S. Navy, where he served from 1969 to 1971 (eventually becoming lieutenant commander). Assigned to the USS Kamehameha, a Polaris submarine, Cook actually wrote his first novel, as he says, “under the Pacific Ocean” (The Year of the Intern, hereafter cited as TYOTI). Asked by an interviewer for Contemporary Authors (hereafter cited as CA) whether he had ever given thought to writing a novel before seizing the opportunity he enjoyed aboard the submarine, Cook acknowledged that he had wanted to begin writing while he was still in medical school, but that he had not had time. Then, the opportunity presented itself, and, as Cook said, “I didn't really know if I was going to be able to write one, but I assumed that I was” (CA, 119).

Although this first book, published when Cook returned to civilian life, was very well received, it did not enjoy as wide a circulation as he had hoped. Cook had a message he wanted to deliver (in fact, in 1973, the year following the publication of The Year of the Intern, he summarized its sentiments in “My Turn,” Newsweek's regular guest opinion column), and he now needed to find a way to appeal to a broader reading audience. Readers of The Year of the Intern had certainly included people with a specialized interest in the practice of medicine (it was recommended reading for both established doctors and doctors-to-be), but Cook was determined to write a novel that would catch the eye of the general public. With this ambition in mind, he set out to discover the secrets of successful popular fiction. Hoping to produce a best-seller himself, he spent six months in 1975 reading and analyzing best-sellers (over one hundred of them, in fact). Cook's reading suggested to him that the mystery-thriller genre would be likely to “capture the interest of the largest number of people” (World Authors, 183), and he therefore decided to write one, drawing upon his own special expertise through the use of a medical setting. The result of Cook's efforts was Coma, a best-seller that was also made into a successful motion picture.

“Learning to write a best-seller ,” Cook later told People magazine, was “like teaching yourself to wire a house” (Jennes, 65). Having successfully published his first novel, he was unaware, until he wrote Coma, of how truly difficult it generally is to break into the highly competitive popular market. In fact, reflecting upon the earlier publication of The Year of the Intern, he commented to Health magazine's John Grossmann: “If I had known then what I know now—that the chances of a first-time author getting published are about as good as winning the state lottery—I don't think I would have attempted the book. I thought you simply wrote a book, sent it in, three weeks later it was in the bookstores, people ran and bought it, and then you went on the Johnny Carson show. I was very lucky” (Grossmann, 56). If Cook was lucky with The Year of the Intern, by the time he was ready to seek a publisher for Coma he had found a narrative formula that was probably guaranteed to win him success. His setting was marvelously authentic, his subject matter explosive, and, as Charles J. Keffer of Best Sellers observed, “I do not think anyone can beat the suspense and the story line developed throughout this novel. It is so close to the truth that one has to reinvestigate the title page to be sure that it really did say ‘A novel by Robin Cook’” (Contemporary Literary Criticism, 131). Coma found readers of the thriller genre ready to embrace the possibilities of medical intrigue.

Before he was drafted into the navy, Cook had served his medical internship in general surgery. When he returned to civilian life, he decided to specialize in eye surgery, and therefore took up a residency in ophthalmology at the Massachusetts Eye and Ear Infirmary (an institution affiliated with Harvard Medical School). Cook was a resident there from 1971 to 1975. When his residency was completed, he opened a private practice near Boston and also joined the teaching staff at Massachusetts Eye and Ear. (Later, when he decided to commit more time to writing, he took a leave of absence from his Harvard teaching appointment.) Readers might be interested to note that two of Cook's villainous doctors, Outbreak's Ralph Hempston and Blindsight's Jordan Scheffield, are themselves ophthalmologists. Additionally, the medicine of the eye is featured in a couple of Cook's thriller plots. Blindsight's central action is concerned with the great demand for cornea transplants, and, in Mortal Fear, where unsuspecting victims are administered a dose of a sinister “death hormone,” the deadly substance is cunningly introduced into patients' bodies through the mucous membrane of their eyes. In Cook's most recent novel, Contagion, the central character is an opthalmologist who has been driven from private practice by a profit-oriented medical corporation.

