Your Next Best Book
One of the great delights about book signings is talking to fellow readers. Sounds simple enough, but with the right crowd and in the right atmosphere, it can take unexpected turns. So it was that I found myself one early April evening in rural Alabama, half an hour from home in the oasis of a public library. This was a return engagement, having spoken there two years before. Now with the release of Control Group, I jumped at the invitation to return. The pleasantries and prepared remarks were familiar enough. Afterward, though, we sat around plates of homemade pimento cheese sandwiches liberated from their crusts and talked about our favorite books. We listed our favorite authors. Neil Diamond’s book came up. So did the Lee Childs series. Someone asked me to recommend their “next best book”. The question didn’t catch me off guard. I’ve had a steady intake of two-dozen books a year for almost a decade. There are plenty of to choose from. I’ve also encountered amazing books over the last year: beautifully crafted, lyrically written, creatively executed, and downright entertaining. I’ve also read some real duds, but why dwell on those. Nobody likes a hater. Here is my own “Top 10” Reading list over the last year, listed in no particular order and summarized at a glance: Fiction: Exit West by Mohsin Hamid : a contemporary novel about refugees and migration from the war-torn middle east as seen through the eyes of young lovers. Setting Free the Kites by Alex George : a coming-of-age novel about two teenaged boys growing up in small town Maine. Painted against a backdrop of pain and loss, this book sings. Commonwealth by Anne Patchett : an epic tale of the impact on two families lives after an affair at a christening. Patchett could’ve been a therapist with her insight and ability to parse out emotions and serve them up to make readers blush with recognition. Before the Fall by Noah Hawley : a tale of loss and redemption after a plane crash, told in revere chronologic order. How can you know the ending 5 pages in and stay up late to find out how it all happened? Hawley is a master at suspense. The Whites by Richard Price : hard-boiled detective novel, with a twist. Trust no one. The Swans of Fifth Avenue by Melanie Benjamin : a delightfully gossipy novel looking at Truman Capote’s social life in Manhattan. Eligible by Curtis Sittenfeld : a modern retelling of Pride and Prejudice, with a wickedly funny twist. Having lived for 8 years in Cincinnati certainly helped enjoy this eminently readable tale. Non-Fiction: Between the World and Me by Ta-Nehisi Coates : National Book Award-winning essay on race relations in America told by a journalist for The Atlantic. Empathetic and a painful look a the bias of “those who consider themselves white.” Powerfully influential for today’s culture. American Lion by Jon Meacham : Award-winning biography of Andrew Jackson, beautifully detailed. Anyone who can infuse life into a lithograph has a gift for story telling. That it can inform our present day politics makes it all the more relevant. When Breath Becomes Air by Paul Kalanithi : a mid-life memoir by a neurosurgeon cut-down at the dawn of his career by cancer. While all the...
read moreOut of the Closet
In her 1965 award winning performance of The Sound of Music, Julie Andrews crooned to the Von Trapp children, “Let’s start at the very beginning.” Indeed, that’s a very good place to start if you’re singing a Rodgers and Hammerstein song. Or writing a novel. But what if you’re a first-time narrator, steering through the auditory straits of a sound booth? For me, Chapter 13 seemed a very good place to start. The extent of my acting career began and ended in high school. A supporting role in Carousel and then Guys & Dolls, followed by a part in the play My Three Angels, taught me how to lose my inhibitions in front of a crowd. By the time I graduated, though, my acting days had ended. Once I decided to narrate Control Group and completed my narration courses, I had to decide the best way to execute the task. I started with three immutable facts: I am not a trained voice talent. What I love most about reading aloud is creating characters. I had 42 characters that needed a voice. Where to begin? I soon realized that like any production, certain characters would take center stage. They would need fully realized voices and personalities. Mackie, of course, is the protagonist, and his voice—in my head and in my ear—was always going to be my own, even if his actions were not. Red Pescatelli, the antagonist, sounded like the Muppet’s “Rowlf the Dog” on a bad day: a little bit deeper, a little more gravely, and a lot more manipulative. Forty voices to go. My southern soul is steeped in the sweet sounds of an Alabama drawl, so I could tweak my mom’s accent or raise the pitch of voices I heard around town and call forth the words of Donnie and Loretta Sims, the Sheriff, and Earl, the night security guard. While I’m sure the dialect denizens would bust me on my west Texas interpretation of Douglas Schofield, I had so much fun playing the big man from BioloGen that his words rolled off my tongue. Several characters simply had to be different from the others in the scene. When Meredith and her sister, Frances, are talking over the oxygen tubing in the labor and delivery ward, one voice came out bright while the other sounded weary. No one would mistake me for a female, but their motivations made them stand apart from one another…and from the rest of the cast. For my crew at the National Institutes of Health, I drew upon Seinfeld and A Cricket in Time Square. To my ear, no one said “worried female New Yorker” like George Costanza’s mom, so I tried on a version of her voice for that of Scott Hoffman’s secretary, Yolanda. A few years ago, when I read the part of “Harry the Cat” to my youngest daughter for her installment of “Dad’s Summer Book Club”, I went all out to try on a goofy Brooklyn accent. I reprised that role for Control Group, but tried to spruce up the Brooklyn with the sound of a stocking cap and a cigarette for the part of Eddie Fackler, the bad guy’s bad guy. After a few isolated lines for computer prompts, waitresses, nurses, and reporters, and I was just about...
