Book Review: Do No Harm by Christina McDonald

From Christina McDonald comes an unforgettable and heart-wrenching novel about the lengths one woman will go to save her son who has been diagnosed with a rare form of cancer.

Some people are so happy with their lives, that for a split-second, they label it perfect. The ancient Greek philosopher Solon had a stark antidote to such folly: Call no man happy before he is dead. Keep that in mind when you meet Detective Nate Sweeney, his wife Emma, a doctor at the local hospital, and Josh, their empathetic, adorable, Star Wars-loving five-year-old. Opioid addiction has infiltrated Skamania, a small town in the Cascade mountain range in Washington state. Both Nate and Emma are affected by this modern-day epidemic as when Nate is called out to an overdose scene in the run-down Mill Creek neighborhood. 

Nate had been called here for domestic assaults, drug busts, and once a murder. But increasingly, the calls were about opioid overdoses. As such, the lieutenant had recently told his detectives to investigate both fatal and nonfatal overdoses in an effort to trace the drugs back to the dealers.

Emma has a new patient, Alice Jones, a frail fifty-four-year-old. Her loud-voiced husband says Alice’s back is sore from gardening. Emma makes conversation, reaching out to a fellow-gardener: “I have a whole freezer of vegetables I grew this summer. It’s pretty tough on our back and knees, though, isn’t it?” Alice says that occasionally her legs feel numb, so Emma orders an MRI. 

“Can you give me something for the pain?” she asked. “I’ve heard OxyContin is good for back pain.” 


I kept my face neutral. The opioid crisis had made it difficult for doctors to know where the line was, when to prescribe pain medicine and when not to. It was a doctor’s job to help people, to assuage their pain, and yet I’d watched other doctors’ patients succumb to addiction. I knew about addiction firsthand, from my brother. I refused to let my patients become another statistic.

Her brother? What’s that about? Coincidentally, while Nate is telling his boss, Lieutenant Dyson, about his investigation of Santiago Martinez, a high-level drug dealer, two out-of-town cops show up asking for Nate. The man is wearing a tailored suit that Nate suspects might cost more than his annual salary. Special agents Lisa Hamilton and Phil Tyson tell Lieutenant Dyson and Nate that Martinez was one of their confidential informants. Nate is suspicious—why did the two Seattle cops ask for him by name?

Hamilton crossed her arms. “Do you know much about your wife’s brother?”


Nate straightened, suddenly alert. “Ben? Ben’s been in and out of jail for drug dealing, petty theft, did a few years for assault. Emma hasn’t heard from him in years.”


Nate gaped at her. He’d never even met Ben. From what he could tell, Emma was the smart, successful one, while Ben was the total fuckup.


“Ben Hardman might be linked to the head of this gang. Hell, he might even be the head, for all we know. Either way, we need to find out who’s running it before more oxy and fentanyl hit the streets. We want you to be the lead detective of our local task force.

Nate is uncomfortable going after his brother-in-law, estranged or not. It’s a clear conflict of interest. But his boss points out that his retirement is only a year away and that Nate will have a clear shot at becoming the force’s lieutenant if he helps the Seattle task force bring down the drug ring. Dyson isn’t subtle: “More money, more regular hours with your family.”

Christina McDonald seeds Do No Harm with references to the prevalence of opioid abusers, floats allusions to money and what it can buy, all foreshadowing the tragedy about to befall Nate and Emma. There were signs. Josh had been a bit under par. Emma’s mother-in-law Moira tells her she put Josh down for a nap when he didn’t feel up to going to school, but no parent anticipates a call saying their child is in the ER. Emma rushes to his side with Nate not far behind. The hospital runs tests and Josh’s parents are asked to join two doctors, one of whom Emma knows from her troubled childhood, Dr. Palmer, a noted oncologist. Josh has leukemia, a virulent, fast-moving variety. There are two treatment options, one of which is experimental and incredibly expensive and their insurance will not cover the costs. How can a young family, barely meeting their month-to-month bills, afford a $500,000 price tag for an extremely promising treatment? Almost without stopping to breathe, Emma decides she’ll raise the money for the treatment by selling scripts. Colloquially, she will sell prescriptions for oxy to addicts, giving them the ability to get drugs legally at drugstores. Nate’s solution is to gun for the lieutenant slot that will come up in one year, even though the price of admission is to bring his wife’s brother to justice. Inevitably, Emma and Nate’s individual solutions collide with horrific consequences. 

Stop reading now if you don’t want to learn a significant plot point. Emma’s entrée to the drug underworld is a former hook-up, a devastatingly attractive friend from high school, and her brother Ben’s best friend. He also happens to be Josh’s natural father. Emma broke it off with Gabe a few weeks before she met Nate: she and Nate fell for each other hard. When Emma realized she was pregnant, she sought genetic testing. For whatever reason, she decided not to tell Nate that he wasn’t the father of “their” upcoming baby. Emma is a woman with a complicated past and keeping secrets is something that is part and parcel of her life. She forces Gabe’s compliance by telling him that he has a son, a son who will almost certainly die without experimental drug therapy. 

Right about now, the title of Jim Morrison’s biography, No One Gets Out of Here Alive comes to mind. Christina McDonald explores the moral choices the protagonists face with clarity and compassion. How much has the war on opioids prevented folks with excruciating, valid pain issues to go without treatment? Emma lost her family when she was a teenager. She and Ben went into foster care and then she and Ben went their separate ways. As a mother and as a wife, given her tragic background, she is desperate to protect her family. But there’s that unavoidable question: do the ends ever justify the means?

Set aside some time before starting Do No Harm because you will not be able to put it down. 

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  1. Chris albert

    A stellar work of psychological suspense that will leave you breathlesss

  2. Marilyn

    The topic is just very difficult, but it seems to me that everything turned out!

  3. halenabob

    Do no harm wins the best seller award in the USA. This book is about a woman who save her child by his heroic act. Being a mother she did everything for her son.

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    If I thought or asked the book lover the best book of the year? They absolutely said Do No Harm by Christina McDonald. I’m pretty sure this book is the reason for some people’s smiles.

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