Q&A with Danielle Ofri

Danielle Ofri, M.D. and Ph.D., is the author of What Patients Say, What Doctors Hear. Her other books include What Doctors Feel and Singular Intimacies, and her work has appeared in a variety of publications including The New York Times and Slate. She is the editor-in-chief and cofounder of the Bellevue Literary Review. Ofri is an associate professor of medicine at the New York University School of Medicine and treats patients in New York's Bellevue Hospital. She lives in New York City.

Q: Why did you decide to write about communication between doctors and patients in your new book?

A: With Dr. Juliet Mavromatis and her patient Morgan Amanda, I was struck by how differently they told the same story. Often, there’s an imbalance in knowledge, but the two had so much affinity personally—they were self-deprecating, they took responsibility, they recognized what may have contributed to the interaction—and yet it was so different.

That was how the book began. I thought, "Now I will get tons of doctor-patient pairs and solve all the problems." But that didn’t happen. If [the interaction] goes well, there’s not much to write about, and if it doesn’t, the person doesn’t want to talk. Then I began looking into the research…

Q: What do you see as some of the most difficult aspects of the doctor-patient dialogue?

A: For the doctor, meeting with the patient is one incident on their rounds; for the patient, it’s their life. For the patient, especially if they’re quite ill and have been waiting months, there’s so much pent up in this. The whole way of seeing the meeting is different…

Ultimately, it’s unbridgeable. You can’t be 100 percent in one patient’s life. Today I paid a house call. It took an hour and a half, which is not sustainable; I could be seeing four patients in the office. For that hour and a half, I was in that patient’s perspective.

There’s a different way of seeing things, from a medical-social perspective. The doctor sees it in terms of illness; the patient sees it in terms of their life. We categorize things: diabetes, cardiac. For the patient, it’s all one: “I don’t feel well.” The language can clash.

Q: Did writing this book affect your own communication style with your patients?

A: It did, especially [the idea of] not interrupting patients. I’ve really taken it to heart. I had to fight myself and just remember to make eye contact. I had to overcome my instinct to just get things done. I try to force myself not to do that, but instead to look at the patient and put down my pen.

It reminds me to make sure I’ve addressed how they’re feeling. Are they walking away feeling frustrated? Even if I’ve done everything clinically, did I spend time on the social side?

Q: Do you think more doctors take that approach than not?

A: Our natural inclination would be to do that, but we’re beaten down by the requirements of modern medicine, such as the new computer rollout. We want to, but we end up being pulled away. If we had less to do we would follow our inclinations more.

Q: What do you see looking ahead when it comes to the dynamic between medical professionals and patients?

A: If we don’t take active steps to preserve [the communication], we’ll be on the road toward a computer system [of interaction]. It gets overwhelming. You have to be insistent about preserving time for communication. It’s not just because it feels good, but it’s better medicine. When you ignore the talking part, you’ll make errors.

Q: So what do you see as the role of computer systems in medicine today?

A: It pulls doctors’ attention away from patients…it also fragments how the doctor thinks. The computer forces you to think in a way that a computer thinks.

Q: Are you working on another book?

A: Yes, I started working on a book about medical errors. Communication is one of the most important things in avoiding medical errors.

Q: Anything else we should know?

A: This book is not geared toward doctors. It’s a human interest book. You’re not going to get through life and avoid the medical world; we’re all going to be there. Putting effort into improving communications and reducing medical errors is paramount to all of us… 

--Interview with Deborah Kalb

Jan. 7

ON THIS DAY IN HISTORY
Jan. 7, 1891: Zora Neale Hurston born.

Q&A with Michele Campbell

Michele Campbell is the author of the novel It's Always the Husband. A former federal prosecutor in New York, she now lives in New Hampshire.

Q: How did you come up with the idea for It's Always the Husband and for your three main characters?

A: I took inspiration from my own college days, and also from the fact that I was living in a college town at the time I began writing the book. I knew I wanted to write about female friendship gone very, very wrong. 

I needed a setting that would explain why three extremely different women, who have little in common and are clearly bad influences on one another, might form an intense friendship. 

I found the answer in memories of my own freshman year of college. You leave home for the first time and are suddenly surrounded by kids your own age, who may be smarter, prettier, richer, and, yes, nastier than you. That moment is incredibly intense, fraught with drama and peril as well as learning and growth. I think it makes for a very compelling read! 

Q: You tell the story from various characters' perspectives. Did you write the chapters in the order in which they appear?

A: I tried to balance the chapters so that each of the three women had space to tell her story. These are not the nicest, kindest characters in the world, and that’s entirely purposeful. 