read moreAn Author’s Voice
What does it mean when teachers of writing talk about an author’s voice? Is it style? Word choice? Pacing or prose? And is that something that an author can easily define, or is it best defined by more objective readers? In the summer of 2005, with a stack of pages that comprised the first draft of Control Group, I flew across the country to the Santa Barbara Writer’s conference to find out. One voice I heard while there was that of Ron McLarty. Dubbed by Stephen King as “the best book you can’t read,” McLarty’s debut novel, The Memory of Running, reached its first audience not in print form but as an audiobook. Hearing McLarty tell his story in the rich baritone of his actor-turned-writer’s voice, I clearly remember thinking, “One day, I, too, want to share my stories in audio form.” After hearing him speak, I read his book. Then, I listened to him read it. I felt as if he represented every inflection and pause just as I’d imagined. Yes, one day I’d love to do that. First, though, I had to write the book. Fast forward ten years. In the fall of 2015, at a reception for the incomparable Doris Kearns-Goodwin before hearing her speak, a colleague from Children’s Hospital encouraged me to consider recording one of my books as an audiobook. Shortly after that, before a noontime medical lecture, another colleague at University Hospital said she consumed most of her fiction from audible.com, and if my work found its way onto an audiobook format, she’d love to hear it. Maybe these two had a point. I did love reading aloud to my kids. I did hear the voices of my characters when I wrote them. What would it look like to bring them to life in a recording booth? Finally, on Thanksgiving Day 2015, these disparate desires coalesced into opportunity. While dining with my cousin, a trained voice talent (who, ironically, has voiced the part of a doctor in commercials), I shared my desires to narrate my own work. From her own professional experience, she knew who to call. All I had to do was pick up the phone. I did. Twelve months later. Sol Stein’s book, Stein on Writing, has perhaps the best twelve pages on writing effective dialogue I have ever encountered. His comments on A Writer’s Voice are not bad either. According to Stein, himself an editor of American literary giants, an author’s voice is simply an “amalgam of the many factors that distinguish a writer from all other writers.” It’s as recognizable as the voice of an old friend on the phone. The reason I waited a year before calling the studio was the uncertainty I heard in my own voice. By the time Control Group went into final production, I had over a decade and a half of writing experience—and the training that went along with that. But what did I know of recording? I knew what an author’s voice sounded like when composed at the kitchen table and then read silently, but I couldn’t begin to digest how to verbalize that. How could I vocalize that same style when I read aloud? What if I got it wrong in the minds of my readers? The same hobgoblins of insecurity that...
