PTSD and Human Remains

“I hate how Miss Marple solves murders and remains completely unaffected by them,” said my friend Jessica. “I like that Hope is real.”
Dr. Hope Sze is real to me, too.
The problem is that Hope has gotten a little too real in my latest book, Human Remains.
After the hostage-taking in Stockholm Syndrome, Hope has post-traumatic stress. Which means I have a few problems, as a writer.
1. PTSD may not be compelling to read about. Hope is numb and antisocial and angry. Not the cute little pixie detective your average reader might want to get to know.
2. Hope has a lot of backstory. For starters, I have to mention the hostage-taking and the fact that she has two boyfriends, without too many spoilers.
3. Normal writer concerns: I try to set up character, setting, and a problem in the first paragraph, ideally in the first sentence. I also need to establish that she’s an Asian female physician and that the story is set in current-day Ottawa, Canada, just before Christmas. Finally, I have a clear voice for Hope.

Here are the first 201 words.

Next, I'm coding it based on these three main concerns.

You may argue about how successfully I've accomplished my goals, and how well I'm telling a story, which is the ultimate bar for a novel, but one of the things I like about writing is the problem-solving. You get more skilled, but there's always another part of the craft that needs work.

The "My name is Hope Sze" paragraph is not my first choice, because I prefer subtlety in explaining the hostage-taking backstory, but in the end, clarity and accessibility to new readers were more important than my poet's sensibility. Also, I feel like it's a tribute to Sue Grafton, because I would smile in recognition when she'd start off, "My name is Kinsey Millhone..."

I generally have to add setting in afterward. Mysteries are all about plot, to me; I already have Hope's character and voice; but especially for this one, where she works in a stem cell lab, I had to tour Dr. Bill Stanford's stem cell lab, quiz him and Dr. Lisa Julian, and still ask questions months later. Even then, Michelle Poilly, a local college science teacher, asked me pertinent questions about adding shakers to the virology lab or explaining plasmids differently.

I don't pretend to be a PTSD expert, either, but at the Writers' Police Academy last summer, I had the opportunity to meet Paul M. Smith and his service dog, Ted. Paul is a counsellor for traumatized officers and their families. Paul suffers from PTSD himself, so he has a service dog named Ted. At one point, when students surrounded Paul with questions, Ted came up to Paul, reared up on his rear legs, placed his paws on Paul’s shoulders, and looked him in the eyes, grounding him.

Maybe that's why Hope befriends a dog named Roxy in this book. I believe animals are a wonderful way to rebuild ourselves.

What about you? How do you balance all the information you have to convey with the story you must tell to hook the reader?

And how do you talk about the serious issues in the world?

MD/Ph.D. Dr. Stephen M. Stahl points out that PTSD is an increasing problem. Of the soldiers in Iraq and Afghanistan, he estimates 1 in 1000 died, and 1 in 100 were injured, but as many as 1 in 5 ended up with a mental illness (PTSD, depression, or suicide). Twenty to thirty veterans die from suicide every day.

As writers and readers and citizens, how do we acknowledge these terrible realities, yet continue to create and shape a better world?

Do You Do Artist Dates?

“The Artist Date is a once-weekly, festive, solo expedition to explore

something that interests you.” Julia Cameron

An artist date is permission to play. Every week, you are supposed to explore something that makes you smile.

When I first heard about them, I was excited, but I circled around the idea cautiously, like an animal scenting something new. What is this thing called play? Am I allowed to indulge in it, or do I have to spend every waking moment working as a doctor, a writer, and a mother?

For me, because I live in the country, one of the barriers is physically getting to something that interests me. It takes me an hour to drive to Montreal, 1.5 hours to drive to Ottawa, and more if there’s snow or traffic.

And yet, it’s almost always worth it.

I think this is why writers love conferences. You go from isolation to a collective army of smart, funny people who love the same things you do (reading, writing, and Riesling). You can get some of the same vibe online, but it’s not as fun as in person.

Steve Steinbock & Melissa Yi at Bloody Words 2014

“It’s Brigadoon!” said Steve Steinbock, of Ellery Queen’s Mystery Magazine, who suggested I come to Bloody Words, the former Canadian crime conference.

“Huh? What’s Brigadoon?”

He explained that it’s a town that materializes out of nowhere, and then it’s gone. “Brigadoon!”

“Brigadoon,” I repeated, still a bit confused, but enjoying his enthusiasm.

Another barrier for me is that I hate spending money. I went to Left Coast Crime last year, felt guilty about spending money, and quizzed other authors in attendance if they felt guilty, too. The answer: no, with the unspoken corollary of "Why are you wasting your time here worrying about it?" Stacy Allen was kind enough to answer in detail. She said something to the effect of, “You have a gift. Everyone here has a gift. It’s a crime not to use it.”

With thanks to Lisa de Nikolits for the photo!

I just spent a long, long weekend in Toronto. The main goal was speaking at OLA, the Ontario Library Association superconference, through Crime Writers of Canada, on the Friday. I spent my two minutes explaining the genesis of Stockholm Syndrome (chasing after an escaped prisoner, as I explained in my interview with CBC Radio's Robyn Bresnahan here), connected with new readers, learned of literary conferences in Renfrew and Kingston, met James Wigmore, an author who’s a retired forensic toxicologist, and Judy Penz Sheluk invited me to post on her blog.

I stayed extra-long so that I could sing in a mass choir with MILCK, my favourite new singer--a brave, talented, risk-taker whom I'd like to emulate in many ways.

How about you? Do you do artist dates? Do you spend money on your art, and on your writing career?

Why does an author need an e-mail list?

