How NOT to Write Medical Scenes in Fiction
By: Lawrence Martin
Tags: Medical Fiction, Medical, Fiction Writing, Writing Tips

By Lawrence Martin, M.D.

drlarry437@gmail.com

As a retired physician (pulmonary and critical care medicine), I pay special attention in my critique group to “medical scenes.” Almost every week I hear read aloud at least one such scene — involving doctors, nurses or paramedics. Character A is shot and taken to the ER; Character B visits a specialist for her rare disease; Character C overdoses on medication; Character D is visited by family in the intensive care unit. There is a wide variety, but they almost all have one thing in common: something is not right with the portrayal.

I always try to point out just what isn’t right, why the scene doesn’t work or make sense, and why other readers with any knowledge of the medical field will find the scene problematic. I do this in a friendly way, and usually the writer thanks me, and agrees to make needed changes (but not always!).

I can’t overemphasize that if the writer gets it wrong, the wrongness will likely have an adverse effect on the story. Here are just two common mistakes from novels in progress, shown by example.

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BACKSTORY: Dirk McGirt tried to kill his business rival Sam Simpson in New York City. Despite being shot with three bullets, Simpson lived. After life-saving surgery, Simpson is transferred to the hospital’s ICU, in “critical condition.” This information is in the next day’s newspaper. McGirt reads the paper and agitates over how to finish the job; he worries about being implicated if his victim survives to talk to the cops. McGirt decides to call the hospital, to check on Simpson’s status. His call is transferred to a nurse in the ICU, where a nurse takes the call.

SCENE

“Hello, can I help you?”

“Yes, this is George Simpson, Sam Simpson’s brother. I’m in California and just learned my brother is in the hospital. Can you tell me something about his status? Is he going to make it?”

“So far, your brother is stable. He’s on life support, but the doctors think he’ll pull through.”

“Life support?”

“Yes, a mechanical ventilator. It’s doing the work of breathing for him. We’re hoping he can get off the machine in another two to three days. Will you be traveling to see him?”

“I’m leaving on a plane this afternoon, will be there tomorrow. When are visiting hours?”

What’s wrong with this scene? It is simply not realistic, given the HIPPA (Health Insurance Portability and Accountability Act) regulations. Medical information is not divulged to strangers, and certainly not over the phone. It’s an unintended mistake that weakens the ensuing story.

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BACKSTORY: Jon Jones, age 47, is seeing a female psychiatrist, for depression and anxiety. He is a writer, currently suffering writer’s block, which he attributes to a failed marriage. He and his wife, now living separately, are in the midst of a contentious divorce. His psychiatrist is an attractive woman, in her late 30s, Dr. Melissa Throckmorton. Jon has been seeing her once a week, for the past two months. In this scene in her office, Jon is talking about his wife. It takes place toward the end of his session, where the patient is talking with Dr. Throckmorton about his wife.

SCENE

“Melissa, she is really busting my chops. Now she wants my car. First it was the house, then all the jewelry, then the time share. But why does she need my Ferrari? It’s just a legal game, to get at my retirement money.”

“And it keeps you from writing?”

“How can I? Every time I sit down to write, instead I just think about how I can hurt her, get her off my back.”

“Honey, as I’ve told you before, don’t think those thoughts. You need to concentrate on the positive. Get through this divorce, and go back to doing what you know best.”

[After further conversation]

“Well, Melissa, I feel a little better. Just hope it lasts ’til next week.”

“It will.”

Doctor and patient stand, and as he prepares to leave, she gives him a hug. “Hang in there, Jon. Things will get better. You’ll see.”

What’s wrong with this scene? You should not show professionals in an unprofessional light, unless that is to be part of their character. In this example, Jon calls his psychiatrist by her first name, and then in the end she is shown acting in an unprofessional manner, hugging and calling him “honey.” This would never happen in a true psychiatrist-patient relationship, and when I pointed this out, the author replied he wanted to show the doctor had empathy for the patient. Well, no! That’s not how psychiatrists show empathy. More importantly, the reader is going to assume there is some hanky-panky going on, and that it will all come out later. Except there isn’t and it doesn’t; the author meant to portray this scene as an ordinary therapist-patient relationship, leaving the knowledgeable reader confused. If you are going to show professionals acting unprofessionally, there should be a reason.

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There are other examples I’ve encountered of “medical mistakes” in fiction scenes. Here are a few more

· Telling us what is happening without showing. “The doctor assessed the wounds and decided surgery was needed” [What were the wounds?]

· Factual mis-statements, e.g., administering penicillin to a patient in 1935, when the drug was not available until the mid-1940s.

· Using clichés like “my doctors told me…” when only one doctor is involved

· Giving the wrong skill set to a specialist (e.g., having a gastroenterologist do abdominal surgery)

· Making a patient’s status “Do Not Resuscitate” without discussion with the patient or the family

· Having doctors perform an autopsy without obtaining permission from the family

· Mis-stating medical treatment for specific conditions, e.g., surgery for a collapsed lung (ordinarily treated with a chest tube)

I am not alone in pointing out factual errors in our club members’ fiction. A retired marine points out mistakes in military scenes. A retired police chief does the same regarding crime scenes. And our technology guru frequently points out mis-statements about items like computer viruses, cell phones, and space travel. (If you’re going to put astronauts on Mars and have them call home, don’t show a scene with zero delay in the conversation; each transmission between the planets will take several minutes.)

In fiction, of course, the story is made up. But if you want to engage readers, information that you intend to be factual or realistic should be so. It slows the reader down, or stops them completely, when you craft some aspects of your work out of ignorance. The mistake may be minor, but sometimes minor things bother people the most.

So if you want to write medical scenes, you have two choices. Make them realistic, so they don’t stop the reader. Otherwise, major deviations (e.g., an unprofessional psychiatrist, a stupid nurse, a doctor practicing beyond his training), should be integral to how you plan to develop your story. Unrealism is okay if you can show the reader you know what you’re doing, and the deviation makes sense. Otherwise, not recommended.