Author Archives: Dylan Blacquiere

The Art of Writing Medicine – Pitfalls

So you want to write a scene with a medical element to it. The bad guys have knocked the love interest unconscious, or someone needs to die of an awful disease, or you need to establish that your physician character knows (or doesn’t know) what she’s talking about. But you want to make sure you do it right – not too much detail but enough so that you don’t look foolish. How do you walk that line?

It’s probably easier than you think it is. First of all, big breath – unless you’re actually writing an article in The New England Journal of Medicine you’re probably not going to have to be exact. Readers don’t want verbatim quotes from a medical textbook, but rather details that enhance or propel the story, or help to define who the characters are. That said; you do get points for accuracy, or at least some form of plausibility.

In no particular order, here are some suggestions to avoid common pitfalls when it comes to writing medicine in science-fiction and fantasy

  1. Nothing is absolute, within reason.  There’s no hard and fast rule to state that your medicine has to be accurate, and for many, engaged in world building of alien species or seeing the needs of the plot, being shackled to the rules can limit the creative work. That said, there are always certain things that people will pick up, especially if they have some medical knowledge of their own. The bottom line is that you don’t have to show yourself off to be an expert, but you should  be able to use common sense as to when you can fudge it and when you need to do research, or better yet, ask for help.
  2. Avoid the common errors. That is, there are certain mistakes that are so common that you should just be able to avoid them as a matter of course. Just because people on TV or in movies can get up and keep going after being given CPR, that doesn’t mean you should write it that way. In real life, getting a pulse back after CPR is a rare thing, and if you do, it’s still more likely to lead to a screaming ambulance ride, a breathing tube and an advanced cooling protocol, and a stay in intensive care. Likewise, being hit on the head such that a character loses consciousness is a serious neurological emergency; at best it’s a concussion when they wake up, and at worst there could be serious bleeding inside the head.
  3. The more crucial the point, the more specific you’ll have to be.  This stands to reason; if the medical plot point is minor then it won’t require as much detail in the story as something major. As an establishing fact of your alien’s biology, to say that there are three biological sexes can be a great way to establish difference. If your story depends on that fact for a plot point, you’re going to have to put some thought into how to describe that. It seems simple enough, but it means that if you’re going to trip up anywhere, this will likely be it. Do the research, think about what will or won’t work, and then go for it.
  4. Alien/fantasy medicine can work best as a variation of what we know. If part of your story hinges on a fact of alien biology, one way to make it plausible is to use the human known version as a template and diverge from that. In “Star Trek”, Vulcans have green blood that is based on copper instead of iron. The writers didn’t just make that up, however; in our own bodies, iron is a key component of hemoglobin, which carries oxygen in our red blood cells by binding its ionic form to oxygen. Copper ions are also used in our body – not for the same purpose, but it’s not a complete leap to suggest that evolution couldn’t use it for an analogy to hemogloblin. Likewise for organ structure or diseases or other biological facts; one way to get started is to vary from a known theme.
  5. Alternatively, vastly different biology/medicine is better left to the imagination. If you are planning to detail the biology of a species or a race that is vastly different from ours, and you want to make it something completely unrelated to what we know – well, there’s no reason you can’t, but this might be a situation where it’s best to go for less detail instead of more. Getting bogged down into what makes everything so different and alien may end up overwhelming the reader. Better to stick with a few tantalizing details and leave the rest to the imagination without worrying too much about explaining.
  6. The medicine serves the story, not vice versa. Finally, keep in mind that none of these suggestions trump the basic need for good storytelling, believable characters, and compelling plot. It won’t do you any good to explain your thesis about your alien species sixty-four chromosomes or your brilliant doctor’s ability to transplant anything into anybody if it swamps the fundamentals of good writing. Using medicine or medical characters in a story needs to move the story forward, not get it mired in exposition and detail.

Next – writing a good doctor.

