I'm often asked where do I get the inspiration for my books. There are of course, many sources, the core of my stories drawing on my experiences in ER and the practice of Medicine. But each novel has it's specific spark that began the idea. The Darkness Drops: My inspiration for The Darkness Drops arose from two separate conversations. The initial one involved physicians from Russia who had witnessed, and survived, the first and only known leak of anthrax from a bioweapons facility in the former USSR. Their account fascinated me, and set the back-story for Anna and Yuri. The second developed from a restaurant dinner I attended with a group of doctors who were experts in bioterror preparedness. It soon became evident that they did exactly what a writer of thrillers must do–namely, put themselves inside the mind of a fiend, and dream. I don’t remember what we ate, but all the other diners within earshot began to talk in hushed tones and study us most warily. I came away wondering how any of us would sleep that night. Yet what fascinated me more than the plots they hatched were the people themselves, all of them veterans of drops into hot-zones and level-four virology lab work with the most deadly organisms on earth. How do you walk home and kiss your kids goodnight knowing that one slip-up in a protective protocol might expose them to hemorrhagic fevers or fatal toxins? Worse, after listening to some of the scenarios they cooked up involving bioengineered organisms, I began to wonder how I’d respond in ER if confronted by a mystery outbreak for which known treatments do not exist. Once started down that path, I had the beginnings of a story I couldn’t get out of my head, and Terry Ryder was born. The Inquisitor: I had written a first draft for a quarter of the story when, in March 2003, reports began to come in about the battle against SARS at Toronto hospitals. The tremendous toll that such stress took on doctors, nurses, and staff was all too imaginable. The fear that they might miss a step in all the protective measures, or that even strict adherence to proscribed protocols requiring masks, gowns, and gloves might not offer sufficient protection, and that perhaps nothing short of HAZMAT suits could protect them, suggested a hellish "new normal" environment where a house of healing became an environment as hostile as an alien planet. Doctors found themselves catapulted back to the era of previous centuries when, during epidemics, healers were as much at risk of dying as their patients. Definitely not what we signed up for in medical school, it provided a whole new order of "mean streets" for the setting of my story. Unfortunately, as ever more incidents of emergent infections and antibiotic resistent organisms continue to appear, I fear it may be a non too distant reality. Lethal Practice: The seminal event of this story is also the eureka moment that started my writing career. It began on a Sunday afternoon in August 1987 when I'd been reading a Dick Francis story. For those of you who aren't familiar with his work (I can't imagine there are many) he does stories about horse racing from the jockey's point of view. This particular book opened in the middle of a race, the sounds, smells, rhythm, excitement, and thoughts, all from the rider's perspective. I wondered if I could create the same intensity describing one of ER's most intense moments, a cardiac arrest. Three hours later I had the opening scene of what would become my first book. Death Rounds: I'd been trying out ideas for a follow -- up to Earl Garnet' debut, and returned from a brain storming session with my editor in New York to find a warning on my office desk from the center for disease control in Atlanta. It advised physicians about a new strain of drug resistant bacteria, methicillin resistant Staphylococcus aureus, or MRSA, that had begun to acquire the genetic capacity to inhibit the one remaining drug that could kill it, vancomycin. Prior to the discovery of penicillin in the forties, staph had been the primary killer responsible for deaths from wound infections, both in cases of accidents and surgical operations. Since then scientists have been a constant race to come up with new antibiotics as Staph acquired resistance to old ones, but now there would be no new agents in the wings. It struck me that modern hospitals would be pitched back to the time when all we had were soaps, ointments, and isolation, and that inspired the events in the story Death Rounds. (PS. The actual organism postulated here emerged in a few US hospitals over the last year. The newest antibiotics, in combination with old, are effective in only a third of the cases.) The Procedure: An Article in The Wall Street Journal described the saga of a young, Spanish -- speaking woman who lived in Texas and who had developed a moderately severe case of depression. Her doctors recommended admission to a psychiatric ward for more concentrated treatment, but her HMO had a system whereby they found it cheaper to provide an airline ticket and transport such patients to a central hospital they owned in LA. However, just as it's cheaper to make widgets in third world countries than in the US, and less regulated, someone in LA found it cheaper still to fly this woman to a hospital in central America where she was put in a locked ward and given electric shock therapy. Her husband, still under the impression she was in LA, only found out the truth with great difficulty, and when he insisted she be returned to the US, the authorities of the central American hospital dropped her off at the local airport, but with a ticket that could only be used two weeks from that date. The article concluded that the HMO in question was "under investigation." After picking my jaw up off the floor, what really fascinated me was the mentality behind such a travesty. Most people in health care administration don't get up and say, How can I act really stupid today. But idiotic things do occur, and this story, though extreme, made me think that maybe a litany of absurd practices that are too often the norm throughout HMOs were also once isolated incidents that became systematic. So I did what all writers do, played what if, in