Volume 13, No. 1, Spring 1997
by Eileen Dreyer (St. Louis, Missouri)
There's just no place like a hospital for finding life
and death struggle. A cliché, certainly, but one that serves
an excellent purpose in the world of mystery. Why do I choose to
write mysteries set in medicine? Actually, there are several very
good reasons, from the intellectual to the perfectly selfish.
The first and foremost of these is, of course, that life and death
business. A hospital isn't just a convenient setting. It's an
automatic notification to my audience that desperate things can
happen here. The stakes have already been set, the playing field is
familiar. Everybody who has read Frankenstein knows that doctors hold
the power of life and death and, sometimes, rebirth in their hands.
Every television show from Dr. Kildare to ER reinforces
the concept that in medicine split-second decisions make the
difference between life and death -- and that not only very good
people, but very scary people can be making these decisions. By
setting a book in the world of medicine, I have already let my
audience know that no matter how much humor is involved, the
consequences of what happens here will not be frivolous.
The second reason I use medicine is one people might not really
consider. Not only is medicine a natural place for mysteries to
occur, but medical personnel make natural detectives. It is, after
all, what we are trained and paid to do. What is disease, after all,
but a mystery? We are presented with a patient who exhibits a certain
set of symptoms and complaints, and it is up to us, the detective
team with its laboratory findings and hunches and deductive reasoning
to find out what the culprit is and contain it. We correct an
imbalance in the system, which is exactly what the best detectives do
in good fiction.
Therefore, the impulse to extend the doctor's or nurse's interest
and talent in detecting beyond the realm of medicine is a natural
one. It is in his or her very nature to solve mysteries.
The third reason is what I call the Marathon Man factor. In
this wonderful movie, the villain is a dentist, which means, of
course, that he uses his dental tools for torture. When I saw the
movie the first time, I lasted as long as it took him to open up
those gleaming, nasty little instruments. I listened to the rest of
it from the lobby -- with about half the audience. William
Goldman, who wrote book and screenplay, didn't have to explain a
thing to terrify his audience. He knew he had them the minute that
case was opened.
The same principle holds true for medicine. Any sensible person is
simply afraid of hospitals. As much as we want to trust hospital
personnel, we're really terrified of them. After all, we are at their
mercy in a foreign world where people speak a foreign language and
hold our lives, our dignity, our sense of self in their sometimes
callous hands. Add to that automatic dread the thought that while we
are in that place, at our most vulnerable, we find out a murderer is
set loose among us. As an author I feel absolutely no compunction
about using this natural fear to notch up the tension in a book
without ever having to print a word.
An example from my own work is my HarperCollins paperback A Man
to Die For. Using William Goldman's dentist as my inspiration, I
instead made my villain a psychopathic, serial-killing gynecologist.
See? Any women out there reading those words doesn't even have the
crack the cover of the book to fear this guy.
Now to the selfish particulars. It's easy. I know medicine.
Because I was not only raised in a medical household but spent some
twenty years working trauma centers, I know the world of a hospital
as well as Wambaugh knows police stations. I know the lingo, the
priorities, the secrets, the terrible truths nobody tells the public.
I loved the people I worked with, the job I did, the world I
inhabited. Since one of the reasons we read books is to learn about a
world we're not familiar with, I take great delight in sharing my
world with my audience.
I also write from a rather unique perspective. Most traditional
medical mysteries are written from a doctor's viewpoint. Let's face
it. Most of popular media focuses on the doctor's viewpoint. But if
you want to know about how a hospital really works, a doctor is
usually the last person to ask. Better yet, ask a nurse. Because a
nurse deals with every level of the hospital hierarchy, and knows
better than most how very scary hospitals really are.
The other wonderful thing about writing in the medical field is
that I never run out of ideas. The field is fluid and dynamic. The
problems are ever-present and as cutting edge as next week's news.
And, to be perfectly frank, I get the satisfaction of killing off all
the people who contributed to my burn-out. In A Man to Die For
I killed off doctors, in Nothing Personal hospital
administrators, and in Bad Medicine lawyers.
