Yes, it was way more intimidating than I’d anticipated. As a debut novelist I didn’t expect Oxygen to find a wide audience. In fact I knew it was a long shot to be published at all, so I felt quite unfettered. My original goal was to finish a novel and gracefully park it on my closet shelf until my grandchildren discovered it decades from now. By contrast, Healer was already under contract when I started writing it. I knew it would be read and critiqued, which made it harder to smother my own editorial harping. I completely threw out the first two drafts and only then discovered the heart of this story and this family.

To grow as a writer I have to push myself toward different voices and characters, and even genres—not write the same book again and again. That can feel risky. But at some point it’s critical to stand back from your own work as an author and let it march into the world without you, let the reader own it, analyze it, and take it forward.

Item deVery much. But I also drew on the experience of friends, family, in fact most of the women I know. Almost nothing changes your life as dramatically as becoming a parent, and parenting is a completely consuming job. I’ve spent many days at work feeling guilty about not being home, and plenty of days at home worrying about my job. But we live in an era when most families need two incomes or are single parent households. We have a highly educated and talented generation of women who want to work outside the home. At the same time, American families have dispersed; relatives and grandparents aren’t there to help out and high quality child care is expensive. It’s as if we fixed one half of the problem—expanding opportunities for women in the workplace—but we are sadly lagging in realistic options for every income level.scription

I have a theory that a book is a collaborative art; it isn’t complete until a reader absorbs it and animates the page with colors, scents, sounds, and the emotional responses borne of their own experience. That’s when characters and story fully come to life. Meeting readers is my chance to discover if what I envisioned made it onto the page intact. Writing fiction is an incredibly solitary pursuit—in some ways it’s utterly selfish narcissm (not that we can’t all use a little selfish narcissm now and then). That can be forgiven when a reader is entertained or enlightened or distracted from their own problems by the words I wrote. The other thing I love about meeting readers is having a chance to thank them in person for keeping books and publishing alive. If people don’t buy books, books will go away.

I live on an island off the coast of Washington and I volunteer for an NGO that supports projects and developments on an island in Nicaragua. The more I learned about the history of Nicaragua and the United States’ economic role in Nicaragua’s political development, the more I decided it was the perfect country of origin for my character Miguela. Since the early 1800s the United States has played an intrusive and often dark role in Nicaragua’s struggle for democracy. That is certainly not a unique political story, but it is a good example of how power and money can change the course of a nation and crush the dreams of its citizens. While it’s easy to say that those who work hard can better their lives and increase their standard of living, for most of the world the place and position into which you are born will dictate the life you lead.

In 2008 our family traveled to Nicaragua and spent two and a half weeks touring the country. It is violently beautiful, a land of volcanoes, jungles, raw coastlines and ecologic wonders—still largely unspoiled by tourism with people who are welcoming and generous. It was one of the best trips we’ve ever taken; a chance to show our children another culture, stepping outside the bubble they had come to assume was normal.

Compared to a lot of authors (and certainly anyone related to me under the age of 25) I have a fairly minimal footprint on Facebook and Twitter. But the Internet has completely transformed the way readers and authors communicate today. As much as I worshipped authors when I was young, I don't remember ever writing one a letter. Now I hear from readers all the time through Facebook or my website. It’s a gift to get such spontaneous feedback from people—honest reactions to my novels, parallel stories from their own lives or their medical experiences. It’s given me an appreciation for the breadth of opinions a book can generate: praise, catharsis, emotional identification or disagreement, criticism and controversy. All from the same 300,000 words printed in exactly the same way!

Facebook and Twitter and my website let me send announcements about my books, my talks, even photos and stories about my personal life to the general public, targeted groups or specific individuals. That has unprecedented power, because it turns me into a real person instead of just an author's name stamped on the front of the book. And it lets readers propel books based on their own passions—the viral power of connecting one friend to another and another. On the other hand, like any dazzling new toy, the Internet can be a Pandora’s box. It’s easy to let social media take up too much space in our lives. In the end the most precious commodity any of us has is time.