To make the book suspenseful, readers need to believe that any one of the three women could be a killer, and any one a victim. So, each character has some bad in her. But by giving each her own chapters, readers have the insight to sympathize with her motives and actions. 

In terms of the order of the chapters, I end up re-organizing and adjusting as I write, using 4x6 inch index cards to makes notes for each scene. I post the cards in order on a bulletin board and then shuffle them around, again and again, until I get it right. 

Q: Without giving anything away, did you know how the book would end before you started writing, or did you change things around as you wrote?

A: No. I have a detailed outline, but once I start writing, the process takes on a life of its own that is not entirely predictable. It’s quite magic, actually. I can’t explain how I know what to write next, but once the prep work is done, the characters and story take over. 

Once I have a solid first draft, my editor reads it and gives me notes. Then the rewrite process begins. For every page that makes it into the finished book, I probably wrote three to four pages that got edited, changed and rewritten beyond all recognition. 

The end product has to be good enough to grip readers’ imaginations and keep them guessing about whodunnit until the final page. I admit, with It’s Always the Husband, I was guessing myself. The identity of the killer changed several times as I wrote, and the ending surprised even me!

Q: Who are some of your favorite authors?

A: At the moment, I’m on a huge suspense kick. I love B.A. Paris, Ruth Ware, Shari Lapena, Liane Moriarty, among many others.

Q: What are you working on now?

A: I am working on revision to my next book, called She Was the Quiet One. It’s about two sisters and a murder, and will be out in July 2018. You can read a summary and get a sneak peek at the cover here.

Q:  Anything else we should know?

A: It’s Always the Husband will be out in a gorgeous trade paperback edition in May 2018! Thanks for featuring me.

--Interview with Deborah Kalb

Jan. 6

ON THIS DAY IN HISTORY
Jan. 6, 1931: E.L. Doctorow born.

Q&A with Alison Hughes

Alison Hughes, photo by Barbara Heintzman

Alison Hughes is the author of the new young adult novel Hit the Ground Running. Her other books include Lost in the Backyard and Kings of the Court. She lives in Edmonton, Alberta.

Q: How did you come up with the idea for Hit the Ground Running, and for your characters Dee and Eddie?

A: The idea came out of the blue, as we were driving through the US/Canada border crossing on a family holiday back in 2007. Border crossings are one of those highly official places, like the security check at an airport, where even when it’s routine, there’s an element of tension.

I think one of my kids said something like, “This would be pretty scary if you actually had something to hide!” And there was my idea. Two kids, trying to cross the border with something to hide.

The characters evolved over time, like the book (which took about ten years from first draft, through many drafts). Eddie was always Eddie – smart, interesting and odd. At first, Eddie stole the show. But Dee came into her own when I learned to let her humor and uncertainty shine through.

Q: How did you choose the areas your characters would travel through?

A: We made the three-day, round-trip drive from Edmonton, Alberta, to Phoenix, Arizona, several times to visit relatives. So I always knew that was the route Dee and Eddie would take. I took detailed notes on our last trip so the trip was completely accurate (down to the “Got cows? We got bulls!” sign).

Q: This is your first YA novel--was your writing process different this time?

A: I don’t think the writing process was different from the middle grades I’d written. You think, you sit, you write. What was different was that it took a little time getting all the details right – speed limits, residency requirements, highway numbers, etc. I had a long talk with a very nice border services agent who walked me through how they would deal with two unaccompanied minors.

The book was a lesson in perseverance. It took 10 years to develop, because it was one of the first books I’d written. My editor passed on the first draft of it (and she was right), so I left it went on to write and publish a bunch of middle grades and picture books, but always kept this story in the back of my mind. Whenever I started a new project I’d think: “You realize those kids are still on that highway, right?”

So finally I buckled down and rewrote the story, and by that time I was much better at this writing thing, so it came very smoothly. Sometimes you have to listen to that pigheaded little voice inside you that says ‘this is a good story, these are good characters.’

Q: Who are some of your favorite writers?

A: I’m glad you said “some”, because children often ask me to pick one and that’s just too difficult. I love all the old classics, like Charlotte Bronte, Jane Austen, and Charles Dickens. I like Zadie Smith and Ian McEwan and J.K. Rowling. And I also love a good murder mystery from writers like Dorothy Sayers, Patricia Wentworth, Ngaio Marsh and Elizabeth Peters.

Q: What are you working on now?

A: A YA novel set in 1969, just when the times were a-changing. I’m also working on two picture books and a middle grade is percolating.

Q: Anything else we should know?

A: Hit the Ground Running was nominated for the 2017 Governor General’s Literary Award! Such an honour for a humble little story of two kids in a car.

