A Conversation with Peter Clement

Q. Peter, you made your debut as a novelist in 1998 -- with Lethal Practice. Would you give us a thumbnail description of your life before Lethal Practice?
A. Much of my routine was similar to the one I have described for Earl Garnet -- working ER shifts, teaching, attending meetings, and keeping the department functional. It's a pretty typical job description for any ER chief -- the thrill of working the big cases interspersed with the mundane business of making sure everything is stocked, staffed and ready for whatever comes through the door…twenty -- four hours a day, every day of the year. As with most ER doctors, the rest of my life rotated around the schedule that regulated our shifts. As an ER physician to do anything socially and he or she will probably consult this document even before checking with their families or companions to see if they're free. As much as I miss the clinical work and the teaching, I certainly don't miss the hold which that infernal piece of paper had over my comings and goings during the last twenty years. However, since leaving ER to make time for writing, I seem to have fallen under the sway of a new tyranny called "the deadline." When I wasn't in ER, the rest of my working week was spent tending to my private practice, and, as much as possible, I retreated to our country home with my family on weekends. And now? Now I write full time, but still retreat to the country home with my family.

Q. What inspired you to embark upon a writing career?
A. My kids asked me that all the time, especially when they were younger. "Why write books?" they'd demand to know -- when I could be spending time on really important activities, such as playing with them or doing computer games. The easy answer is that I thought ER would be a great location in which to set a modern thriller. I have always loved mystery stories told in the first person -- especially work by the masters, such as Chandler and Hammett. I knew that by using the immediacy of the device, I would let the reader actually become an ER physician and experience his excitement, his fears, and his doubts. I couldn't resist the fun of introducing someone very evil into this special world and seeing what would happen. Buy my young sons didn't buy that stuff. I then appealed to their own love of storytelling, and I explained that I share that love. But they reply, "Sure, we all love stories, but why do you want to be one of the people who writes them?" That stumped me. But a former classmate of mine who happened to be having dinner with us gave what I think is the truest answer I've been able to come up with. She looked at my kids and said, "Because he has to."

Q. And why fiction rather than nonfiction?
A. From nonfiction we learn what has been and what is. In fiction I like how we can play with what might be.

Q. On the pretext that writers, including novelists, "write what they know," how much of your first two novels is based on your own experience as a doctor in charge of a hospital emergency room?
A. My job as a writer of fiction, I think is to create a medical world that is realistic, as opposed to being real. Any doctor doing any writing must protect patient confidentiality above all. That being assured, I made up the medical setting of my stories much in the way we create teaching cases for the residents. In those, no one's medical history is recognizable, but the realities of the problem being observed are accurate. My experiences as a chief exposed me to many of the ethical, political, medical, and economic issues at play in most modern ERs. I then made up fictitious scenarios involving some of those same issues and set their forces loose in my stories. The not -- surprising result is that I've received comments from all over America that "it's just like my hospital." One way or another, these days we all seem to be looking at variations of the same difficulties in ER.

Q. ER physician Earl Garnet is the emotional and intellectual center of your first two novels. In what ways is your protagonist similar to -- and completely unlike -- his creator?
A. Garnet is married to an obstetrician; so am I. Garnet has a son; I have two. Garnet has a large poodle; our family has two. Garnet and I share a love for a log home on a little piece of paradise in the mountains an hour from our respective cities. One of the things I liked about being chief was that I could hire the best and brightest emergency physicians I knew, and Garnet is a tribute to them. Am I like Garnet? I certainly identify with his commitment and his passion to be good at what he does, but I'm probably more like a Garnet wanna -- be. When I first became chief and announced my intent to hire a physician who was very much of Garnet's caliber, one of my friends in ER gave me an astonished look and blurted out, "You can't be chief over him! He's better than you!" One thing's for certain: I'm a better doctor for having had the privilege of working with the Garnets of the world.

Q. What about the character Richard Steele that you introduced in Mutant and Critical Condition.
A.He's a more flawed person, and darker. I needed him to tell those particular stories. Part of the theme of those two books involved how an exact science like medicine can be affected, sometimes for the worse, by the problems and imperfections of those who practice it. When dealing with important fields, such as the major themes of these two stories, genetically modifying organisms in Mutant, and stem cell therapies in Critical Condition, the results can be lethal on a big scale.

Q. The concept of Death Rounds is really provocative. In your novel of the title, Earl Garnet says, "Some doctors shunned the process, but I couldn't have continued as a physician without it." In effect, is this you, Peter Clement, speaking as well? How widespread is the practice of death rounds? And why do some doctors shun it?
A. That quote is me speaking. I was taught early on that the autopsy was the ultimate tool of quality assurance, and that all deaths, especially the ones we think we understand, can teach us our failings. On a personal level, I always felt I gained as an emergency physician by subjecting myself to that kind of review. The next time a similar case came through the door, I could react to the problem with just a bit more certainty, precision, and speed.

Most hospitals have some form of morbidity and mortality review -- they're also called M&Ms. Unfortunately, they aren't always applied systematically to all cases, and sometimes these forums are conducted in an aggressive manner, the physician responsible for the case being put on the defensive and nobody learning anything except that it's better to cover up errors to protect your ass.

I always felt the secret to making death rounds work was to keep the sessions from becoming too accusatory and, if a mistake in the treatment of a patient was found, to focus comments on how all of us could avoid making that same error in the future. IN most instances, only a fool would fail to grasp that he or she could have made a similar slip in a second of inattentiveness, and when a death was ruled preventable, no one dared point accusingly at the physician who was responsible.

But the process, even when it's kept civilized, is tough to endure. A physician who tends to be insecure about his or her clinical skills in ER is liable to be afraid to face such revealing scrutiny. Unfortunately, it may be that very sort of scrutiny by peers that could either elevate the physician's competence and confidence to a level that would render them safe for ER work -- or reveal once and for all that he has no future in critical -- care medicine.

Q. Your third book, The Procedure, paints a very dark picture of health care. Is it that bad?
A.In a word, yes. The seminal events in that story are true. I just connected the dots about where those events, if left unchecked, could take us.

Q. You chose a pseudonym for your novels. What was the thinking behind that decision?
A. Peter Clement is my first and middle name, given to me in honor of my grandfather. I wrote under this name as a way to help keep my writing activity separate from my activity as a doctor, and to establish from the outset that it would be as inappropriate for anyone to call my place of practice about my books as it would be to phone Ballantine in New York about making an appointment to see me for a sore knee. At my medical office I had partners, busy secretaries, and phones that were already kept busy by patients trying to reach all of us. A promise I made myself was not to let my work as an author intrude on my colleagues and patients.

Q. Mortal Remains, your latest book, is a departure for you. The mystery spans twenty -- seven years, and medical detail is more a part of the story, not the story. And though you return to Garnet, we see events through the eyes of other characters as well. You'd done multiple points of view in Mutant and Critical Condition, but Garnet stories were first person. Why the changes.
A.Mortal Remains is that kind of story. It demands telling from different points of view. And I must say it was fun to see Garnet as others see him. He can be a bit insufferable at times.

Q. What's the game plan for you, and Earl Garnet -- after Mortal Remains?
A. I'm starting to work on a seventh novel. As for Earl, I'm sure he'll be around ER somewhere.