book First, Do No Harm

reviewed by Adrienne Friedberg

Published in Issue No. 162 ~ November, 2010

Knife Music, the title of David Carnoy’s debut novel, refers to the soundtrack surgeons choose to accompany their own performance in the operating room. This medical thriller opens like a scene from one of the better episodes of ER. A paramedic calls in the particulars of a motor vehicle accident to the trauma center at Parkview Hospital in Menlo Park, California; a 16-year-old girl with apparent head, neck, chest and abdominal injuries is awake at the scene. Four minutes later Ted Cogan, the on-call trauma surgeon, greets the victim as she’s being wheeled into the OR and assesses the situation. Her racing pulse and low blood pressure suggest internal injuries, possibly the rupture of a vital organ. Then, with the amusing if predictable swagger of the ruggedly handsome and smugly charming, Cogan does what he’s been trained to do and saves her life.

Carnoy takes us through the procedure step by step, with a cinematographer’s eye for detail; preliminary X-rays, recitation of blood counts and vital signs, the location of the latex glove dispenser, the look of the girl’s eyes over her oxygen mask as the head nurse cuts away blood-soaked jeans, mock turtleneck, bra and panties to reveal muscular legs, flat stomach and the various cuts, bruises and scratches on her legs and torso. The paramedics’ paperwork shows that her name is Kristen. Zealous interns chime in with questions designed to assess her mental state, and the patient groans in pain. The surgeon controls the scene like its writer controls the story, with the easy confidence of a crack technician who knows his way around the human body as well as the psyche.

Cogan is tall, with the boyish good looks of a Gen-X movie star that are only enhanced by the lack of sleep that comes with his job. He has the grace of a natural athlete (he pitched for Yale), a quick wit, and genuine compassion for his patients. Carnoy bathes him in a bright Northern California light, showcasing his strengths but also revealing his blemishes. He’s a bit of a womanizer, somewhat lonely but also commitment phobic, and a more than a little arrogant. Still, he’s eminently likable.

When Kristin is found dead six months later hanging from the shower-head in her own bathroom, Hank Madden, a homicide detective that even defense attorneys think of as a decent guy, is assigned to the case. Madden walks with a limp, the result of childhood polio, one of the last recorded cases. He achieved his rank through hard work and dedication, allowing himself no self-pity. Like Cogan, Madden is smart and likable. Under different circumstances the two men would have liked each other. Then again, Madden has an innate distrust of doctors; all those childhood visits left some horrific scars.

Kristen had been a popular, well-adjusted kid, not a typical suicide. But a few months after her accident her grades started slipping; she was moody in more than the normal teenage way. Her worried mother had snooped around Kristen’s room and found her journal, in which Kristen had written about being with Dr. Cogan around the same time her behavior had started changing. After a prolonged fight with her parents in which she insisted she wasn’t raped, that she had done as she pleased, Kristen, a movie buff, watched “An Officer and a Gentleman,” one of her favorites, for the last time. The note she left said only, “I will not be a victim.”

“Kristen didn’t feel like a victim,” her best friend later tells Cogan. “But everybody wanted to make her one.”

The journal and a CD-R labeled “Knife Music” that Madden finds on Kristen’s desk are enough evidence for him to start investigating the man who saved her life in the opening scene. As Cogan’s lawyer, an ex-lover, explains, “There’s something called foreseeable harm. You may not have intended to cause her to commit suicide, but by sleeping with an underage girl, the law says you knowingly inflicted an emotional injury.” If the prosecution can prove that injury led to her suicide, Cogan could end up with a manslaughter charge, two to five years in prison, and the loss of his medical license.

Knife Music is part medical thriller and part police procedural, and it certainly has all the gut-level suspense of a detective story. But this is no ordinary thriller. In the tradition of Richard Price or Dennis Lehane, Carnoy digs so deeply into the past experiences that have led to the motivations, secret or subconscious thoughts of each of his main characters that you almost feel guilty for eavesdropping. He has a remarkable ear for dialogue; in a line or two or maybe a single phrase of age-appropriate lingo he conjures a character’s history and emotional baggage, masterfully rendering the rhythms and inflections of speech, cadence, tone, and cultural dialect. Cogan and his doctor friends play tennis at the club and chat about wives, children, and sex; Stanford frat boys at the cleverly named “Rejection House” (it used to be the admissions building) plan parties and try to get laid; cops drink diet coke or beer and talk about cop stuff; sixteen-year old girls gossip and bicker like sixteen-year-old girls. Movies and popular music are the common language of all these characters; images from iconic films of the past three decades appear throughout the narrative as reminders of who we are and who we’ve been. The people in this story are so human, so fleshed out, that one can’t help but recognize them.

Tying together all the elements of this excellent literary thriller is the author’s cinematic sense of pacing. The novel covers a period of about ten months and is written in the present tense, except for the intermittent flashbacks that supply back-story. Carnoy zips backwards and forwards through the immediate and distant past with remarkable ease, giving the reader an easy-to-follow time-line in the form of a police log date stamp at the opening of each scene. Along the way he manages to reveal just enough of the hidden depths of his characters’ hearts to keep his reader turning the pages.

Knife Music
By David Carnoy
352 pp. Overlook

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Adrienne Friedberg earned her MFA in creative nonfiction at Sarah Lawrence College. Her essays, short stories and poems have appeared in various literary journals, including and The Citron Review. She lives and works in New York City with three daughters and one Portuguese Water Dog.