My Own Medical Thriller

I don't write medical thrillers because I only like to do research up to a point, and the amount of research I'd need to write in that field is well beyond that point.

We all can name a few biggies, though. Robin Cook and Michael Palmer each wrote several. I first met Michael Crichton through The Andromeda Strain, and learned years later that he won the Edgar for A Case of Need, originally published under the pen name Jeffrey Hudson. Tess Gerritsen, also a doctor, wrote several thrillers before she unleashed the Rizzoli and Isles series.

I'm now involved in my own medical thriller without planning it at all. So far, it has a happy ending.

Two Sundays ago, I finished my workout at my health club and returned to my car. I had found a space ten feet from the entrance, and now I was sandwiched between two SUVs, each slightly smaller than the state of New Jersey. Looking behind me was like looking through a soda straw.

The entrance driveway lay at about 7:00 to my space. The driveway is narrow, especially when cars park on both sides of it, so a sign proclaiming "One Way [right turn only]" guards the entrance. It was almost directly behind me. Another sign says "Do Not Enter" and stands to the left. This makes sure all traffic in that narrow driveway moves counterclockwise. Theoretically.

I eased out, looking to my left, where traffic should come from, and a driver who decided to turn around and take the short way back hit my car. Damage to both vehicles was minor--I have a broken taillight and a dented quarter panel--and I got the worst of it. We exchanged insurance information and notified the appropriate people, then went on our way.

Several hours later, my left arm felt heavy and weak. I've hosted a bad back since 1971, and this felt like the mild collision aggravated the long-standing problem. Oh well. Then my wife noticed I was having trouble using that hand to type at the PC and insisted that we go to the hospital.

The staff looked at my symptoms and medical history (both my mother and grandmother had strokes) and sent me for a CAT scan. Over the next several hours, I got lots of practice telling various doctors, nurses, interns, nurses, technicians and administrators my age (72), the month (January) and that we were in New Britain, Connecticut. I became expert at repeating "Today is a sunny day" and touching my index finger to my nose the other people's fingers in turn.

Every two hours, a nurse or tech asked me for an encore. I had to resist their pushing and pulling with my left hand, which was discernibly weaker. I had no indicators of being a stroke risk: I weigh 15 pound more than when I graduated from high school in 1965, I quit smoking about 15 years ago, my cholesterol level has pleased my primary-care physician for years, and I don't use cocaine. I average about half the "tolerable(?)" amount of alcohol allowed to men my age, and women are more prone to strokes anyway.

So what? The staff decided to treat the issue as a Transient ischemic attack (TIA), in which the blood supply to the brain is blocked for a short period of time and produces symptoms that resemble a strok. In my case, that was the weak arm.

My listening station for The Eagles

 By about 5 am the following morning--roughly 17 hours after the accident and ten hours after my arm first felt weak--I felt fine. But the night felt like I was a shooting scene with police scouring me for shell casings, blood spatter, footprints, and a partridge in a pear tree. I lost count of how many people asked me to answer those questions again and tested my arm and leg strength and coordination. They were like different detectives asking the same questions to see if my story changed.

By early afternoon, they also gave me an MRI, which is kind of cool if you're not claustrophobic. The kids running the machine both looked like former students. Truthfully, when you teach in the area for 33 years, everyone looks sort of like a former student. These two guys let me choose the music to listen to while they ran me through the tube. I picked the Eagles over Katy Perry, Adele, and someone else I'd never heard of.

Back in my room, I talked to two more doctors, three more nurses, had my sixteenth and seventeenth blood pressure checks, and told my age, location and the month again. Finally, the lead doctor told me he was pretty sure I did not have a TIA, but they wouldn't definitely say my troubles were related to the fender-bender, either.

