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article imageIs the medical thriller in need of life support? Special

By Les Horvitz     Jul 16, 2015 in Entertainment
New York - What’s the future of medical thrillers? Is the genre that was pioneered by Robin Cook, Michael Crichton, Michael Palmer and Tess Gerritsen in danger of losing its edge?
And just how closely to the facts should writers adhere when they’re plotting their stories? These were some of the issues that several established thriller writers — many physicians themselves — tackled at a roundtable discussion held earlier this month as part of ThrillerFest,an annual gathering of the International Thriller Writers at New York’s Grand Hyatt Hotel. The session was moderated by D.P. Lyle, a cardiologist practicing in Orange County, CA, and the author of several books about forensics (Forensics and Fiction, Forensics for Dummies).
Surprisingly, most of the panelists agreed that for all the advances in medical technology, many suspense writers weren’t doing a particularly good job in holding up their end of the bargain. “They aren’t keeping pace with legal thrillers,” one panelist said, adding that medical thrillers were becoming more like “medical soap operas,” so that the integrity of the genre was being eroded. Presumably, the eight panelists didn’t believe themselves guilty of perpetrating a medical soap opera, but no one was able to offer a prescription to the problem.
With so many writers — both aspiring and professional — in the audience, Lyle turned the discussion to a more technical question: How to convey information about medicine in fiction, especially when it’s technical in nature. “How do you keep the reader from feeling left out?” Most of the panelists seemed to agree that if the story didn’t work and the characters didn’t engage the readers, it didn’t matter how accurately the author managed to get the medical details. The author’s primary obligation was to provide only enough information as necessary to understand what’s going on. “Sprinkle information throughout the novel, don’t dump it,” advised Patricia Gussin, a pediatrician as well as a bestselling novelist.
“Use medicine or science to drive to a solution, but don’t overwhelm the reader and make sure to be jargon-free,” urged Kathy Reichs a bestselling author (Deja Dead) who worked as a forensic anthropologist for the Office of the Chief Medical Examiner of North Carolina. “Don’t dumb it down. Use some of the same skills a lawyer does when addressing a jury.” Her advice was echoed by Mark Rubinstein,physician, psychiatrist and author, who said that as an expert witness “my first job was to entertain and then to inform.”
“In medicine we talk about probabilities and impossibilities,” Lyle said. That’s to say, someone may have a good chance of surviving a particular illness although recovery can’t be guaranteed; by the same token, a disease may be so far advanced that it’s impossible to save the patient. Fiction, on the other hand, is all “about ‘possibilities.” While something may not be possible now then maybe it will be in the future or in some alternate reality. Robin Cook’s chilling novel “Coma” is Exhibit A, playing as it does on patients’ fears that when they’re put under anesthesia that they may never wake up. There’s no hospital — at least none we know of anyway — that’s keeping comatose patients in storage for harvesting their organs, but Cook made us believe in the possibility. Or as Rubinstein puts it: “Anything is possible, but make it seem real.”
Another panelist cited an example from his own life. Some time ago, he said, his father was operated on for cancer; when he recovered he suffered a rare reaction to the anesthesia that affected his olfactory system; he was unable to smell anything again. Several years later, the novelist’s wife had an operation from which she emerged with hyperosmia — a heightened sense of smell. This unusual coincidence inspired a novel in which the villain — some writers prefer to use the term ‘antagonist’ — had hyperosmia, giving him the ability to know his victims’ personalities and even discover their genetic profiles by the scents they gave off.
Gary Birken , an author and pediatric surgeon, noted that antagonists don’t necessarily have to be human. “They can be a disease or some other entity.” And if the antagonist is human, he or she can freely flout laws and morals with impunity. Take Hannibal Lecter, the psychopathic (but charming) cannibal killer who since he was created on the page by Thomas Harris has undergone several incarnations, most recently in a well-regarded NBC series. “The beauty of it is that he’s so likeable,” Birkin said. “Just as long as you don’t do dinner with him.”
Most of the panelists had no trouble departing from the reality of the operating theaters, clinics and offices at least when it comes to creating their fictional worlds. However, they drew the line about the way medical practice is often depicted on TV or in the movies. Some writers like Reichs have enjoyed a good relationship with Hollywood; the Fox TV series, “Bones,” is based on her novels. Others like Lyle are less sanguine; he once told producers who were developing a film adaptation that he wouldn’t ever do to his story what they were doing to it. “And what’s that?” they asked. “Butcher it,” he replied. One panelist recalled watching a program where a patient was given a bronchoscopy in his living room, a diagnostic procedure which would never be performed outside of an operating room. Lyle complained that he’d seen too many scenes where one character knocks out the other with a single blow. “A one punch knockout is practically impossible.” Nor can you knock someone out, stuff him in a trunk, and three hours later open the trunk and pour some water on the victim to rouse him. “Usually he’d wake up in an hour, he’d be a little groggy and disoriented, but then he’d be angry and come after you.” It was one thing to go light on medical details and jargon to propel the story and make it dramatic; it was quite another to stray so far from reality that it strained credibility to the breaking point.
Birken recalled an observation made by the late Tom Clancy when asked to explain the difference between fiction and reality. “Fiction,” he said, “has to make sense.”
Sometimes fiction makes a lot more sense than reality as the writers could attest from their own experience. Lyle told a story from his days practicing at a hospital in Birmingham, AL. A father and his adult son, he said, were having “issues,” so they decided to settle their problems with a duel. And what better place to hold their duel than right outside the Emergency Room entrance of a major hospital? That way they could be assured of being treated immediately. Lyle was working in the ER when the two exchanged fire. Both men ended up sprawled out on the ER ramp with three gunshot wounds to the torso. “The father was the better shot,” Lyle recalled. Father and son both survived and recuperated in beds next to each other, their differences presumably resolved.
Possibly the most troubling revelation to emerge from the roundtable discussion came from Mike Tabor. In addition to his fictional career, Tabor is a noted forensic dentist, often called upon as an expert witness to interpret dental evidence, identifying human remains by a single tooth, for instance, or a murderer by a bite mark left on the victim’s arm. However, in recent years, advances in technology have called into question how forensic evidence used in court has traditionally been analyzed and interpreted. “DNA is now considered the only real forensic science,” Tabor said, since an analysis of a DNA sample can establish with near certainty — a 99.99 percent probability of a match — whether a suspect was involved in a crime or not. That certainty can’t be guaranteed by other forms of widely used evidence like blood spatter, bite marks and even fingerprints. “You can say that no two snowflakes are alike, but how do you know for sure? You can’t examine every snowflake.” That goes for fingerprints, too. There’s no way of proving that no two are alike. Forensic experts are worried about the development. Thousands of suspects, after all, were convicted on the basis of evidence that may not be so rock solid, after all. “We don’t know where this is going in the future, but it’s a little scary.”
More about medical suspense, International Thriller Writers, ThrillerFest, DP Lyle, Kathy Reichs
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