A novel beginning

Here's the scene. A 52-year-old man is brought into the emergency department, comatose after collapsing in a restaurant. Residents and the ER chief crowd around the inert body as a nurse urgently calls out vital signs, then shines a penlight into the man's dilated left pupil. Pandemonium reigns, but despite the din everyone hears the patient's rating on the coma scale: 3. “A corpse would score 3,” quips a resident. The diagnosis? Left-side intracranial bleed from an aneurysm or an arterial venous malformation. The prognosis? Not good. Hopeless is more like it, explains the protagonist in Dr. Peter Duffy's recent medical thriller, The Procedure. Had the patient come to Emergency when his blinding headache first hit, the outcome might have been different. But after reading a few more pages of ER repartee, the reader learns why the patient waited too long. And it turns out he's not the only casualty in the book, a mystery in which there is more than 1 gruesome murder and more than 1 suspect. And some of the villains are doctors, particularly the ones who ration essential care based on the bottom line. That's the subtext of a plot about subterfuge and hidden rivalries in a major North American hospital, says author and physician Peter Duffy, known as Peter Clement in the publishing world. “This is a book about people who withhold care with impunity. Whether it's Parizeau, Harris or Klein cutting health care or Wall Street maximizing profits, the squeeze on hospitals and emergency departments is the same.” Duffy knows these conflicts and pressures well because he practised emergency medicine for 20 years, including 8 as chief of the emergency department at a Montreal hospital. Now a full-time novelist, he puts his medical experience to good use. The protagonist in his first 3 books, Dr. Earl Garnet, is a fortyish ER physician in a major urban centre with 20 years of practice behind him, a young family and a sympathetic gynecologist for a wife. Although this matches Duffy's profile fairly closely, the author has purposely set up barriers between his professional identity and the persona he invented. “I wanted a clear distinction between my activity as a thriller writer and my life as a physician,” he says, explaining why he chose Clement, his middle name, as a nom-de-plume when he began to publish. “Sometimes I unconsciously used physical set-ups that were familiar to me. But I did not want the emphasis to be on my situation, but on the story.” His own story is interesting nonetheless. Like horror author Stephen King, Duffy has always loved thrillers, beginning with John Buchan's The Thirty-Nine Steps, which he read at age 10. The idea of writing medical mysteries came to him in the early ‘90s, when he was at the peak of his professional career. “I wasn’t going to see or do anything new at that point,” he says. At first he wrote in his spare time, and then he began splitting his week between medicine and writing. Eventually he took a 2-year sabbatical from medicine. By that time Duffy had been at work on his first novel, Lethal Practice, for a couple of years. “I was writing every spare moment, evenings, weekends and holidays, and living like a resident,” he says. When he finished the manuscript he contacted Bantam Books, which publishes the work of Jonathan Kellerman, a psychologist-turned-mystery-writer. After 3 months with no response, Duffy called. He “got lucky” and ended up with the same editor as Michael Crichton, probably the most famous physician-turned-novelist. Duffy has now published 4 books in 4 years. “After the third book they wanted a 2-book deal — a book a year with an offer too good to refuse — so I really had to let go of the practice.” The first 3 paperbacks sold about 150 000 copies each. His latest, The Mutant, is a sinister tale about genetically modified foods, an idea he developed after attending a UN conference in 1999. “I like a book to be smart, I like it well written and I like it to be very immediate,” he says. He also wants the reader to learn about someone else's world, whether it's that of a stressed-out ER physician, an aggressive psychotic patient or a burned-out homicide detective. “The characters have to be flesh and blood. I like to look at extreme situations, and how ordinary people deal with them. There are a 100 000 stories in a hospital, and if you take the time to hear them, there's no shortage of material.”

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