Remarkably, Robin Cook wrote his second, third, and fourth novels while both maintaining his private practice and serving on the staff at the Massachusetts Eye and Ear Infirmary. Cook acknowledges that he writes rapidly (The Year of the Intern and Coma were reputedly drafted in six weeks and Sphinx in ninety days), but it is also likely that the disciplined habits he acquired while studying and practicing medicine have in fact served him well as a writer. When asked by an interviewer for Contemporary Authors whether it was difficult to establish a writing routine while practicing medicine full time, Cook answered that in his experience the two activities seemed to complement one another. “Medicine,” he stated, “is a very episodic type of phenomenon where every fifteen minutes or so you're being faced with another problem to solve; you're making decisions, interacting with people all the time. Writing is just the opposite. You're sitting in your own room surrounded by your own objects, by yourself, for protracted periods of time. In a way I think the two things are compatible” (CA, 119).

After the publication of Brain, Cook decided to take an extended leave of absence from the active practice of medicine, and it now appears that he no longer intends to return to his original occupation. He has busied himself in the meantime with the prodigious task of researching and writing thirteen additional medical thrillers, and he remains an outspoken advocate for medical reform. His favorite reading, he recently informed the editor of Reader's Digest Condensed Books, remains the New England Journal of Medicine.

Cook's reading habits and longtime interest in all manner of medical issues keep him well abreast of new developments in his field, and he delights in opportunities to speculate about future trends in his profession. Indeed, in a 1989 interview for Omni, Cook had some startling predictions to make:

I also believe that viruses are going to be useful in the genetic-engineering revolution. We're going to see a change in our perception of viruses. We'll no longer view them as some sort of inimical enemy. They may be much more helpful than we realize (Bryant, 22).

These intriguing predictions notwithstanding, Cook knows that issues surrounding organ transplants, viruses, and genetic engineering all lend themselves to suspenseful treatment in the hands of the writer of medical thrillers, and thus takes up these matters in Coma, Outbreak, and Mutation. He also has some thoughtful observations to make about cancer treatment, a subject he explores in both Fever and Terminal. As he told John Grossmann, “I think the major problem in cancer research is the system: The drug firms want the cure for cancer to be a white powder they can patent. I think the solution will come through prevention and an immunological approach, which are less likely to have that kind of economic impact. This is where I'd like to see the research concentrated” (Grossmann, 57).

Besides keeping up with developments within his field and conceiving plots for chilling thrillers, Cook enjoys refurbishing and decorating houses or apartments. He maintains homes in Boston and Naples, Florida, and has recently redecorated an apartment in New York City's Trump Tower. His current interest in architecture and decor is in fact given expression in a recent novel, Acceptable Risk. There his protagonist discovers that she too is fascinated by old buildings and by the creative challenges inherent in tackling problems of renovation and artful decoration. When he is not busy pursuing one of his many creative inclinations, Cook enjoys playing tennis, skiing, or organizing a pickup game of basketball at Columbia University's medical school gym (which is now called the Robin Cook Gymnasium in honor of the benefactor who arranged for its complete renovation). Basketball, as it turns out, is also an interest that Cook has found means to incorporate in his fiction. In a truly fascinating way, his perceptive study of the social conventions that inform playground basketball in New York's inner city plays an important role in Contagion, his latest thriller.

Twice married, Cook has no children. His first wife was a young Scandinavian woman whom he had met while working with Jacques Cousteau in Europe. They were married in 1968 and divorced only a few months later. A relationship that “was more romantic than practical” (Jennes, 65), as Cook later revealed to Gail Jennes, it came to an end just before he was drafted. In 1979 Cook married Barbara Ellen Mougin, an actress and model who served as the inspiration for his characterization of Denise Sanger, a central figure in his fourth novel, Brain. An end to this marriage, which was apparently a very happy one for several years, is seemingly signaled on the acknowledgments page of Mortal Fear, where Cook thanks the many friends who offered him support during “difficult” times.

