In recent years, medical-legal fiction has shifted from courtroom pyrotechnics to process-rich narratives that inspect how complex systems behave under stress. Devices leave audit trails, hospitals run on protocols, and the law meets medicine in places where responsibility may be dispersed across teams and technologies. Within that terrain, the death of a single patient can become a stress test for institutions. Kurt A. Dasse’s novel Law and the Heart places its inquiry inside that fault line and follows the evidence wherever it leads.
Dasse structures the novel less as a whodunit and more as an examination of how institutions, surgical services, risk offices, and police determine what counts as fact. The book asks whether modern systems built for safety might obscure individual accountability, and whether data trails created by medical devices may clarify events or merely add another layer of interpretation. It treats narrative as an analytic tool: each scene presses on a process, a policy, or a record.
The story centers on the implantation of a left ventricular assist device (LVAD) at a Singapore surgical center. The patient stabilizes post-operatively, then dies during the night under circumstances that appear inconsistent with device failure. Dr. Nathaniel Belder, the visiting American surgeon, confronts the implications of a successful procedure followed by a sudden loss of life. Sandra Ng, a medical lawyer, enters as both observer and advocate for procedure: she pushes for documentation, insists on proper handling of logs, and helps frame questions that might fall outside clinical habit. Detective Gou brings an investigative lens to a hospital world that speaks in acronyms and handoffs. Together, the trio navigates the surgeon’s dilemma: when outcome contradicts expectation, who gets to tell the story of what happened, and on what basis.
The investigation pivots on evidence handling, unfolding along three intertwined strands. First, laboratory results show a serum potassium concentration consistent with lethal hyperkalemia, a finding that shifts the case from presumed device malfunction to possible poisoning or iatrogenic error. Second, the LVAD’s internal records document timestamped parameters and error codes indicating that no antecedent pump fault occurred and that the physiologic sequence is consistent with a primary cardiac event rather than a hardware failure. Third, the chain of custody becomes decisive as the narrative traces who accessed the patient, the room, the records, and the explanted device, revealing routine gaps in sign-offs and transfers that matter greatly once an inquiry starts. Together, these strands place the hospital’s risk management office under scrutiny and force alignment among clinical duties, legal standards for evidence preservation, and police requirements for unaltered documentation.
These elements place the hospital’s risk management office under scrutiny. The department’s posture, to protect exposure, and manage narrative intersect with clinical obligations to disclose and with police requirements for unaltered evidence. Dasse stages meetings where risk, law, and medicine speak past each other until documents or logs compel alignment.
Several themes drive the book’s inquiry. The first is the uneasy mapping between legal categories, negligence, causation, foreseeability, and clinical categories such as complication, adverse event, and failure to rescue. A second theme is trust: families extend it to clinicians, clinicians extend it to devices and colleagues, administrators extend it to process, and investigators extend it to the integrity of logs and samples, yet each form of trust remains contingent on documentation. A third theme is love, presented through Belder and Ng not as melodrama but as a human counterweight to procedural intensity, raising questions about judgment and risk when personal stakes are present. The final theme is accountability, portrayed less as a single verdict and more as a distribution across roles and decisions, with implications for policy, engineering, and the next patient’s odds.
Dasse’s professional background in physiology and device development supplies the technical scaffolding: LVAD physiology, pump thrombosis mechanisms, alarm hierarchies, and the practicalities of explant analysis. Scenes involving the handoff from the operating room to the stepdown unit, and the interplay among surgeons, perfusionists, and biomedical engineers, read with procedural specificity. The novel avoids glamorizing any role; it treats medicine as coordinated work whose failure modes are often mundane, access badges, unlabeled syringes, incomplete logs, until they are not.
The book also pays close attention to the evidentiary life of technology. In many thrillers, a device is a prop. Here, the device is a narrator that speaks in parameters and timestamps. Its “testimony” still requires translation: clinicians contextualize it physiologically; lawyers weigh admissibility; detectives test for tampering. That triangulation gives the story its documentary feel.
By setting the case in Singapore, Dasse can juxtapose a high-resource clinical environment with distinct legal procedures and hospital governance. The location is not an exotic backdrop; it is a jurisdiction with its own rules for medical records, police authority in clinical spaces, and media disclosure. The novel’s systems focus mirrors real-world debates about how to assign responsibility when advanced therapies involve teams, vendors, and software histories spread across continents.
The central question is not simply “who killed the patient” but “who owns the narrative of the death.” Is it the hospital’s morbidity and mortality conference, the risk committee’s disclosure letter, the police report, or the courtroom transcript? The book suggests that each forum might capture a different truth: clinical improvement, legal sufficiency, and public accountability. The tension among these forums is the story’s true antagonist.
The risk office functions as a character with a limited mandate: minimize liability, maintain operations, and control the message. Dasse shows how that mandate can conflict with an investigative need for sunlight. Internal emails, delayed log releases, and cautious language in family meetings illustrate how institutional risk management, even when lawful, can distort the search for causal clarity. The novel neither vilifies nor exonerates; it records organizational behavior under pressure.
Ng operates at the seam between clinical discretion and public duty. She pushes for preservation orders and guards against casual data overwrites. Gou pursues leads that hospital staff regard as improbable until lab values and badge-access records remove doubt. Belder, while defending his clinical judgment, must accept that device success does not preclude homicide. Each character holds a fragment of authority, and none can solve the case alone. The book’s collaboration model aligns more closely with incident command than with lone-wolf detection.
Accountability narratives determine whether a case becomes a sentinel event with policy change or a closed chart with lessons lost. Dasse uses the aftermath, policy memos, training adjustments, and vendor notifications to show how facts migrate into procedures. In that sense, the novel treats justice as both verdict and redesign. Readers see how one death can alter staffing patterns, access controls, and documentation practices.
Because the book foregrounds evidence handling and procedural reasoning, it lends itself to seminars in medical ethics, health law courses, and biomedical engineering programs. The chapters can anchor discussions on adverse-event reporting, data integrity, and the admissibility of machine logs. For readers outside those fields, the narrative functions as a plain-language tour through how modern hospitals make and defend causal claims.
Dasse’s long involvement with cardiac assist technologies informs his understanding of LVAD behavior under stress, the distinction between pump failure and primary cardiac arrest, and the interpretive limits of log files. He writes clinical spaces as workplaces rather than stages. The accuracy does not serve spectacle; it serves the audit of process that the story requires.
Law and the Heart positions a single perioperative death as a systems investigation. It follows numbers, then motives, and treats records as characters whose reliability must be tested. The novel maintains focus on institutions, how they assign responsibility, absorb blame, and revise practice, while allowing space for the private costs borne by the people inside them. In doing so, it offers a case study in truth and consequence, with the heart as both organ and jurisdiction.
