Writing a Medical Thriller

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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