To date, two of Robin Cook's novels, Coma and Sphinx, have been made into large screen motion pictures, and three others, Mortal Fear, Outbreak (renamed Virus), and Terminal have been specifically produced for television audiences. His fiction has been translated into Spanish, and many of his books are available on audiocassettes. Cook, a widely recognized figure within the contemporary literary scene, serves on The American Heritage College Dictionary's select Usage Panel.

Robin Cook's Autobiographical First Novel

The Year of the Intern, written before Robin Cook determined that he would learn how to write a thriller novel, is intended to be an exposé of the “adverse environment” (TYOTI, 2) that he sees as a condition of the institution of medical internship. The novel is thus passionately earnest, indeed polemical, in its tone, and it is clear that when Cook wrote it, he had hopes that his poignant account of the ways the internship experience works to demoralize and harden idealistic young doctors might excite members of his profession to institute a change. Cook was, in this respect, somewhat disappointed, for although he was invited to be a keynote speaker at a subsequent conference on medical education, the book “didn't cause any particular movement to look into these things” (CA, 119). In Cook's opinion, the medical internship unfortunately remains a “kind of a hazing year” (CA, 119). Later on in his writing career, when he chose to master the possibilities of the suspense genre, Cook found a very different means to voice an exposé.

Dedicated to “the ideal of medicine we all held the year we entered medical school,” Cook's first novel recounts the disillusioning experiences of one Dr. Peters (interestingly, a first name is never offered), intern at a community teaching hospital in Hawaii. It is the only one of Cook's seventeen novels to date to employ a first person narrative voice. The central character (generally called the protagonist) addresses the reader with an intimacy that is appropriate to the story he has to tell. The novel, which begins on the fifteenth day of Dr. Peters' internship, is divided into three sections that correspond to the different medical rotations that comprise the surgical intern's hospital assignments over the course of a year. Thus the first section, “General Surgery,” relates Peters' initial experiences as an acting physician. The second section, called “Emergency Room,” begins on the 172^nd day of his internship, and the third section, “General Surgery: Private Teaching Service,” takes up Peters' story on his 307th day of service. A concluding section, “Leaving,” summarizes Dr. Peters' feelings on the 365th day, as he happily passes his responsibilities on to another beginning intern, the eager and idealistic Dr. Straus. And thus, as the book's ending suggests, the grueling, exhausting, and enervating cycle of medical internship will begin anew. The question that hangs in the air almost seems to answer itself: will Dr. Straus, after his year of internship has passed, emerge with his hopes and his high ideals intact?

The Year of the Intern marks Cook's first use of the episodic structure of plot development that he employs with such notable success within his suspense fiction. In this first novel, where plot is mainly a recounting of a series of unrelated events (events that Cook describes as “a synthesis of my own experiences and those of my fellow interns” [TYOTI, 2]), there is admittedly little occasion for the writer to demonstrate the skill that will later be his hallmark. Nonetheless, the story convincingly portrays the gradual transformation of an empathetic young doctor into something of a cynic, and in the closing pages of the book this change is emphatically registered upon the reader through Cook's use of a shrewd plotting device: with a wonderfully delicate touch, he repeats the moving scene with which his novel opened. This time, however, he places Dr. Peters in the position of detached observer of an event that less than a year earlier he had himself experienced with a great deal of pain and confusion. By the end of his internship, Dr. Peters has forgotten the immense trepidation he had felt the first time he “had been faced with the sole responsibility for pronouncing death” (TYOTI, 5).