The Art of Writing Medicine – Introduction

I think everyone gets a strange mixture of feelings when reading characters who do the same things we do. When a character in a piece of writing has the same hometown, or the same hobbies, I always get excited to see how true the details ring – never wanting the story to get bogged down with the shout-outs, mind, but interested enough to see if the writer knows what they’re talking about. It’s always the most fun, though, when someone has the same job as me.

You see, I’m a physician. And people love to write about physicians, about medicine; in fact, we’re one of the great tropes of genre fiction. Sci-fi, thrillers, even romance novels love to have physicians in them. It’s a perfect setup! If you’re writing a noble protagonist, who better to be selfless and caring, dedicated to healing the sick and doing good works for all? If you want a slick, smarmy villain, who better than the thoughtless physician who cares nothing for patients, deep in the pockets of the pharmaceutical agency or some other sinister cabal? We do half-crazed pretty well, with all kinds of pretensions to playing God; mad doctors have been a staple of science-fiction and fantasy since Frankenstein and Moreau.  A dashing love interest for the romantic hero or heroine – who wouldn’t want to snag a rich doctor, probably good with kids and not too bad on the eyes? The physician is one of those great tropes in fiction that can go any way you please, hero to villain to anything in between.

Even when we aren’t the focal point, doctors make great Fifth Business, as Robertson Davies might have said.  Physicians can be great plot propellers, even if they aren’t main characters – who better to provide exposition to a sudden health crisis, or be forced to reveal some terrible secret, or be a focal point that the heroes must find to heal an injured comrade. Really, a physician can be almost anything in the story, and done well, there’s almost no role that we can’t fill.

Done well, though – there’s the problematic thing.

As with any field, medicine can be a hard thing to write. There is a lot of detail involved, and getting something wrong can turn a knowledgeable reader into a ruthless editor. This is no different from computer science, or history, and it can depend on the scale of the error; getting the name of the surgical instrument wrong is a far cry from an unrealistic portrayal of childbirth or a head injury. As well, getting the details right doesn’t help if the scale of detail swamps the reader. I once wrote a story where a crucial plot point depended on the reader knowing how chromosomes divided during reproduction, and while I think I did a good job explaining the process, it still was nearly half a page of a cytogenetics lecture. It can take a lot of skill to do this properly – or to realize if there’s a better way to explain it altogether.

My next few posts will be dedicated to the art of writing medicine. Sooner or later most writers have some medical plot point or physician character, even if minor. In my next post we’ll talk about some of the common pitfalls that writers experience beyond just getting the medical science wrong.  After that, we’ll take a look at how to write a good physician character, how to write believable medicine in your fiction, and we’ll even look at how to use it in “realistically unrealistic” ways for those of you who like your medical science mad. I’ll talk about other health professions in fiction beyond the physician – after all, multidisciplinary teams are the norm these days – and finally, we’ll look at some interesting ways that medicine could be used beyond the routine tropes of fiction.

I’m looking forward to this Grand Rounds of Fictional Medicine, and I hope you are too.

Managed Expectations

One of the things that the contributors to this blog do, as part of a larger community of writers, is to set goals for the coming week that we broadcast to each other. The things that we need to do, or aspire to do, written there and stated plainly to the others in our writing group. The following week, we not only make new goals, but we account for our progress on the old ones. It’s been a way that we can keep in touch with the goals of others, and act as encouragement for those who need it, or to celebrate in each other’s accomplishments. Sometimes we’ve cheered as someone gets a publication, and sometimes it’s been something as simple as praising someone meeting their quota of words for the week. It’s been a great way to keep in touch with what people are doing, and what people are hoping to achieve.

In another sense, it’s a way to keep each other accountable to our goals, even if the only sanction is a sense of shame at not having lived up to the standard you’ve set for yourself. There have been times where I have cheerfully and earnestly placed a goal – say something modest, like writing a few thousand words – only to fail at it, and then have to face up to writing that accounting the following week.