read morePick Your Poison
I love drugs. They’re the currency with which I practice my profession. Not a day in the office goes by without completing at least one transaction that involves them. I’ve learned to field questions about the over-the-counter varieties (Which cough medicine do you recommend?). I’ve learned to negotiate the economic value others place them (If I get this one off the $4 list, will it work as well?). I’ve heard men in highly-polished shoes wax poetic about pills. I’ve seen doctors draw their ethical shades of objectivity when being paid to discuss them. I’ve laughed with late night comedians as they crack jokes about their potency. Magazines devote back covers to their potentials. Football games air commercials about them…often pairing grey-haired men with younger women. Dr. William Osler, master clinician at Johns Hopkins Hospital at the turn of the twentieth century, was onto something when he wrote that, “the desire to take medicine is perhaps the greatest feature which distinguishes man from animals.” Ever since my pharmacology class in medical school, much of my training has been devoted to learning the form and function of pharmaceuticals. Much less time has been devoted to their names. One creative joy of writing Control Group was building a pharmaceutical company that needed a medicine cabinet full of blockbuster drugs. BioloGen Pharmaceuticals is my fictional baby-biotech born in the pastoral beauty of southwest Ohio, founded on the idea that more perfect drugs can be created by mechanizing the process of research and development. Rather than testing for side effects in rats and humans, the founders of BioloGen developed an Automated Device to Acquire Molecule, affectionately called ADAM. This machine runs potential chemicals through a battery of tests to see if they will be harmful in humans. When promising “hits” are discovered, ADAM can then test these compounds against computer-simulated biologic systems to see if side effects will develop. Never underestimate the hubris of a human with a good idea. The story takes place in 1993, ten years before completion of the human genome project, yet the founders of BioloGen have unparalleled faith that their machine has enough information to bypass the traditional regulatory process of drug development to offer safe medicines quickly. My research for the pharmaceutical industry initially came in the form of drug detailers, a.k.a. pharmaceutical representatives, coming to the office or hospital to educate physicians about their goods. I had an occasion to visit the administrative wing of a pharmaceutical company years ago, and even had a “back stage tour” of some of the mechanisms used to create new drugs. The soaring potential of Big Pharma is experienced by anyone who’s been on the receiving end of a medical transaction. The fun in fiction, though, comes in finding the fly in the ointment. In naming the drugs in Control Group, I tried to stick to what I’ve observed in the pharmaceutical industry: “X” sells, as does a three-syllable name. If the sound can piggyback onto something aspirational, all the better. Second-best is simply sounding like the condition that’s being treated. Here’s a roster of BioloGen Pharmaceuticals’ greatest hits: ArthroDerm : this was low-hanging fruit in the name-game. “Arthro=arthritis, Derm=skin”. This patch is used to help arthritis pain. In fact, with several arthritis patches already on the market, I was surprised...
read moreA Rose by Any Other Name
A friend of mine won a contest in which the grand prize was to be killed by Lee Child. For fellow fans of the Jack Reacher series, this was just about as good as it gets. I met Andrew Peterson at the Santa Barbara Writer’s Conference in June 2008, months before Dorchester Publishing published his debut novel, First to Kill. Apparently Lee Child held a character-naming auction in which he chose three names to be included in a forthcoming novel. Who wouldn’t jump at the opportunity to have their namesake rendered in the mind of the most prolific thriller writer today? Sure enough, when Delacorte Press published 61 Hours in 2010, my friend found himself as a cop on the Boston beat. It didn’t turn out so well for him. SPOILER ALERT: He gets nailed on page 283. “Peterson was sprawled across the front seats, dead from a gunshot wound to the head.” For me, my characters’ names come not from contests but from context and the world around me. Indeed, in the 13 years since completing the first draft of Control Group, most of my character names have undergone a metamorphosis. As I take stock of this current cast, here’s a rundown of some of the characters in the final version of Control Group—and how their names crept into the story. Interestingly, only one made if from first to final draft: Karen Kiley At BioloGen – Karen Kiley : She made it into the sixth page, chapter one of the first draft in the fall of 2004 (under the working title Big Pharma). “After their first interview, Carter [sic] had left with the impression that Karen Kiley was the consummate marketing executive: she had the boldness to ask for what she wanted and the charm to get it.” I saw the last name Kiley on a relator sign in our neighborhood while walking the dog. Knowing she had a hard edge under her soft smile, I thought I’d add a similar hard “kuh” sound to her first name. Douglas Schofield : He started as Douglas Kay for the first 5 years of the novel, based on a fellow physician’s last name. I later realized, though, that I needed some visual and aural differentiation of the character names to set him apart from Kiley and the then-protagonist Carter. During the 2013 dismantling re-write, while reading a Civil War history, I came across General John Schofield. I liked the sound of the name enough to simply “Find and Replace” his sir name in the text. For me, the “big man from West Texas” was alway just Douglas. Red Pescatelli : The early drafts had him as Hank Pescatelli, but once Blood Money came out featuring bad guy Hank Stone, I needed a new name to pick on. I had long ago settled on Pescatelli from a contestant on the flash-in-the-pan NBC hit Last Comic Standing, but I struggled to find the right first name. Weeks after I had figured out Mackie’s motivation (with the loss of his son setting up a sabbatical that gets him to BioloGen), I found myself in a church pew behind an elderly man with a bright red birth mark stained across his bald scalp. If chance favors the prepared mind, then I was ready in...