People keep telling me to get e-mails from my readers. And they make good points. Like this:

“You can’t build your content on rented land. So many brands and companies build their audiences on Facebook and Google+, which is fine, but we don’t own those names – Facebook and Google do.” Joe Pulizzi, Founder of Content Marketing Institute

"You’re not just a status update that’s there and gone, you’re right in someone’s inbox, where they receive other important communication from their work, family, and friends." Nathalie Lussier, Digital Strategist at Ambition Ally

"Email marketing consistently generates 80-90% of our landing page traffic." Corey Dilley, Marketing Manager at Unbounce

But what really caught my attention was that my friend, Maggie Jaimeson, credits her mailing list with kick-starting her writing career. She took a Facebook ads course with Mark Dawson, learned how to make effective Facebook ads and how to band with fellow authors, and has recently celebrated a milestone: 10,000 subscribers.

Okay! Time for me to get some subscribers. I had a few hundred, mostly students who'd signed up after I'd spoken at health care conferences. Not the same audience as eager book-buyers.

I set up a landing page. I tried Facebook ads, but found them relatively expensive. What really worked for me? Instafreebie.

 You give away a free book--I used the short stories that Kobo had commissioned for the Gone Fishing mystery contest--in exchange for an e-mail address. My first one is here: https://www.instafreebie.com/free/qpGYY

Don't just use their free feature, because then you can't harvest the e-mail addresses. Instafreebie gives you one month free trial of "Plus" ($20/month) or "Pro" ($50/month). You can link it to your Mailchimp account and set up your mailing list there.

Then look on the Instafreebie forum and bundle with other authors in your genre. I bundled with a thriller group and got 350 downloads before I figured out that I had to upgrade to get the addresses (select "opt-in required"). So that was sad--except Instafreebie decided to feature me on their blog, resulting in 600+ e-mails. Altogether, 1000 people downloaded my book without me spending a dime, because I'm still on the free trial.

I'm currently doing a Horror and Suspense giveaway, a Chinese New Year celebration is starting up, and I can’t wait for the chick lit group on February 1st.

Of course, nothing's perfect. One author pointed out that you can end up with a lot of unsubscribers and complainers, because these readers are looking for free books and may get enraged if you a) have the temerity to send them a message, and worse yet, b) charge money for a book. However, I'm looking at my friend Maggie and her 10,000 subscribers. I want to be like her. And so I'm willing to try.

If you want to try, too, this is my Instafreebie referral link. No pressure. https://www.instafreebie.com?invite_code=cpSHuy8qdh

Another thing Maggie does is join with other authors to have contests. We're just finishing up the Transformations Contest on Jan 23rd at 11:45 Pacific Time with $250 in gift cards and $50 in book prizes. Depending on your time zone, you may be able to grab a free copy of EXPENDABLE and other terrific books: http://www.maggielynch.com/giveaways/transformations-contest/

I'm writing this past my bedtime, so please excuse any lack of lucidity. Please feel free to ask questions or provide tips of your own. I'm always looking to learn.

And in case you ever want to sign up for my list, it's very chill. The picture of my kids in squid balaclavas was very popular. https://landing.mailerlite.com/webforms/landing/x6d4e4

The Medical Post: Illness and Imagination

So while I was wrestling with my book monster, I missed the “Loaded Magazines” week on Sleuthsayers. The only outlet I write for regularly is the Medical Post. I love them. http://www.canadianhealthcarenetwork.ca/physicians/magazines/the-medical-post/

You might find some story ideas here. Say, Medicine’s psychedelic renaissance. Or...

Dr. Masajiro Miyazaki: From enemy alien to local hero in central B.C. by Dr. Sterling Haynes

After Pearl Harbour, the Canadian government rounded up any Canadian citizen with Japanese ancestry and either imprisoned them in relocation camps or deported them to Japan. (Meanwhile, Canadians of German or Italian ancestry, the Axis forces, did not have their property seized.) The government confined Dr. Masajiro Miyazaki to Lillooet B.C. When the local physician died in 1944, and they suddenly needed a doctor. Dr. Masajiro Miyazaki became their doctor. And their coroner. And their police doctor. And their alderman.

Julie Connolly: Single Mother, Solo Practice

Julie's a single mother of five children. She runs a solo practice in northern Ontario, including labour and delivery, which means she’s up all day and night.  “I was at the hospital for much of the night with a labouring patient….I still have meconium on the cuff of my sleeve.” Read more here.

She was interviewed about having her electricity cut off at home. Two of her five children are deaf and need to recharge their cochlear implants every day. 

And she still wrote two of the top most-clicked articles of 2016.

Let’s all give Julie a standing ovation!

P.S. She appears in my YMCA doctor video https://youtu.be/cKUQvrmYdAc, near the end. I wrote about that here.

Shawn Whatley also had one of the most popular articles of the year. “It’s not burnout, it’s abuse.”

Well said, Shawn. We’re tired of getting trampled. It also helps me because, as I mentioned here, I got sick last year. I called it burnout. But if the system is paying us less, demanding more, and slandering us, yep, it’s abuse. Shawn has proposed solutions as well, and has spearheaded a conference for doctors on careers outside of medicine. I’ll be talking about writing. http://nonclinicalmds.com/ 

Finally, I'm honoured to have one of my own articles chosen for the best of the year.

The sin eater by Dr. Melissa Yuan-Innes (April 5 issue)

"Dr. Yuan-Innes reflects on a old Welsh myth of the sin eaters that Margaret Atwood writes about in one of her short stories. “We study to the point of exhaustion and work inhumane hours for the privilege of seeing the worst of human nature,” Dr. Yuan-Innes writes. While she had gotten into medical school believing doctors were heroes, the revelation in Atwood’s story gave her pause: doctors are sin eaters in their own way, often shunned and depraved as a result of their work."

