How to Write Like A Doctor

It happened again.

A book came highly recommended – a lovely romance, with intelligent characters and a grown-up perspective. The set-up was fantastic; the dialogue was hysterical. The hero, however, wasn’t a surgeon. I mean, the author said he was a surgeon, but he had two weekends off in a row.

Not a surgeon.

I almost bailed on the book at 50%, because I had such since problems with the way the author messed around with the rules of healthcare, both clinical (nope, kids don’t get to eat if their surgery is delayed) and social/cultural (don’t get me started). Despite that, I stuck with the book, and by the time the couple found their happily-ever-after, I sincerely had a tear in my eye…

…in part because in the scenes right before they kissed and made up, the “surgeon” was so unhappy he acted like a jerk to his patients and coworkers. That part was believable.

Seriously though, not all surgeons are jerks, but when they’re not in the OR, they generally spend most of their life with their nose in a book….or, more accurately, a medical journal or a laptop. If you’re going to convince me that they’re also charming and funny and have great social skills, you better get every other detail right: things like their training, hospital culture, and the reality of working only 60 hours on a good week.

And that’s where I want to help! My perspective may be somewhat skewed – I’ve worked primarily in academic medical centers where the physicians rotate between clinical work, research, and teaching – but for a long time now, I’ve wanted to pull together a talk to help authors navigate the world of medicine. Which is a LOT to cover, so let’s get started.

First stop: hospitals. So, you want to have your mind blown? Think about this: people get admitted to hospitals because they need nursing care, not medical care. If all you need is a doctor, you can be seen in a clinic. (More about nurses later.)

The other thing to know? Hospitals are incredibly expensive. They can’t afford to admit someone “to run a few tests”, and they’ll discharge you as soon as possible. Like, when my 80-some year old mother-in-law fractured her hip, she was sent back to her adult family home two days (TWO DAYS) post-op. (I was horrified, but everything went okay.)

Obviously I don’t have space to list every diagnosis that’ll get your character a hospital bed, but if your plot goes there, make sure the patient has something they couldn’t take care of at home, and expect them to be discharged before anyone is really ready for it. (WebMD is a good reference for clinical questions and concerns.)

Also, leaving hospitals AMA – against medical advice – is a thing, and can be a dramatic plot device. Just know that in the real world, insurance companies generally won’t cover a stay when the patient leaves AMA, so if your police detective or otherwise employed and insured main character is contemplating that move, there are real-world consequences.

As I implied earlier, hospitals are run by nurses, and nurses come in a variety of types. Nurse techs or nurse assistants have completed a certificate program and can assist with basic patient care tasks. They’re often nursing students trying to get some real-world experience before they take their boards.

Licensed practical nurses (LPNs) have completed a one-year program and passed a certification test. They function in much the same way registered nurses do, with some minor variations in the tasks they’re allowed to perform.

Registered nurses (RNs) are the backbone of the place. They’ve completed either a two or four-year program and passed their State Board exam. They also often have additional training &/or certification in a specialty area, and they are required to keep current on their continuing education credits to maintain their licenses.

Nurse practitioners are registered nurses who have completed either a masters degree program or a doctor of nursing practice degree. An NP is a specialist – I’m licensed as an NNP, or neonatal nurse practitioner, which means I take care of preterm or sick infants. We work from a medical model, which means we do many of the things physicians do. Generally NPs have a couple years clinical experience in their specialty area, so we bring bedside nursing assessment skills to our medical decision-making.

Word to the wise: don’t confuse nurse practitioners and licensed practical nurses. I read a book where the NP was passing out patient meds, which…no. NPs write the orders, LPNs pass out the meds. Got it? Good.

There are a number of other people who are directly involved in patient care. Respiratory therapists (RTs) focus on the patient’s cardiopulmonary health by directly assessing the patient’s breathing and by managing the medication and equipment required to support them. Like with nursing, RTs complete a two- or four-year program and must pass a certification test.