read moreNo, thank you
I got my first literary rejection in June 2005 at a table for two. This was no anonymous letter, either. I was seated on a white folding chair, poorly balanced on a grassy hillside of our writer’s retreat, wearing scratchy slacks and stiff sandals bought for the occasion. The tanned lady flipped through my first five pages with the casualness of a seasoned Los Angeles literary agent, which she was. “I won’t drag this out,” I remember her saying. “It’s not ready. I’m the wrong agent for this.” Was there a right agent for a work that was not ready? I din’t know, but I was willing to find out. Over the next 8 years, I sent copies of my manuscripts to 72 agents, editors, and publishers. Each one, in their own special way, said “Thank you, but no.” Here are some of the most memorable rejections: “We do not feel strongly enough about your project to pursue it further.” “I honestly don’t feel that I could represent your work with the requisite enthusiasm.” “You have a good idea, but I am not the right agent for this.” “Although you propose an interesting book idea, I did not feel I would be the best agent to represent you at this time.” “After considering your material, we have decided your project is not something we feel we can successfully represent at this time.” “That you for letting us review CONTROL GROUP, which we read with great interest. Unfortunately, we have determined that we are not the appropriate agent.” “I’m sorry to say it’s not right for me.” “I’m afraid I must pass.” “While the idea was interesting and thought provoking, the thriller just did not grab our attention.” “I’ve had a good first reading of CONTROL GROUP, so I’ll be reading the novel myself in the next few weeks” [November 2005] “I’ve finally had a chance to read CONTROL GROUP. The premise is good and the background material is solid. In the end, the tone is too Cincinnati—medical thrillers have to be so slick, even if the reality is not.” [December 2005] and finally… “In my view, I don’t think I—or any agent—will succeed in New York with CONTROL GROUP. It does have a surface readability and some tension, too, but I just didn’t get involved with the characters.” [December 2008] Wow. What a long list of literary shortcomings. And what great feedback! Had that November 2005 “almost yes” from a major publishing house not been turned off by a tone that was “too Cincinnati”, I would have still been left with a story that was not slick enough, and three years later, still may not have cracked the code of how to get the reader more involved with the character. No one wants to be repeatedly rejected. No one wants to hear directly to your face: “your writing stinks”. But for my development as a writer, I needed that. I needed to know that I had enough talent to continue writing. I also needed to hear that in those early drafts, my writing wasn’t ready to publish. I needed to learn the writer’s craft first. Those 72 rejections helped me to see that. Not at the time, of course. It took me years to understand what “medical thrillers…[being] so...
read moreIt’s Good to be Back
When I signed my first book contract in the spring of 2012, my publisher and I envisioned Control Group as the third book in the Cooper McKay series. We set a target date for publication of February 2015. “Plenty of time to get it right,” we thought. Indeed, I had completed the first draft ten years before that projected date. But time has offered me a perspective that has helped to reframe—and to improve—the story. Those two additional years have given Control Group what it has needed to be the novel it should be. A run down of the last 13 years in the life of Control Group looks like this: 4 months writing the first draft 1 week wondering if this was the next great American novel (All of the remaining weeks since realizing it was not) 1 month workshopping the novel (in four 1-week blocks over 4 years) at the Santa Barbara Writer’s Conference 5 years improving the narrative arc, character development, plot, pacing, and writing technique After that, 5 more years sitting on the shelf, making way for Blood Money and Command and Control Then, a book contract and a rebirth 1 year eviscerating the original manuscript, extracting the first protagonist, dialing back the story twenty years, inserting Mackie’s storyline, and stitching it back together by re-typing it 1 year editing, including adding in “Meredith’s” story line and the “Present Day” framing Sprinkled throughout, lots of corrections, rephrasing, word-smithing, and editing. Had Control Group come out when I wanted it to, months after completing the first draft of what was then my first try at writing a novel, I never would have known what kind of a writer I could become. It is unquestionably improved because of the editorial advice I have received over the years. It is also better because it was given time to grow into the novel it could become. I’ve learned that there are seasons of writing that don’t always involve new words. Seasons of creativity and seasons of revision. Seasons of preparation and seasons of release. I’m now moving into a season of publication. It’s good to be back....
read moreSo You’re Exposed to Ebola. Now what?