Thank you, Medical Post. Long may you reign.

Wrestling the Book Monster

“I’ve heard other writers say this: eventually you’ll struggle with a book. The plot will unravel, the characters will elude you, the theme will mishmash….

I just turned in my fourth novel, and I’m so happy to be rid of the Book Monster.”—Kate Moretti, author of The Vanishing Year

When I read Kate’s words on Writer Unboxed, my heart dropped in recognition.

Yes. I have spent over a year wrestling with one.

I never fully related to writer’s block. It’s not like I couldn’t physically write. The imagery of a single block didn’t appeal to me.

But a Book Monster? Some unknown, dripping thing rising from the depths of my subconscious swamp, its ichor and poisons hewn by my enemies, fearsome and loathsome, multi-tentacled and growing every-stronger?

Kate pointed out character and plot and author doubt problems in her excellent article. Now that I’ve finally vanquished the first draft of Human Remains, I’m going to share a few Book Monster symptoms with you, and see if any of you can relate.

How do you recognize a book monster?

How did mine get so out of control?

1. Plot? Where, where?

My plot popped and locked and waacked all over the place. I had lots of ideas, so I’d write 10,000 words with that murderer or 20,000 words with that subplot, only to change my mind the next week or seven.

I’ve always been a panster (“flying by the seat of my pants” kind of writer), because if I already know what’s going to happen, I won’t bother to write it.

After months of this, I considered plotting the book out properly instead. I also went to the Agatha Christie exhibit in Montreal and considered adhering to a strict formula like she did in And Then There Were None. Anything to stop the madness.

What finally happened was that I decided on a murderer and started writing toward that. If my mind said, Wait! Try this other murderer instead! Or Hey, you shouldn’t—, I ignored it and kept writing. No more changes. Well, some changes. But an inexorable overall structure.

Nanowrimo helped as well as hindered. I wrote 16,000 words before I stopped myself and said, No, Mel, no more words! Figure out what you’re doing with them first. But I enjoyed the feeling that the writers of the world were uniting to finish their manifestos, and it’s not a coincidence that I buckled down and finished on the last day of November.

2. No joy

Writers talk about suffering for their art.

As Walter Wellesley “Red” Smith said, “You simply sit down at the typewriter, open your veins, and bleed.”

But I used to like writing, or at least like having written. Most of the time, I still did—except when I’d stop and look at my latest manuscript chunk and say, “Wait a minute. How does that fit anywhere?” And, because I hate waste, writing over 250,000 words and knowing I was going to toss 75 percent was torture that I felt helpless to stop.

It made me not want to write. It made me want to read about Brad and Angelina instead of pounding out the words that were just going to get incinerated anyway.

3. Too much self-pressure

CBC Radio’s The Next Chapter chose Stockholm Syndrome as one of the best crime novels of the season.

I’d go to work and a nurse would say, “Where’s your next one?”

Mysterical-E published an excerpt of Stockholm Syndrome and interviewed me for their latest issue here: http://mystericale.com/current-issue/

I love it. But I also worried.

I’d strived to make every book in the series better than the last. But what if I couldn’t do it? I could already feel the Amazon reviewers filleting me and roasting me.

I felt relieved to hear Elizabeth Gilbert quote her mom as saying, “Done is better than good.” Because more and more, this Book Monster had to be done.

4. A symptom of a greater problem

One year ago, I battled back pneumonia during the book launch of Stockholm Syndrome. In retrospect, I’d never gotten physically sick for more than a few days. My body couldn’t heal up while I spent sleepless nights trying to work and write and publicize simultaneously.

Yep, I’m that doctor who was a terrible patient.

So finally I stopped and slept, and woke up and wrote. Because that is what I do. Only it came out in inefficient, convoluted bursts., so I wrote a back pain book instead. Then came back to my Book Monster, and which I called a Creative Drought at the time.

Looking back, I wonder what might have happened if I’d taken a break from my writing, the way I did from the emergency department. I’m good at powering through, don’t stop, don’t give in to fatigue or sadness or temptation. But sometimes it’s more efficient to take a rest and come back.

The trick is figuring out how to do that.

If you have a book monster, I’d like to hear about it!

’Cause misery adores company.

And also, because I have to do the second draft. But first, I’m taking a break! Partly because I just worked hideous hours in the emergency department, but also because maybe I’m learning something. Not only about writing, but about life.

Hate Crimes in Canada, Eh

I was supposed to work on my novel on Wednesday. Instead, I found myself on Facebook, looking for wisdom and solace. Most of my friends are either writers, health care workers, or both. I did find comfort in them. But I was also shocked by my newsfeed.
Peterborough is a small city of about 80,000 people and home to Trent University. After I graduated from my program in emergency medicine, I did my first locum in an even smaller town close to Peterborough. Beautiful area, green, lots of smiling people. Almost all white people, but that's the norm in a small Canadian town. Usually, rural-ites are friendly. Not always. In my life, no one has flung urine at me.
Although once, a teenager ran up to my dad in Ottawa with a plastic bag clenched in his hands and said, "Are you Japanese?"
I was maybe twelve and didn't know what to do.
My dad said, truthfully, no.
The guy ran away with his bag, which seemed to contain some sort of brown liquid.
Close call.



