Thursday, December 14, 2023

Q&A with Marschall Runge




Marschall Runge, M.D., is the author of the new novel Coded to Kill. He is the executive vice president for medical affairs at the University of Michigan and dean of the university's medical school.


Q: What inspired you to write Coded to Kill, and how did you create your cast of characters?


A: I love reading thrillers. It is pure escapism for me. But I never thought about trying to write one until two unique events crossed my life.


The first was when a patient gave me a John Grisham novel. The patient could have been a character in a Grisham novel – he was an attorney who had fallen on hard times, lost his family and license and then started having heart problems. I am a cardiologist.


He was one of the most genuine and reflective people I’ve met and he just showed up one day with Grisham’s latest. I was instantly captured by Grisham’s writing style and started paying attention to how authors constructed their books. The patient is the model for a key minor character in the opening section of Coded to Kill.


The second event occurred after I started trying to write a medical thriller. At one point I had what I thought was a good draft and a friend pointed out a conference hosted by Michael Palmer and Tess Gerritsen (two terrific medical thriller writers) called “Medical Fiction Writing for Physicians.”


I imagined there would be only a few people trying to do what I was doing and signed up for the course. I arrived at a beautiful inn on Cape Cod to find nearly 300 other doctors!


Spending three days at the conference was both sobering and inspiring. It gave me a way to focus on my approach to plot and character development.


The most common – and probably best – advice is to write what you know about.


Early on, it became clear to me that there was a lot of promise and peril in regard to Electronic Health Records, which were being implemented by hospitals across the country. The promise of having a patient’s full medical history at your fingertips was a tremendous advancement.


But it quickly became evident that online access to medical records did not come without risk. In the early days, health care providers could read the medical record of a person of interest with little repercussion (we have much better protections in place now, of course).


This real-life tension – which in a thriller becomes a battle between good and evil – struck me as a promising premise for a thriller set near Chapel Hill, where I was living at the time.


When I started writing, I knew there were some points I wanted to make about the potential uses and abuses of this technology in the years ahead. It was great fun imagining how EHRs could become instruments for curing diseases and identifying new pathogens, such as the virus that causes COVID-19, before they became epidemic.


I also wanted to address the threats such progress poses to privacy and how it is already contributing to rampant burnout among physicians, nurses, and other caregivers. EHRs, like so many other “labor-saving devices,” almost always tend to add to workloads.


As I began writing, I chose two characters to focus on.


First there was my hero, Dr. Mason Fischer, a former star football player at the University of Texas who performs secret missions for his medical school mentor who has ties to the CIA.


Next there was my villain, Hugh Torrence, a former NSA honcho who sees EHRs – which are not just repositories of information but also linked to treatment approaches – as the Holy Grail of spy craft. Basically, the technology created to extend life could just as easily be misused in diabolical ways to end it.


As I started developing Fischer and Torrence, their cohorts started to emerge because each needed help along the way.


I have spent my life working in hospitals which are true melting pots – everyone from everywhere passes through them – and so, almost organically, the other characters turned out to be a very diverse crew of men and women.


Once each character emerged – like Fischer’s love interest, Dr. Carrie Mumsford, and his confidant, RT – it was great fun to flesh them out in my mind and then on paper. The trick was to not just have them serve the plot, to do what needed to be done to move the story along, but to make them believable, complex individuals.

Q: Without giving anything away, did you know how the novel would end before you started writing it, or did you make many changes along the way?


A: Yes and no. What I knew for sure was that I needed to open with a bang and also end with one and that the ending had to resolve the chicanery and skulduggery involving the Electronic Health Records system being developed at Drexel Memorial Hospital.


One of the fun things about writing is that you constantly surprise yourself – on numerous occasions I’d ask myself, “Where did that come from”?


That was true of so many of the characters that emerged through the writing and in the various plot twists. I would say I came up with three-quarters of the scenes in Coded to Kill while I was writing the book, as one sentence seemed to require the next and one situation seemed to require another.