Social workers provide invaluable support for patients and their families, connecting them with necessary resources while they’re in the hospital and after discharge. (So no, your surgeon hero doesn’t need to drag his new girlfriend into a patient’s room where she can instantly connect with the family and identify their needs. Find another way to prove she’s a decent human being. Ahem.)

Physical therapists, occupational therapists, and speech therapists all provide key support to a patient’s recovery, as do nutritionists and pharmacists. In the interest of space, I’m not going to specify the range of academic preparation and certification required to function in these roles, but every professional involved in patient care contributes a unique and valuable perspective.

Other random thoughts...

Not all hospitals have residents. Most academic or teaching centers (the ones with interns and residents) are associated with universities, though some private hospitals run selected residency programs.

Most (all?) hospitals have adopted computer based charting. THERE ARE NO PAPER CHARTS AT THE PATIENTS’ BEDSIDE. Also, HIPAA – the national law around patient privacy – is a thing. It affects who can be at the patient’s bedside, and how patient information can be communicated.

So if your characters want to brainstorm in the elevator, make sure they don’t drop names or other identifying patient information.

Hospital administrators exist in their own world – and it’s usually pretty classy. Most, but not all, have been involved in patient care in one way or another, but the higher they get on the ladder, the less clinical work they’re responsible for. In addition to the RN or MD on their resume, they’ll usually have an MBA or MHA (master of hospital administration).

Since I started by bitching about doctors, I’ll close the circle with them. To become a doctor, a person must complete a bachelors degree (4 years), score well on the MCAT (sort of like the SAT but HARDER), and complete three years of medical school. By the end of their second year of medical school, most have decided on which area they want for residency.

First year residents are called interns, and residency programs are usually three or four years long. After residency, some will continue their training by applying to a fellowship program. These are in specialty areas; for example, pediatricians have completed a 3-year pediatric residency program, but pediatric cardiologists did a 3(?) year fellowship in cardiology after residency.

Do the math. Four years of undergrad + three years of medical school + ~ three years of residency, at a minimum. That means most new physicians are around 30 years old, older if they did a fellowship. Some programs – surgery or neurosurgery, for example – take substantially longer.

I do love my day job, and I could probably keep going, but I’m going to stop here. If you have questions, leave them in the comments, and thank you for reading along. There’s no reason for fictional malpractice!!

Advertisements

How to Stay Sane on Deadline

Here’s a fun fact most of you probably already know about me–I’m a champion procrastinator. I developed a knack for procrastination in high school, then majored in it in college, pulling papers and midterms and finals out of my you-know-what like it was my job. Sure, cramming sucks, but doing things ahead of time like a responsible human means you have to give up essential pastimes like reading, watching TV, spending hours on YouTube, going down Wikipedia research holes, and googling infinity Nic Cage gifs.

Procrastinators, you know what I’m talking about.

But here’s another fun fact: you can’t write and edit an entire book in one night. As a writer, I’ve had to learn to actually manage my time to some degree. But no matter how good I am with my time, it never seems like enough, and when deadlines come knocking, it always feels like a mad rush to get things done. As I fight through that latest push, here are my tips on surviving any deadline with sanity intact.

Don’t stop moving! It can be really tempting to plunk your butt in your chair and glue your face to the screen and stay that way until…whenever your thing is due. But try sticking to whatever your normal workout routine may be–exercise has been proven to raise endorphins, lower stress, and improve sleep (even if that doesn’t happen until 3 am). If a sweat sesh isn’t in the cards, taking a break for a five minute walk, a quick stretch, or a few jumping jacks will bring blood flow to your brain and improve concentration.

Put things in perspective. I have a pretty vivid imagination, which means when my anxiety gets out of control I start picturing really extreme worst-case-scenarios that are totally unrealistic. Sometimes, thinking through the real-world consequences can be calming. If I don’t turn in my manuscript on time, will I die? Nope. Will a surprise meteor destroy life on Earth? Doubtful. If you can’t talk yourself down from a cliff, try to figure out who will. My husband and my literary agent are both pretty practical people. Now, whenever I start to spiral I’ve learned to reach out to them for realistic advice and feet-on-the ground guidance.