America’s worst microbial nightmare stepped through the looking glass and into our lives this September when a patient arrived at a Texas hospital harboring the first U.S. case of Ebola. In the months preceding this index case, news organizations had tracked the West African death toll of this unforgiving virus. A plane carrying an infected American missionary to Atlanta this summer put the nation on high alert. Now that the Ebola patient in Texas has died and his caregivers infected, the obvious question had to be asked: could an Ebola outbreak happen here? Surprisingly, this is not the first time the Centers for Disease Control and Prevention has had to contain a deadly virus imported from overseas. In the last decade, rare cases of infections from Ebola’s dirty cousins (collectively known as hemorrhagic fever viruses) have washed up on our shores. What makes those pathogens different, however, is that they slipped into the country outside of the white-hot glare of international attention. Richard Preston’s 1994 bestseller, The Hot Zone, chronicled the earliest Ebola outbreak. Now twenty years later, public health officials are asking what might happen if Ebola spreads in the United States. Medical Perspective: In my own corner of the medical world, I spend large portions of my day interacting with patients and their viruses. For most of those who bring viruses in to see me, over-the-counter medications and a dose of reassurance are prescriptions for improvement. But Ebola is no ordinary virus. And these are no ordinary times. Imagine being one of the staff members who first interacted with the infected Texas patient. Two days before he was diagnosed, he visited a local emergency department with non-specific symptoms. Like thousands of patients before him, he was sent home with the diagnosis of a viral infection. Unknown to everyone at the time, though, he had a rapidly replicating Ebola virus ticking in his blood stream like a biologic bomb. Everyone who interacted with him—from the staff who checked him in to the nurse who checked his vital signs—is probably fearful for their own health. If one of the exposed patients came to my office, what help, besides words of comfort, could I possible give him? As it turns out, public health officials already have advice for those exposed but not infected: Don’t Panic: Exposure to a person with Ebola is perhaps the second greatest fear for the general population. The father of all fears, however, has to be the concern of actually contracting Ebola. Know that the chance of getting Ebola in the U.S. is remote. Solid medical evidence confirms that in order to contract Ebola, a person must directly interact with body fluids from an infected patient. Most of the infections in West Africa have spread through direct contact with these body fluids, either while tending to ill patients or treating the bodies of Ebola victims. Casual contact in an airplane cabin or sharing a space in a waiting room is not a risk factor. For clinical personnel, the universal precautions already employed offer an effective first line of defense. Stay Home: Even though exposure does not sentence one to illness, casual contact with an Ebola patient may have swept someone up in an infectious disease dragnet. In this setting, a period of quarantine at home is...
