Prognosis: Guarded (eBook)

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Whenever she doodled, she always drew hearts.

First line, first novel, written on a hospital progress note in 1977. It was the original opening line of Prognosis: Guarded, and its transfer to the opening sentence in Chapter 2 of the novel is how I recognized my attic version as circa 1980-81. This revision had been recommended by an editor in New York who wanted more mystery to jump out of the very first sentence.

When I wrote that original opening line, I was on duty for the surgical service at University Hospital, Oklahoma City, awaiting the next beeper page to the emergency room or the ICU. Of course, scribbling words of a novel on a hospital form while waiting for a crisis was pure escapism.

“Pulling an all-nighter” had once been an undergraduate battle cry, applicable for nearly every college exam. But now, an all-nighter was the norm. Every other night. This was the era in surgical training prior to work-hour regulations. The first year of surgical residency required 36 hours on, 12 hours off, extending to 40 on, 8 off, on occasion. Then, after that agonizing first year, from the second year on, night call was only every third. What luxury! One out of every three days, the surgical residents were privileged to leave home for work and return that very same day – for the next 4 years or so. For me, the tension was not in the life-and-death dramas that played out during surgical residency. It was the sleep deprivation, now understood to be far more detrimental than once believed. Mind-altering, soul-shattering sleep deprivation, one of the most effective means of torture, as it turns out.

I don’t recall who gave me the bug that piqued my interest in novel-writing, but I was bitten 7 years earlier, while still an undergraduate at the University of Oklahoma. The bug was the Andromeda Strain, a 1969 science fiction novel written by Michael Crichton, a story that was, incidentally, about bugs (viruses). Anyway, someone gave me a copy of the book two years before the hit movie version introduced Crichton to the world (though he had been writing since 1965).

I had already secured a place in medical school for the next year, and when I learned that Michael Crichton was a Harvard Medical School graduate (who never did an internship and never practiced), I questioned my dedication to medicine. If I could come up with a plot like Andromeda Strain, I’d chuck it all and become a writer. Of course, it was only a fantasy at the time. But years later, when University Hospital became my primary residence, well, fantasy gradually took root.

Whenever she doodled, she always drew hearts.

By the time I wrote those words, I had a plot worked out in my head: Old lovers reunite; together, they stumble upon strange happenings at a hospital in Los Angeles; plot expands beyond villainous doctors; and then – before the phrase had been entered in the cliché hall of fame – “the hunters become the hunted.”

Escapism. During medical school and residency, I’d already escaped to other worlds with Tolkien’s trilogy and Asimov’s Foundation Trilogy, but the outer limits of Middle Earth or the cosmos were not enough. I needed further escape.

While all writers have a favorite vignette about someone who encouraged their talent, I believe mine is unique. My springboard to serious writing had something to do with my routine progress notes, written on the very purple-edged paper on which I’d begun my handwritten novel (no typewriters in the surgery call quarters; no computers at all). Early in the second year of my surgical training, a nurse rendered a bizarre compliment about my handwritten chart notations.

Ordinarily, daily progress notes were either illegible or so fragmented and disjointed that even the treating physician struggled to decipher. The introduction of the SOAP note into the “problem-oriented medical record” a few years earlier offered some clarity by organizing the documentation of every patient’s hospital course into: S = subjective, O = objective, A = Assessment, P = Plan. Yet, notations were uniformly abbreviated, and often incoherent. As mentors told us regularly, the most important thing to document is A & P, that is, Assessment and Plan. For me, this meant careful phrases and pertinent sentences as part of logical conclusions.

And this is what the nurse said to me one day while I was making rounds in the fall of 1976.

“So, you’re Dr. Hollingsworth? Your progress notes are so fun to read. If you string them together day after day, it’s like the patient’s chart becomes a short story that you can’t put down.”

Escapism. If I can make the dullest prose in the world “hard to put down…”

The plot for my story continued to bounce around in my brain, and I had worked out most details by the time I wrote the sentence about doodling, ironically, on a blank sheet designed for hospital progress notes.

You might be longing to hear the details of this masterpiece, a plot so unique that I landed in the office of Hollywood agent Harold Greene signing a rich and famous contract. But if I walked you through the details now, nearly a half century later, you might wonder: “What’s the big deal?”

For context, however, travel with me back to 1976. Marcus Welby, MD had just completed its TV run. Prior to that, Dr. Kildare and Ben Casey were the superheroes of medicine. And before that, well, you get the picture. While those television programs thrived on dramatic conflict, there was one thing never in doubt – the high-minded, God-like character of the physicians. Even in the comedic themes of M.A.S.H., Hawkeye and Trapper John came across as extraordinarily talented, which only magnified their irreverent charm.

My idea was simple, at least in retrospect – instead of a corrupt doctor, or corrupt cabal of doctors, could one create a medical facility wherein every single employee – doctors, nurses, support staff – were all in on a Big Secret? (Note: John Grisham would not publish The Firm until 1991). And in my plot, that secret was beyond a reader’s imagination in 1977.

Perhaps not as terrifying as a great white shark, still, having to enter the hospital is an inherently frightening event. In many ways, creative suspense is merely magnification of that fear. But why would such a malevolent hospital exist? I narrowed it down to two options, both of which were hot topics at the time – witchcraft or organ transplantation. The purpose of the institution would be the procurement of body parts and organs for either Satanic ritual (Rosemary’s Baby goes to medical school) or organ transplantation.

“The Occult Revival” had been the TIME magazine cover story a few years earlier, and interest in the topic did not seem to be waning.

As for organ transplantation, initial success came in the 1950s, but the mid-70s was a period of rapid growth and acceptance, with better results and a wider variety of organs that could be transplanted. Media coverage was frequent and spectacular.

I decided on organ transplantation in that it was easier to understand how an entire hospital staff could deceive themselves into believing they were accomplishing more primary good than secondary harm. My title from the git-go was Prognosis: Guarded. It was a phrase used sometimes to fill in the blank after “A” for Assessment in progress notes, when the patient’s life hung in the balance, while the doctor wrote his or her SOAP note, illegibly.

Remarkably, I had sole claim to that title for many years, decades in fact. Since book titles are not subject to copyright laws, one is free to create titles for their books as they like. Only recently have other books used the same, or nearly the same, title as mine, though they are either non-fiction or dissimilar stories to “my” Prognosis: Guarded. But, for the record, my title was registered with the Writers Guild of America in 1977. This is the long way of explaining why I added the subtitle – The Breakthrough Novel of 1977 That Tried to Break Me – to distinguish my book from others. The mere fact that you’ve already found this particular book means that you’ve bypassed title confusion.

Returning to the story about the book, over the course of that academic year (1976-77), as a Level II resident in surgery, I escaped, when possible, by refining the details for the plot. As for characters, I decided upon a female protagonist, and after dragging a male colleague in with her, (ahem) “the hunters would become the hunted.” If you are gathering a memory of Geneviève Bujold and Michael Douglas, there’s a reason. Press on.

With the story details settled by the spring of 1977, I was itching to begin my one-year fellowship in Surgical Pathology at UCLA where no night call and plenty of sleep would be the norm. I would have time to start drafting the novel. In those days, residency in general surgery lasted five years, but sandwiched in the middle, Year Three, residents were encouraged to go to the surgical laboratories, usually an out-of-state institution. I opted for a year in pathology for reasons unimportant to the story at hand, yet parenthetically, this experience was probably the most pivotal year in my training. Yet, no night call and plenty of sleep was so foreign to my norm for the past two years, that the prospect of one year in sunny California seemed...