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INTERVIEWS AND ARTICLES

Ten years ago, I met a man who changed my life. He was a homicide detective. He had recently retired and had begun a new career protecting American businessmen traveling in Russia. While in Moscow, he'd heard from Russian police that children were vanishing from the streets. They were convinced these children were being shipped by the Russian mafia to foreign countries as organ donors.

 

That story horrified me. I'm a mother, with two sons who at that time were just about the right size to serve as organ donors. As soon as I got home that night, I called my brother-in-law, who was a reporter for the magazine Newsweek. He was about to leave on assignment for Moscow, and I asked him to investigate the rumor. When he returned, he told me that he couldn't come up with the evidence - if it really is the Russian mafia, he said, that story would be hard to track down.

 

Weeks later, I still couldn't stop thinking about those missing children, and about what kind of people could commit such crimes. When a premise grabs hold of me like that, when it won't let me go, when it makes me angry, or upset, or frightened - I know that's exactly what I should be writing about. I envisioned two characters: one a crippled but resourceful Russian boy who would survive by his wits alone; the other was a woman doctor on the cusp of achieving her lifelong dream as a transplant surgeon. I would take readers into the world of transplant surgery. I would show them doctors at work in the operating room, give them a front-row seat as surgeons harvest hearts and save lives.

 

Excited, I called my literary agent to tell her about my great plot idea. She said: "Hold on a minute. I agree, it's a terrific premise for a thriller. But I'm sorry, to write that book, to have any credibility, you'd have to be a doctor." Well. There was a little something I had never told my agent. Something that I had thought was irrelevant up till that point. "I have to confess something," I said. "I am a doctor. I'm a board-certified specialist in internal medicine." There was a long pause. Then she blurted: "Why the hell aren't you writing medical thrillers?"

 

A very good question. Up till then, I had been writing romantic suspense novels with plotlines that I, personally, thought were exciting: espionage, crimes of passion, women on the run. It didn't occur to me that readers hungered to know about the world of hospitals and autopsy rooms - the very world that I had worked in and knew so well. During training, we doctors dash off to so many code blues, pump on so many chests, that it became almost routine. Medical crises that the public considers high drama are just part of a day's work for a doctor. We didn't realize how fascinating our jobs must seem to everyone else.

 

I went on to write that medical thriller about the kidnapped orphans. Harvest was my first book to hit the New York Times bestseller list. I now understand that readers hunger for secrets. They want to be brought into worlds they're not privy to. The world of doctors and hospitals is especially fascinating to them, because it's the scariest world of all. That's where life-and-death dramas play out every day. Yes, you go to hospitals to be healed. But they're also places where you get poked with needles and cut with scalpels. It's a place where you could die.

 

My agent told me: "Very few writers have the background to truly reveal those secrets. You can bring your readers into that scary world. You can tell us what it's really like to be a doctor." That's what I've tried to do, ever since - tell readers secrets. Show them what it's like to hold a scalpel and slice open an abdomen. Show them not only what doctors do, but also how we think and feel. What we hear and touch and smell, all those sensual details you can only know if you've actually stood in the operating suite or the autopsy room and smelled bone dust, or watched blood well up in an abdomen.

 

There are also secrets we're not eager to tell. About the E.R. doc I knew who used to snort cocaine before he'd take off in his private plane. Or the anesthesiologist I worked with who'd put his female patients to sleep, and then assault them on the table. Or this one, which is my favorite, about the medical residents at San Francisco General Hospital, who were so tired of admitting, again and again, this particularly obnoxious drunk with an infected foot, that they all chipped in to buy him a one-way plane ticket to Los Angeles. They told him that when he got to L.A., he should catch a taxi straight to the emergency room at USC medical center and ask to be admitted. One of the residents even drove him to the airport. Two weeks later, a large envelope arrived in the mail from USC, addressed to: "The medical residents at San Francisco General." There was no letter inside, just a single X-ray. It was a hand, with its middle finger extended.

 

Real doctors. Real stories. But how did I go from writing medical thrillers to crime fiction? Again, it was one of those chance conversations that inspired me. I was on a book tour for my fourth medical thriller Gravity, about flight surgeons and the space program. A woman reader came up to me at a book signing and told me that she wasn't interested in space exploration. She wanted me to write about a subject she was interested in. "What would that be?" I asked. She answered, quite enthusiastically: "Serial killers and twisted sex." Taken aback, I asked her what she did for a living." I teach the fourth grade," she said. I thought, if even fourth grade teachers crave books about serial killers, there must be a huge market in this. I hadn't planned to write a serial killer book. But that woman got me thinking about how I might approach that tried-and-true serial killer story in a unique way. A way that would bring my medical training into the story. In every book I write, I look for some disturbing premise, something that gives me a little chill.

