How to Write a Mystery

by Mystery Writers of America

  Imagine this: I am in my car sitting in stopped traffic on a major motorway close to London’s Heathrow Airport. It is half past five on a Friday evening and I am on my way home from work. I have left a good two cars’ distance from the vehicle in front of me, a brand-new Mercedes-Benz. I am not sure which came first, the crashing sound that seems to be all around me, or the realization that my car has been shoved at speed into the Mercedes-Benz and is crumpled back and front. Without a second’s delay, I know I have to get out because I can smell gasoline—I filled my tank after leaving work—yet my door is jammed, so even though my neck really hurts, I clamber over my briefcase and a bag of shopping on the floor of the passenger seat. The drunk driver behind me—on his way to Heathrow following a liquid lunch—did not see the stationary traffic and was speeding at over seventy miles per hour when he hit me. One year later I am walking along a street when I hear a car skid, the sound of brakes shrieking behind me. I am suddenly out of my own skin, my heart pounding as I clutch my neck. I remember this day when writing a scene in which a young woman has to return to a place where she has seen death of a most terrible kind, and I am trolling through my memories trying to recall what it feels like to relive terror. And not for the first time I ask myself, How would I feel if… while grappling with a completely different event at a different time—which works when I bring together knowledge gained in research and season it with a visceral response to craft a painful scene.

  The essence of how those experiences were used is in a melding of experience and research, which is at the heart of character. I am not trying to give my characters exactly the same experience that I had—how could I, for we exist decades apart?—yet I can take a certain sensation and, with my understanding of the past, develop authentic time-appropriate responses to a given situation. I bear in mind that behaviors are often different when the vast changes in society across centuries and cultures are taken into account. Consider the following example, whether you are setting a story in fourteenth-century Rome or nineteenth-century New York.

  Research conducted by medical historians during the Iraq War revealed interesting differences between the responses of soldiers to death in World War I and in the contemporary army. It was the sort of study that provides a lesson for the writer of historical fiction. In the early 1900s, even small children were accustomed to seeing dead people, because loved ones often died at home with the family gathered around the bed to bid farewell and bear witness to the passing. Death in childbirth was not unusual, and it was also somewhat common for people to die in domestic accidents, or on farms and in factories. However, though many young men had seen death, they hadn’t seen lots of blood and gore, so trench warfare and the realities of the battlefield were psychologically wounding—soldiers expected the death, but not the torn bodies. Fast-forward to 2003. Most of the soldiers had been raised on TV, film, and video games where they saw a lot of blood and gore. The problem for the young soldier was that witnessing the blood and wounds on the battlefield wasn’t quite as shocking as it had been for his great-grandfather, because in his experience, actors blown to pieces on the screen turned up again in another movie, or the game character could be made to resurrect several times over. The on-screen battlefield had not led to death—yet it did in the reality of modern combat, and thus grave wounds leading to never seeing that person alive again became a source of PTSD in young soldiers. This example demonstrates that we mustn’t assume that the response of a person to an event two hundred years ago or even fifty years past is going to reflect our twenty-first-century perspective.

  Examining your motives for writing the historical mystery can spotlight many avenues for exploration as you craft the narrative. Your curiosity will reveal plot points and opportunities to ground your story in its time—a sense of wonder is a powerful attribute for the writer of the historical mystery. “I sort of backed into historical fiction,” says Laurie R. King, adding, “I wanted to write about a young woman who became apprentice to Sherlock Holmes, and his author finished with him in 1914—so I rapidly started learning about the years during and after the Great War.” And for Rhys Bowen, the call came from family connections. “I was raised by my grandmother and great-aunt and heard stories from them of the Great War, Edwardian times, the twenties. They all sounded exotic and interesting.”

  For every historical mystery published, there is an author who could be lost under a mound of papers and books gathered for research purposes, and having spent a small fortune on those materials, plus traveling to walk the streets of another city and hotel bills along the way, becomes determined to use all accumulated material. But here’s the key to a balanced historical mystery—just because you did the research and spent all that money and gave all that time does not mean you have to use every single piece of acquired information. Not every bloom clipped should make it into the vase. I believe research should be a bit like an iceberg—only 7 percent of it should be visible above the surface. And the rest? Trust me on this one—it will inform every single word you write. Research included with a mindset of “I’ve got it, so I’ll use it” will become a speed bump in the story, causing reader interest to evaporate under a surfeit of architectural detail as the historical provenance of every single street is recounted on your protagonist’s route as she roars through 1800s Boston. Think: “Balance.” And how do you know when you have that balance? Read sections aloud and be honest with yourself regarding the places where the pace slows, and then be prepared to kill your darlings—arguably the most useful assassination in your mystery. All facts quoted should be correct, with names and dialogue appropriately reflecting the era—but use your research as if it were a powerful spice you’re about to add to soup. Taste often to ensure ease of digestion.

