Joel Shulkin, MD is an author and practicing physician. A 1999 graduate of New York University School of Medicine, he did a residency in Pediatrics followed by a fellowship in developmental pediatrics, and served in the US Air Force, stationed in Germany. He is currently in the practice of developmental behavioral pediatrics in St. Petersburg, Florida, specializing in the evaluation and treatment of children with developmental and behavioral disorders.
Joel is the author of two critically praised novels, Adverse Effects and Toxic Effects, in the “Memory Thieves” series, and several short stories. His short work has appeared in various print and online journals and has won several awards.
The following interview is condensed and edited from our conversation.
SF: Good afternoon, and thanks for participating in this interview.
For background, just to clarify, you’re a developmental behavioral pediatrician. So I assume that you deal with, for example, children with autism or with intellectual or developmental disabilities, things like that?
Correct. I overlap with neurology, psychiatry, and psychology, but my emphasis in on child development. And I’m a pediatrician, so I still also deal with how general pediatric issues affect children’s development.
You’re part of a long tradition of physician-writers. What is it about doctors that makes them good authors?
Well, I think part of it is that attention to detail. Another is that we’re good with mysteries. Most of what we do, short of some areas that are algorithm-driven, is about solving mysteries, so that helps when we write anything in that genre. And I think we’re perfectly poised for writing medical thrillers, because we know all the details. If we really think about what scares people the most, it’s their health; the pandemic was a good example of that. Knowledge about all the different diseases and things that can happen to your body, and being able to describe it in a way that feels realistic—I think that really captivates readers.
Did you take any college writing courses or anything else like that?
I did, I took a couple of additional creative writing courses in college. And I also had a philosophy and literature course where we read George Orwell, and the Handmaid’s Tale and Waiting for Godot, and I got really interested in more classical literature for a little while. I read the whole of Shakespeare’s work.
I was also writing some creative nonfiction back then, but I put it all aside when I got into medical school, and all the way through residency and my time in Europe, although to help take my mind off medical stuff outside of work hours, I wrote songs for a little while.
What kind of reader were you growing up?
I always loved reading, got started reading Isaac Asimov, I think maybe when I was in middle school, definitely by high school, and I read some Stephen King back then also. I was also interested in writing. I wrote my first short story as an assignment for English class, and I recently dug up and revised that short story and just got it published in the newest volume of Short Story America. It was a fantasy story, and I continued to be mostly interested in fantasy and science fiction.
How did you get started? Not the fantasy short story in English class, but professionally? For example, did you attend writers’ groups, or courses? I know a group called SEAK used to offer courses for physicians who wanted to become authors.
I had gotten one of those flyers from SEAK, and it was back when they were still doing contests. I wrote a short story called “Simon Says.” I haven’t gotten this one published yet, but it was about a psychiatrist visiting a very difficult patient—complicated, bipolar, manic—and I submitted it, and it ended up winning first prize. And I thought, OK, maybe I should write more medical kinds of things. After that, I was at a Massachusetts Medical Society meeting and Michael Palmer was there, giving a talk about how to write medical thrillers. I attended, and I got to talk to him afterwards about it. He really encouraged me and said, “If you write a medical thriller, I’ll give you my list of agents, I’ll write a blurb for you, do whatever you need.” He was mentoring me and supporting me. So that really got my foot in the door.
Then I was on a bus riding into work in Boston on a snowy day, and there was nobody else in the bus, it was completely empty, just me and the driver. At the next stop this guy got on, and out of the entirely empty bus, he sat down right behind me. I thought that was just kind of uncomfortable, but then my writer’s mind started working; I started thinking how creepy it would be if I were a woman in that situation. And how really freaked out I would be if he leaned forward and said something like “I know who you really are.” When I got home and told my wife, we came up with the basic idea for Adverse Effects, the first book. I wrote literally one or two chapters a day; my wife would read the chapters as I wrote them, and she would just tell me “Go back and write the next one.”
How did you get representation?
Once I got it set up and got some feedback, I queried multiple agents. I probably got about 90 or 100 rejections, and each time I’d go back and look at it and try to make some revisions, set it aside for a while, make more revisions. Eventually, four years ago I think, I entered a contest in Florida, maybe a Florida Writers Association thing; they gave me some feedback and I made some more changes. During a Twitter pitch contest one agent popped up; I looked at her manuscript wish list, and I thought, she sounds like my focus is just what she’s looking for. I ended up sending a query directly to her. I didn’t hear anything for a week, and then went back and looked at my manuscript, and I realized I had changed the prologue, and I thought the old prologue was better. I changed it back and sent her a follow up email that said, “I know that I already queried you, but I want you to know that I made some changes that I think you’ll like.” She immediately wrote back and requested the full manuscript.