 

I began to think about blood, which we all find disturbing. What a marvelous, complex substance it is, and it hold so much symbolism. Then I thought about blood tests, and how much intimate information we can learn about a person from a sample of their blood. Whether they've smoked a cigarette in the last hour. What drugs they're taking. Whether they're diabetic or pregnant or dying of leukemia. When you go the doctor and get your blood drawn, what happens that tube of your blood? It's the most intimate substance you can hand to someone, yet it routinely gets passed off to a series of strangers. What if one of those strangers, someone who's hardly noticed, uses that blood to find out all sorts of secret things about you? What if he uncaps the tube, sniffs it, and gets sexually turned on by it? And what if he chooses you as his next victim because of something about your blood, something special?

 

That was the premise of The Surgeon. It was a serial killer novel that bridged the gap between crime fiction and medical suspense. My characters were policemen and doctors, people whose very jobs make them natural witnesses to tragedy - and to evil. In the end, that's what crime fiction really is: the exploration of evil. Most novelists approach it from the policeman's point of view, which makes perfect sense. Cops respond to a crime, they investigate, they make the arrest. But murder does involve trauma and dead bodies. Who jumps into action when a critically injured victim gets wheeled into the ER? And who later examines that victim on the autopsy table? Who opens the corpse, removes the organs, sees, with his own eyes, the cause of death? It's the doctor. Policemen see one part of the crime; doctors see another. Together, they witness the full tapestry of evil. That dual point of view was the approach I used in The Surgeon. I had no idea it would launch a series. Or that Jane Rizzoli, who started off as just a secondary character, would end up taking over the story. Nor did I realize that the villain, Warren Hoyt, would demand more attention as well.

 

After I finished writing The Surgeon, I started to write a thriller about nerve gas. But Warren Hoyt, my old villain, continued to haunt me. "I'm not done yet", he said; "I have another story to tell." He had planted himself, uninvited, in my head, even into my marriage. My husband Jacob and I would even sit at dinner talking about Warren, as if he was a real person. It got to a truly absurd point when Jacob and I were vacationing in Italy, and we passed a billboard with the advertisement: "Come and visit our torture museum in San Gimignano." Jacob stopped the car and looked and me. "You know who wants to go there, don't you?" he said. As if Warren was sitting in the back seat, demanding a visit. So we went. Because Warren told us to.

 

That's how I ended up writing a sequel to The Surgeon - something I'd never planned to do. In The Apprentice, Warren Hoyt returned. So did homicide detective Jane Rizzoli, this time, as the star investigator. And a new doctor is also on the case: Dr. Maura Isles, the coolly cerebral medical examiner whose scalpel reveals clues both grotesque and horrifying. Rizzoli and Isles are the yin and yang of crime-fighting. One is quick-tempered and impulsive; the other logical and self-contained. Two women, each struggling, in her own way, to deal with the violence she sees. Since my own background is in medicine, I'm very much like Maura; I try to use science as my scalpel to dissect evil. It means I approach crime fiction from a slightly different angle than other writers might. I plant clues that only a doctor would recognize. Or I'll linger over particular details that I myself remember when I stood in the autopsy room.

 

In The Sinner, my third book in the series, the premise itself was inspired by what I saw while practicing as a doctor in Hawaii. During the 1860's, in Hawaii, thousands of people suffering from leprosy were forcibly uprooted, and shipped to the island of Molokai, where they were abandoned on the beach at Kalaupapa. When Belgian priest Father Damien arrived to minister to the leper colony, he described a place of horror. "Sores appear on the feet and hands," he wrote. "The flesh decays and yields an infectious odor. The breath of the lepers poisons the air." By the time I became a doctor, the disease was treatable, and the colony had been disbanded. But there are still lepers living in Hawaii, and I got the chance to examine a number of them. Many were terribly disfigured because the organism had chewed away at the bones of the hard palate, and their faces had collapsed inward. No wonder leprosy was such a horrifying disease in ancient times; it didn't kill you, but it destroyed your face, and turned you into an outcast. In biblical times, being infected was evidence that you were a sinner. In medieval times, lepers were burned at the stake or buried alive. Church law required that you wear a leper's cloak, and carry a clapper or bell to warn people that a monster was approaching. Even today, the disease still infects a million people around the world. My husband once diagnosed a case of leprosy in a blonde nurse who came into his office one day, complaining that her arm was numb.

