Author of the Month
Peter Clement writes from experience. A physician for three decades, Clement spent twenty years in the ER and the last ten years as Chief of Emergency Medicine at a major metropolitan teaching hospital. He writes well-plotted medical thrillers that keep readers chasing one red herring after another. His latest, The Inquisitor, is the fifth in the series about Dr. Earl Garnet, who also is an ER chief.
Clement has written seven books in two series. Beginning with Lethal Practice in 1998, readers have found Earl Garnet in a variety of murderous scenarios, from deadly doctors to deadly diseases. Mixed in with these lethal ingredients is a serious portion of ethical dilemmas. Some of the topics heís tackled have foreshadowed what appeared months later as newspaper headlines. His second book, Death Rounds (1999), dealt with drug-resistant Staphylococcus bacteria, and The Mutant (July 2001) dealt with bioterrorism involving modified organisms before the horrors of anthrax after September 11. The Mutant and Critical Condition comprise the second series involving an ER doctor and a TV personality.
Clementís fourth book in the Earl Garnet series, Mortal Remains (2003), divulges the back story about Earl Garnet and is crucial reading for anyone who has been following Dr. Garnetís exploits. That book introduces a new character, Dr. Mark Roper, a country doctor who is also the local coroner. These two physicians capture Clementís own dual personality. He works and lives in the city but retreats to a log cabin nestled next to a mountain lake. This setting was the locale Clement's chose for the climax of his first book, Lethal Practice.
I caught Peter Clement at his cabin and we chatted by phone about his work.
Janie Franz: Could you describe where you are?
Peter Clement: This was a place that I discovered a quarter of a century ago, in the mid 70s. Itís a mountain lake, about a half a mile by a third of a mile. Itís a valley thatís surrounded by whatís locally called mounds. They are really hills but theyíre enough that youíre enclosed. And thatís all that you see. Itís a valley that has been undisturbed except for the corner that we built our home on. It was laid down by glaciers about 10,000 years ago.
It came with a log cabin that had been built in the 30s, but itís now been expanded into a 14-room log home with all of the indoor amenities added as opposed to what was there in the beginning, which was a mile-and-a-half walk up the hills through the woods to an outdoor facility. Just to give you an idea, we drink the lake water. Itís all spring-fed. At about its deepest, itís around 55-60 feet deep.
Itís full of speckled trout. I donít fish; I eat them. Theyíre really healthy and tough to catch and only the best fisherpeople can. They [the fisherpeople] are most welcome because we always have great meals from them. Itís a very special place. Itís sort of been the heart of a busy family, but this is where we have our family times. My kids were raised knowing this, and to the point that, when we went to other lakes and rivers, I had to teach them, "Look, you canít drink the water."
Looking out, itís what you see is just as it was. Itís in the wild. There are bears in the valley beyond, but they donít come near us. The animal husbandry is done by our two large poodles. They kind of bark up, and the valley is theirs.
JF: They are kind of your security force there.
PC: Yeah. Itís all that works. All the signs and postings in the world donít take care of things like they do. Itís a very special place.
Iím a very schizophrenic person and I wouldnít be OK all the time here. Iíve got to have my dose of major urban center, and yet I wouldnít want all that either. So thatís what Iím looking at, and itís a gorgeous fall day. Itís especially special in winter where we get heavy snow. Everybody knows woods are natural in the summer, but when it's really winter, I find it spectacular. Sometimes silent and cold.
Being log, the cabin is built just the way our ancestors lived in this northern part of the continent. Itís cozy, but, boy, it can it get cold and windy outside. But itís a special place to be.
JF: It sounds like something that would appeal to me. I like being out in the wilderness.
PC: I decided to come here today just because it was such a great day. This is a good excuse because I knew we wouldnít get phone calls interrupting us here. Itís just a perfect day up here.
JF: So, this is where you write, for the most part.
PC: I certainly do a good part of my writing here. I also do a good part of my writing at home in Montreal. Before I left medicine to do writing full-time, I used to come up here on the days I wasnít doing medicine and just really be alone and get lost in it. Sometimes, Iíd do that for a day and a half and would get a lot done.
When it began to be full-time, it was in a different kind of mission. It was almost too quiet up here to do it full-time. It became more 9 to 5 or 8 to 5. It was just good to have a family and everybody coming home after school, after work, sort of putting a period at the end of the day. As opposed to my other profession that I couldnít take home with me, writing was hard to stop, at least to get free of it, get away from it. The normal routine of getting up and having breakfast and everybody going off to school and work and whatever, and then having the writing time, and then at the end of the day where I had to stop and go and eat with everybody... I write both places. I do sneak up here just because itís so great.