  The historical mystery is one of the most popular literary forms published today, offering the writer an opportunity to explore the human condition across the ages, through different cultures and while characterizing people in conflict with themselves and each other—and for writers who like comedy, there is always humor to be found in times past. Rhys Bowen has observed, “Historical novels are popular now because there is much to feel uneasy about in the present.” As a writer of historical mysteries, I could not agree more, and in my own experience, readers are looking to the past not only for a sense of power over events, but also to observe qualities of endurance and resilience and an ability to come through troubling times, so all is well that ends well. Which brings us back to Jane Austen.

  As writers of historical fiction, we ply our craft as if we are in the midst of the action, as if we are right now, in this moment, wearing those hobnail boots, or that tight whalebone corset, or the scratchy bloodstained uniform with lice along the seams. We must write as if we are personally facing the eight-course Edwardian lunch or the meager meal of unleavened bread and water in an Egyptian slave’s quarters. Immersed in that other time and place, we take our match to the fire. And we write.

  SUZANNE CHAZIN

  “I write because I want to have more than one life,” novelist Anne Tyler was once quoted as saying. I agree. When I sit down to write, my fun comes not from looking into a mirror, but from peeking into someone else’s window.

  The Medical Thriller

  Playing on the reader’s real-life fears and hunger for insider knowledge.

  TESS GERRITSEN

  Many of us are afraid of doctors and hospitals—so afraid that the stress of just being in a doctor’s presence can make our blood pressure soar. The phenomenon is so well known that there’s a name for the syndrome: white-coat hypertension. As a physician, I know these fears are sadly justified because a hospital is the most dangerous place many of us will ever find ourselves, a place from which we might not make it out alive.

  Medical thrillers play on these very real fears, and they’ve been scaring readers for half a century, ever since medical doctors Robin Cook (Coma) and Michael Crichton (The Andromeda Strain) introduced the genre. Doctors or nurses usually play prominen
t roles in these stories, but the central character of your thriller needn’t be a medical professional. What is necessary to your plot is a theme that focuses on medical science or ethics, as well as medical settings or situations.

  While it helps to be familiar with this world, you don’t need to be a doctor to write a medical thriller. Just by being a patient, you may have experienced something that frightened or unsettled you, and that experience may be enough to launch your story. Although I’m a medical doctor, it was my experience as a patient that inspired The Surgeon, my first Jane Rizzoli novel. While I was having my blood drawn for routine lab tests, it occurred to me that blood is the most intimate thing we routinely hand over to a stranger. Those blood tubes can reveal many secrets about you—whom you’re related to, which illicit drug you last ingested, what disease you’re likely to succumb to. What if your blood sample ends up in the wrong hands? What if that person decides, based on your blood test, that you will be his next murder victim? That became my premise for The Surgeon.

  If you’re searching for a story about medical ethics, you’ll find inspiration just by reading the newspaper. In the U.S., where medical care is expensive, you’ll find heart-wrenching stories about families desperate to keep a loved one alive. When a lifesaving drug is scarce, which patient should get it? Who gets to live and who is simply allowed to die? These life-and-death decisions are the dramatic engine of the genre. Imagine the desperation of a parent with a dying child. Think of how far you’d go and what rules you’d break to save your kid’s life. This desperation can inspire any hero—or villain.

  Brave new science, and its unintended consequences, is another common theme in the genre. What are the consequences of cloning? What if you could edit the DNA of babies to make them more “perfect”? What if a pharmaceutical company’s new miracle drug has a fatal side effect—one they’re desperately trying to hide? I’ve found ideas for my stories in journals such as Discover, Science, and Scientific American, where cutting-edge discoveries are first reported. My novel Life Support was inspired by an article about a form of mad cow disease that was transmitted by human growth hormone harvested from cadavers. That scientific tidbit made me wonder: If we found a medical fountain of youth, what could possibly go wrong?

  Pandemics are another perennial theme in medical thrillers, and no wonder; whether it’s Ebola or some new strain of bird flu, pandemics threaten us all. The infectious agent need not even be terrestrial. Crichton’s Andromeda Strain, about a deadly extraterrestrial organism, raised the stakes even higher by putting the future of all humanity at risk.

  I should add a cautionary note about topics that seem difficult to sell. No matter how well written and well publicized they are, thrillers about cancer or HIV or Alzheimer’s seem to have a tough time on the genre market. Perhaps these subjects are just too close and too painful for us to contemplate, and readers shy away from confronting them in fiction. (I confess I do.) If your medical thriller about cancer keeps getting rejected, it may be because you’ve chosen a subject no one wants to think about.

  My literary agent once told me that readers choose medical thrillers because they’re hungry to know secrets. They want to know what doctors know, how they think, and what really goes on behind the doors of the operating room and the morgue. You may not need to be a medical professional, but since your story most likely features medical professions and settings, you need to be familiar with the world in which doctors and nurses work. What does a doctor’s average day look like? How do they evaluate a patient in crisis? When things go horribly wrong in the hospital (and too often they do), how do professionals react?

