Barbara E. Wilhelm

When to know when enough is enough.

In recent years, the bar for surprising or shocking the reader has been raised ever higher, and the literary net has been cast out to ever greater distances in search of new areas to trawl for plot inspirations. At some point, the writer has to sit back and decide when he or she has found a reasonable level of “shock and awe” or has crossed the line into a realm of violence, revulsion or depravity for its own sake. The goal of a well-constructed thriller is to offer surprises without painting situations that would unnecessarily repulse the reader.

This can be the equivalent of walking a verbal tightrope. We have all experienced the excitement of a scary story or an amusement park thrill ride, but part of the ability to enjoy these sensations comes from knowing that in the end, we will emerge unharmed. Similarly, fictional characters we love may encounter physical or emotional difficulties, but somehow, we know that they will live and become stronger as a result of their trials. Such is the time-tested formula of soap operas, though in that medium, reality is often suspended beyond a level that would be credible for a writer of a novel.

As a reader, I do not like to see a beloved character so scarred, physically or emotionally, that it becomes painful to read any further adventures. More than one popular fiction series has ventured perhaps too far into the darkness. Once that line is crossed, it is difficult to return. The joy the reader has come to expect from following their favorite character can be forever diminished by the memory of a repulsive prior encounter.

With the continued “pushing of the envelope” in all media, there is a danger to assume that readers are so jaded and bored that only the most extreme situations and the most graphic descriptions of violence or calamity will hold their interest. Readers primarily want a good story, and a book should be a welcome escape. Of course, we as writers need to include surprises and scary moments, but we need to remember that even a thriller does not require a certain body count to make us turn the page.

The level of emphasis on the personal lives of the characters in a thriller can also be tricky. One needs to create multi-dimensional characters without throwing in large amounts of detail that is not relevant to the story.

Another possible pitfall on the road to writing a medical thriller is to become so involved in the technical aspects that the book reads more like a text. This is not to say that an author cannot impart significant amounts of interesting and useful information via the story. No, it means that it must be integral to that story and presented through the characters so that it drives the plot. Indeed, learning more about subjects that are of interest to a compelling character is one of the enriching aspects of reading.

Part One: What makes a thriller a medical thriller?

Barbara Wilhelm (Mela Barrows Bennett) is the author of Murder Makes the Rounds. Click here to read an interview with Barbara Wilhelm.

What makes a thriller a medical thriller?

What makes a thriller or a suspense novel a medical thriller? A successful novel in this genre needs more than a few scientific terms tossed in at random. Placement of the plot points and the medical aspects must be carefully spaced. How does one weave these together to make a coherent work? For the framework, you need a sound storyline. The plot must build and pull the reader along. The scientific/medical aspects of the story should be sprinkled through the manuscript like breadcrumbs; a literary trail for your readers to follow.

One caution to the writer: Don’t hide anything. Leave your clues or your verbal tidbits along the path, though not necessarily staring the reader in the face. Whether the reader notices them or not depends on how savvy they are, as well as how expertly the story is constructed. It is all part of the adventure of reading. The writer’s task is to entice readers to look, but the clues must be there to find. Some of the writers of the past century would pull out a new character or reveal some hitherto undisclosed major clue in the final pages, but for today’s reader this is considered poor practice and highly unsatisfying.

Where does one get inspiration for their medical suspense/thriller novel? Scan the titles on the shelves in your local bookstore. The phrase “ripped from the headlines” can be applied to many. When an unusual cause of death or public health issue hits the news, expect to see it in the next wave of bestsellers. With the rise of serious infections with scary acronyms such as MRSA and VRE (not to mention “flesh-eating bacteria!”) it is no surprise that these have followed AIDS into the areas of medical fiction. One key to a successful thriller is that it incorporates scientific fact. The story must be plausible, not matter how unlikely. Picture a “perfect storm” of one bad event leading to another, which might be nearly impossible to replicate in reality, but nevertheless is possible.

Medical professionals who turn to writing fiction have a wealth of experience and personal cases to draw from for inspiration. By making composites of situations and characters, one can weave a fascinating case study from real life into a fictional story without compromising confidentiality. Doctors, nurses and medics spend much of their day listening to people with a variety of problems and this knowledge can serve as a background against which one can paint a story. All writers can find ideas from the media—taking a bit of this and a dab of that to add to their verbal canvas to create an original work.

Writing a medical thriller requires mastery of two worlds: constructing a good story and finding interesting medical points to thread into that story. This is a difficult task, but one that when done well, is extremely satisfying both for the author and for the reader.

Part Two: When to know when enough is enough.

Barbara Wilhelm (Mela Barrows Bennett) is the author of Murder Makes the Rounds. Click here to read an interview with Barbara Wilhelm.

Writers are a diverse lot. We come from every possible background and occupation. What is special about coming to writing from a medical background? I think that because doctors are accustomed to continually learning, we are open to new thoughts, new ideas and new ways of looking at the old. Each new piece of information must be weighed for its value, as it may be entirely useless or a true breakthrough. Reading stimulates ideas, and as we read a great deal of technical material, it is no surprise that many writers from medical backgrounds write about what they know best: medicine.