this case imagined HMOs beginning to uniformly practice the "cheeper widget" kind of thinking and what might be the consequences. The Procedure is the result. Enjoy. Mutant: Sometimes the inspiration for a story can be a very small incident or discovery. In 1997 there were medical alerts about an incident in which a strain of influenza normally found only in birds had jumped the species barrier and infected a small boy in Hong Kong. Though he tragically died, the timely slaughter of a million chickens halted any further spread, and the medical community relaxed. Two years later while going through some medical journals, I happened to spot an obscure publication by a scientist who specialized in a microorganism called the cow -- pea chlorotic mottle virus. Curious why anyone would be working on something so esoteric, and what made it relevant to a medical journal, I took a closer look. He'd demonstrated that when the organism lived on a genetically modified plant, it could play a role in transferring the new genetic material, including the vectors designed to jump new genes from one species to another, to other microbes residing in the leaves and branches. My first reaction was, Who cares? Then the author asked, what if these genetic make -- overs altered the virulence of otherwise benign viruses, bacteria, and parasites. Red lights went on big time. The worst scourges to infect human kind involved bugs that, through spontaneous changes in their genetic makeup, jumped the species barrier and infected man. The 1918 flu epidemic that killed over twenty million in six months is believed to be a strain of flu that came from pigs. AIDS is thought to be a simian virus that jumped to humans from monkeys in the thirties. And of course the Bird flu incident. Thankfully such leaps are rare in nature. But what if something lowered the species barrier, and made the emergence of such new infections more common? I soon had the premise for the story Mutant. I began writing it early in the year 2000, and by the time of its publication, July, 2001, the story had become a "what if" tale of bioterrorism involving genetic vectors, rogue American scientists, modified organisms, and attacks with crop dusters over New York City as well as in the American heartland. That was three months before 9/11. And now there is SARS, another virus to jump the species barrier. What scares me is that lost amongst all the headlines about SARS were two more reports of Bird Flu in February of this year, both near Hong Kong, and subsequent cases in Belgium, Holland, and northern France. This means that two different organisms have jumped the species barrier, each leap supposedly a rare event, and both have occurred within months of each other. Coincidence? Or is something more serious going on that is lowering the species barrier in general and we haven't grasped it yet? This one scares me. Critical Condition: During the interminal recount to determine who would be President, what caught my attention were a steady drumbeat of reports about whether stem cell research would be curtailed in the US. Every doctor and scientist shuddered at that prospect, because nothing holds as much immediate promise to cure crippling illnesses that until now we can only try and control. Heart failure, arthritis, diabetes, the after effects of strokes, multiple sclerosis, liver disease -- treatments of these will undergo a revolution as a result of what we've come to call regenerative medicine. The central concept is simple. Stem cells are pleuripotential. They can go on to differentiate into any kind of human tissue -- heart, muscle, bone, pancreas, brain, myelin sheaths for nerves, liver etc. Already doctors in Germany are conducting trials to see if they can regrow functioning cardiac cells in the damaged heart walls of heart attack victims. And Canadian researchers are seeing if stem cells can restore lost brain function to stroke victims. These are benefits we'll have within years, not tens of years, as will be the case with gene therapies, and will extend both the length and quality of our lives as much as the discovery of antibiotics did. So when talk turned to possibly putting a lid on this research, I thought, What if -- there are those words again -- a group of maverick doctors decided to secretly use stem cells on seriously ill patients who might otherwise die or be permanently disabled? At first I intended they'd be the heroes, but as my research progressed and the story developed, I found a much grayer, more nuanced reality that reflected the rich landscape of conflicting agendas that exists in all major research centers. In the end the characters evolved into people with a wide range of motives, most well meaning, but some more laced with a thirst to be first than others, and of course, no one could ignore the financial bonanza at stake, for better or worse. And the consequences -- medical, political, and personal -- turned out to be mixed at best, sometimes partially successful, other times dangerous, sometimes lethal. A lot like real medicine. Mortal Remains: I had glanced at an article at the back of the New York Times several years back about a woman who disappeared a decade ago. She'd left a life of privilege to return to university as a mature student and entered medical school, where she proceeded to do well. That in itself impressed me, knowing the rigors first hand. But one evening she drove home from her husbands country estate -- he stayed behind -- and was seen by the doormen of her apartment meeting with a strange man. The next morning that same doorman witnessed her leave, alone, with a suitcase, and no one ever saw her again. I couldn't get the story out of my mind, and I began to think, What if something like that happened twenty -- seven years ago, when Earl Garnet was still in his last year of medical school. I supposed they were classmates, and friends. I imagined that both the woman's husband and father -- in -- law were powerful members of the hospital and medical school where Earl trained. And finally, Earl revealed to me that he had been the unidentified man she met the night before she disappeared, but had never told anyone. The wheels started to turn.