Critical Judgement

A character in Palmer's latest medical chiller (after Silent Treatment) refers to the industrial enclave of Patience, Calif., locked among mountains above San Francisco, as ""Faustville."" It certainly seems as if the town has made a pact with the devil in order to thrive. Emergency room doctor Abby Dolan has been at Patience Regional Hospital for only a few months when she begins totting up ""NIWWs""-her shorthand for patients whose complaints offer her ""no idea what's wrong."" The hospital and town are literally overshadowed by the manufacturing giant Colstar, a cliff-dwelling international battery-making concern whose security rivals that of the Pentagon. After Abby's fiance, Josh Wyler, a new Colstar employee, suddenly exhibits alarming manic symptoms and threatens her with violence, Abby begins to wonder if Colstar is exposing its employees to the toxic heavy metal cadmium, a battery component. It doesn't take her long to cross Colstar security chief Lyle Quinn, or to be approached for help by an earnest group known as the Alliance, headed by Abby's handsome ER colleague Lew Alvarez, who also suspects that Colstar's chemicals are harming the town. If the soulless but many-eyed corporation, secret underground labs and evil experiments on unwitting patients are familiar elements to medical suspense fans, Palmer, an M.D. who worked in emergency medicine, renders them, for the most part, gripping and fresh. Scenes of medical terror (particularly one involving a claustrophobic patient who suffers an allergic reaction inside an MRI cylinder) are wrenchingly scary, and the imaginative final twists confirm that Palmer is reaching the top of a demanding craft. Doubleday Book Club main selection; Literary Guild and Mystery Book Club alternates; simultaneous BBD audio; author tour. (June)