I do step afield in my next book for HarperCollins, Brain
Dead, and fulfill a special request from my sister to kill off
ex-husbands. But I still lay bare the workings of a hospital where a
new Alzheimer's unit may be the very thing to save the hospital, a
marginally surviving town, and all the patients in this revolutionary
research facility. That is, if the facility isn't killing more than
its patients in the meantime. It is up to the intrepid forensic
nurse, of course, to find out -- at great peril to herself.
And what's a forensic nurse, you ask? Well, that's what I mean
about medicine being fluid. Forensic nursing is one of the newest
subspecialties available to nurses today. I happen to be the
unofficial mascot for the International Association of Forensic
Nurses, as a matter of fact. If you want to know more about what they
do, read the book. You know you'll find out something new about a
world that, face it, makes you just a little nervous. Even without a
murderer running around inside.
Every week on Diagnosis Murder, Dr. Mark Sloan
is able to unravel a puzzling murder by using clever deductions and
good medicine to unmask the killer.
I wish I could say that he's able to do that because of my
astonishing knowledge of medicine, but it's not.
I'm just a writer.
I know as much about being a doctor as I do about being a private
eye, a lifeguard, a submarine captain, or a werewolf... and I've
written and produced TV shows about all of them, too.
What I do is tell stories. And what I don't know, I usually make
up... or call an expert to tell me.
Writing mysteries is, by far, the hardest writing I've had to do
in television. Writing a medical mystery is even harder. On most TV
shows, you can just tell a good story. With mysteries, a good story
isn't enough, you also need a challenging puzzle. It's twice as much
work for the same money.
We always begin developing an episode the same way -- we come up
with an "arena," the world in which our story will take place. A UFO
convention. Murder in a police precinct. A rivalry between mother and
daughter for the love of a man. Once we have the arena, we talk about
the characters. Who are the people the story will be about? What
makes them interesting? What goals do they have, and how do they
conflict with the other characters?
And then we ask ourselves the big questions -- who gets murdered,
how is he or she killed, and why? How we solve that murder depends on
whether we are writing an open or closed mystery.
Whether the murder is "open," meaning the audience knows whodunit
from the start, or whether it is "closed," meaning we find out who
the killer is the same time that the hero does, is dictated by the
series concept. Columbo mysteries are always open, Murder
She Wrote was always closed, and Diagnosis Murder mixes
both. An open mystery works when both the murderer, and the audience,
think the perfect crime has been committed. The pleasure is watching
the detective unravel the crime, and find the flaws you didn't see. A
closed mystery works when the murder seems impossible to solve, and
the clues that are found don't seem to point to any one person, but
the hero sees the connection you don't and unmasks the killer with
it.
In plotting the episode, the actual murder is the last thing we
explore, once we've settled on the arena and devised some interesting
characters. Once we figure out who to kill and how, then we start
asking ourselves what the killer did wrong. We need a number of
clues, some red-herrings that point to other suspects, and clues
which point to our murderer. The hardest clue is the finish clue, or
as well call it, the "Ah-ha!," the little shred of evidence that
allows the hero to solve the crime -- but still leaves the audience
in the dark.
The finish clue is the hardest part of writing a Diagnosis
Murder episode -- because it has to be something obscure enough
that it won't make it obvious who the killer is to everybody, but
definitive enough that the audience will be satisfied when we nail
the murderer with it.
A Diagnosis Murder episode is a manipulation of
information, a game that's played on the audience. Once you have the
rigid frame of the puzzle, you have to hide the puzzle so the
audience isn't aware they are being manipulated. It's less about
concealment than it is about distraction. If you do it right, the
audience is so caught up in the conflict and drama of the story, they
aren't aware that they are being constantly misdirected.
The difficulty, the sheer, agonizing torture, of writing
Diagnosis Murder is telling a good story while, at the same
time, constructing a challenging puzzle. To me, the story is more
important than the puzzle -- the show should be driven by character
conflict, not our need to reveal clues. The revelations should come
naturally out of character, because people watch television to see
interesting people in interesting situations... not to solve puzzles.
