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Interview: March 3, 2006

March 3, 2006

As a bioethics researcher and medical student, Joshua Spanogle has acquired a wealth of expertise and firsthand experience to fuel his medical thriller, ISOLATION WARD. In this interview with's Suspense/Thriller Author Spotlight Team (Carol Fitzgerald, Joe Hartlaub and Wiley Saichek), Spanogle discusses how he used his writing to explore current medical and ethical issues, and reveals how he managed to pen a novel in the midst of his grueling schedule. He also explains the book's noir influences and sensibilities, as well as the didactic element he included to enlighten readers. You currently are a student at Stanford Medical School. What inspired you to write ISOLATION WARD in the middle of your pursuit of an M.D.? How did you manage to find time to write a novel, given the stress and pressure that medical students encounter?

Joshua Spanogle: I wrote my first novel, also a medical thriller, the year before I entered medical school. The process was so painful I said I would never write another if that didn't find a publisher. It didn't find a publisher, but the rejection letters were encouraging enough that I decided to give it another go. Never say never, right?

The first draft of ISOLATION WARD was penned in the summer between my first and second years of medical school (that first summer is the only one we have free). Stanford was wonderfully supportive and awarded me a grant to work on the book. The schedule was grueling --- full days during the week, half days on the weekends ---- but I was very thankful for the time. After finishing the draft, I spent the next eighteen months revising and rewriting --- before and after class, sandwiched into my time in the lab, on weekends. There were a lot of sacrifices.

BRC: You have also served as a researcher at the University of Pennsylvania's Center for Bioethics. Did any of your experiences there influence your work on ISOLATION WARD?

JS: Very much so. Though my work at Penn centered on hospital ethics committees (not really the stuff of medical thrillers), I was in an environment that taught me how to think about issues in an ethics framework. Furthermore, as you can imagine, modern medicine is fertile ethical ground, and I wanted to explore that in my fiction. I chose the medical-scientific milieu of the book (xenotransplantation) because the stakes are very high on both sides of the ethical debate, i.e., a solution to the shortage of organs vs. unknown infectious risks.

BRC: What inspired you to make Dr. Nathaniel McCormick an officer in the Centers for Disease Control and Prevention, rather than a staff doctor in a hospital? Did you work closely with the CDC while conducting research for the book?

JS: The investigative duties of CDC officials fit well with the mystery/thriller format, so, for me, it was only natural that Nate would be part of the CDC. To make him a staff doctor in a hospital would have limited the geographical scope of where the book could go. Besides, I'm a huge fan of the CDC and what it does.

I'm very lucky in being at a medical school where I can access people who worked at CDC. A few of them read the manuscript and directed me accordingly. Unfortunately, a student budget and lack of time prevented me from visiting the CDC campus in Atlanta, which is one reason the book doesn't visit the campus. I did speak with a current Epidemic Intelligence Service (EIS) officer, though.

BRC: The women who are affected by the virus are mentally impaired. In your plot, you touch upon the sensitive issues of sexual activity in group homes as well as the sense of community amongst these women. What made you choose to have these women as the victims, and to develop this plotline?

JS: There are a number of reasons for this. First, while living in Washington, DC, I'd read of a man who ran a string of group homes for the mentally handicapped in Baltimore. He was charging the state an astronomical amount for the sub-sub-standard care he provided to the residents of his homes. While they were languishing, he spent his time on a horse farm in Maryland. The situation was repugnant enough to find its way into the book. Second, I have an affinity with society's most vulnerable people. At times, we dehumanize those with mental disabilities, and I wanted to present them as fully as I could --- with different needs and wants and, yes, sex lives. Finally, having the virus rampage through the hodgepodge system we have to care for the mentally impaired, and amongst people who have a difficult time giving an accurate medical history, provided more obstacles for Nate McCormick to overcome.

BRC: We found Dr. Nathaniel McCormick, whom you introduce in ISOLATION WARD, to be a unique character. He is infused with a noir sensibility that you manage to blend perfectly with his medical knowledge, so that he comes off like a combination of Philip Marlowe and Ben Casey. Are you a fan of noir fiction? Are there any writers in the genre who you feel have particularly influenced you? And is McCormick's character modeled after any real world individual(s)?

