A Special Feature Series: See Part 1, Part 2, and Part 3

At the welcome reception for my MFA program I was asked the following question: when my novel is published and on bookstore shelves, next to which author would I like to see it placed?

I had never thought about this and found myself unable to come up with a satisfactory answer. Later, as I mulled it over in my spartan dorm room, the reason I could not answer this seemingly straightforward question became clear. I was writing a medical thriller, yet I had been unable to find a novel of the same genre that left me satisfied at the end, nor had I read an author of medical suspense whom I wanted to emulate.

That changed when I read Isolation Ward by first-time novelist Joshua Spanogle. In Spanogle’s novel I found a likeable protagonist, a group of well-drawn secondary characters, and a writing style that held my interest. As part of my course work for that semester I decided to reread Michael Palmer’s Extreme Measures (one medical thriller I had actually finished) and revisit some of the others I had attempted to read. My goal was to pinpoint what I liked about Spanogle’s novel, what I did not like about the others, and use these findings to help develop my own style.

Even before I started the project I had a sense of why I lacked enthusiasm for most medical thrillers. The plots are exciting, and the tension is high, but the characters do not seem real. They are almost universally stiff and one-dimensional, and it is interesting to note that the one dimension that these unlikable characters possess is perfection.

In Palmer’s Extreme Measures, the protagonist, Eric Najarian, an ER physician in training, is regarded as “perhaps the best that White Memorial (the fictional equivalent of Harvard Medical School’s main teaching hospital) had ever trained—the best in a hospital that had spawned 150 years of the finest physicians anywhere.” “When he wasn’t working killer shifts in the ER, he was in the library or the lab. If the ER was backed up at the end of his shift, he would pitch in a play intern for as many hours as it took to catch up.” In addition, the handsome, well-built Eric wakes at 5 am every morning for an hour of intense calisthenics, then skims through medical journals while he drinks his orange juice and eats his bagel. Naturally, he has no social life as he is totally consumed by medicine.

In Robin Cook’s Coma, a genre classic that has sold more than eleven million copies, his protagonist, Susan Wheeler, is so beautiful (with wispy hair the color of winter wheat, blue-green eyes that change color with different light sources, and ultra-white, perfectly straight teeth), no one takes her brilliance as a medical student seriously. Her classmates chide her for her perfect attendance, her monotonous series of A’s, and her perfect lecture notes which they always want to borrow.

By contrast, Spanogle’s protagonist, Nathaniel McCormick, M.D., is a study in character deficiencies. By page three we know that Nate cannot sleep at night. By page twelve we learn that his “professional relations”—critical for a physician—is an area that needs improvement. By page eighteen we learn that he was kicked out of the prestigious M.D.-Ph.D. program at Stanford University, and he smokes cigarettes. We don’t know why he can’t sleep, get along with his peers, or why he got the boot from Stanford, but we know we are dealing with a complex, multilayered main character, and we’ve been given some questions to ponder as the story unfolds. What we have not been given is pages of exposition in the first chapter detailing physical appearance and background information.

As I’ve studied the craft of writing, I’ve learned that when a character experiences stimuli that should elicit a physical, emotional or intellectual response, it is very important to have the character react to those stimuli. At the climax of Extreme Measures, Eric Najarian “watched in stunned horror” as his former friend and colleague, who turns out to be the villain, gets his hands and half his face blown off by an explosion and then stumbles into the street where an eighteen wheeler plows into him. As the truck disappears (an omniscient narrator informs us that the driver is stoned on methamphetamine and doesn’t notice the dead man stuck to his grill), we go into a scene break. The story resumes with Eric’s efforts to untie himself and Laura, the beautiful woman who has become caught up in the danger along with Eric. This is such a momentous event—staring death in the face, having your life spared at the last moment, seeing a human being get blown up and then squashed by a big rig—yet, I was merely told that he “watched in stunned horror.” I was clearly disappointed by the lack of a physical and emotional response to such an astonishing turn of events.

In contrast, when Nate McCormick embraces the woman to whom he was once engaged, we get to share what is going on in his head:

The primordial, undefined warmth that I’d felt toward her years before, and spent years trying to kill off, returned. Before I could stop myself, I’d reached out and touched her shoulder. A small gesture, but it was enough. She rolled to my chest and began to sob. My arms closed around her. Her tears dampened my shirt. They were hot and wet. They felt just as I’d imagined.

So, the dangerous fantasy had become real. Standing there, clutching this woman I’d loved, rocking her, whispering in her ear, I knew I had crossed a line. Crossed into what, however, I did not know.

This is just one of Nate’s many responses to what is going on inside and around him. His physical, emotional and intellectual responses to the internal and external stimuli he experiences allow us to get deep into his head and understand what makes him tick. This results in a compelling character that we come to know well and ultimately care about.

Is Nate McCormick a complex, multilayered character? Yes. Like Tony Soprano, Nate is at war, not only with the world and other people, but with his own traits, tendencies, and desires. His complexity invites conflict, internal and external, and that makes him another great example of Depth of Character. Is Eric Najarian a complex, multilayered character? I don’t think so. Robert McKee says a well-developed character needs at least three dimensions. For me, Eric falls well short of this. He faces plenty of external conflict, but virtually no internal conflict.

If you are a reader who might enjoy a character-driven story of medical suspense, I think you will like Isolation Ward. If you are a genre writer, and you want to avoid the cookie-cutter hero and add depth to your characters, get Spanogle’s book and study it.

By author Richard Van Anderson of  rvananderson.com