That said, the original manuscript for the book was well north of 1,000 pages – the published version is 304 pages. They say that most of writing is editing and that was certainly my experience.


It was hard to lose characters and sections; my first draft featured a central character I was quite proud of: a brilliantly devious codger called the Colonel. It was painful to scrap him but I realized that he just slowed things down.


I loved all my characters–heck, I loved all my words. But at the end of the day I had to be ruthless, getting rid of everything that didn’t serve the story and the reader. It was truly an exercise in addition by subtraction.


Q: What do you hope readers take away from the story?


A: Ultimately, I hope they are entertained. That’s why I read thrillers – for armchair adventure and excitement involving characters I care about, either because I love or fear them.


As I wrote and then edited and edited and edited the book, I kept trying to streamline the prose and speed up the action without sacrificing the fullness of my characters and the complexity of the plot.


At heart, I tried to write a book that I would want to read. As much as I love an absorbing story, I also like to learn things along the way.


In Coded to Kill I tried to share my concerns about the current and potential drawbacks of Electronic Health Records. Hospitals have become prime targets for ransomware attacks because they house so much high quality, highly organized information about patients.


These are almost always financial crimes – thieves want to steal credit cards, bank accounts and social security numbers – as opposed to High Torrence’s more lethal designs in the book, but the threats to privacy are very real.


So, too, are the strains EHRs and other technologies are putting on doctors, which I depict. It is often said that there are no solutions in life, only trade-offs; almost all benefits come with costs. I tried to capture this complexity for readers in Coded To Kill.


Q: The writer Iain Pears called the book a “beautifully written, complex mix of medical drama, espionage story, and hi-tech skulduggery...” What do you think of that description?


A: I was excited but a little nervous when a friend said he had asked Mr. Pears to look at the manuscript. He is such an accomplished writer; I wanted to hear what he thought of the book – and, at the same time, did not.


I was thrilled, of course, that he loved the book, but also, as a writer, immensely gratified that he had read the book I thought I had written.


What I mean by that is that writing is a solitary pursuit. You’re there by yourself, arranging words to create an effect in an imagined audience – scare them here, get them to root for your hero there, make them believe all is lost before it isn’t.


While writing Coded to Kill, I thought I was accomplishing this, but, at the end of the day, the author’s opinion is secondary compared to that of the reader.


When Mr. Pears offered his response, I was delighted because I had hoped the book was beautifully written; I had consciously tried to mix medical drama with espionage and no thriller worth its salt lacks skulduggery.


Hearing a gifted writer say I had accomplished what I set out to do – that I wasn’t crazy all that time I was crafting my story – was beyond satisfying.


I also eagerly read the reader reviews on Amazon, Barnes & Noble, and Goodreads. I am so thankful that people are reading and enjoying Coded to Kill, and every comment is a chance to improve my writing. 


Q: What are you working on now?


A: I decided an appropriate next “target” for Mason, Carrie, and the rest of the gang is generative artificial intelligence and deep machine learning.


We are doing exciting things in this area at the system I lead, Michigan Medicine, and I have spent a great deal of time learning all I can about the power of these evolving technologies.


At the end of the day, though, a thriller needs to revolve around the battle between good and evil and a medical thriller more precisely as the use and misuse of technology.


Right now I’m thinking the novel’s conflict will center on how AI is being applied to cellular rejuvenation and the concept that aging can be slowed, or even reversed. Like EHRs, this is very topical; it is being actively investigated in biotech and big pharma. And it also raises lots of fascinating ethical dilemmas.


Q: Anything else we should know?


A: First, I have had so many people help me in my journey to develop an intriguing medical thriller, that I will be forever grateful. This includes my family, who read endless iterations of Coded to Kill, and friends. And, very importantly, J. Peder Zane, with whom I worked very closely as “writing partners.” He is a truly talented writer.


Second, I do love talking about Coded to Kill and medical topics in general and am always happy to speak to groups, like book clubs or others, interested in these topics.


--Interview with Deborah Kalb

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