  You also need to know how one becomes a doctor. The most common mistakes I’ve come across in the genre, both in novels and in film, spring from ignorance about the process of medical education. In the United States, it’s a lengthy journey that starts with a college degree. These four years in college are often referred to as “premed,” but you’re not actually learning any medical skills yet, so never have a premed character perform an appendectomy. Your undergraduate degree can be in any major (mine was anthropology), but to apply to medical school, you must complete a year of college biology, a year of physics, two years of chemistry, a year of English, a semester of biochemistry, and mathematics through calculus. Most medical schools also require applicants to take the Medical College Admissions Test, a daylong multiple-choice exam that tests your skills in science, critical thinking, and psychology. Since only about 40 percent of applicants are accepted to any U.S. medical school (and some elite schools have acceptance rates as low as 3 percent), you’ll need both a high college GPA and a good MCAT score to compete against the approximately 53,000 other college students who are also applying to medical schools.

  While getting into medical school is a challenge, once you’re accepted, you’ve made it through the most difficult part of the winnowing process. Medical schools want their students to succeed, and the vast majority of medical students will graduate (although misconduct or significant underperformance will certainly get you expelled). These four years of focused medical studies include classroom and lab work as well as hands-on rotations in hospitals, operating rooms, and clinics. This is when you truly learn the art of being a doctor. You also learn what it’s like to go thirty-six hours without sleep, to feel the warmth of splattered blood in the operating room, and to watch the life drain from a patient’s eyes. It’s a grueling, challenging, sometimes heartbreaking four years, and it takes grit to make it across the finish line to graduation. And since more women than men are now enrolling in medical schools, these brand-new doctors are more and more likely to be female.

  But even with your freshly minted medical degree, you’re still not ready to practice medicine. Postgraduate training (otherwise known as a residency) still lies ahead. Depending on which specialty you choose, this can add three years (for internal medicine, family practice, or pediatrics) to five years or longer (surgical specialties), with some subspecialties such as neurosurgery requiring a whopping seven years of postgraduate training. These various specialties and subspecialties can be confusing to laypeople, and novelists sometimes mistake “neurologist” for “neurosurgeon” or “cardiologist” for “cardiothoracic surgeon.” Learn the difference before you describe a neurologist (who doesn’t wield a scalpel) as a neurosurgeon (who does).

  The eleven-to-fifteen-year educational marathon from college through residency requires intelligence, stamina, and determination. In a thriller, these are the qualities you’d find in a hero… or a formidable villain. But doctors are also human, and the profession suffers from higher rates of suicide, depression, and substance abuse than does the general public. A flawed and emotionally vulnerable doctor is believable in a novel; a truly stupid doctor is not.

  If you’re not in the medical field, how do you find the details and anecdotes that will give your story the all-important aura of verisimilitude? Talk to a doctor or nurse. Ask them what their average day is like. Ask them about their worst day and their best day on the job. Ask them about their triumphs (they’ll be happy to share these) and their mistakes (which could be harder to pry out of them). But don’t make this visit a fishing trip; before you take up a professional’s valuable time, know what you need to ask and have a list of questions prepared. Prior to the meeting, do enough research to already be familiar with the technical vocabulary specific to your plot. By now you should already know the bones of your story and many of the crisis points. If the crisis is an internal abdominal hemorrhage in the operating room, then look up the basic anatomy of the abdomen and which major blood vessels might rupture. Know the surgical instruments that would be on the OR tray and what each one is used for. Know the difference between a scrub nurse and a circulating nurse and the role of each member of the OR team. Prepared with that knowledge, you will save both your time and the doctor’s when you sit down and ask: “Your patient’s blood pressure is crashing on the table. What’s the first thing you’d do?”


  A large part of making your story believable is using authentic lingo. If your MD character says to another MD, “The patient had a heart attack,” your story loses credibility. But if he says instead, “The patient had an inferolateral MI” (a specific type of heart attack), suddenly the dialogue is believable—even if your readers have no idea what “inferolateral MI” means. The television series ER gave viewers a real taste of the characters’ world because the writers didn’t dumb down the dialogue. Their fictional doctors talked like real doctors, even though the audience probably understood only half of the medical terms being batted back and forth. Emotional context was crucial. It didn’t matter that viewers didn’t know the meaning of “V-tach”; all they needed to hear was a panicked character saying “Oh my god, he’s in V-tach!” and they understood that V-tach was a very bad thing.

  Your use of medical lingo, while essential to authenticity, is a delicate balancing act for writers. Without it, the thriller loses its verisimilitude, but use too much and the reader will be frustrated by all the incomprehensible words. One way to make the terminology easy to understand is to include an everyman, a lay character who’s as new to these words as the reader is. He needs other characters to explain things to him, and whatever he learns, the reader learns. Another strategy is to simply let the emotions of the scene do most of the explaining, the way ER did. They didn’t stop to define every medical term, yet it didn’t take long for viewers to learn what “stat” means. If a character says in an urgent voice, “I need those results, STAT!” its meaning becomes clear.