Monday, August 1, 2011

Medical Mondays: What To Ask


I get weekly email medical questions from writers about diseases that affect their characters.

Often, I find myself replying with a slew of questions for the writer. With anything as complicated as a choosing a diagnosis to suit a character and plot, it takes sleuthing to figure out what's going to be a good fit.

Here are some of the questions I often shoot back to writers after I get an email.

1. Age. In order to pick out a good diagnosis, many diseases are age-specific. It wouldn't make sense to have a young, healthy 16 year-old have a stroke out of the blue, for instance.

2. Baseline status. Are they healthy? If I have a character who's already saddled down with high blood pressure, diabetes, obesity, and is addicted to smoking and alcohol, it's very easy for me to figure out what diseases they'll fall prey to. A perfectly healthy person who suddenly got a life-threatening condition? That narrows down the diseases significantly.

3. Impairment. How "out of it" or impaired do you want your character to be, leading up to the dramatic diagnosis, or after? Do you want someone suffering from memory loss? Because that will be a major issue in a first-person POV, won't it? Not impossible, but it brings up serious plot issues. What if they're bed-bound from a serious motor vehicle accident? It might get tedious to have every single scene around a hospital bed for many chapters in a row.

4. Timeline. How do you want the timing of the disease or problem to play out? I get a lot of questions along the lines of "I need them to die within 6 months of finding out they're sick." FYI--the shorter life span they have, the more limited diagnoses I have to use.

5. Physical symptoms. Related to impairment, above. Are they going to be visibly affected by the problem? Are we talking bulky tumors sticking out out their neck, or wasting away to a skeleton? Is the author okay with the character being exhausted all the time, or having rashes and stuff?

6. Playing the Odds and Believability. If you want me to pick a particular disease, I'll tell you if it's just not believable. If a disease only targets only women, I'm not going to suggest it for a male character. There are exceptions, of course (for example, men get breast cancer. They do.) But you'll have to make it work with your story.

7. Think out of the box. We tend to gravitate towards cancer as a dramatic, life-threatening diagnosis to throw at our characters. But heart disease, emphysema, diabetes, rheumatologic diseases (like lupus), neurologic diseases (like multiple sclerosis, Huntington's disease) and many, many others are also killers in their own, very particular ways. Our poor, overworked, fictional oncologists! There are a lot of illnesses out there that can kill and disable. But I can help find some of these diseases with you.

8. Is the character willing to be treated? The natural history of how a disease plays out is hugely affected by whether the patient will do all the treatments necessary. So a disease that's usually well-controlled and won't kill in the short-term (like type 1, insulin-dependent diabetes) can kill if the person refuses to take insulin. That's a twist that many don't consider.

So just a warning. If you ask me a question, likely I'll multiply it five-fold when I email you back!

If you've got a fictional medical question, let me know! Post below or email me at
All I ask is that you become a follower and post a link on your blog when I post your answer.

50 comments:

Jessica Bell said...

I do actually :o) My MC in my next project has her vocal chords slashed and eardrums perforated as a punishment for breaking a law. Can vocal chords be mutilated from the outside of one's throat with a surgical instrument? Would it hurt to 'swallow' as the wound heals or do vocal chords have no connection to the pharynx? Also, would it be a difficult procedure to perforate someone's eardrums and make them go deaf? Sorry, this is a biggie ... :o)

Old Kitty said...

I especially like no. 7 - discovering other not so well know but just as traumatic and potent as cancer is really interesting - and would probably help with character development too!

Yikes, just read Jessica Bell's questions. Yikes again - can't wait to read the answers!! Take care
x

Sarah said...

Lydia, this is so true. When I get psychological questions from folks, I always end up sending back a slew of questions! Thanks for sharing your thought process with us.

Clarissa Draper said...

I asked you a medical question on last weeks post but I didn't know I was suppose to email it to you. My bad. Can I email it to you this week?

Alex J. Cavanaugh said...

So many considerations!

Stina Lindenblatt said...

This is where having a background in pharmacology and physiology helps. I'm already asking myself these questions when I try to figure what to hit my character over the head with.

I read one YA contemp novel I love in which the mc suffers from amnesia from the very start of the book. It was great because she had to unlock the secrets to what happened that night leading up to the accident (and why the guy she didn't like suddenly thinks they're dating), but she didn't want to admit the truth about the degree of her memory loss to anyone.

B.E. Sanderson said...

With this WIP, I wanted to pick your brain so bad I could hardly stand myself, but one question would turn into hundreds. Maybe when I get ready for readers, I'll beg you to vet it. Until then, though, thanks for all you do to help other writers get the medical stuff right. =o)

Chris Phillips said...

I like the questions. I knew I was leaving out info, but figured only you would know what you needed to know.

Kerri Cuev said...

Very good points. I have to write this down before I think to give a medical condition to a character.

Lydia K said...

Hey Jessica,
Wow, cool questions! These are going to need a little research. I'll email you as soon as I can!

Clarissa, My bad! I'm sorry I missed your question from before. I've got it now, and will get to work on it too. :)

Lydia K said...

Chris, you're right--and you inspired this post because you got me thinking about the process. Thanks!

Stephen Tremp said...

I actually have a question concerning diseases and toxins. I'll get that off to you shortly. Thanks in advance for an help you can provide.

Creepy Query Girl said...

wow- great things to take into consideration. None of my mc's have had to deal with illness in themselves or others quite yet. I did find myself doing research on abortion though and some side effects.

Bossy Betty said...

Love number 8. It can say so much about a character. Avoidance? Aggressiveness? Optimism? Resignation?

Angela Felsted said...

Interesting. I have a brother with type 1 diabetes, so I know how that particular one can play out. Not a pretty picture.