Sometimes I write my rationalizations – oh, what the hell, excuses. I was busy. I did this instead. I did that instead. Et cetera. Sometimes – the times when I really didn’t have an excuse – I just didn’t say anything. A flat, inflectionless statement of the coming week’s goals, as though last week’s mark had been completely forgotten.

Inevitably that leads to a sense of frustration and failure. Wracking up week after week of missed bars is not a good feeling, and there have been times when I have felt that keen frustration that comes achingly close to just calling the whole thing off, taking a hiatus, not bothering to keep up with the accounting.

This is the wrong way to go about it. If you’re at all like me – someone who has a desire to write, but has a whole lot of life in the way of it – it’s important to keep those goals, and those reckonings. But maybe they have to be shifted. Maybe this won’t be the year that the blockbuster gets written or the screenplay gets done. But maybe, if you can block off some time, hit your small achievable goals, well, that well keep the whole thing from turning into an inescapable morass of shame and failure.

For me, I have my final licensing exam for my medical boards in May. I will not have time to do much writing in these last five months – I just wont. Afterward, we’ll see. In the meantime, what goals can I achieve? How can I do enough to justify to myself that I am a writer, as opposed to some hobbyist with an unused laptop in the corner? Maybe for the next five months it will be blog posts, and small submissions to journals that carry prose and poetry in the medical humanities field. Maybe token goals – a scene a week, or a couple of hundred words. Something that won’t detract from the very real need to study for this exam, but will make me feel as though I’m still actively engaged in this equally important passion. A managed expectation, if realistic and still aimed toward the future, can still be an important one, and one that keeps you on the path forward until you can raise the bar higher once again.


The clinical case that made me become a neurologist was a patient with one of those weird clinical syndromes that are usually seen only in a textbook. I was a second year medical student on the stroke ward for the first time; there I met a woman who’d had a stroke in one of those strategic sweet spots that we sometimes see. She’d hit a part of the brain that affected her right visual field, meaning she couldn’t see the right half of the world, but she’d also hit a part of the corpus collosum, the huge tract of white matter that allows neurons in the left and the right hand to talk to each other.

The implications of this were clear as soon as my supervisor asked her to write a sentence. She did so, making a fully legible statement about the sky being blue on a piece of scrap paper.

My supervisor looked at me, as if to brace me for what was coming. “Can you read that, please?” he asked.

She couldn’t. For the life of her, she could not read the phrase she had written down not ten seconds before.

I’m a neurologist, so I know the substrate – her left visual field could see the letters, meaning her right brain could process the images, but because the corpus collosum was knocked out, the visual information couldn’t get to the language centre. The letters she herself had written could not be interpreted; with a blood clot to the brain and a stroke of bad luck, this high-functioning woman had become completely and utterly unable to read. The fact that she could still write seems an especially cruel irony, but that’s the way the brain works.

I write this because it makes me think of the importance of language – as a writer, it seems such a struggle to get the right word on the page, to make the plot flow and the dialogue natural and the characters believable. As a neurologist, I see the things that can happen to our language on a daily basis. The words stop coming out, or a word gets substituted for another, or a person’s speech and comprehension dissolves into gibberish. We have our terms for it – aphasia, alexia, agraphia – but the bottom line is that they all rob people of that ability to communicate, the very medium that those of us who write depend on.

It’s a sobering thing to think, that all of our stories and plots could be lost forever with just the right blow to the right neurons. Our writing, our words, are such impossible and fragile things, and that’s all the more reason to treasure them while we have them. I think about that a lot when I hear of people with language complaints at work – how I would cope, what I would do, if the ability to read or write or speak were suddenly robbed from me.

So, to be a bit of the nagging health advocate, stop smoking, watch your blood pressure, get exercise, treat your heart and blood vessels right. These things usually happen because of a lifetime of bad habits and it’s never too late to turn that around. And appreciate what you read, and what you write – because there may come a time, someday, when it becomes a lot harder to do so.