Where did you get the story line for Command and Control?

In late 2010, fresh off a round of rejections from my previous two manuscripts (Blood Money and one other), I decided that Mackie McKay needed a new adventure. I had cared for people with infections acquired in a hospital setting, and in reading about once such patient, my mind went to the tiny dark place that wondered, “What would happen if a group of hospital acquired infections were not accidental?”

Following that thread of an idea, I started to read more about outbreaks of untreatable illnesses and how the US government (both military and civilian) responded to threats to public health. To answer those questions, I had the opportunity to talk to members of the military (Army and Navy) and former employees of the Centers for Disease Control and Prevention. I had the chance to tour the Pentagon as well as work in hospitals, learning how they contain home-grown infections. All of this combined in my mind like a literary gumbo, and the story sprang from that.


Any other thoughts or themes that influenced the story?

Yes. Using the threads of the January 2010 earthquake in Haiti, a string of reported hospital-acquired infections as a result of poor hand hygiene, and my own interest in public health, the tapestry of a story began to weave itself in my mind.

Command and Control deals with themes of personal safety and individual greed; it explores how the public health system protects us from heath risks beyond our collective ability to treat them, and what could happen when personal ambition pushes back against public heath. The West African Ebola outbreak revisits these themes on a frightening world stage. Fortunately, in fiction I get the change the outcome and choose the ending!


Have you alway been a writer?

I have always enjoyed writing, from high school through college, and sought out courses that gave me the opportunity to do so. I graduated from Vanderbilt with a degree in American History, but pursued my first love of medicine in graduate school, thinking I would leave my writing passions behind. What I soon found, though, was that I used my enjoyment of writing to process the world around me. After difficult days in the hospital, I would often write about my reactions to it, first in journaling and then in short stories. Each of these were for my own enjoyment, but after my formal training ended, I began to call upon my medical experience to generate several ideas for longer works of fiction.


What was the timeframe for writing this book:

I began writing the novel in late 2010 and completed it in early 2012.


Why write a novel instead of a short story?

I love the challenge of developing characters who are at once realistic and nuanced. The platform of a novel allows time to explore personal motivations of my characters, so that at the end of the story, none of them are completely good or completely bad. The long-form of a novel also gives me a chance to allow the consequences of one’s actions and motivations to be fully realized.


What’s the basic story line of Command and Control?

In Command and Control, a recently retired surgeon responds to a person in need on an inbound flight from London. By saving this young man’s life, Dr. Cooper “Mackie” McKay steps into the middle of a CDC investigation of imported lethal infections that threaten the very public health structure of the United States. Mackie soon discovers that the command and control of the outbreak is influenced by the personal ambitions of the Director of the Center for Disease Control and Prevention, the army officer who stands to make the rank of general if she deftly handles the military response to the crisis, and an jilted pharmaceutical executive with an altruistic eye to watch his corporate profits grow on the backs of Haitians impoverished by the recent earthquake.


How do you balance being a doctor and writing a book?

My writing tends to be the end result of months of research and reading. Once I have a story line, I will read as much as I can about the topic (medical topics included) and make notes in a composition book. When I have a general outline in my head, I will create a written pathway for my novel that tends to be no more cleared of literary debris than a backwoods trail. All of that takes place in the margins of my day, cutting articles and jotting notes in the early morning hours of my day.

Once I am ready to write, I tend to plow though 3-4 months of writing most days of the week for at least an hour before my family wakes up. If I can write 5 pages a day or 25 pages a week, that usually allows for completion of a manuscript-length novel in that period of time. Since my writing muse meets me at the kitchen table in the early morning hours, it tends not to encroach up my responsibilities as a dad and a doctor.


How do you balance family life and writing

Since I started on this road to publication, though, the balance has been tougher. Editing and re-writes come with deadlines and most deadlines don’t wait on the gentlemanly pace of early-morning writing. It is during those times that I often have to put other responsibilities aside to complete the task before me. I have tremendous support network at home and at work that “has my back” during those times. Fortunately, deadlines have ends, making it easier to get back to a more predicable reading and writing schedule.


What do you enjoy most about writing?

The rewards of writing come from being able to express myself in a way that others can understand and appreciate. The publication of my first book reconnected me with people I have not seen in twenty years (such as my high school librarian). Writing has also spawned a pack of readers in my house, encouraging my children to read and to opening up avenues of discussion about stories and learning.


There are obvious parallels between the West African Ebola outbreak and the fictional outbreak in Command and Control. Was that intentional?

In one part of the book, a physician at the CDC says, “It’s a global world. A cough in Australia can be a cold in Alabama overnight.” The fictional pathogen in Command and Control speaks to the very real concerns that patients and public health officials have today that illnesses can spread due to the ease of airplane travel. Another parallel is the fear that can be generated by just a few cases of incurable illness. Our attention is focused on what is happening in Dallas with the first American case there, and even though pubic health officials reassure us that contracting Ebola in the U.S. is “near zero percent,” it is hard to be assured of that when so much is still unknown.


Is it likely that an outbreak like you describe in Command and Control could happen in the United States?

It is unlikely that Ebola could spread in an outbreak in the United States, although isolated cases from exposed family members of those infected remains a possibility.


Do you really have concerns about the governmental response to an outbreak, real or imagined?

In spite of the insidious nature of the CDC leadership in Command and Control, which is purely a product of my imagination, this current outbreak has been effectively managed so far on American soil. Public health officials are communicating well, providing physicians with a roadmap to containment, and giving solid, medically-based advice.

Any missteps that have and will occur in the response of the American public health system are not expected to be driven by personal ambition and corporate greed, as is the case in Command and Control.


Why did you work the Ebola references into Command and Control? 

In his 1994 bestseller The Hot Zone and her 1995 The Coming Plague, Richard Preston and Laurie Garrett (respectively) introduced the world to the deadly hemorrhagic viruses of Ebola, Lassa Fever, and Marburg virus. I read those books as I was applying for and entering into medical school. Their tale of real-life plagues that offer virtually no cure stuck with me at that time. When the time came for researching Command and Control, I re-read them to get a flavor of how bad infections with rogue pathogens can be.

Ebola was the poster-boy for deadly viruses and offered a pillar of truth to support my fictional pathogen. Of course, there was no way to know in 2010 that four years later this now-familiar disease would devastate communities in African and threaten the security of the American public health system. Command and Control offers a realistic look at the behind-the-scenes workings of the government’s response to a national infectious threat, and it serves as a cautionary tale for the consequences of greed and pride in public office.