JF: I think this is the biggest challenge as a full-time writer... But it looks like youíve found the key to balance.
PC: Well, itís never perfect. When I was writing my second book, I was still practicing medicine. The first book I wrote— initially to get started—in the space of vacations, Christmas, summer holidays. Over about a year, I got about fifty to sixty pages, enough to sort of say, ďWell, thatís interesting.Ē Then I reached a point where I was finishing a twenty-year mark in ER. I was dividing my time in ER with private practice, family practice. My term as chief had come to an end. In my mind, it was really time to say, ďOk, if I'm serious about writing, itís time to do it or forget about itĒ. So instead of going back to the ER as an Indian, because the Chief work was done, I took a two-year sabbatical from ER to see if I could write a book. I had a week that was half writing, half my private practice. That was nice and I was writing on my own. It took two years to get the book done that way.
Thatís when I showed the book around. It was published and did very well. And they wanted the next one. In fact, they wouldnít publish the first one until we had agree on the next one and I was writing the next one. Because, basically if I was writing a series, they wanted one a year.
When I did the second book that really was on deadline. Also, I wasnít willing to stop my practice because I wanted to make sure I wasnít a one-book wonder and make sure I could do a second one that would be accepted, etc., etc. So, for that one, I almost went back into a residency set of hours. I mean I was doing my practice half-time. To write the book— and it was a literal year from July 1st to July 1st— that meant I was writing evenings and weekends and holidays. Iíd be writing in the evenings and Iíd look up, and it would be two in the morning and I had rounds at seven.
I knew I could do it for a year because thatís what we do as residents, but itís not a life style. Nobody was happy. But it had to be done because I had to find that out. I knew that if this goes and Iím continuing to do this, I would make the changes. And I did. I didnít quit at that point, but I shaved back my practice, rather than half a week, to four half days. I didnít have to do it on weekends, and I didnít have to do it in the evenings.
My deadline—I was able to squeeze it a bit or extend it a bit because of their own publishing problems. It really turned out to be more like 16-18 months—and that worked. But then, they really did want them one a year when they went hardcover. By then, it was three books. By then, I knew to really do it justice, at that time I really wanted to have the year at a time. That was when I made that switch. Deadlines are important. They keep you at it. You donít have time for writerís block when you have a deadline.
JF: Absolutely. Youíll write garbage until something comes.
PC: Youíll just write the garbage. Itís better to have garbage and you wake up and itís morning and you have something to correct. Itís better than the blank page.
JF: It sounds like itís really evolved over time, your schedule and what can keep you creative and keep you sane. How did you job your first book around to get it picked up? What was that process like?
PC: It was really naive. I cringe about it now. During the process of writing my first book, someone told me that I might like to read a book by Jonathan Kellerman. He is a child psychiatrist, which means he has gone through medical school. I loved the book. Obviously, heíd done the time in the wards. Even though it was a totally different field, there was that sympathetic resonance. This was a neat story and a mystery and everything else... He knows the insiderís view because psychiatrists have to do medicine before they become a psychiatrist.
When I finished, I basically phoned his publisher—Bantam. In medicine, you always deal with the top person when you want to do something administratively. So, I asked to speak with the president of the company and got his secretary. The other rule in medicine is: Secretaries make the world go round. I told her, ďI am an ER physician and Iíve written a thriller. Because I read Jonathan Kellerman and I like him. I thought you guys might want a similar book but from the ER.Ē
She told me, ďThe last person you give it to is the president. He doesnít even read.Ē Then she also said, ďYou have to have an agent. We throw away a hundred unsolicited manuscripts a week.Ē
I just said, ďHow do you get an agent.Ē
She said that you get a list from the Library of Congress and stuff.
I just said, ďLook, all Iím wanting is someone to do what I do when I want to read a book: I read the first page. If Iím interested, maybe Iíll go further. If someone does that and then says, ĎYeah,í then Iíll do all that stuff with an agent.Ē
She then said, ďItís in ER?Ē
I said, ďYeah, itís ER.Ē
I think the series, ER, had just come out Ďcause I had to make a decision not to watch it Ďcause I didnít want to consciously copy. Obviously, I knew there would be some overlapping, but I did not watch it. Iím going to do what I do, and theyíre going to do what they do.