The MRI and CAT scan ruled out a thrombotic stroke, but he wanted to be sure I didn't have an embolic stroke (a clot forming in the heart and traveling to the brain instead of originating in the brain itself) and ordered an echocardiogram, basically a heart sonogram. It was fun and the woman administering it was young, attractive, ultra-competent, and hilarious. She let em hear what my heart sounded like during the procedure, more of a gurgle than the lub-dub I expected. She also apologized for the coldness of the gel she spread on my chest and for having to rip the sensor contacts off my chest and taking all three chest hairs with them.

An echo-cardiogram (posed by model)

They finally discharged me about 24 hours after Barb drove me in. I spend the next month taking Plavix, Lipitor (They both sound like Superman villains, don't they?) and aspirin. They don't think I had a TIA, but they're taking no chances.

I still blame the minor accident. On the other hand, it was cool watching a bunch of people who really knew their stuff give me a first-hand tutorial on medical mystery research.

The Invisible Engine

Saturday, I led a workshop on developing plot. It was the second half of my program on preparing for National Novel Writing Month, and I'll do a slightly expanded version (I have an extra fifteen minutes) at the same venue next week.
I know several people who do decent workshops on plot, and I can name more good books about building your plot than any other facet of writing fiction, but there's one idea almost everyone has trouble grasping. In fact, only two of the eight or nine books I often cite even mention it.

Concept and Premise.

Almost everyone understands that a plot is the stuff that happens to or around your protagonist, and most of them understand the idea of cause and effect. Most of them grasp structure and increasing tension, too. But making someone see that his or her premise needs more focus or oomph is hard. Maybe that's because everyone knows it when he sees it, but it's hard to define except by example.

Every story has a concept and premise, but unless it captures the reader's attention, the story won't sell. In fact, it won't even be read.

A concept is simply an idea. It can be a setting, a character, a story line, an imaginary world or practically anything else. But it has to develop into a premise, and that's tricky. The premise usually involves the "what if..." idea, the thing that "goes wrong." Michael Crichton's concept for Jurassic Park is that you can use the DNA from fossils to clone prehistoric dinosaurs. His premise builds on that: What if those dinosaurs get out of control and start eating people?

From that simple but specific foundation, you can build your plot because you have a conflict, setting and characters. You also have the beginning of your elevator pitch to an agent or editor. It even gives you a head start on your cover copy, which I always find hard to write.

I tell my classes that if you can put your premise into language a fairly bright ten-year-old can understand, you've got it.

Two of my books use Roller Derby as a loose concept. The premise of one of them is that a disgraced police officer finds redemption by protecting a group of women who help victims of domestic abuse, and, by extension, help themselves. That's more specific. More importantly, it helps me determine what will happen in the story. There will be roller derby and there will be at least one character who is being abused. The cop will help her. Sure, other things will happen, too, but that's the foundation.

Here is the back cover copy of The Whammer Jammers, which grew out of that concept and premise:

Chicks on wheels, dirty deals, and everything you never dared ask about roller derby. Suspended after a "questionable" shooting, Hartford cop Tracy "Trash" Hendrix hires on to protect the local skaters from vandals while they prepare for a match to fund a women's shelter. He suspects a skater's ex-boyfriend, but the guy has an alibi when that shelter gets torched--and an even better one when he turns up dead. Then a skater is killed in a drive-by, and Hendrix knows someone plays rougher than the roller girls. Unless he can figure out who it is before the match begins, the wheels really will come off.

The fire and the drive-by aren't in the original idea, but they grew out of it and raise the stakes.

Your premise has to generate conflict, and this one does. In my case, that matters because my thought process is far from linear. I can come up with dialogue or character traits on demand, but plot is hard. That's why I need a concrete--but flexible--concept I can turn into a premise. And it needs to promise the reader something she or he hasn't seen before.

Most people stare at me when I tell them there are currently seven women's roller derby teams in Connecticut, but it works. I self-published The Whammer Jammers in 2011. Two weeks ago, I sold out every copy I brought with me to an event because people still want to hear about it.

That's your ultimate test.