A mystery, without the character and story, isn't very entertaining.
In my experience, the best "Ah-ha!" clues come from character, not
from mere forensics -- for instance, we discover Aunt Mildred is the
murderer because she's such a clean freak, and couldn't resist
doing the dishes after killing her nephew.
But this is a series about a doctor who solves crimes. Medicine
has to be as important as character-based clues. So we try to mix
them together. The medical clue comes out of character.
So how do we come up with that clever bit of medicine?
First, we decide what function or purpose the medical clue has to
serve, and how it is linked to our killer, then we make a call to an
expert to help us find us the right malady, drug, or condition that
fits our story needs. If one of our paid medical consultants doesn't
know the answer, we go to the source. If it's an episode about
infectious diseases, for instance, we might call the Centers for
Disease Control. If it's a forensic question, we might call the
medical examiner. If it's a drug question, we'll call a
pharmaceutical company. It all depends on the story. And more often
than not, whoever we find is glad to answer our questions.
For instance, in one episode there's a terrible bus accident and
the passengers are trapped inside. Once they are freed, paramedics
discover one of the passengers is dead. What Dr. Mark Sloan discovers
is that the accident didn't kill the passenger... the man was
murdered. The killer had to be one of the passengers, since they were
all trapped inside after the accident. So someone killed the person
in the five minutes after the accident and before the paramedics
arrived and hoped the death would be blamed on the crash.
We knew we needed a medical clue that Dr. Sloan could find that
would reveal the man's death was actually murder, not a result of the
bus crash. So we called our medical consultant, Dr. Gus Silva, and
gave him the details. He called some of his fellow doctors and got
back to us an hour later with the forensic clues we needed.
One of the paramedics in the episode is cocky, self-confident, and
studying for med school entrance exams. Dr. Sloan, to help her out,
gives her a pop quiz, asking her four questions. She gets one of them
wrong, but Dr. Sloan won't tell her which one because he wants her to
figure it out for herself.
We thought it would be clever if Dr. Sloan realizes she's the
killer because she made the same mistake committing the murder that
she makes in his pop quiz... in other words, her mistake comes from
the same cockiness and over-confidence she demonstrates in her zeal
to become a doctor. We went ahead and plotted the story, but relied
on Dr. Silva to get back to us with just the right, subtle medical
mistake that would trip the paramedic up.
The viewer enjoys the game as long as you play fair... as long as
they feel they had the chance to solve the mystery, too. Even if they
do solve it ahead of your detective, if it was a difficult and
challenging mystery, they feel smart and don't feel cheated. They are
satisfied, even if they aren't surprised.
If Dr. Sloan catches the killer because of some arcane medical
fact you'd have to be an expert to catch, then we've failed and you
won't watch the show again.
The medical clue has to be clever, but it can't be so obscure that
you don't have a chance to notice it for yourself, even if you aren't
an M.D. And it has to come out of character, so even if you do miss
the clue, it's consistent with, and arises from, a character's
behavior you can identify.
To play fair, all the clues and discoveries have to be shared with
the audience at the same time that the hero finds them. There's
nothing worse than withholding clues from the audience -- and the
sad thing is, most mysteries on television do it all the time. The
writers do it because playing fair is much, much harder than
cheating. If you have the hero get the vital information off screen,
during a commercial, the story is a lot easier to plot and the
writing staff can eat out for lunch instead of having pizza delivered
again... and being stuck in a story conference for six more hours.
But when a Diagnosis Murder episode works, when the mystery
is tight, and the audience is fairly and honestly fooled, it makes
all the hours of painful plotting worthwhile.
That, and the residual check.
Lee Goldberg is the author of My Gun Has Bullets and Beyond
the Beyond (St. Martin's Press), a comic thriller about TV, and
is the supervising producer of Diagnosis Murder.
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Medical Mysteries