Hazel McHaffie

medical thrillers

Thriller writing

It was probably a throwaway suggestion: ‘I think you should make your next book a thriller‘, but it’s stuck in my mind – especially as it came from someone in the book world whose opinion I respect.

Well, OK, I’m prepared to consider it at least. But first I need to understand what’s involved. Would my ideas thus far fit into this genre? Do I have what it takes to master this kind of writing? So I’ve been delving into the theory; what I’d need to do to create a good thriller. To date I’ve identified seven essentials.

1. Use dread and frightening possibilities to drive the story.

2. Make it action-packed from the outset. Maintain urgency and tension (short paragraphs, cliff hangers, surprises, active verbs, each chapter revealing something new, etc etc) throughout. Include confrontation.

3. Make the stakes high. Give the bad guys seemingly justifiable aims too.

4. Keep the reader guessing till the end.

5. Give the protagonists lots of baggage and emotional complexity, something to fight against and triumph over. Make sure they endure plenty of grief and anxiety along the way. Some characters at least shouldn’t be what they seem to be. Avoid stereotypes.

6. Build dramatic tension by means of multiple points of view.

7. Have an unforgettable take-home message/meaning.

ThrillersOK, some at least of the basics.

I’ve read plenty of thrillers over the years; indeed I’m a big fan of both Harlan Coben and Robert Goddard, but I fancied testing the theory using something new to me … Hmmm, how come I have so many unread thrillers on my shelves? … Right, let’s choose something with rave reviews … an acknowledged masterpiece … and maybe something medical?

Brilliant. Flashback by Michael Palmer, a qualified doctor cum very successful writer? Fits my bill perfectly.

Young neurosurgeon Zackery Iverson has left an understaffed, under-resourced hospital and dedicated team of colleagues to return to the place where he grew up, leaving behind a broken relationship and almost all his belongings. His new workplace, the ultramodern rejuvenated regional hospital in Sterling, New Hampshire, is thriving under the leadership of his older brother Frank. State of the art equipment, a growing team of specialists, ultra modern facilities, a veritable ‘juggernaut of technology’. Sounds impressive, but where is the heart?

Zack becomes increasingly concerned about the policies and politics behind the veneer of success. How can the hospital board own so much property? Why are poor patients shipped elsewhere? Why is a very senior doctor claiming harassment and a campaign to get rid of him? Why can a young patient recall events when he should have been anaesthetised during a routine operation? Why is Zach’s new friend and colleague, Suzanne Cole, so alert and bright immediately after her surgery; and why is she behaving erratically now? And why is Zach’s own brother resurrecting childhood rivalries?

Old doubts and insecurities raise their heads. Is Zach being naive and idealistic? Is the cut and thrust of a modern medical ‘business’ simply not for him? Should he have stayed as a champion of the underprivileged and poor?

Child's disturbed bedA growing sense of dread starts to unravel in his head when he’s called in to work with 8 year old Toby Nelms, a boy who’s so disturbed he’s stopped speaking, is having nightmarish flashbacks, and is wasting away.  Why is this lad so terrified of hospitals? How does he know about Metzenbaums? – only staff working in an operating theatre would use the word. There can be only one answer: somehow Toby was awake during his surgery for an incarcerated inguinal hernia. But how could he be? And how much of his suspicions dare Zach share with Toby’s desperate mother?

Could some of his colleagues be monsters masquerading as caring physicians and nurses? Is his own brother somehow implicated? Just where do the ethical boundaries begin and end?

Yep, I’d say this fits all of the above criteria. Thrilling! Unputdownable. I’m hooked, reading long after I should be tucked up asleep.

FlashbackBut I note something else important. There are lots of characters and subplots in this story – hard to keep a handle on initially, but gradually they become rounded out and emerge as … the shrewd controlling judge … the anaesthetist with a secret unsavoury history … the cardiologist with an abusive ex-husband and a young daughter … the nanny who has served her family faithfully but is now threatened with a nursing home … the nurse who can be bought … the shallow secretary chosen for her loose morals and voluptuous body. This steady drip of detail from various sources adds greatly to the suspense. You’re left wondering just who is the real baddie in all of this? who else is implicated in some way? Everybody seems to have mixed motives, vulnerabilities and dubious characteristics. And the links between them grow ever more tortuous. A tall order to achieve that level of complex interweaving. Could I manage it? Right at this moment I’m not at all sure I could.

Having a take-home message is less of a problem to me. In this case: how far would any of us go to uphold our personal moral standards? What if it became a question of love and loyalty over rules and systems? Familiar? Yep. My kind of territory.

OK. Let’s try again with another novel, another author … a medical mystery-cum-thriller, Damaged by Pamela Callow. Again stories within stories, lots of intertwined characters with mixed agendas, false trails. A blond dog-walker, a lawyer with a haunting past, an inscrutable judge with a murdered daughter, a rejected policeman … By now I’m hugely impressed by authors who can hold all this together so successfully.

One thing is definitely in my favour. Medicine’s a hotbed of ethical quandaries – that’s why I became a novelist in the first place, of course. All those folders containing ideas and research material amassed over the years? Ideal material for intrigue and mystery and dark deeds.

So, what do I think now? Well, I’m not ruling out a thriller this time around. Indeed I’m already trying to work out some kind of grid that would make my story-line work. But, boy, what an undertaking. I might be gone some time!!

 

 

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Authentic fiction

I do love hearing from readers, and I’m always impressed when they make contact. It’s something I rarely do, but should do more often – no, not with myself, with authors whose work I’ve enjoyed.

‘Star letter’ this week goes to ‘Trish’ who wrote asking for the reference for a medical thriller mentioned in my novel Right to Die. The main protagonist, Adam O’Neill, a journalist who has developed Motor Neurone Disease, lends the thriller to his GP, Dr Curtis, and writes in his diary:

Right to DieHe’d brought back a book I’d lent him, a brilliant medical thriller about a serial murderer who developed aplastic anaemia. I’d been impressed by the twist in the tale, and thought Curtis might appreciate its medical cleverness. The killer went on to have a bone marrow transplant from his sister. Result: when he was a suspect years later the forensic people said he couldn’t be the killer because his DNA didn’t match the samples from the crime scene. Naturally, the hotshot detective got hold of some distant relative and winkled out the story of the transplant and hey ho, the villain’s clapped up in jail and they’ve thrown away the key.

The crime story was entirely fictitious, but of course I was chuffed to find someone wanted to read it. And more delighted still that my correspondent wrote to me subsequently to say she was a nurse who works with people with MND, and how true Right to Die rang with her experience. That kind of endorsement from experts is special. Very confirming.

In a couple of weeks time I’m due to attend a bookclub where the members are going to be discussing Right to Die, so I’m hoping they’ll be as enthusiastic as Trish. I know there’s at least one doctor in the group, so I’m not expecting an easy ride. But the challenge is stimulating, and there’s a particular thrill in hearing other people talk about my characters as if they’re real people. To me they are; I know them intimately.

Trish’s endorsement made me feel so chirpy I abandoned research into auto-immune hepatitis (for my current novel) and went off to try out a new recipe for a raspberry and amaretti gateau. Nicely used up the last of the raspberries from the garden.

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