This is not isolated to Peterborough. Basically, I'm astonished that some people think they have new and wide permission to spew hate.
It was always simmering. When I took my kids trick-or-treating in Vankleek Hill a few weeks ago, a little girl on Main Street stared at me and starting singing, "I see your Chinese eyes" and more under her breath. I looked at her mother, who was staring blankly into space, and back at the girl, who kept singing. I thought, Do I confront the girl? Do I point this out to her mother?
My kids were tired, and we were heading back to our car, so I opted to glare at the girl and keep going.
Afterward, I mentioned it to my white husband. He hadn't even noticed. He laughed and said, "You like to glare."
Actually, what I like to do is trick-or-treat without racist commentary. Wouldn't that be nice?
If you think none of this is real, or it's exaggerated, or it doesn't matter because no one was beaten or died, you may enjoy reading this report on hate crimes in Canada in 2013: http://www.statcan.gc.ca/pub/85-002-x/2015001/article/14191-eng.htm#a2
It has nice charts like this:

I can't not speak.
I respect other Sleuthsayers' right not to engage, but in my mind, there is no point writing about crime fiction and ignoring crimes in real time.
Let me end with some wise words from Dr. Dylan Blacquiere, a neurologist, writer, and friend. I have edited his brilliance for brevity, but you should seek him out:

1. We have to, have to, have to get our own house in order. That could mean engaging with civic politics, writing letters, joining community organizations, running for office yourself. Our institutions are only as strong as the people who participate, and the best way to keep someone like Trump from destroying what we build here is to make sure that we participate fully to strengthen what we have. Clinton lost on turnout. People were not engaged. That means we have to engage. 

2. We have to pay attention to why this happened. Most of his voters are not racists or sexists or stupid. Some of them are, no doubt. But many are people for whom the system is not working, and they saw nothing to lose. That means we have to face these issues head on. Economic inequality. Poverty. Unemployment. Economic uncertainty. Trump's message wins when people are disenfranchised, vulnerable, and uncertain. If our economy is working for everyone in a fairly distributed manner, then a lot of the power of his argument goes away. And ignoring these people, dismissing them, not understanding where they are coming from, not seeing their experiences and not declaring them important, means that they will find some other way to make themselves heard. It's hard to blame them for that; we haven't always been that great at taking their concerns seriously.

3. More than ever we have to stand up and support the vulnerable and stand up for equality. Women, people of colour, LGBT, people with disabilities, immigrants. We have to support our allies and friends in the States who are in a vulnerable and scary place right now. We have to make sure rights and freedoms don't get rolled back here as politicians like Kellie Leitch start rising. 

4. And we have to face some uncomfortable truths - we aren't perfect here, either. Racism exists here. Our relationships with First Nations, especially here, are fraught with broken promises, inequality, and disrespect. Those 
comments that Trump supporters make; Canadians make those too, about women, about natives, about black people and queer people and Muslims and Jews. Many of our institutions have been built on past inequality and oppression. Part of standing against Trump means we have to face up to that and make those things better here. We absolutely do not get to rest on our laurels here; in fact, we have to recognize the fact that in a lot of ways we've done, and are doing just as badly. We need to fix that. If we truly want to stand for something good in a scared and uncertain world it means we have to improve ourselves, too, not just wag a finger at others. 

Bottom line: There's a lot we can't do about this. It's frustrating and it's discouraging and it's depressing. But the sun still came up yesterday. It's going to come up today, and tomorrow, too. There's work to be done. Canada has the chance to be the light the world leaves on for when places like the States and Great Britain come around and come back home. We have to seize that chance by strengthening ourselves, staying involved, and helping to fix the problems that led here and the ones
that will worsen because we're here. 

I spent yesterday numb and avoidant. I plan to spend today roiling up my sleeves and getting to work.

How to Kick @ss: Tami Hoag Edition

I'm fascinated by successful writers. I've decided to launch a new series where I examine authors I admire and try to unlock their secrets to success.

I met Tami Hoag at Writers Police Academy in August. Yes, that Tami Hoag. The one who's hit the New York Times bestseller list thirteen consecutive times, including five separate books within 20 months. #livingthedream

I happened to sit with Tami on the bus, chat with her over lunch, and listen to her speak at the banquet. Here are five pearls from Tami Hoag.

1. “People say I look like a nice woman. And I am. But I am a competitor.”

I love this. All of us, especially women, are socialized to be nice and kind and “After you” and “Don’t mind if I do.” That makes for a smooth society. But if you want to be a #1 international bestseller, you will have to throw down like Tami Hoag.

Well, maybe not exactly like her. In an interview with myPalmBeachPost, she said, "I could knock [you] out with a single punch and can talk about serial killers all day long.” She got into mixed martial arts for stress relief, and rode horses competitively, although she had to heal up five fractured verebrae after a dressage accident in 2003.

The killer instinct doesn’t mean you have to assassinate your competitors. Just get ready to put your shoulder in it, because…

2. “Writing is a mental full-contact sport.”

This may be my absolute favourite line. That was when I realized I have to read more of Tami's books. She is so passionate, so committed to writing, her body reverberates when she talks about it. There are famous authors who want to sit back and enjoy the money and adulation, and I don't blame them, but Tami is still throwing herself into the ring with everything she's got.

Just bought it.

3. “Commitment is a four letter word to me. I am a total pantser. In all other areas of my life, I am highly organized."
The sweet, sweet sound of someone who writes my way, which is to say, flying through the darkness, making it up en route. As Tami put it, "I know what the central crime is. A third of the way through, I say, ‘I don't think he did it.’ I call the editor and say, 'That's not who did it. Do you want to know who did it?’”

4. “You can't please everyone. It dilutes the quality.”

She does get people contacting her to complain that her characters are swearing, but she said she writes exactly how she sees real police officers talking. "I use the vernacular." When readers complain, it "makes me want to go around my office and say #@#%^@# @#^ )()&.@#@"
That made me laugh. Of course, I also like to swear.

