Review of Five South: A Dr. Stuart Mystery by Steve Skinner

“The business side of a hospital lives in a parallel universe to the clinical side. It’s a set up for mischief.” Five South: A Dr. Stuart Mystery by Steve Skinner [1] is a medical thriller that tells the story of the chief orthopedic resident who is assigned to investigate a string of rare surgical complications. The book opens with a series of cases, including a woman who dies on the operating table before a scalpel ever touches her and several elite athletes who undergo routine arthroscopies that become infected with MRSA. With help from an all-star team of his girlfriend who is a pediatric nurse, his best friend who is a pathologist, that friend’s partner who is a detective, and his mentor who was a prominent surgeon before an injury, Dr. Keith Grant uncovers who’s to blame for the tragedies at Sutro State University Hospital in San Francisco.

The author writes from a lengthy career in pediatric orthopedic surgery, which allows for medical accuracy and for his characters to drop valuable clinical pearls along the way. From how to astutely recognize an iatrogenic hypoglycemic seizure to delivering bad news, the author’s wisdom and experience is sprinkled throughout the story. One of the most important lessons comes from an eight-month-old boy with septic arthritis. Post debridement, multiple physicians decided to stick to the current course of medical management when his condition was obviously worsening. It takes a concerned nurse along with the third physician to see him that day to raise the alarm on what turns out to be a MRSA infection not seen on initial cultures. The seasoned mentor of the story reminds us that despite the popular adage, “when you hear hoofbeats, think of horses, not zebras. . . sometimes hoofbeats really are zebras.”

The novel is fast-paced and reveals the disconnected nature of the business and clinical sides of the hospital system, as the team of medical providers try to make sense of the string of complications. The story also follows members of the hospital board and their ulterior motives when it comes to approving a multi-million-dollar orthopedic center and the impending financial audit that would ensue. Dr. Skinner gets in trouble sometimes by including too much medical jargon and then “info dumping” in the dialogue to make it more accessible to the lay audience, occasionally discrediting his characters. However, the novel is entertaining and enlightening for both the trained clinician and the lay reader. There are motorcycles, love stories, police chases, sick patients, clever villains, and a caring cast of main characters that truly bring this story together. For medical professionals, it really highlights the reality that billing and insurance are often elusive, and providers typically don’t know where the money goes. It’s easy to focus on treating the next patient, but sometimes there are system-level problems that demand attention. In the author’s own words, “this book makes hospital politics seem tame.”