Harvest by Tess Gerritsen, Pocket Books, New York, 1997, 343 pages, $6.50. Simon & Schuster Audio Books, read by Jayne Brook, 3 hrs, 2 cassettes, $18.

Review by Del Meyer, MD

Tess Gerritsen, an internist, left a successful practice to rear her children and try her hand at writing. She may never examine another patient since her writing has taken off like a rocket.

Her first book, HARVEST, begins with Gregor and Nadiya purchasing four orphan boys from their Uncle Misha in Moscow. The boys are from 9 to 15 years old but Jakov, at 11, is the smallest and also has a congenital absence of his left hand. He has already done it all--smoking cigarettes for four years, stealing for three and a half, and turning tricks for two. He is the favorite of the visiting ladies. He hates the job and wishes he could just pick pockets like the big boys. But Uncle Misha needs the money for bread and cigarettes. The boys donít want to go to America to be adopted and get rich, but Uncle Misha has himself in mind and not them.

After Gregor gives Uncle Misha a valise with $20,000 American dollars for the boys, the book picks up speed. While Misha is admiring his new treasure, Gregor puts two bullets through Mishaís head, picks up the valise with the $20 K, and goes downstairs to join his wife Nadiya and they travel on to America. The momentum never decelerates as we join the journey and the organ harvest.

But first Dr Gerritsen switches scenes and we land in Bostonís Bayside Hospital, with its famed transplant service. Since this is a high revenue business for the hospital, the administrator sits in on all medical staff meetings and the selection of the doctors for the transplant team to make sure they fit in with Baysideís financial focus.

Thereafter, we are introduced to the protagonist Dr Abby DiMatteo, a first year surgical resident rotating on the transplant service. She falls in love with a senior member of the team, Dr Mark Hodell, and soon moves into his house. This proves to be an ideal arrangement for Dr Hodell to satisfy his biological urges as he has more important things on his mind. Soon Mark proposes by phone while Abby is working. It was such a good feeling, he says, to awake and find her lingerie on the dresser and he wants to make sure itís always there. In her desperation she accepts. This also gives Abby a first year surgery resident, the inside tract to join the transplant team, rather than their own Chief resident.

Abby has a small boy patient, Josh OíDay, who has developed coxsackie cardiomyopathy, is dying, and desperately needs a new heart. He is first on the donor recipient list, but the available heart of an accident victim is directed by the hospital to a wealthy supporter. Abby recruits Dr Vivian Chao, the chief resident, to help her get the husband of the victim to direct his brain dead wifeís heart to Josh. Hospital politics are played against the usual ethics of transplant decisions.

To placate the wealthy donor, Vivian is sacrificed as chief resident. Abby becomes more suspicious when she calls the hospital where allegedly another heart has been harvested but they donít have an operation recorded. Furthermore, the doctor that brought the heart to them cannot be located in any medical directory. Yet Bayside always seems to have the right heart at the right time. When one of the transplant surgeons is found on the top floor of the hospital hanging by his neck, Abby begins her own investigation and discovers that over the years three other members of the transplant team have committed suicide. She finds a detective that agrees with her suspicion but has failed to find hard data as to why these wealthy surgeons who had many plans for the future, suddenly became suicidally depressed--especially when no one noticed any depression.

When Abby finds a cash transaction in Hodellís desk for a million dollar yacht, she runs for safety to another transplant surgeon, but ends up in a secluded operating room as a donor herself. The unexpected reuniting of boy given up for adoption at age four with his mother as her liver is being harvested is a tour de force.

Only a physician would have the background to write such a medical suspense thriller. Gerritsen undoubtedly will join her colleagues, Drs Michael Crichton, Robin Cook, and Michael Palmer in a very elite circle. It would be hard to imagine a second book that equals HARVEST, but the previews of her next book, LIFE SUPPORT, are riveting. Iím on the wait list when it hits the shelves next month.