Medicine, Money and Murder by Anne Pettigrew

In Medicine, Money and Murder, Anne Pettigrew continues to examine the murkier side of medical ethics she first explored in her debut novels, Not the Life Imagined and Not the Deaths Imagined. Her background as a GP gives her access to a deeper understanding of the nexus between care and self-interest and she uses it to vivid effect in her work. Previously she has given us a Harold Shipman-like character to examine the ease with which a serial killer can slip into the depths of evil. In Medicine, Money and Murder, she serves up another deliciously wicked villain but she also turns her attention to the baleful effects of big pharma, to equally chilling effect. 

It is 1971, and Mhairi MacLean, a naïve young woman from Scotland is working as an extern in the Ellis Memorial Hospital in New Jersey as part of a three month summer programme. Away from home for the first time, Mhairi is struck by the differences between Scotland and America, the sleek new multi-storey hospitals compared with the Victorian buildings she was accustomed to back home, the more relaxed lifestyle, the confidence of the people. 

Gradually, though, she comes to realise the differences between American and British healthcare are more profound than she could have imagined. In particular, she is shocked by the way in which the American healthcare system is driven by finance. She wrestles with her conscience as she realises the extent to which health insurance and money are primary considerations. “It’s funny how much clinical practice changes when money comes into it,” she says at one point as it becomes clear that the level and quality of care received by an individual is entirely dependent on their ability to pay, rather than their need. 

Further, the culture of litigation dictates medical practice to an unhealthy degree. The first thing to learn in medicine, she is told, is that “diagnoses can be hummingbirds or sparrows.” And missing a hummingbird would mean getting “your ass sued off”. As a result, patients were exposed to unnecessary scans and procedures, purely to head off any possibility of a medical suit. What happens if the patient can’t afford it, Mhairi asks. “When the bills run up, you get into debt and have to deal with it,” she is told. 

Medicine, Money and Murder is a crime novel, and the mystery begins when a patient being transferred from one hospital to another seemingly disappears. The receiving hospital has no record of her being admitted. Bureaucratic blunder? Or something else? 

As Mhairi and her friends begin to investigate, one person comes to interest them, Dr van Lindholm, a senior Renal specialist at Ellis Memorial, and someone who appears to wield an unhealthy amount of power. Even the hospital’s Medical Chief, Dr Harper, seems cowed by him. As Mhairi continues to observe Dr van Lindholm’s dealings she grows more and more concerned. 

Medicine, Money and Murder is an exciting and fast-paced novel. The crime element is well handled and the medical background Anne Pettigrew weaves in is never intrusive but rather adds a sense of verisimilitude. Mhairi, very much a fish out of water in big, brash America, gradually matures and develops, and proves very much a match for the vested interests arrayed against her.