Separately yourself from distractions…by force if necessary. So y’all know about my smartphone addiction. Add to that a seasoned procrastinator’s ability to turn anything into a distraction, including but not limited to Netflix, Hulu, Wikipedia, Buzzfeed, E! News, etc. I’ve now downloaded apps to my phone, my laptop, and my desktop computer that separate me from my addictions. Figure out what your fix is, and nix it.

Stay fueled, but be smart about it. Snacks and beverages and regular meals are a must. But as someone who has done their fair share of bingeing on coffee and Trader Joe’s Key Lime Tea Cookies while on deadline, I cannot recommend it. Sugary drinks, treats, and caffeine might feel like boosts in the moment, but once the roller coaster goes the other way you’ll inevitably start to feel worse. Healthier fuel, like fruit, popcorn, sparkling water, and the occasional square of dark chocolate will serve you better in the end!

Take breaks. This one is really hard for me. When I’m on deadline I tend to feel a lot of guilt for “neglecting” my work. But I’ve learned that taking genuine breaks (not #3 breaks) does wonders for my productivity. Just make sure it’s relaxing, reviving, or reinvigorating. My favorites are a brisk walk with the dog, a bubble bath, or a few chapters of a book outside my genre (I’m partial to Regency romance!)

Give yourself a break. You’re doing something impressive and amazing and hard! Don’t forget everything you’ve accomplished, are accomplishing, and will accomplish. Be kind to yourself–you deserve it.

You can do this! I promise.

Adventures in Research

Yes, that title is a takeoff of the 1987 movie Adventures in Babysitting. I have totally just dated myself, but high five to anyone who has seen it.

Ahem. I’m currently working on several non-fiction book proposals (two books on women’s suffrage in the U.S. and a biography) and so I’ve been doing a lot of research. Today I thought I’d share some of the cooler experiences this has brought about.

One thing you need to know first is that one of my all-time favorite books is A Discovery of Witches by Deborah Harkness. It takes place in the Bodleian Library in Oxford and the main character, Diana, is an academic researcher.

From the TV version of A Discovery of Witches, which premieres today in the U.S. This is Diana in the Bodleian (yes, it really looks like that). Note the clear plastic book cradle and the white cord-like weights on each side of her.

Over the holidays I had my first experience with archival research at Washington University in St. Louis and at the Missouri Historical Society library (also in St. Louis). At Wash U, I worked with a book cradle (which is just a foam thing that holds the book while you are reading) for the first time and weighted cords that keep the book open (I didn’t end up needing those). I felt like a real researcher, even though what I read wasn’t centuries old; it was just a dissertation from 1965.

The special collections room at the Olin Library at Washington University in St. Louis
The dissertation I was reading on its cradle.

But even cooler was my experience at the Missouri Historical Society Museum. There, I totally felt like Diana Bishop. I had to surrender all my personal belongings into a locker and I could only either type my notes or write in pencil. They wouldn’t let me take pictures of the documents, but I was able to get a few of the room:

One part of the reading room of the Missouri Historical Society Library.

There, I got to:

  • Hold in my hand record books from the Civil War, hand-written by the husband of the woman I’m writing about. It was so crazy to trace his actual handwriting with my fingers. He was a claims agent so the books listed every pension/pay claim by a solider’s widow or orphan that he processed. I only looked at one book out of seven (that was all I needed for my purposes), but I bet each book listed at least 1,000 names. It was also sobering to think of the scale of the loss. Being able to touch history like that really brings it to life.
This isn’t the document, but it is similar.
  • Read the letter he wrote to the Historical Society bequeathing the books to them (Not a copy; the actual letter. It was tucked in the back of one of the books.)
  • Trace him and his wife as they moved around St. Louis over a 40-year period using old city directories (I guess they preceded phone books). I really felt like I was stalking them the old fashioned way, you know, before Google. It was also cool to see the city grow in size just by watching the directories get thicker each year.
  • BONUS: I also found the address for Victoria Woodhull’s second husband right around the time the two met. No records for Victoria, but that isn’t surprising since she was doing business under an assumed name anyway.

