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!