I suppose I should also mention that I’ve got three books out in 2018: Kasey & Ivy, about an 11-year-old germaphobe who has to spend a month in the hospital in the geriatric ward (doesn’t sound like a funny premise, but it is), Hide and Shriek, which is a tense thriller about four kids in a hide-and-seek club who witness a criminal deal, and The Cold Little Voice, a picture book targeting self-criticism and self-bullying.

--Interview with Deborah Kalb. Here's a previous Q&A with Alison Hughes.

Jan. 5

ON THIS DAY IN HISTORY
Jan. 5, 1932: Umberto Eco born.

Q&A with Martha Freeman

Martha Freeman is the author of Zap, a new novel for kids. Her many other books include Effie Starr Zook Has One More Question and the Secret Cookie Club series. She lives in Philadelphia.

Q: How did you come up with the idea for Zap?

A: My engineer friend Anthony mentioned a friend of his who was fascinated with the power grid. This made me realize how little I knew about the subject myself. There happened to be a new book about the grid by Ted Koppel, so I read that – and was alarmed by the dangerous scenarios he described. I wanted to know more, and writing a book is a good excuse to do research.

Q: You based your character Luis on a real-life person. What made you decide he would make a good fictional character?

A: As with all my books, there was more than one inspiration. For Zap, my friend Luis’s life story was another. Luis’s parents immigrated to the U.S. from Nicaragua. They worked very hard when they came to New Jersey, and young Luis – born in the USA -- was left to his own devices at times.

He grew up in a tough town and had some harrowing experiences, stuff I had a hard time even imagining. He told me once it was a toss-up as to whether he’d end up on the streets or go to college and make something of himself.

Spoiler alert: He went to college.

Luis also told me he wished he’d had more role models in books when he was a kid. In a way, Zap is a book for the kid Luis (now 29) used to be.

As a novelist, I write about all kinds of people who aren’t me. I’ve even written from the point of view of a dog and a mouse. In every case, I use my imagination to get into the heads of my characters – and I do research as well. Because Luis is a real person with his own life story, I was extra scrupulous and asked him a whole lot of questions.

The book includes a letter from the real Luis and pictures of him in the appendix.

Q: What do you hope kids take away from this story?

A: My top priority is always that kids read the book from beginning to end and find living in someone else’s head compelling.

With Zap, I also hope they learn something about the science and engineering that underlies technology we all take for granted. After the effects of hurricanes on the electric grids of Puerto Rico and Texas this year, the story seems especially relevant.

Finally, I’m a big fan of a book called All the King’s Men by Robert Penn Warren, which is a fictionalized account of a 20th century politician named Huey Long. Young readers won’t know that reference, but I hope maybe Zap will make them think a little more about how government works, and about our responsibilities as citizens.

Q: What kind of research did you need to do to write this?

A: Oh my gosh – so much! I read extensively on the power grid and electricity in general. Ask me anything about Michael Faraday. I also needed to get up to speed (as best I could) on hacking, so I read a book and several articles about the Stuxnet worm and how it was used to take down an Iranian manufacturing operation.

The book takes place in a town similar to Camden, New Jersey, where the real Luis grew up. So I drove around Camden and researched its history, too.

As always, I leaned on my friends (like Anthony and Luis) to answer questions.

Because there is a big nonfiction component to the book, there’s a lot of information at the end – questions and answers, a glossary, a bibliography. I hope kids and teachers will take advantage of it. I enjoyed writing that part, too.

Q: What are you working on now?

A: Look for If You’re Going to a March, my nonfiction how-to picturebook about kids at political protests, coming from Sterling in the fall. It’s a lot of fun to see the illustrations (by Violet Kim) bring the book to life.

Do you know the tag line from Monty Python? “And now for something completely different….” Sometimes my work feels like that. I am revising a re-telling of The Three Bears in which Goldilocks’ stay is much extended, and Baby Bear feels resentful. It’s hilarious. At least, my editor and I think it is.

Also, I just finished the manuscript for what will be my first nonfiction book for young readers. I call it Curious Kids – 20 Stories of Girls Who Grew Up to Be Celebrated Scientists, but the publisher isn’t so sure about the title. It will be illustrated, so it’s not due till spring 2020.

Q: Anything else we should know?

A: I know both Anthony and Luis because we run together. Or, more accurately, I run along behind them. I am slow but tenacious, and running has been very important to me over the years. In fact, running and writing are similar – one foot in front of the other, one word and then the next. With either one, you sometimes have to slog it out.

Also, Luis now volunteers as a coach with Students Run, a program in Camden, New Jersey, where he grew up. That’s his team in the photo. He’s in the middle in the back.

--Interview with Deborah Kalb. Here's a previous Q&A with Martha Freeman.