I spend a lot of my day listening to people. They tell me about their problems, their ailments, their jobs, their families, what they think about their coworkers, their significant others, their pets. While other writers may have to seek out such opportunities to hear a wealth of stories, I am awash in this. None of these stories is anything I would use directly, of course, but often some small piece sets off my imagination about possibilities. It may become part of a mosaic of many such pieces from different sources to form a whole, entirely apart from what investigated it.

Being organized is helpful in writing and crucial in medicine. Having a sense of structure — a beginning, middle and an end – and seeing the overall concept as a whole is part of the medical, as well as the writing process. When I worked in the emergency department, I often thought of the brief encounters over simple problems as a story in themselves: a patient would come in with a problem, we would find a solution, and they would be on their way.

One does a lot of writing in medicine. Every time a patient comes into the hospital- whether it be a trip to the emergency department or to be admitted – one or more doctors has to write a history and physical. The history, the medical story of a person’s life and present illness, is often the most important part of finding out what is wrong. This is also how we pass the information on to the next doctor or caregiver. Telling this story clearly and coherently is important, and taking the step from writing about a real person to a fictional character is not a quantum leap.

Click here to read an interview with Barbara Wilhelm.

Barbara Wilhelm (Mela Barrows Bennett) is the author of Murder Makes the Rounds.

Barbara Wilhelm

1. How does your career as an MD play a part in your writing?

In my medical career, I have held a variety of positions in emergency, occupational and family medicine, and this wide range of experiences has given me much to draw from. Having a scientific background (I was a chemistry major in college) helps with the technical aspects of writing about scientific subjects, and having to explain complex concepts to non-science people helps me to write in a way that a more general audience can understand.

2. Considering the medical thrillers you have read, how realistic do you think the majority are?

Generally, very. The best thrillers are those that understand that crossing the line from science fact to science fiction puts them into another genre. The plots must be possible, no matter how improbable. In medicine, when one makes a list of possible causes for an ailment—a so-called differential diagnosis—the most common causes are designated so for a reason: They are the most likely. In a book, or on CSI, the culprit will be the least likely, though often far more interesting, cause.

3. Can someone who is not an MD write a medical thriller?

Certainly, though being an allied health professional (nurse, paramedic, or physician’s assistant, for example) or a medical technician with laboratory or radiology training is helpful. Other writers need to invest a great deal of time in background research or have ready access to experts who can provide technical assistance with the science in their novel. However, being a great storyteller is more vital than having any specific training.

4. Who or what is your greatest inspiration for writing?

Reading books and seeing interesting stories on television or film. When I find a particularly intriguing character or situation, thinking about it starts the creative process and I will go off in any number of directions. I get my best ideas at the end of the day when I lie down and try to settle the zillion thoughts in my head and have to focus on one of them. It’s better than counting sheep.

5. What is your favorite book?

Trick question! This is like asking a chocoholic to pick one piece out of a five-pound box of their favorite kind. (Anyone for Godiva Dark?) Though I read mostly popular series mystery fiction, I also have some favorite areas of nonfiction, especially archaeology. No surprise then, that I am a huge fan of Elizabeth Peter’s Amelia Peabody series.

Click here to read Barbara's latest article.

By Barbara E. Wilhelm, M.D. (Mela Barrows Bennett)

The challenge of writing a medical thriller is twofold: One has to have a full command of the skills and process of writing a good novel and at the same time incorporate technical knowledge into key aspects of the story. These elements need to be woven in seamlessly, lest the finished book read like a text. At the same time, the book must obey the basic rules of a good novel: tight plot, something to hook the reader from the beginning, and compelling characters.

One of the first plotting decisions is to select the premise—that piece of science that will provide the rationale for the central concept. It is not a coincidence that many of the best medical thrillers are written by medical professionals, often involving aspects of their own specialty. Writers are most comfortable writing about what they know. The possibilities are without limit, and in this day of bio-terrorism, even old diseases such as smallpox and plague have gained renewed interest. But beware of frequently-employed devices, unless you can think of a new, and fiendishly clever, twist.

One common method for presenting the factual material is to set up one of the characters as an expert. That character can, by actions and dialogue, explain the key points in terms that can be understood by another character that is not an expert, but a reasonably intelligent layperson. This device provides a clear, succinct presentation of the science and lets the dialogue drive the story.

In a great thriller, the reader feels a sense of unease. It could happen to them, if they were in similar circumstances, but they are really sold because they care about what happens to the key characters. The author must create strong attachments to those that are put in jeopardy. If characters are introduced and then killed off or threatened before the reader forms a bond with them, the reader won’t care what happens, no matter how clever the premise is. And while the author may need to sacrifice one or more characters, I advise keeping the extent of the calamity short of apocalyptic. Readers have a harder time getting emotionally involved if the story wipes out the planet than if the evil is up close and personal, striking at one or more now-beloved characters. Witness the success of television soap operas.

Another good rule is to keep some small thread of hope throughout the story, without allowing a quick resolution to the problem. Consider offering a series of situations that seem to present a solution, then have one of the characters tear it down. This gives the reader points of relief, yet builds the suspense by following each disappointment with an even more awful set of circumstances.

In summary, a medical thriller starts with the basics of a good novel and uses scientific or technical material as an integral element of the story. The science is important, but it is not a substitute for good, basic writing.

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