Then she said, ďWell, send it along and send it in care of me with a letter explaining what you did. Iím not promising anything,Ē
It went off. I waited three months and didnít hear anything. I made a phone call; they never heard of me. Nobody remembered anything.
Someone vaguely said to me, ďOh, yeah. We gave that to Kellermanís editor.Ē Which was sort of what I was hoping would happen.
So I phoned over there, and they said it was going up the hierarchy of readers. They got me to the person who opened the file and who said, ďActually, you got fairly good reviews. Yes, itís on itís way, and the editor is going to read it.Ē
I said, ďGreat. When?Ē
They said, ďAnother three months.Ē
So, I waited that time and then when I didnít hear, I again phoned back. This time, I talked with the editor and she said, ďI know youíve been waiting, and you certainly got high recommendations, and I promise you Iíll read it this weekend. Iíll get back to you.Ē
And she did. She said, ďYouíre publishable.Ē
And I thought, ďWow!Ē
Then, she said, ďUnfortunately, Iím the editor for another medical thriller writer, a guy named Michael Palmer.Ē Iíd never heard of him. She said, ďThat would be conflict of interest.Ē
I said, ďNot only am I disappointed. It sounds like youíre an ethical person, and I appreciate that.Ē
But she gave me names, and it turns out she was really a very senior, reputable person in New York publishing. When I used her name, people called me back, like in ten minutes. Out of that contact, I got both names of agents and editors. It was from that process that that book got revised, rewritten, and up to par and ready to be presented and was bought by Ballantine.
JF: Youíre not alone in some of the unorthodox ways to get published. Granted, itís out of naivety and not knowing the system.
PC: It was so rough when I realized what I sent them.
JF: You should see what they get. Thatís also why people are avoiding the industry snarls and going to Print-On-Demand. There is so much garbage out there and so poorly edited. But these people are selling books... What was the revision process like? As you worked with agents and publishers to get the first book out. Was the story still there? Were there just scenes you had to rework or delete?
PC: There was a lot of cutting. It really depends on the writer. In my case, one person put it: ďWe have to get the Russian novelist syndrome out of you.Ē [laughs] They do that with all new writers. I like my Russian novels, but I knew exactly what they meant. It was then learning about pacing, learning about keeping that inner dialogue down to minimum, and action being predominant. Balancing all that was what was unique about my work.
What I like in a book is that you introduce readers to a world that they wouldnít ordinarily inhabit. My thing was to be inside the head not just of a doctor but of an emergency room physician. Just to see that and learn how really touch-and-go it can be, and how on the outside it might look definite and yet inside youíre confronted with life and death situations with lots of possibilities. Itís all best judgment and nothing is clearly black and white. Thereís always that inner drama set against a very big clock. That has its own excitement and defines people and creates a world in which youíre with people who rush to try and rescue what everybody else shrinks from in terms of trauma and violence. These people also leave that and try to go out and be mothers and fathers and lovers and parents, and not be shut down by what theyíve seen and coped with every day.
JF: The glimpse I saw of the ER at the beginning of Mortal Remains was accurate. For the few of us whoíve been in the emergency room for various things, it really rings true. I feel like Iím a little mouse in the corner watching everything and getting a real insight into what the doctor is thinking, how youíre trying to keep the patient at ease. The patient may be bleeding like crazy and has to be rushed out some place, but youíre not telegraphing that urgency to the patient.
PC: Thereís always that inner dichotomy. It is not as certain as we may appear to be. And thereís the managing of that—well, just managing like in anything that is technical and yet also thereís this high-powered urgency of being life and death. All of us—even in my last shift in EMERG in twenty years—you always have that little tightness in the gut when you walk in to do a shift. Thatís what you live on.
JF: And that adrenalin. Itís a wonder that you havenít had an ulcer before now.
PC: If youíre that, you donít last. Thereís a certain breed that thrives on it, and theyíre the ones that are there over time to become veterans. They, too, can burn out—and do. When I left EMERG, I was nowhere near that. I really left too soon. I was at my peak. But I donít think it was too soon at all.
JF: What is your writing day like?
PC: Itís very mundane. I get up and usually Iím sitting down by 8:30, somewhere between 8 and 9. Thatís partly me, too. Medicine is something that requires discipline and structure, and yet it also imposes it. That also becomes what I must do in order to feel that Iíve spent a productive and useful day at work. I need that structure. Just as it is required, I require it. Iíll work—the first big rush—until about 2. Then I take a break, then go back to writing or little odds and ends or revising. Sometimes, when itís just one of those days when nothingís working, Iíll just then get it down and wind up at 5 or 6 so thereís something there the next day.