Readers are first introduced to Dr. Peters as he is summoned in the middle of the night to confirm the death of an elderly patient. Although Peters has obviously witnessed death before, he has never before been responsible for making the “judgment call” (5). Stricken by the burden of this new responsibility and uncertain of what he should do, Dr. Peters wavers: “He was dead. Or…was he?” In touching detail, Cook depicts Peters' moments of uncertainty: I took out my stethoscope slowly, postponing the decision, and finally settled the pieces into my ears while I held the diaphragm on the old man's heart.…I couldn't hear the heart—yet couldn't I, almost? Muffled and far away?…My overheated imagination kept giving me the vital, normal beat of life. And then I realized it was my own heart echoing in my ears. Pulling the stethoscope away, I tried again for pulses, at the wrists, groin, and neck. All was quiet, yet an eerie feeling said he was alive, that he was going to wake up and I was going to be a fool. How could he be dead when I had talked with him a few hours ago? I hated being where I was. Who was I to say whether he was alive or dead? Who was I? (TYOTI, 5–6)

Dr. Peters applies his stethoscope again, and finally says, “He's dead, I guess” (TYOTI, 6), but there is more for him to do. He must now call the next of kin, and this presents him with a new set of anxieties, as he tries to determine what he should say: “I tried to think of some neutral word, one to convey the fact without the meaning. ‘Dead,’ ‘demise’…no, ‘passed away.’ ” When an experienced nurse appears and asks him to sign the death certificate, Peters wonders aloud when the old man died; the nurse's scornful reply takes him by surprise: “He died when you pronounced him dead, Doctor” (TYOTI, 7). Not sure even yet that the man is really and truly dead, Peters fights the urge to go back and check the pulse once again.

This poignant (and sympathetically comical) scene—wherein the young doctor confronts mortality and most reluctantly admits it, awkwardly yielding to its horrendous finality—is echoed in the concluding chapter. On this occasion the experience is Dr. Straus', and Peters' response takes a measure of the changes he has undergone in his year as intern. Peters is packing his belongings when Straus phones him:

As the telephone conversation continues, punctuated with many hesitations on Straus' end, it becomes quite apparent to the reader (though not to Peters) that Straus is suffering uncertainties very similar to those that earlier confounded Peters. Straus does not know what to say to the family or how to handle the necessary paperwork. Indeed, he seems to need someone else to confirm the death, but Peters refuses to help him out. Thus Straus is left to undergo alone the intern's traditional rites of initiation, and Peters, for whom a full-fledged “medical practice was at last within sight” (TYOTI, 189) wonders whether he should purchase a Mercedes or a Porsche. (He knows that the Cadillac is a favorite car with surgeons, but this conspicuous status symbol is not—at least not yet—quite to his taste.)

Offering the first of Robin Cook's highly authentic depictions of life within a hospital setting, The Year of the Intern examines hospital politics, outlining the hierarchical order that defines staff members' relations to one another. It emphasizes the competition that exists among the interns—all striving to catch the attention of the hospital's most important doctors. It portrays occasional incompetence in medicine, often the result (at least in cases involving interns) of exhaustion or confusion. The novel takes a measure of the psychological wear and tear that naturally occurs when people witness others' suffering or death, and it even notes the various physical discomforts that are a doctor's lot: for example, the irritation of being unable to scratch an itch within the operating room's sterile conditions. The hospital setting brings with it associated problems, those of dealing with drug companies or handling insurance claims. All of these details and others (debates, for instance, about the relative advantages and disadvantages of Medicare) are significant to Cook, who is interested in capturing as realistic a portrait as possible of both the intern's typical experience and the general flavor of hospital life. (Before submitting his manuscript for publication, he asked eight other young doctors to read it and confirm his observations.) Indeed, for the reader who is curious about the inner workings of the medical profession, The Year of the Intern provides an excellent introduction. Gail Jennes describes the work as the “rather sour tale of the harsh life led by doctors in training” (Jennes, 65), but World Authors notes the book's importance, claiming that “it can be seen as part of a growing protest against the processes of depersonalization built into medical training” (World Authors, 182).