5. “Somehow it's all there. Somehow it's all good.”

In other words, trust the process. In the end, even if she has to get her editors to tell her whodunit, or she has to take back a book to rewrite it to her satisfaction, at the end of six or nine months, she's once again created a brand new, character-driven thriller that has a bajillion readers clamouring for more.

Do any of these pearls speak to you? Are you a competitor? Is writing or reading your mental full-contact sport? Sound off in the comments. And if you'd like to hear more about Writers Police Academy, I'll be blogging about it at my own personal website. Cheers!

Viruses and you

“A crappy virus is one that kills its host.” —Agnes Cadieux of the Ottawa Hospital

At our Can-Con 2016 infectious diseases panel, Dr. Anatoly Belilovsky, a paediatrician and SF writer from Brooklyn, explained that the most virulent viruses have jumped from animals to humans, killing the host before figuring out how to be less destructive. (You can imagine that a dead human isn’t as effective at passing on the vector when the body is buried inside the ground.)

Dr. Belilovsky said, “Rabies is not a human infection. It’s happy on bats. When it jumps to dogs or humans, it doesn’t do so well.”

“It’s a virology drive by,” said Dr. Dylan Blaquiere, a neurologist in New Brunswick.

Agnes Cadieux talked about how herpes simplex, herpes zoster, and even HIV are evolving to co-exist with humans.

Dr. Anatoly Belilovsky, Dr. Dylan Banquiere, Agnes Cadieux, Dr. Alison Sinclair, Dr. Melissa Yuan-Innes, Pippa Windsong 

Pippa Wysong pointed out that often a flu virus will kill the very young and the old. With Spanish flu, the cytokine storm was what killed people. This targeted people with strong immune systems.

The Spanish flu killed over 50 million people, and that was in 1918. If a virus struck like that today, the consequences would be absolutely devastating.

One audience member asked about superbugs and antibiotic resistance. One key problem is patients asking for unnecessary antibiotics. I can tell you that I’ve spent many cumulative hours explaining that no, you don’t need antibiotics.

Them: But I’ve lost my voice!

Me: Yes. I hear your hoarse voice. And 90 percent of the time, laryngitis is viral.

Them: I’m coughing up yellow and green stuff!

Me: Those are just old white blood cells. You have bronchitis. Seventy-five percent of the time, it’s viral.

Them: My throat is red!

Me: Most of the time, your sore throat is viral. Strep throat only causes ten percent of cases. And even if it is strep throat, a normal immune system will kill the bacteria almost as quickly with or without antibiotics. The strep strain in our area does not attack the kidneys (glomerular nephritis) or heart (rheumatic fever).

There are exceptions, of course. For example, I prescribe antibiotics to people who have emphysema and two out of three of the following: more cough, shortness of breath, and/or a change in mucous, because they may go on to develop a devastating pneumonia. You always have to watch out for premature babies, transplant patients, people on steroid medication, HIV patients, and so on.

But most people are healthy, with perfectly good immune systems, that can and will fight off infection. As my friend Dr. Michael Sanatani pointed out, “What’s the one thing bacteria have never developed a resistance to?”

Answer: Our immune system.

Voltaire put it this way: “The art of medicine consists in amusing the patient while nature cures the disease."

Of course, we have many more powerful weapons than in Voltaire’s age, but the problem is that, as one doctor put it when he was trying to convince us not to use a too-strong class of antibiotics when we don’t need them (fluoroquinolones), “We’re using bulldozers when we can use shovels.” Because patients are demanding them. Because patients don’t want to hear “Suck it up.” Because it’s faster to write a prescription than explain over and over again that you should save antibiotics for when you need them, or else they won’t work when you do need them. Plus they cause diarrhea and other problems.

Viruses and bacteria are a normal part of our environment. In fact, viruses make up 8 percent of our DNA. I, personally, avoid antibacterial soap, which kills the “good” bacteria and allow the more dangerous ones to propagate. Thank goodness the FDA agrees with me.

It's time to stop the fear. Dr. Alison Sinclair said, "When have you ever heard the word 'virus' in the media without it being preceded by the word 'deadly'?"

The solution to fear is education.

I'll be writing more about Zika on my own personal blog, http://melissayuaninnes.com/the-zika-page/, so please follow me there if you want to know more.

To your health!

Dare to Be Bad: Human Remains

Once upon a time, two writers challenged each other to write a story a week. It didn’t have to be good. In fact, their motto was “Dare to Be Bad.” But it had to be done at the end of the week.

If a writer failed to write a story, s/he had to buy the other a steak dinner. Because they were poor, this was great incentive.

They wrote a story a week. They mailed the stories to editors instead of obsessively rewriting. They got better and better. You may recognize their names today as Nina Kiriki Hoffman and Dean Wesley Smith. I met them when I was a winner in Writers of the Future in 2000 and found both of them inspiring.

Karen Abrahamson,
Jay Lake,
Dean Wesley Smith,
Leslie Claire Walker

After going to Writers Police Academy this month, I realized that part of the reason that I was locked up on the fifth Hope Sze book, Human Remains, was that I wanted it to be amazeballs.

Now I still want it to delight, entertain, shock, and thrill, but I also want it to be done. And I want to loosen up about making it perfect.

William Stanford, Ph.D.

I also got a jump start in June when I visited the stem cell lab of William Stanford, in Ottawa. He kindly gave me a tour and okayed the science in the following excerpt, which may or may not make the final cut of the book, but will probably teach you about CRISPR and other awesome innovations.

Rough draft excerpt of Human Remains, by Melissa Yi

“Do you know what CRISPR is?” said Tom, the head of the stem cell lab. He pronounced it crisper, which made me think about my parents’ overstuffed refrigerator and/or the best potato chips.