read moreGone With the Wind: Part Three
GW2 Day Six: Great stories generally have great settings. As I mowed my way through the first four hundred pages of Gone With the Wind, I had convinced myself that the great setting of the story was Tara. After all, Scarlett’s father won the land in a poker match, built the plantation with his own stubbornness, then raised his daughters and buried his sons there. Understandably, Scarlett’s affection for Tara motivates her sell her own happiness to maintain it and then sustain it. Having come to a stop tonight around page eight hundred, I realize my mistake. The great setting of GW2 is not Tara but the South itself and Scarlett’s relationship to it. [Scarlett] “wasn’t like these people who had gambled everything on a Cause that was gone and were content to be proud of having lost that Cause, because it was worth any sacrifice,” Margaret Mitchell writes. “They drew their courage from the past. She was drawing hers from the future.” The great settings that serve as a backdrop for this epic drama are the many faces of the South. Afternoon parties at Twelve Oaks Plantation. Wartime weddings in Atlanta. Dusk at the saw mill. Each of these scenes relies upon inlaid detail of the physical setting and the characters interacting on those various stages. Tara may well feature prominently near the end of the book, but that location alone has not been enough to sustain Scarlett. With the last hundred and fifty pages ahead of me, I think Mitchell is too coy to allow one physical location to dominate the story. I suspect that even Scarlett, who is quick to rail against other southerners if it suits her ambitions, cannot function outside the setting of the South. GW2 Day Seven: How much pain can one person endure? After nine-hundred-fifty pages of this epic story, Margaret Mitchell crams a miscarriage, the death of a child and then a sister-in-law, plus lost love in the last fifty pages. “Now, [Scarlett] had a fumbling knowledge that had she even understood Ashley, she would never have loved him; had she ever understood Rhett, she would never had lost him.” Poor Scarlett. I started this novel one week ago with an eagerness to understand what makes Gone With the Wind so remarkable, so enduring. Certainly great characters that are well paced and believable are key ingredients. Plot twists carried by rich dialogue against a terrific setting help as well. But having completed the entire novel, none of those ingredients alone or in combination explain the greatness of Mitchell’s novel for me. They are like well-oiled gears in a clock, each crafted and inserted in such as way as to make the story tick. For me, what gives this novel an exceptional quality seems to be Mitchell’s ability to tap into universal themes of humanity. Neither Scarlett nor Rhett, neither Ashley nor Melanie are archetypal characters. Each is richly complex, which makes them believable. But even Scarlett’s character arch as she comes of age cannot insulate her from carrying the burdened of consequences from her earlier decisions. Mitchell’s novel is a microcosm of our own lives, with expectations and disappointments. Even a reader picking up the book seventy-eight years after its initial publication can find all the joy of love and...
read moreGone With the Wind: Part Two
GW2 Day Three: Ellen is dead! Bullets in battle cut down the Tarlton twins! Doc Meade’s shoeless son Phil was killed, too. Am I really subjecting myself to this literary assault? After offering up a complex female lead and submerging her in the wiles of war, Margaret Mitchell is holding my head in the pages of her book and not letting me come up for air. Only four hundred pages in and I feel as if she’s hijacked my imagination. Mitchell’s success (so far) in GW2 resides in a six-syllable word that supports the best stories. It’s one of my favorite pompous writing words: verisimilitude. By training her eye on the details of the Civil War, and by moving her characters against the backdrop of battles, Mitchell has painted a realistic world on the tapestry of her story. To be sure, she may have taken literary license with life on the plantation or with regional dialects, but my interest doesn’t stumble on the fiction as it is so closely woven into the fact. I’ve become a part of the story, and I cannot seem to help it. In my mind, there was no way Scarlett would make it through the wagon road back to Tara after Rhett dropped her off. But when she proves me wrong, her reward is a demented father, a dead mother and a decimated house. Of course it has to be this way—verisimilitude in a time of war requires it—but I ache in seeing her expectations dashed against the rocky shores of war. I willingly started down this primrose path this week, and it has led to that delicious literary heartache and disappointment that great fiction can provide. Can Scarlett rally to revive Tara? I certainly hope so, or else Margaret Mitchell has a lot of explaining to do. (To be fair, she has 600 more pages to do it.) GW2 Day Four: She shot the damn Yankee in the face! Are you kidding me? “Like lightening, she shoved her weapon over the banister and into the startled bearded face. Before he could even fumble at his belt, she pulled the trigger.…Yes, he was dead. Undoubtably. She had killed a man.” It took me a moment to digest that passage. I didn’t see it coming. But I should have. Great stories seem to make readers squirm with character threats, plot twists, and unmet expectations. The best of the genre, though, produce plot twists from the crucible of character development. While it’s my own reluctance to see Scarlett as someone who would kill a man, Margaret Mitchell credibly planted the seeds for this scene. Any woman who claws her way back home through a battle zone clearly demonstrates steely resolve. Any character who saves her plantation by pulling up her petticoats and callusing her hands shows the reader what she is capable of: ruthless revenge and self preservation. I now see that nothing about Scarlett’s actions is inconsistent with her character. In fact, it defines her all the more. As I stuff my bookmark on page five hundred in Gone With the Wind, I am appreciating the genius of Mitchell’s story telling skills. By demonstrating Scarlett’s love for the old life, by showing her desire for stability in her little world of barbecues and leisure, Mitchell...
read more