I’ve always been interested in the gap between the image we present to the world and who we are in our private lives, riddled with insecurities and stalled dreams. The world of medicine provides great fodder for this topic, because when you decide to become a doctor you adopt an identity. You wear a white coat and put two new capital letters behind your name, and a new title in front of your name. You are assigned a rank in society, auto-populated with presumed intelligence, education, and authority. It can be seductively easy to hide behind the veneer attached to the profession.

It takes so long to go through medical school and residency and fellowship and the stressful years of a new practice that it’s too late to turn around if you discover medicine is not the career you’d imagined. So I sometimes wonder if there isn’t a larger than average cache of charlatans lurking in the medical world—people who don’t always feel like they belong. Maybe this is only my fiction-writing mind at work but the idea intrigues me, and it’s much more fun to write about characters when I get to scrape away their polish and tattle on their flaws. The gap in Claire’s working life set these flaws into higher contrast; she never really got a chance to establish her medical career. The timing of Jory’s premature birth collided with a professional catastrophe that made it easy for Claire to turn away from medicine and pretend it was all for her daughter. Then there’s the question of money. Once Claire no longer had to support herself or her family, how much courage did she really have to go back to a job that had nearly overwhelmed her? What did she need to discover about herself when she had no choice?

No matter how moving or engaging a story is, if the characters in it don’t ring true to life the story feels flat. And while I don't write autobiographically, I do use my life and experiences as an emotional sounding board—testing dialogue and reactions for veracity against my own emotional responses even when a character behaves contrary to my personality. It can be exhausting, but also illuminating and provocative. Readers often assume that I am my protagonist, and friends and family wonder how much I’ve borrowed from them. I haven't seen any permanent rifts from that yet, but it can be a struggle to keep stories honest when I sense they are paralleling some recognizable event. On the other hand, that’s also one of the main attractions of reading isn’t it? Discovering pieces of yourself in new worlds and imagined characters? It can go a long way toward making one feel less alone in the world.

Definitely! Every doctor feels it. You skate out of medical school confident that you are a master of medical facts, and then you collide with the patient who can’t be diagnosed, saved, or even satisfied. Humans aren’t cars or airplanes. They respond differently to medications and therapy. They manifest the same disease in variable ways, which is why no physician can precisely answer questions like, “how long will I live with this?” It’s why a doctor who’s treated a hundred cases similar to yours can boil the ocean of numbers and statistics down to reasonable advice for your particular situation. It’s also why the Internet can be a potentially unreliable source of medical information. Years ago I was asked to write flow diagrams for a dot.com startup company that intended to sell point-and-click diagnoses and treatment plans to patients and physicians—a laughably hopeless business plan, because it included no link for perspective: that intuitive and invaluable skill that develops only with time and careful attention, year by year, patient by patient.

Well, if you envision balance as standing in the middle of a see saw or bongo board, you know it’s not a static point. It’s a continual shifting of weight and muscle, taking and giving and sometimes failing. I work at both endeavors part time, which seems to add up to one and a half jobs! One advantage of my medical specialty, anesthesiology, is that my direct patient care responsibilities largely begin and end in the operating room, so when I’m off duty I’m not worried about my patients and can more easily immerse myself in what I’m writing. But medicine and fiction are more complementary than might be obvious—after all, look at the number of exceptional plays and poetry and novels that have been authored by doctors, from Chekov to Carlos Williams to Verghese.

I had a literature professor in college who said, “Without death there would be no poetry!” I’m not sure I agree with that—even immortal teenagers can get mighty emotional. But I do see patients every day who have been cheated out of decades of life, and writing is an outlet I use to make sense of the inequality of biological fate. And when I take a longer view of these two mixed careers, I recognize that staying challenged on more than one front keeps me from getting complacent about who I am and what I am capable of doing. As long as I have certain constants in my life, my family, I love to surprise myself by testing my limits.

I have succumbed to the personal fact that my need to write is similar to being infected with a chronic virus. It seems to be the only cure for quieting the incessant narration of life that goes on in my head. Within a week of figuring out the ending to Healer I heard some new characters dancing around in there, and they’ve already begun their journey