I then saw on Twitter that she was commenting that she was reading a new thriller and was loving it. She was hoping that the author was going to be able to keep it up, and I’m thinking, Man, I hope that’s me. So I “liked” the tweet and she immediately followed me back, so I knew that it was my piece. And then I got the phone call from her.
What are you reading these days in your spare time—if you have any?
If it weren’t for Audiobooks, I would never have time to read; I listen to it on the way to and from work. But most of them are thrillers, not necessarily medical thrillers but thrillers in general. Occasionally I’ll read something outside that genre; there’s another author from Blackstone [his publisher] who wrote this book that was set in the South. It’s all about institutional racism, and that was a very interesting read. I try to delve a little bit outside the genre and get ideas from that as well.
The most recent book I’ve read is Razorblade Tears, by SA Cosby. The depth is incredible, and it’s a thriller which also deals with racial issues and LGBT issues in a very sensitive way. I met Shawn at ThrillerFest, and he’s a super nice guy.
You mentioned institutional racism. In Toxic Effects you have that nice bit where the policeman wants to set up a group to help police and Black youths get along with each other, right?
Yeah; when I was writing Toxic Effects, it was right around the same time Black Lives Matter was coming to a head. Several authors had started commenting about how they were looking back at their own writing, and the idea of “hero cops,” and kind of rethinking that. I know and respect the police; a detective who I mentioned in my acknowledgments, Adam Richardson, runs the Writers Detective Bureau, a podcast where he gives feedback to writers who are trying to write police scenes or crime fiction. He had a podcast once where he expressed his own frustration over the whole situation.
I knew I couldn’t say, “I’m going to try to present what it’s like to be Black in this situation,” but I also wanted to think about how I could address that. I also needed to express my feelings about this in a way that reflects “Hey, there are good cops out there, you know? There are good cops trying to deal with this as well.” And especially because I had my detective, Wilson, as a major character, how could I just leave him be? How can I make my “hero cop” a hero, and have him not deal with a situation like that?
This brings up two further points. One is that when you’re writing you must be very aware of contemporary issues that pop up that may make you change direction or incorporate other viewpoints. In writing a medical thriller, or a science-based thriller, you know, science can change. You may have a plot line that suddenly falls apart because some discovery is made that changes things.
Right, exactly. That’s why I feel bad for anybody who released a pandemic book a few years ago.
And the other thing, which you alluded to in your acknowledgements, is how important it is to get all the intricate details right, in an area that isn’t necessarily your area of expertise, like police work. Readers can be very picky if you put wrong information in a novel, right?
Absolutely. And that’s why I listened to that podcast; I had gone back with both books and made some changes, sometimes even at the last minute.
But even beyond that, as I said, I’m not a psychiatrist [or] a memory specialist. So for both books, I had to do a lot of research into what studies are out there, what new developments are coming out. The second book was so much neurology that I had to do more research. I ended up having another author that I know, who is a neurologist, read an early manuscript to get their feedback and make sure that I was accurate when it came to things like Alzheimer’s and the technology that was being used.
The diagnosis of autism has exploded in recent years. Have you ever written an autistic character? I imagine you have to pay very close attention to be sure that anything about your patients that might be identifiable doesn’t unconsciously bleed over into your writing.
Absolutely. As to the second part of that question, I’m very conscious about that, even though most of what I do isn’t right for medical thrillers anyway. Sitting in the clinic and discussing things with parents [isn’t] really edge-of-your-seat kind of stuff. But I do try to make sure that if I bring anything in that is reflective of experiences I’ve had, they’re just little things that someone might have said or things that I’ve seen multiple times, so it’s not reflecting on any single patient. One of the books that’s in process right now is set in Hawaii, and it is about a general practitioner, so I throw in some cases and situations that I experienced in Hawaii, like treating kids who’d gotten infections from swimming in the hot pools, but that was fine because it doesn’t tie to any one individual patient with any patient identifying information.
I haven’t specifically written an autistic character. In the book set in Hawaii, I do have a character who is sort of on the spectrum. I never really come out and say that she is, but just kind of try to have that in the background.
When it comes to developmental aspects, it’s definitely a bit trickier. Of course, I’m going to have to make sure that I’m not characterizing any one individual. Autism is a very wide spectrum, and if you’re going to be accurate, you’re not going to be using cliches, like Rain Man, who really isn’t in any way archetypal for autism; as a savant, he really represents less than 1% of all autistic people. There is a wide range of patients.
You write under your own name, so patients and families and community members know exactly who the author is. Did you ever consider writing under a pseudonym?
I thought about it. In fact, I originally was going to use a pseudonym, and then the publisher actually asked me to use my real name. They felt that the readers would be able to look me up and say “Well, he’s a doctor, so he knows what he’s talking about.” I feel, especially now with social media, that any time a medical professional tries to have any kind of presence, people are questioning their credentials, even with verification. So why not make it easier for them? If I’m using my real name, anybody can Google me and see that I’m a doctor and not just making this up.
