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A Surgeon’s Perspective on Writing Fiction

The joy of being a physician began when my medical school acceptance letter arrived. The satisfaction of improving the health of others is hard to put into words. However, the life of a physician isn’t always roses. A doctor’s day-to-day life is filled with evaluating life-changing risks and dealing with complex human problems. I love this work and I wouldn’t trade it for anything. I've been a board-certified orthopedic surgeon since 2000. During these years I’ve averaged about a dozen surgeries and a hundred clinic patients each week. However, working at this pace takes a physical and psychological toll. Physician burnout is real. After several decades it became clear I needed to improve my work-life balance, so I decided to take a stab at something that didn’t involve patient care, something I’d wanted to do since I was a boy – write a novel.

I’d written a master’s thesis and a Ph.D. dissertation; how hard could it be to write a novel? With that in mind, one August evening in 2014 I sat down at my computer and started typing the kind of story I love to read, a medical thriller, of course. Wait! What was I thinking? “C’mon,” you say, “it can’t be as hard as surviving a surgical residency.”

It’s a close second.

Six months into the project I’d completed a first draft. About this time the concepts of story structure, dialogue, character arc, and plot development began to hit home. I began to comprehend the complexity of writing good fiction. If you think nailing a broken femur, repairing a torn rotator cuff, or replacing an arthritic joint is hard, try writing a novel.

Faced with this challenge I did what I’ve always done when confronted with an obstacle. I hit the books, reading classics about writing fiction by Stephen King, Robert McKee, John Gardner, Anne Lamott, Shawn Coyne, Elmore Leonard, Sol Stein along with many others. I took online courses, attended writers' conferences, listened to countless author interviews and podcasts, and read as many blog posts as possible. I felt like I’d earned a Master of Fine Arts degree from the School of Hard Knocks.

After three and a half years, multiple rounds of developmental editing, copyediting, and proofreading I completed my first medical thriller, Fractured. Now what?

Well, if you’re an author with an unpublished manuscript you’ve reached a fork in the road. This is when the byzantine world of book publishing begins to reveal itself. Do you attempt the traditional route or do it yourself?

Getting traditionally published by one of the big New York publishing houses requires a literary agent that will accept you as a client. The agent will then use their connections and influence in an attempt to sell your manuscript to an acquiring editor at Simon & Shuster, Penguin Random House, Macmillan, etc.

If you’re a debut fiction author with only academic research articles for publications and no online platform the odds of attracting an agent are practically nil, zippo, zilch. Sir Edmund Hillary had an easier task. If you think getting accepted into medical school is hard try getting a literary agent to represent you. That’s when the cold reality of the business of publishing smacked me upside the head. The gateway to traditional publishing is heavily guarded and literary agents are the gatekeepers. It’s a business, and it’s about sales. Sure, there are exceptions. Every now and then a newbie writer steps up to the plate and hits one out of the park like Andy Weir did with The Martian, or Dalia Owens’ smash hit Where the Crawdads Sing, but these are lotto-winner rare. Consider that three million new books are published every year. Even if you have a great, well edited story there are many other business factors agents and publishers have to consider. The magnitude of becoming traditionally published became crystal clear when I attended a close friend's book launch a few years ago. His editor, employed by an imprint of Simon & Schuster, told me that my friend was the first new (read previously unpublished) writer he’d signed in five years! Let that sink in for a moment.

Now let’s talk about rejection. If you’re of the opinion surgeons can be aloof, arrogant, cold and callused, forget about it. Editors and agents make surgeons look more empathetic than Mother Teresa. Fiction writers must persevere in the face of overwhelming adversity. Emotional callus develops to help writers deal with rejection, but thick skin isn’t enough. Cowhide isn’t tough enough. You’ll need armadillo armor if you’re going to succeed as an author. If you think Sisyphus had it tough, try getting a novel accepted for publication. For months I spent hours each night composing personalized letters sent to over seventy-five literary agents pitching Fractured. I went to conferences and personally pitched to agents. Demoralizing doesn’t describe the result. Occasionally I’d receive a request for additional material but most of the time my efforts wound up unanswered.

What was I to do? I didn’t have years to wait. So, I asked myself, should I consider independent publishing? This would effectively cut me off from the traditional publishing path. The Big Five publishers consider Amazon one of the Four Horsemen of the Apocalypse. In many cases, unless you are a local author, independent bookstores will not carry your books if they are published by an Amazon imprint. But what choice did I have? Be blocked by the gatekeepers or make my own way? I’d done the work and believed in my book. So, I made my decision.

My hand shook as I wiped the sweat from my brow and exhaled. I mustered courage and clicked the send button. The decision had been made and the deed done. I submitted Fractured to the Amazon Kindle Scout program in November of 2017. After a thirty-day campaign KDP bought the ebook rights and published Fractured in March of 2018. It didn’t hit “the list” but it’s been well received if you believe the over five hundred reader reviews. The second book in the series, Hyperion’s Fracture, won the Killer Nashville International Writers Conference 2020 Silver Falchion Award for best thriller. The third book in the Mark Thurman series, Stability Island was released in December 2022.

You know what they say, one good stab leads to another. Book four is in the works and I’m off to the OR. If you haven’t read Fractured check it out.


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