“I do.” I swallowed and tried not to look obvious about it. Medicine teaches you not to show fear. Tom’s eyes were kind and steady on mine, but I’ve seen preceptors act super understanding to your face and then sabotage you with a substandard evaluation. “At least I understand the concept of cutting genetic code with ‘scissors’ made of clustered regularly interspaced short palindromic repeats.”

That’s another evaluation trick. If you can spout jargon immediately and correctly, they’re more likely to nod and leave you alone. I wasn’t getting the vibe that Tom was hostile—quite the opposite, actually—but I needed a good evaluation on this rotation, or Ottawa wouldn’t accept me and McGill might fail me, both of which would torpedo my career.

Tom rubbed his chin and gazed out his window. Of course, it was a sign of status that he had a corner office with a window, but I got the feeling that he would’ve hung out in a sun-free basement for decades as long as it meant he could research stem cells. I relaxed a smidgen. He said, “Do you know the back story? I wouldn’t expect you to, but it’s fascinating.”

I nodded and smiled. Yes, please. Tell me the story. If you get them talking while you ask intelligent questions, they recall you fondly on your evals, and there’s less of a chance you get tripped up on weird questions about DNA sequences.

He said, “Yoshizumi Ishino first noticed these repeating DNA sequences in E. Coli in 1987. They were separated by short unique clusters of DNA, which was strange, because repeated DNA usually appears consecutively.”

My mind was already ping-ponging around. E. Coli causes a lot of urinary tract infections and is therefore considered my personal enemy. But I tried to contribute to the conversation. “Yes, I listened to a podcast on it. They compared it to sounds. So the repeat DNA sequences sounds like”—oh, God, now I was going to have to do it. I honked. Tom stared at me while I honked like a duck, five times, my cheeks burning. “And the sequences in between are all different. Like…” I honked, made an eee! sound, honked, oohed, honked, clicked, honked, oinked, honked, and meowed.

Tom stared at me. “I have never heard it explained it that way before. Which podcast was this?”

“Radiolab.” My friend Tori had sent me the link. Thank you, Tori. “They had better sounds, of course.”

“No, I like yours. I’m going to use that in my next lecture. That should wake ’em up.”

“I’ll send you the link.” I don’t know if I’ve ever been more embarrassed in a professional lab. But I could also tell I’d won him over within the first hour of arrival, which boded much better for me getting a stellar reference letter. I resisted the urge to cross my fingers.

“Did they also explain what CRISPR does?”

“They said CRISPR was like a mug shot of the bacteria’s enemy viruses. Like, when a virus attacks, the bacteria send out the ground troops of their immune system, but most of the troops die”—just like marines. Just like Tucker and I almost did—“and so do the bacteria. But if the bacteria survive, their enzymes cut the viral DNA up and then store short sequences—the CRISPR—interspersed with their own DNA. That way, they can carry around mug shots, or most-wanted ID’s, of the viruses that almost killed them. So if they ever run into the same viruses again, they can ID them right away from the CRISPR and send out targeted forces to vanquish them, in the form of enzymes that will slice up the viral DNA.” Faster than cutting off a zombie’s head during the upcoming apocalypse, I wanted to add, but didn’t. He already thought I was weird enough. 

There were a lot of problems with my explanation. It was super basic. I wasn’t talking about B-cells or T-cells because Radiolab hadn’t. I couldn’t even talk intelligently about RNA. I was sketching the surface. If he asked me to dig deeper, I was pretty much toast. At least I got to sneak in the word “vanquish.”

“That’s pretty good,” said Tom, drawing his eyebrows together and pursing his lips. I couldn’t tell which way he was going, i.e. if he liked my explanation because it was understandable, or if it pained him because it was too low brow. “Did they talk about Cas?”

“Not so much, but I know they’re the enzymes that do the actual cutting.” On of the online science articles, a commentator had lamented that Cas9 and other enzymes do all the work, but CRISPR gets all the credit. Another commenter said that CRISPR had the sexier name. They were a team, though. CRISPR identifies the bad guys, and then Cas9 or another enzyme will step up and do the slice and dice. Like a sheriff and an executioner, although I don’t know the legal or immune system well enough to give a proper analogy.

“And do you know how CRISPR and Cas are revolutionizing research?”

My turn not to grimace. He was a tougher customer than I thought. “I know that this technique is faster, cheaper, and more precise way to cut a gene sequence than we’ve ever had before. I know that once you cut out the sequence you don’t want, all you have to do is plant another sequence you do want, and the bacteria will help mend it by replacing the bad sequence, so the media is already fantasizing about designer babies. I know that zinc finger nuclease and transcription activator-like effector nucleases can handle longer DNA sequences, but they’re slower and less likely to work.”

“And knockout mice?”

I was starting to sweat. I’ve never worked with mice. It’s a miracle I ever got into medical school. Luckily, Tori had told me a little about her research with mice whose genes that have been disabled, or knocked out. “You used to have to inject altered DNA from embryonic stem cells and hope that they’d get incorporated through homologous recombination.” He didn’t blink. Using jargon didn’t impress him. I guess, for him, it was about as jaw-dropping as an ingrown toenail was to me. Damn

it. “The mice that successfully incorporated the altered DNA were called chimeras. Then you’d hope that the chimeras would breed and make more mutant DNA, so by the third generation, maybe you’d get a mouse with both copies of the mutant allele. But with CRISPR/Cas9, the system edits the gene right away, and the first generation has the mutation.”

Tom smiled. “Why stop with one mutant gene? We could do five at the same time. CRISPR is also the best cross-species technique so far. We used to confine ourselves to mice, rats, fruit flies, zebra fish, and C. elegans, but right now, I’m waiting to see if there’s a species that CRISPR doesn’t work in.”

