Cover image of "Spasm," a novel about biological warfare in New York

Here’s a story that only a gifted writer could successfully pull off. The key figures could hardly figure as principals in anyone else’s novels. The rootless young men in a depressed small town who’ve formed a would-be right-wing militia. Four Russian biological warfare specialists. A small-town doc in Upstate New York who doubles as the coroner. And the stars of Robin Cook’s long-running series of medical thrillers, Jack Stapleton and Laurie Montgomery. Spasm is the 15th in the bestselling series, and it’s a terrific piece of work.

A vacation turns into a fraught, high-stakes investigation

Jack and Laurie are both pathologists who work as medical examiners in New York City. She’s the top dog in the Office of the Chief Medical Examiner. Jack, her husband, is on her staff of 40 physicians and more than 800 other staff members. In their world, they’re the go-to experts. So, it makes sense that Robert Neilson, who attended medical school with Jack, would turn to them when he encounters a truly baffling case in his work as a coroner Upstate. And, as luck would have it, Laurie has been feeling overworked and overwhelmed. So she jumps at the chance for a brief vacation when Jack proposes they accept Bob’s invitation to spend a couple of hours examining a troublesome corpse during several days of R&R. Except that (naturally) the case is far more puzzling, and more problematic, than anyone might have imagined.

Spasm (Jack Stapleton and Laurie Montgomery #15) by Robin Cook (2025) 345 pages ★★★★★

How biological warfare in New York might be carried out
A typical processing system to purify drinking water. Note that there are multiple points of entry for toxic additives. Image: Wikipedia

Here’s what happens

First, we meet the local right-wing militia

Before Jack and Laurie even enter the picture, we meet Ethan Jameson, a disturbed young man in a small isolated town in Upstate New York, He’s the leader of a local would-be right-wing militia he’s called the Diehard Patriots. Sixteen other young men like him have joined the group, reflecting the deep depression the town fell into when a local manufacturer went out of business.

But to Ethan’s chagrin, the Diehards don’t really know what right-wing militias actually DO. So, Ethan has accepted an offer he turned up online from a Russian named Viktor Mikhailov, a spare-time commander of a highly organized, well-established paramilitary organization in Koltsovo, Russia. Now, Viktor, his lieutenant, Nikolai Alexeyevich Petrov, and two others are in town. They’re holed up in a huge mansion Ethan has rented. And in the evenings they venture into the woods with the Diehards for target practice and maneuvers.

Next, enter four Russian scientists

The problem is, from Ethan’s perspective, that Viktor and Nikolai rarely turn up for the training sessions. They only send the two younger men. But we know that both Viktor and Nikolai are medical doctors as well as PhD biochemists, with Viktor having an additional PhD in molecular biology. And their maneuvers with the Diehard Patriots are merely a cover for the microbiological lab they’ve set up in a barn behind the mansion. (The two younger men are technicians who do the heavy lifting.) And the lab is dedicated to establishing proof of concept in the field for Viktor’s radical new brand of biological warfare. They’ve already tested it on a small scale locally and are intent on contaminating the water supply for the whole town.

Finally, Jack and Laurie show up

At Jack’s urging, Laurie temporarily takes a vacation from her position as Chief Medical Examiner at the OCME. She will join him for a weekend getaway on an invitation from Robert Neilson. Bob’s the sole physician in Essex Falls, an idyllic town tucked away in New York State’s Adirondack Mountains. He also serves as the local coroner. And he is totally baffled when a healthy young pest control worker has died inexplicably. Symptoms point to pesticide poisoning, but lab tests show no evidence of this. Meanwhile, at the same time, the town is experiencing a wave of rapid-onset, Alzheimer’s-like dementia in otherwise unremarkable patients. And Bob knows when he’s outclassed. The job calls for the pros from the big city.

The pieces of the puzzle slowly come together

Jack and Laurie travel north expecting a working vacation. Instead, though, they find a community earnestly intent on returning America to the 1950s. But that’s not Jack and Laurie’s problem. Two young men have died recently, both of them known local extremists. Before dying, they’d complained of muscle spasms, nausea, and severe anxiety. And Ethan is at the heart of the unfolding mystery. He’s an exterminator by day who uses what are obviously toxic pesticides that seem to explain his death, sans the spasms.

As Jack improvises a role as acting Hamilton County coroner, the investigation pulls him deeper into local militia politics and foreign sabotage, eventually putting his life directly at risk. Cook fuses pandemic-era anxieties, domestic extremism, and Cold War-style espionage into a thriller that treats a quiet Adirondack town as the front line of a much larger conflict.

About the author

Photo of Robin Cook, author of this novel about biological warfare in New York
Robin Cook, M.D. Image: IMDB

Robin Cook founded the genre of the medical thriller with his 1977 novel, Coma. He has since published 26 other standalone novels and 18 in the Laurie Montgomery and Jack Stapleton series. Many of his books have appeared on the New York Times bestseller list, and many have been adapted to film and television. He has sold an estimated 400 million copies of his books worldwide.

Born in 1940, he is an opthalmologist with an MD from the Columbia University College and Physicians and Surgeons and training in his specialty at Harvard. Cook is also an aquanaut who learned the craft while serving in the US Navy from 1969 to 1971, mustering out as a Lieutenant Commander. He served aboard the submarine USS Kamehameha.

I’ve also reviewed Night Shift – Jack Stapleton and Laurie Montgomery #13 (A tense medical thriller from a master of the craft).

Check out 10 great medical and biological thrillers.

You might also enjoy two novels by Tess Gerritsen, Harvest (A classic medical thriller about organ transplants) and Gravity: A Novel of Medical Suspense (An action-packed medical thriller set in orbital space),

Two medical novels by Abraham Verghese might also interest you: The Covenant of Water (A deeply moving tale of life, love, and loss in 20th-century India) and Cutting for Stone (A deeply affecting medical drama set in Ethiopia).

If you’re looking for good mysteries and thrillers, check out:

And you can always find the most popular of my 2,400 reviews, and the most recent ones, on the Home Page.