Interview with Josh Bazell

Doctors in training don't get a lot of sleep. The newly minted M.D. and debut author Josh Bazell must not sleep at all. While finishing his medical degree, Bazell also found the time to complete his first novel, a crime thriller called Beat the Reaper about a mob hitman turned doctor. A medical mafioso? Sounds suspiciously autobiographical, but Bazell insists that he's not running from the Cosa Nostra like his protagonist. Still a medical resident in San Francisco, Bazell is now working on his second book. He chatted with Goodreads about his reverence for Arthur Conan Doyle, the original doctor-cum-writer, and his penchant for footnotes.

Goodreads: Your protagonist is a man of two extremes—a killer-for-hire named Pietro Brnwa who transforms himself into a doctor named Peter Brown with help from the Witness Protection Program. What was your inspiration for this unusual character? Can two such extremes exist in a person?

Josh Bazell: I wanted to explore the extent to which people can change themselves. So I needed extremes, and since I wanted the character to end up as a doctor, it seemed reasonable to have him start out as a killer. As to whether a change of that magnitude is possible in reality, I think it is, at least to the extent that Pietro accomplishes it. He never gets to the point where it's easy—just to the point where, with enough ongoing effort, it's possible.

GR: Despite Pietro's sometimes cynical inner monologue, his actions demonstrate devotion to his patients. Are your own feelings on the state of the health care system similarly conflicted?

JB: Pietro is paying off a moral debt, which as far as I know I am not, but we both get a lot out of practicing medicine. Clearly many of the issues I describe in the book, such as the fact that private insurance and pharmaceutical companies are deeply involved in patient care but don't have patient health as their primary motive, are real. And anything that takes as much time from you as medicine does probably causes moments of doubt. But I've been fairly happy with my choices.

GR: Written in the first person, Beat the Reaper is Pietro's narrative, and it also includes his footnotes, which he uses to define medical terminology (location of the celiac plexus), offer running commentary (the ongoing influence of The Godfather on mobsters), and even insult the reader's attention span. How did you develop these footnotes in his voice?

JB: The tolerability of that kind of ornamentation comes down to how entertaining it is. Footnotes seemed like a plausible thing to try because the book touches on science and medicine, and they ended up adding a kind of additional time frame, since they seem to "take place" later than any other voice in the book, but I still tried to make sure you could ignore them if you wanted to and still understand the book.

GR: The book weaves together present and past. Flashbacks are interlaced with the story of the day when Pietro's past catches up with him. Was this back-and-forth structure difficult to create?

JB: Yeah, it was. I'm particularly aware of it now that I'm working on a book with a less complicated structure. It raised some interesting flow-through issues that I hope I've resolved in favor of the reader.

GR: Some say that convincing dialogue is one of the hardest components to write. Given your screenwriting background, what is your approach to dialogue?

JB: In my opinion, convincing dialogue is actually harder to write in screenplays than in fiction, because in a screenplay the dialogue has a larger burden to advance the story. In real life the things people say out loud relate only poorly to what they do and think, and fiction gives you a bit more room to play with this.

GR: Did you have a long-standing goal to be a writer? After studying writing as an undergraduate, you decided to attend medical school. What happened in between, and how did you return to your writing goals in medical school?

JB: I've wanted to write professionally since I was nine. I became seriously interested in science a few years later, and for most of my life I've tried to advance both pieces simultaneously, which has sometimes been difficult. I put off med school for a while because I was afraid it would keep me from writing, and once I was in med school I tried to stop writing to concentrate only on science. But neither approach seemed to work for me.

GR: How have you balanced medical school and residency—an educational process that is notorious for its grueling hours—with the demands of writing a novel?

JB: What seems to work for me is to try to concentrate on only one task at a time, and to treat writing and my day job as vacations from each other.

GR: What will be your next writing project? Another novel with Pietro?

JB: Yes. Pietro Brnwa continues. Within the confines of a sequel, I'm doing my best to make the next one equally enjoyable but also surprising.

GR: Describe a typical day spent writing. Do you have any unusual writing habits?

JB: I'm bad at this. I'm getting slightly better at having a regular writing schedule, but usually I work project to project, spending more time each day on a project as I go along. It's like how rats speed up near the end of a maze. Clearly it's better to be scheduled.

GR: Who are some of your influences in the crime genre?

JB: There are a lot of them, but the writer who's most important to me is Arthur Conan Doyle, who first published just out of med school and whose most famous characters met in med school. I also like a lot of the pulp guys: Frederic Brown, Jim Thompson, Harry Whittington, and so on. In terms of pacing I would cite James Cain, Benjamin Appel, James Ellroy, and Ken Bruen. But like I say, there are a lot of them.

GR: What are you reading now? What are some of your favorite books and authors?

JB: I mostly read crime fiction, nonfiction, and classics, but I just finished a so-called literary novel, The Circus of the Earth and the Air by Brooke Stevens. It has about 20 things I hate in a book—dream sequences, doppelgangers, magical realism, and so on—but was fantastic. Before that, which I also loved, was Philip Pan's new book, Out of Mao's Shadow. The books I've read the most number of times are probably Lucky Jim, White Jazz, Double Indemnity, and Kidnapped. And if Katherine Dunn's new book comes out this year, I'll be ecstatic.