JS: I'm so glad you picked up on this! One of my goals was, actually, to bring as much Chandler and Hammett into the medical thriller as I could. Nate, of course, is neither Philip Marlowe nor Sam Spade, but he is a bit of a misanthrope and more than a bit tortured. I also wanted to give some Nick and Nora Charles flair to the relationship between Brooke Michaels and Nate McCormick. Devotees of noir will probably point out the thousand ways that Nate McCormick is not a traditional noir archetype but, as you say, I was going for a sensibility more than anything else. Chandler and Hammett are giants, and I tried to learn from them and incorporate what I could from them.

Nate McCormick is not modeled on any particular real world person. He is, however, a composite of different people I know in medicine and outside of medicine. I haven't yet met anyone in public health who was quite so brash. Surgery, yes. Public health, no.

BRC: Just prior to ISOLATION WARD being published, there was reported to be a cluster of deaths of young women in California apparently related to a prescription medication. Did a similar real-world incident inspire the events that take place in ISOLATION WARD?

JS: There were a few real world events that inspired ISOLATION WARD. I don't want to give too much of the book away, but suffice it to say that the sexual "perversions" in the book are based on fact. Additionally, the idea of using patients in a persistent vegetative state as they are used in the book was proposed --- in a public forum, no less --- by a surgeon. Finally, the promise and the risks surrounding xenotransplantation are all based on fact.

BRC: An impressive aspect of ISOLATION WARD is your ability to present complex scientific concepts in understandable terms. Did you find this difficult to achieve?

JS: This was hard, but teaching was one of my foremost goals with ISOLATION WARD. It's a tricky balance. I wanted to keep the story moving and the characters interesting (knowing that interesting characters do not go on ad nauseum about molecular biology), so I resisted the urge to go deep into detail. There's only so much jargon you can force people to look at before they glaze over. However, I also wanted to make the science challenging; I didn't want to dumb things down. Readers are very smart and discerning, and my responsibility to them is to present the science truthfully and rigorously, at least in a general sense. Medicine does a good job of erecting walls around its knowledge base --- with jargon, with a very particular way of presenting data --- and I wanted to bring some of those walls down.

BRC: When did you first become interested in writing? Did you have an interest in writing before you decided to enter the medical profession? Did you always plan to write in the medical thriller genre?

JS: Stories have been in my life for a long time. My parents read to me from a young age. I wrote a ten-page fantasy "book" in 5th grade, and skits through high school. In college, I took fiction and playwriting courses and learned the beginnings of craft. After college, I had a couple of short stories published in small literary journals. Throughout this time, I collected a file of rejection letters as thick as a fist.

As for working on a novel, I needed a base of expertise on which to build. Acceptance to and matriculation in medical school gave me that foundation. I chose to work in genre fiction for a couple of reasons. First, for me, some of the most exciting writing comes out of genre fiction. Second, the medical thriller format provided structure, which allowed me to direct my attention to character, motivation, and theme. Most of all, though, I like reading thrillers.

BRC: Do you plan on continuing your writing career after you graduate from medical school? Are you leaning toward private practice or toward a medical investigation position similar to McCormick's?

JS: I definitely plan to continue writing after graduation. There's a wonderful balance provided by medicine and writing. Medicine--- its intellectual work, collegiality, and patient contact --- is a great break from the solitude of writing. Writing provides a chance to process what happens in medicine and to exercise the other half of the brain. The two endeavors work nicely together. Besides, as for hanging up the stethoscope for the pen, I didn't really choose medicine as a path to being a writer: there are many, many easier (and cheaper) ways to become a writer than by going to med. school.

Regarding my path in medicine, I'm working that out right now. My lab research was in orthopedic surgery, but I have been entertaining other options lately. Whatever my specialty, my ideal position would be an academic one: I love the academic environment.

BRC: Who are some of your favorite authors?

JS: Michael Crichton's early work (A CASE OF NEED, THE ANDROMEDA STRAIN) is amazing. Nelson DeMille is one of the most literary writers working in genre fiction today, I believe. (THE GOLD COAST captures voice and place better than most books in any genre). I owe a lot to Robin Cook, especially to COMA. Ian McEwan is amazing. Raymond Carver was my first major influence and I read him obsessively. Lee Child seems to be channeling Chandler and Hammett better than any other modern author I know of. Then, of course, there are the big guys themselves: Chandler and Hammett.

BRC: We understand that you're currently working on a new novel. Is Dr. McCormick again the protagonist? When can readers expect to see your next book?

JS: Nate McCormick is the protagonist in my next novel, GROWTH FACTOR, which will be released next year.