I’ll be going back to Wash U soon to finish the section of the dissertation I didn’t get to. Then in June I’ll be visiting the University of Virginia archives in Charlottesville to try to get a hold of their family papers for this couple. Who know what adventures that will bring?!!

I wish I could find the words for how cool it is to experience history in a whole new way with this type of original documentation. Awe and speechlessness are the only ones coming to mind. But it is more than that; there is an emotional component, a connection to the past that you feel in your heart. It’s totally different than seeing a picture/photocopy/scan or reading a book where the author describes the document. This may sound odd, but there is an element of humanity that lingers in those original documents, one you can feel.

If you ever get the chance to visit your local historical society, do it. Mine had really cool stuff like a whole series of books listing soldiers during the Civil War and others just on marriages in Virginia or New York (or another state. I think they had those for most states). I would imagine you could really slay genealogical research at a place like that. And they had two types of card catalogs, the one like we had when I was little and then a bigger one that didn’t list books, but rather was almost like researcher’s notes; snippets of information. Kind of like hyperlinks on the web, but physical.

In case you forgot what a card catalog looks like. Source: Adobe Stock.

I love having the ability to view documents online (like census records and old newspapers) because that is great when you can’t view them in person. But when you can it’s an experience like no other. I think if more people were given the opportunity to touch a piece of history (especially as kids), they would have more appreciation for it and for those who lived before us.

Date Last Modified

November 30th you logged into the NaNoWriMo website and verified your 50k words to win the damn thing. And it felt good, right? To see that massive word count concurred in just a few weeks. That was a great feeling, both of accomplishment and relief.

Until.

It hits you.

The book isn’t finished.

Now, if you went into NaNo with a couple tens of thousands of words, winning NaNo might’ve meant finishing your book. Or if you were writing a Middle Grade book, that sucker is probably done. But if you didn’t and if you weren’t, rest assured, that book ain’t done.

50k does not make most books, I’m sorry to say. You’d see far less writers ripping out their hair, staring dead-eyed at Twitter, and drowning in coffee if it did.

The one bad set up of NaNo is the holidays come right after. December is often a whirlwind for most folks, trying to get things done, seeing family more than ever, friends and food and stress and cold and all the things. And maybe you told yourself it was okay to take a short break after such a big accomplishment. And you told yourself that’s okay because look! You wrote so much and have far less to finish, so you can get back to it totes easy. No worries.

Then New Years comes along and you realize the date last modified on your manuscript is 11/30/18. And all those warm fuzzy feelings of accomplishment and relief are but a memory.

Trust me, kid, we’ve all been there.

But that doesn’t mean anything. It really doesn’t. It doesn’t mean you’ve failed, it doesn’t mean the book won’t ever get done, it doesn’t mean anything. It just means it’s time to pick back up where you left off and finish the damn thing. The good news (or maybe bad news?) is, there’s no countdown clock watching your progress now and you don’t have to do the next 50k or so words by January 30th. Of course, you now know you could, if you wanted.

So, cue up your playlist, fix yourself a nice cuppa, and put those fingers to the keys and hit your daily goal.

Now, for the rest of you. You know who you are: the ones who won your first NaNo, didn’t give up in December and finished your first draft and are so freaking ready to start querying this month.

Stop it.

Don’t.

Close that email and back away.

A first draft is never, ever ready for the slush. Do not burn bridges with agents by sending out queries premature. And if you’re going the self-publishing route, back away from KDP and BN Press and abort that upload. A first draft is not ready for that either.