I hesitated, checking his eyes to see if my explanation was good enough. I held my breath, praying that he wouldn’t ask what C. elegans was. Dear Supreme Being, should you happen to exist and care to hear my pleas, if Tom doesn’t ask me about C. elegans, I promise I’ll look it up later.

He high fived me. “Good enough! You’re the first person who ever honked at me to explain CRISPR.”

I sighed, a mix of relief and despair, while he reached for the doorknob of the pale wooden door behind his desk. It opened directly into his lab. He said, “That’s great. You’re going to fit in here just fine.”

He waited for me to enter, so I did, and he said to my back, “You’ll have to tell me about the dead body another time, though.”

There you have it. I am officially daring to be bad. I'm posting the opening chapter of Human Remains on my website as well.

How about you? Dare to be bad?

Harry Potter and the Love of Reading

I love Harry Potter.
When we moved to Montreal for my residency in family medicine, I was too cheap to buy the next two Harry Potter books, so I read at least one book in French, for free, from the library. To my surprise, it wasn't as funny. The jokes didn't translate. The funniest part was me figuring out that bouledogue meant bulldog. So I broke down and bought the books in English, which turned out to be a great investment, because after I caught gastroenteritis from one of my little patients on paediatrics, I ended up reading the first four books over and over again.

Harry Potter and the Goblet of Fire was my hands-down favourite. The Quiddich! The tournament! Ron and Hermione! The agony of Cho! Dragons! Merpeople! The heartbreaking but necessary ending. Oy oy oy oy oy oy oy, to quote another one of my patients.

The magic wavered during Order of the Phoenix. Harry was so angry, Umbridge so unbearable, that I finished it and all the other books, but I closed my heart. I read the battle scenes quickly, bracing myself for the deaths of people I loved. I never re-opened books 5 to 7 again.

It's only in the past few months, starting the series with my ten-year-old son, Max, that the magic has not only returned, but doubled, tripled, and had quintuplets. I had re-read the first four books, of course. But it took me until a good halfway through OOP (Order of the Phoenix) with Max before I finally pushed everything aside and said, "Nobody bother me until I finish this book." Then I re-read the last two books and found them much better than I'd remembered. Yes, even the epilogue.

I dragged my children on a two-hour drive to their first-ever Harry Potter unveiling. I was working the next day, and they fell asleep on the way there and back, so we only stayed for about half an hour, but I'm glad I did it. I wished I could've made it to the parties in Winnipeg (thousands gathered in Assinboine Park) and Calgary (transformed into Diagon Alley!).

So, on July 31st, Harry Potter and JK Rowling's birthday, I had to work in the emergency department from 0800 to 1800. I wore a white shirt, a tie, and a velvet jacket in their honour. But I hadn't stayed past midnight the night before to buy a copy of Harry Potter and the Cursed Child, so I'd either have to buy an e-copy after work, make a special drive in for a paper copy on my day off, make my husband pick one up, or do without until they shipped a copy to my rural house.

Enter Tiff, a fellow HP mega-fan and unit coordinator. On her break, she headed to the bookstore and picked up a copy for her and a copy for me. Mischief managed!

I finished reading Harry Potter and the Cursed Child this morning. It wasn't as complex and finely-wrought as the novels, but it still made me think about good and evil, and I teared up more than once.

I don't want to imagine a world without Harry Potter. Not only do I love the stories, the author, and the fact that JK Rowling supports charities, but there are studies on how Harry Potter and other fiction can create empathy, especially in young readers. Plus other fantasy authors, like Linda DeMeulemeester, have benefited from the rising demand for new worlds.

Is it any wonder that our baby was born with a lightning scar? ;)

Dear Jo,
Thank you for all you've done.
Love,
Melissa

Sweet Dreams and Armpits

A is for…

I'll start off with the second part of the title first.
When I get a trauma case, my priorities are ABC, or C-ABC

C-spine (some experts put this first, so we don't forget to immobilize the cervical spine)

Airway: is the patient talking? Bleeding? Suffering from a burn that will close off the airway?

Breathing: now check the lungs and chest. Look at the respiratory rate and oxygenation.

Circulation: is s/he bleeding anywhere? How are the blood pressure and heart rate?

D is for disability, which means a neurological exam. Pupils, reflexes, and strength if the patient will cooperate.

Dr. Scott Weingart, an emergency physician intensivist based in New York, emphasizes E for Exposure in penetrating trauma. You need to find the entry and exit points so the patient doesn’t bleed out from a bullet wound in the back while you’re messing around with a chest tube in the front.

So even before establishing airway, if the patient is maintaining an airway and has no blunt injuries, Dr. Weingart inspects “every square centimetre” of the patient’s skin, including the axillae, the back, the gluteal folds and the perineum, including lifting up the scrotum in a male patient. A much catchier mnemonic, proposed by Dr. Robert Orman, an emergency physician in Portland, Oregon, is: “armpits, back, butt cheeks and sack.”

With thanks to Leigh Lundin for pointing out that I had forgotten to post, and to the Medical Post for originally printing this clinical pearl.

Sweet Dreams

And now for a happy dance: one of my writing dreams has come true. When I looked at Rob Lopresti's column, I recognized the Forensics book cover by Val McDermid.

Why? Because it was chosen as one of CBC's best crime books of the season--along with my own Stockholm Syndrome.

Kris Rusch has said that you should make sure you set writing goals, which are within your control, as well as dreams, which are pies in the sky.

Well, I've been wanting to get on CBC's The Next Chapter for years. So I updated my list of writing dreams and goals here.