You're so generous to answer medical questions for writers.

Carol Kilgore said...

This doesn't surprise me. Sort of like going to the doctor in real life. You guys always have questions :)

Lenny Lee* said...

hi miss lydia! wow i didnt ever think bout all the stuff you could need to know before you could answer a question. im gonna copy down what you said so i could give you more stuff when i send a question.
...hugs from lenny

GigglesandGuns said...

Can't tell you how helpful this post is not just for consulting you but for writing in general.
Thanks so much.
Mary

E. Arroyo said...

Thanks for doing this! It has helped me a lot.

Suze said...

I like no. 3 a lot. I have a character who cannot hear in one of my books but she is very adept with reading lips and is surrounded by characters who either sign or pick it up quickly. I tend to not like to overly 'impair' my characters because I take too much pity on them. I am beginning to wonder if this does not make for too static a narrative ...

Elizabeth Varadan aka Mrs. Seraphina said...

Great post, Lydia. These questions and suggestions are really helpful. This is another post I'm bookmarking for future reference.

Sarah said...

This kind of mirrors the whole writing process, doesn't it? Questions lead to more questions lead to more questions. It's never straight-forward, especially with research.

Janet Johnson said...

I think it's so awesome you do this! I feel really lucky to have my own personal medical fact checker at home, and he has definitely helped me get through some tricky things.

mooderino said...

Excellent thought provoking questions. Always so much more of the iceberg under the waterline.

cheers,
mood

cherie said...

That's a good list to consider when writing about a character with a medical issue. Thanks!

Linda Gray said...

Two of your questions made a lightbulb come on in my brain and illuminate a tragic character I knew in real life. A boy in college (age) who had Type 1 diabetes, insulin required, and hated those facts with a deep and abiding hatred. In this case I think the age was more of an emotional factor in the actual tragedy, which was not the illness, but that he couldn't accept it. He went on a cruise after graduation and drank himself into a diabetic coma and died. He will be in my next book. Thank you for the great factors to consider.

Elle Strauss said...

Interesting point about how writers often default to Cancer. Great questions here.

Jennifer Hillier said...

This is so thorough! Wow. You might have to start charging a consultant fee for your advice. ;)

Karen Lange said...

I'll have to remember these points. Good thing we have you around to keep us on track. Thanks, Lydia!

Jen Daiker said...

I love how detailed you are with your Medical Mondays! You've helped me so many times with my mystery illnesses it's awesome!!!

I never thought about age-appropriate diseases. That's such a great tip!

Heather said...

LOL! A disease shopping list for writers. I love this! Bookmarking it! You're brilliant my dear.

Roland D. Yeomans said...

I heard of Dr. Feel Good, but you are Dr. Feel Bad for all your writing friends! LOL. Another great post, Roland

Emy Shin said...

"Our poor, overworked, fictional oncologists!"

I feel terrible, but this made me laugh.

Thank you for this list, Lydia. These are really great questions.

Ciara said...

Wow, there is a lot to consider.

vbtremper said...

Great list! Thanks for sharing. I especially like your reminder to think outside the box, or beyond the usual diagnoses.

-Vicki

vbtremper said...

Great list! Thanks for sharing. I especially like your reminder to think outside the box, or beyond the usual diagnoses.

-Vicki

Slamdunk said...

Informative list.

Yes, the best responses to a question usually involve a reply of multiple questions and lots of research by the person asking.

alexia said...

Great post! Medical Mondays are always so interesting. I actually thought about you the other day when I was writing a hospital scene, so I may hit you up with a question or two in the near future. It looks like you've got a few to keep you occupied until then :)

julie fedderson said...

Lydia--love that you are trying to make fictional disease as real as possible. If only my patients had their stories as well thought out!

Shelley Munro said...

Hmm, I do have a question but I need to think about it a bit. I must come back and dig into your archives. You have some very interesting things in your sidebar.

Cold As Heaven said...

My favorite is Tourette's syndrom, and I possibly have a touch of it myself ... at least my wife think so >:)

Cold As Heaven

Magan said...

My cousin is in med school and he told me that in the real world a Dr. can leave the room and look up something, but they can't do it in med school so it's like using a calculator after college...is that the right analogy? I don't know what this has to do with this post, but does it make sense?

Jen Chandler said...

Posts like these are so helpful, especially considering a murder mystery plot. I've always enjoyed the ones where the character dies and everyone just "knows" it was from natural causes except for the main character. They pick up on something, some tiny little descrepancy and at the end, ties it together with logic and medical reason to show you the victim was indeed murdered.

Thanks for these guidelines!
~Jen

itssacred said...

I temporarily forgot you did this. I do have a question for you regarding one of my characters time in a psych-ward. I am sending it now!!!

nutschell said...

Love this post! For some reason, I totally see Dr. Maura Isles (of Rizzoli & Isles) reading this post aloud. :P
nutschell
www.thewritingnut.com

M Pax said...

I love the idea of a disease shopping list. Fabulous. lol I'll take five heart attacks, please, and is the dementia ever going on sale? :)

Medeia Sharif said...

I'm guilty of 7--I used cancer in a wip years ago.

These are all great things to consider when giving a character an ailment.

Lydia K said...

Magan,
Much as I'd love to pretend I have a photographic memory of Netter's Anatomy Atlas or that I can spew off the statistics on every article from each issue of the New England Journal, I can't. My strength as a doctor is feeling comfortable with what knowledge I have, and being an expert at finding the answers when I don't.
:)

Beth said...

You've really given me a lot to think about with this post. Thanks!

Leslie Rose said...

Your checklist alone adds some great character depth. I'll be bookmarking this one!

 
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