When I finish a first draft I give myself a week at minimum and up to a month away from the book. I don’t look at it, I don’t print it, I don’t actively think about it (sometimes those thoughts sneak in though and usually for a good reason). Then I go back and read the whole thing from start to finish, making notes as I go, picking up on dropped plot threads, plot holes, inconsistencies, etc.

Then I make the changes I’ve noted. Or, worst case scenario, the total rewrite or massive edits.

Then I read it again. Yup, I get three drafts done before my editor or beta readers get it. And once they’re done, that means five drafts before I’ll call it finished. Sometimes more.

Your book isn’t ready. But it will be. You just can’t rush it. Rush that first draft, get that shit on the page, get it done. But now comes the work. Now comes the real book. Now comes the gold. Your work is worth the work. Do it.

Now comes the shameless self-promotion. If you’re a newbie writer and don’t have a circle of writer buddies you can go to for beta reading or content editing, I do offer both services and I do have some openings, so feel free to go to my website, have a browse, and hit me up. If you mention this post, I’ll give you 10% off!

Starting Fresh

I know, I know, fellow Scribe Liv just wrote a post about New Year’s resolutions. But it’s that time of year when we all look back on the old year and welcome in the new, and I’ve been doing a fair amount of reflection on the things that have served me that I want to welcome along with me, and how to say goodbye to the things that didn’t.

2018 was a big year for me! Most notably, it was my publishing debut year. That came with a lot of incredible firsts for me. My first glimpse of the cover artwork for my book, which coincided with another big landmark–my 30th birthday! I signed nearly twenty thousand copies of the book for a total of six (!!!) different book subscription boxes, and then had to keep that fact a secret for nearly six months. I got my first trade reviews, including my first run in with the dreaded Kirkus monster. I got my first glowing peer reviews, and then I got my first scathing peer review. I corresponded with my first “fans.” I tried to ignore being tagged on social media for one-star reviews.

I laughed. I cried. I tasted each sugary high and bitter low and tried to savor them both, because they were all part of this crazy dream coming true at last. But now–just over one month after release–I’m looking into 2019 with a few new intentions, while also trying to bid farewell to a few old habits that are no longer serving me.

Overcoming the sophomore novel slump. Oh, friends. Let me tell you, the sophomore jinx is real. I’m not allowed to give any details about the book I’m writing yet, but I will say that it is breaking me. I was warned about this by friends, fellow writers, even my agent, and I’m ashamed to say I didn’t believe them. “But I’ve written five-full length novels before!” I said, carefree and cocksure. “How could this be any different?”

Well, it feels super different. But I plan to keep reminding myself that this book begins with a first line, and ends with a last. I’m the same person who wrote my debut and all those other books before it, and that means that I’ve only gotten better than before. I have to keep trusting myself and my writerly instincts, and putting in the work until the thing is done.

Breaking up with my phone. Hi, I’m Lyra, and I’m an addict. It’s gotten pretty bad, people. I feel like I’m constantly reaching for my phone in every spare moment, scrolling mindlessly through my social media feeds or swiping dully at Candy Crush or some other dumb games. I really really want to cut down on phone time, so if anyone has any genius tips or apps (ironic, I know) to help cut the proverbial cord, let me know!

Inviting more ambient creativity into my life. Somehow, along the journey of turning my writing into a profession, I forgot how to create for fun. I used to draw, and sing, and write bad poetry, and read for pleasure. Now it seems like I’m either grimly plugging away at a book or story I’m trying to sell, or dicking around on my phone (see above) while watching Netflix. I want to pick up a pencil and doodle. I want to journal again. I want to try my hand at a Bob Ross tutorial. I want to join a choir. I want to write something no one else will ever see, in long-hand.

Sometimes I feel like by becoming a writer, I opened a front door of creativity but then closed all the windows. I want to open those windows again, to let some of that light back in.

What are your intentions or resolutions for the New Year? Let me know!