I’ve had some patients who’ve said, “I saw your interview” or “I’m reading your book,” and any experiences I’ve had like that have been positive. But if I ever wrote in another genre, I might consider using a pseudonym.
On your website’s homepage, it says that you have three novels in progress. How does somebody have three novels in progress at once and have a medical practice?
It’s a common question. And working in a clinic full-time and raising twins. What I do is every morning from about 5:30 to 6:30, I have an hour to write. I try to write 500 words minimum, and some days it’s a lot more than that; if I happen to have cancellations and I’ve got time over lunch, I can do a little work on my laptop. I also have Scrivener, which is an app that synchronizes my writing on my tablet, computer, and on my phone. If I’ve got a work in progress, and I’m sitting at the auto shop or the car dealer waiting for an hour, I can pull it up and do edits and write more on my phone.
If I’m working on a manuscript, I’m only working on that one until it’s finished, and then I set it aside to go and work on the next one. The works “in progress,” are either in a state of research, or revision, or one of those three is actually currently on submission with my agent. But in two and a half years I was able to get those four manuscripts completed.
When you write, do you write an outline and plot out the whole novel? Or just let it flow?
Yeah, am I a “plotter” or a “pants-er?” Do I fly by the seat of my pants?
I refer to myself as a “plants-er,” kind of in-between. Adverse Effects was pretty much just “pantsed” out. I just wrote it chapter by chapter to see what was going to come next. I couldn’t do that for Toxic Effects, because I had a deadline. I had to have an idea of what I wanted, so I wrote a rough outline. The next books I’ve written, I’ve done more about really making a clearer outline, but not super detailed.
I’ve recently started writing my first non-medical thriller, and I have that outline already. Then I can make changes along the way if I need to. With an outline, I tend not to totally let things go; you hear about writers who have a side character who runs away with the story, and that usually doesn’t happen because I know whose story it is, and I know what I want to be happening and how I want the character to change by the end of the book.
Your two completed novels are about memory, and the topic of memory is fascinating. How easy is it to pharmacologically reconstruct memory? Is that something people are actually doing at present, or is this something in the far-off future?
There are studies looking at either erasing memory or trying to recover it. And of course, you’re trying to help support memory in Alzheimer’s, for example. But certainly, if anything, it’s more like a sledgehammer than a precision screwdriver. It’s not like Eternal Sunshine of the Spotless Mind, where they targeted specific memories and said this is what I want to recover, and this is what I want to eliminate; that idea is far off in the future. But one of the aspects in Toxic Effects, the toxin, actually has been studied in Alzheimer’s, looking at how that can be used to eliminate certain memories. And in the first book, the experimental drug– those endocannabinoids that we use– those are actual studies looking at trying to restore memories to improve memory consolidation.
I think the one point that I try to make in the story, so it’s not completely out-of-the-question science fiction, is the concept that memories don’t completely get erased. You think about people who have fugue states where they just psychologically block their memory; the memories aren’t gone, their access is just blocked. When people have traumatic amnesia, unless the brain tissue itself is completely destroyed, those memories are still there. It’s just a matter of accessing them. It’s just like on your hard drive on a computer: when you erase memories from your hard drive, they’re not really gone. It’s just that you’ve erased the file direction to access them.
I think our brain is very much the same way with all those chemical synapses and chemicals, storing that information; if it’s still there, then there is a way to access it, we just have to learn how to do it.
Will there be a third book in the series?
I certainly hope so! Given the ending of Toxic Effects, I think there needs to be.
Great. Any closing advice for those who would be authors? Other than keep trying, despite the rejections?
You only need one “yes.” And most importantly, you want [to find the agent] who is going to be fighting for your book, who’s going to love your book, not just somebody who says, “OK, I’ll take you on.” That’s why I felt like even though it took me so long, I found the right agent, because there were times during the first and second submissions that I needed support. I went through three different revisions; we sent Toxic Effects to the editor twice and twice the editor said, “This is essentially crap.” By the second rejection I was really feeling down, and it was my agent who said “No, I know you’re a really good writer, let me take a look at it.” She gave me feedback and that helped me figure it out, and I had an epiphany of “Oh, I know how I can fix it.” That’s what a writer wants: someone who is going to be there in their corner.
The other thing is, it’s not a matter of having enough time. It’s a matter of being dedicated enough to carve out the time. It was a matter for me of saying I’ve got an hour a day, and I’m doing it. I wake up before everyone else gets up, and sometimes I write the full 500, sometimes more, sometimes less…as long as I’m writing each time. If you do 500 words a day, in six months you’ve got a 90,000-word manuscript.
So you can’t just sit around waiting for the muse. It’s a regimen.
Well, thanks very much for taking the time to share your story and your insights with us. Good luck and continued success.