Goal: unlocked!

Of course, I have approximately 2 million other unrealized goals, but it's a start. How about you? What are your writing goals and dreams?

Signing out so I can get some sleep before my ER shift tomorrow. I hope I won't need to use my C-ABCDE mnemonic, but you never know what'll happen.

Peace.

Aliens, Hot Dogs, and the Case of the Missing Rat Island

Once upon a time, experimenters took a bunch of rats and divided them into two groups. Both groups were dropped into a tankful of opaque water, but one group had an island, not visible under the surface, so those rats could eventually rest with their heads above water. The other group would…swim until they sank.

Luckily, the experimenters pulled all the rats out of the water before they could drown.

The next day, they set both both groups of rats in the island-less tank.

The rats who’d had islands swam twice as long as the rats who’d never had an island.

Bestselling author Jennifer Crusie pointed out that if you’re a writer with an island—basically, a writer with faith, a writer with resilience, a writer with grit, a writer who’ll keep swimming, writing, perfecting the craft, submitting, and persevering twice as long—that is the ticket to success.

For years, I’ve wrestled with this concept. It totally makes sense. But how can you force yourself to become a rat with an island? You can’t just hit yourself on the head and say, “Zowee, now I know everything will work out, if not this century, then the next!”

I got a clue last week, when I flew from Montreal to Los Angeles for Sci-Fest LA. I was a finalist for the Roswell Award for the best short science fiction, for the second year in a row. I was pretty sure a comical story like “Humans ’n’ Hot Dogs” wouldn’t win, so I considered staying home.

Then I thought, Nope. I’m going. I’m going to have fun and celebrate, whether or not I win $1000.

Award-winning Hollywood actor Rico E. Anderson read my story. Yes, that Rico E. Anderson. Boras in Star Trek: Renegades. The man in Criminal Minds, Modern Family, Young & Hungry, and Bones, and The Fosters in June. He got his first big break in the 2005 Academy Award Winning short film, Mighty Times: The Children's March.

Do you prefer theatre? Rico’s got you covered. His stage credits include Oedipus and Malcolm X.

Or, if you’re like my dental hygienist today, you’ll recognize him best from a recent episode of Grey’s Anatomy.

So no wonder I was surprised and delighted by Rico’s interpretation of “Humans ’n’ Hot Dogs.” He seized the audience’s attention from the first syllable. He adopted voices for different characters, including aliens, a homeless man, and a pack of skateboarders. He winked. He worked the spotlight. He was funny, dynamic, and likeable.

The audience laughed and cheered.

And yet I didn’t win the Roswell Award.

<Pause to grieve.>

So many people adored my story, though. “It was so funny!" “The judges were absolutely gleeful after reading your story.” “I try to keep an eye out for stories that are suitable for young adults, and yours was it.” “Promise me you’ll keep on writing.”

And I loved Rico’s interpretation.

I could slink back to Canada, quietly weeping over my defeat.

Melissa Yuan-Innes and Rico E. Anderson

Or I could try something else. Something a rat with an island might do.

We weren’t allowed to record Rico’s performance at the Roswell Awards. But what if he recorded it later, and we released it as an audio book?

This is a financial gamble. A short science fiction story by a relatively unknown author isn’t going to light up the bestseller lists any time soon. This would be a special project. One for people who love wee gems, who support the underdog and love art for art’s sake.

Rico and I are going to crowdfund it. I decided to avoid Kickstarter and just have donations go to PayPal through olobooks [at] gmail [dot] com, to try and make every penny count. Both of us are committed to making the best production possible.

And the rewards. The rewards!

Donation levels

Any donation: heartfelt thanks and a backstage picture of Rico shirtless (to show off the wounds for Grey’s Anatomy, not just to ogle). Goal: unlocked! I’m posting it to my website (http://melissayuaninnes.com/bringing-humans-n-hot-dogs-to-life/) in case any SleuthSayers have sensitive eyes.
Wiener ($5): an advance e-book copy of Humans ’n’ Hot Dogs and enormous thanks from Rico and me.
Pepperoni ($10): an advance deluxe e-book copy of Humans ’n’ Hot Dogs, including cartoons, inside tips on how to how to network in Los Angeles, and behind-the-scenes stories from Sci-Fest LA, Caltech, and Buzzfeed
Bangers ($20): deluxe e-book and you’ll be the first to hear the audio book, before it’s uploaded to Audible, iTunes, and other retailers. Humans ’n’ Hot Dogs all the way!
Chorizo($25): now we’re cooking. Deluxe e-book, audio book, and line producer credit in the book.
Andouille ($30): now we’re sizzling. All the previous rewards, co-producer credit in the book, plus a copy of my audio book, The Most Unfeeling Doctor in the World and Other True Tales From the Emergency Room
Bratwurst ($50): smells absolutely delicious in here. Must be your generosity. Includes all of the above, with associate producer credit in the book
Mortadella ($100): every single previous reward, with executive producer credit in the book, an autographed photo of Rico (yes, he’ll even do the shirtless one if you ask nicely), and a copy of the print book, shipped anywhere in the world for free. Yes, a real, live, print book that you can pass on to future generations, along with Rico’s stunning rendition of my oeuvre.

In other words, Rico and I are going for broke.

He’s a full-time actor in Los Angeles. He’s used to taking this kind of risk.

Me? Not so much. I no longer feel like rejections are mental razor blades, but I’m embarrassed when people turn me down. Yet I can see how handling failure wisely is one of the keys to success.

Rico and I may fail.

We may fail spectacularly.

But we’re both going to keep on swimming, and we hope you do, too.

Sleuths: are you a rat with an island? If so, how did you get that way?