 

For years, I wanted to use leprosy as the subject of one of my thrillers, but I couldn't think of a way to weave it into a plot. Then one day, I came across an obscure medical monograph published by a Danish University. The title was: "Leprosy Changes of the Skull." And suddenly I had my premise for The Sinner. It was right there, in an X-ray: the telltale clue that would point Maura Isles to the truth. Something only a doctor would have seen.

 

In my new book, Body Double, I again draw from my experience as a doctor, but this time the premise isn't taken from science, or inspired by a particular disease. It comes from a very personal moment of horror that I experienced in the autopsy room. Every doctor, in the course of his training, is expected to watch a number of autopsies. You want to learn as much as you can from your patients. Should one die under your care, you're expected to attend the autopsy. You want to find out what mistakes you made, what disease you missed. Every single one I've watched was upsetting to me, because these were people I'd known while they were still alive. A day before, I might have been talking with them.

 

Last year, I thought it was time I should view another autopsy. I hadn't seen one in years, and I wanted to make sure my memory was still accurate. I contacted the medical examiner in the state of Maine, and she invited me to come observe one. The morning I was scheduled to go in, I called her office to make sure there would be an autopsy that day. "It'll be a quick and easy one," she told me. During the night, a man had been found dead in his apartment, almost certainly of an accidental drug overdose. The paraphernalia was found beside him on the couch, and he had needle tracks on his arms. I thought: okay, this is not going to be upsetting. It's an adult, and I don't know this man. The body's intact, without any trauma. I'll have no problem watching it. I drove to the ME's building. Got gowned up, gloved up. Pulled on the paper hair cover, shoe-covers and mask. Walked into the autopsy room, where the morgue assistant had already prepped the body. So far, so good, I was feeling okay. Then the M.E. told me the dead man's age: 21. And suddenly, it hit me. That's my son's age. The whole time I watched that autopsy, I was thinking about my son. Could there be anything worse than seeing someone you love lying on the table?

 

That's when the writer in me took over. I'm always searching for the worst possible scenario, the worst that could happen. The one premise so stunning that it cries out to be a novel. I thought: what if you saw yourself getting autopsied? Wow. How do I go about working that scene into a book? That was the inspiration for Body Double. It came as a sudden flash of horror while I was standing in that room, watching the M.E. at work. I've learned, through the years, to recognize that emotional punch in the gut that tells me: this is a story. If something scares me or horrifies me or makes me angry, then it has the power to launch a plot.

 

And that moment in the autopsy room was how Body Double got hatched. The book opens as Dr. Maura Isles returns from a business trip to Paris. She arrives home to find a crime scene in front of her house. A woman has been shot to death in a parked car. As Maura gets out of the taxi, everyone turns and stares at her, as though she's a ghost. Because they think she is a ghost. The dead woman in the car looks exactly like Maura. When she attends the autopsy the next day, it's as if she's watching herself being cut open. Jane Rizzoli is in charge of the investigation, and she's baffled by the fact that there's almost no record of this dead woman's existence. Soon they learn who the mysterious woman is - and it leads Maura on a search into her own family history. Once again, I try to dissect evil.

 

In this book, I ask the question: is evil hereditary? Can it be passed on through the generations? Last year, there was a serial killer case in Oregon with an astonishing twist. A young man went to the police, complaining that his father had assaulted the young man's girlfriend. He wanted his father arrested. In that same neighborhood, several young girls had vanished, and the police wondered if this man now in their custody was responsible. They began to dig up the father's property, and they found bodies. Young girls' bodies, some encased in concrete. The man was a serial killer, and his own son had pointed the police in his direction. Then came the twist. The police looked back into the family's history, and discovered that the killer's father had been a serial killer as well. Two generations of evil were in that family. What was like for the young man to learn that both his father and his grandfather were monsters? Does he worry that he might pass on that gene to his children? Does he wonder about his own impulses? Does he ever think that he might be a monster as well?

 

In Body Double, Maura Isles struggles with those same issues when she discovers the secret of her own heritage. Jane Rizzoli is back, as well -and very, very pregnant. Also back is Dr. Joyce O'Donnell, the psychiatrist who formed such a creepy bond with Warren Hoyt in The Apprentice. This universe of characters continues to move on with their lives. And you'll see them change and grow as they confront new horrors in books to come.

 

copyright Tess Gerritsen 2004.