Thereís little tricks, too. Sometimes you like to leave off where you know where youíre going to go, but you just donít do that because you can dive in much easier and you get going the next day.
JF: So, you sort of leave yourself your own little cliffhangers.
PC: Not even that. Itís just, ďOK, now I know where Iím going.Ē But sometimes thatís the point, and Iíll quit. I dive in on that the next day.
JF: Thatís a good trick. At least you arenít just sitting there trying to figure out where youíre going next.
PC: Sometimes a good nightís sleep sorts that out. You wake up and you go back to the place that you thought you had no idea what you would do next. And, itís there. Itís not always like that, but if I have something clear cut and itís near time, Iíll quit before, rather than write it. I use that as a springboard for the next day. Sometimes, you reach and you have no ideas and then itís time to quit.
JF: Do you outline or do you just let it flow?
PC: I outline, then change it all. [laughs] The best parts are the stuff thatís just serendipity. Mark Roper was not in the outline. My story was about Earl Garnet and about a hand coming out of the past and just grabbing him by the throat.
When I sat down, I had the opening scene where they had to find the body. I thought Iíd have to introduce a character. And thatís another thing, I donít like just having spirit characters. You have to say something about them. And then if youíre going to go to the trouble of introducing them at all, why not make use of them.
I knew I had to have a country physician. I canít say that I didnít outline Mark Roper; thatís not true. I did outline that there was the country physician. But, it wasnít to the extent that he became a main character. When I sat down and said, ďOK, whoís going to discover the body?Ē I thought, ďLetís say theyíre looking for something else. They couldnít obviously be looking for her.Ē Who would be doing that?
Then I remembered that my father-in-law was an old-time doctor, and he also served a while as the coroner. Why not just lock them together and make him a young guy, make him a different generation, and that heís fresh? And that you would have to have that for him to have the relationship he had with the murder victim. If he were the coroner and he were the guy who found the body, it would be so much more efficient... That just grew.
In writing the character, I just said, ďThis guy is a neat character.Ē The outline was vague. There would be a doctor and he would work together with Earl Garnet. It was still going to be an Earl Garnet story. It changed radically when he played such a prominent role. And then, there was the possibility of comparing country with urban, which I appreciate so personally, and it became just such a stage to play with that. It changed a lot.
And then the Lucilla Connor character that came inĖher involvement—that evolved as the story went, that extra connection that she had. Why was she there? Was she just a resident and they happen to click or does she have her own agenda? That was actually suggested by the conversation with editors, tossing ideas back and forth.
First, I thought, ďNah, itís too big a cliche.Ē Then, I thought, ďWell, there could be a way to make it work.Ē This came from experience with residents and why people come back to residency after being out a while. If there was a way that it wasnít such an odd coincidence, then thatís what I worked out, and it certainly added a dimension to it.
Thatís the fun stuff, and it always is the best stuff. Thereís no way I could have outlined that at the outline stage. And it just grew. You know when thatís happening, youíre on to something... And, the bottom line is not the income. Itís being read. That justifies the doing of it.
JF: Tell me about your latest book.
PC: For the few of us whoíve been in the emergency room for various reasons, The Inquisitor was accurate. That one is more a really inside, pressure-cooker, hospital-based story, yet I think an interesting one. Itís about that zone between life and death.
Again, it came from total serendipity. You talk about planning. I had some ideas. Then, I ran into one of the hospital chaplains in the corridor, a rollicking, joking guy. And he said, ďWhen are you going to make one about a priest?Ē
We kibbutzed for awhile. Then I was out in the parking lot, and I thought, ďHoly, sh--!Ē and it just hit me. The whole idea, the whole book just hit me. It just kind of came down on me like a ton of bricks. Again, where Mortal Remains allowed me to get out of the hospital and into the woods, this one just clamps down the lid and lets it fester. But again, beyond all the planning and looking for a story. Bang, out of the blue!
Also, the priest happens to be a priest from the Greek Orthodox church. Itís different. So, that was an interesting experience. Outlines all went out the window.
JF: Peter Clement will always surprise his readers.
Lethal Practice (1997) [Dr. Earl Garnet]
2009's Honorary List