Transplant by John A. Elefteriades, MD
With his debut novel, TRANSPLANT, Dr. John Elefteriades introduces readers to Athan Carras, a brilliant heart surgeon who is kidnapped by a ruthless billionaire after refusing to perform an unethical operation. The billionaire will stop at nothing to force Carras to perform the forbidden operation. Seduced and threatened with unspeakable loss, Carras must decide: How far will he go to save the life of a loved one? Though TRANSPLANT is fiction, Dr. Elefteriades believes the ethical dilemma it poses is all too real. Between his day job and actively promoting TRANSPLANT, he discusses his novel and the frightening concept it addresses.You are the author of over 200 scientific publications on a wide range of cardiac and thoracic topics, but this is your first novel. What makes the Chief of Cardiac Surgery at Yale/New Haven Hospital decide he wants to write a novel? And when do you possibly find the time?
I have always had a deep respect for the arts. In college at Yale, my studies had three areas of emphasis: physics, French literature, and psychology. I have always loved to write. In the past two years, I branched out from scientific writing to do two books for the general public: Your Heart: An Owner's Guide and The Woman's Heart: An Owner's Guide. For me, this was testing the waters with materials for the general public. I had always wanted to try fiction, and so, I took that leap. Although it was difficult, the process was very enjoyable - so different from what I normally do in the operating room and the clinic. In fiction, you can make the characters do whatever you want. There is a vicarious thrill involved.
I had the privilege a good number of years ago of operating on Robert Ludlum (The Bourne Identity, among many), for his heart. (I am not revealing any secret here, as he kindly dedicated one of his novels to our team.) Mr. Ludlum spent quite some time speaking to me and answering my questions about the creative process. Getting the central "nugget," he told me, is the hardest part. Once you have that, he said "you can just hang characters and plot onto the structure of the central 'nugget.'" He said, for him, the "hanging" part is easy. Mr. Ludlum was one of the greatest fiction writers of all time. I also had super advice from Matt Hughes, a great science fiction writer (Fools Errant, Fool Me Twice), who taught me principles of fiction like "Show, don't tell." He advised me to let the reader surmise from the developments what the characters are thinking and feeling; don't tell the reader directly.
The book was written nights and weekends, in stolen moments of "off time," and on airplanes. I have had the great fortune that my work has taken me to 27 foreign countries to lecture and operate; that makes for a lot of time in airplanes and hotel rooms to plot and write. The travel also provides great fodder for story telling: I worked on the island of Haiti for three months, and it is to that island that the protagonist, Carras, is kidnapped.
How did you come up with the idea for TRANSPLANT?
I honestly don't know exactly how the central idea came into my head. I don't want to give away the ending, but once the central concept came to my mind, I wondered why the ethical scenario had not happened in real life. I certainly think it will.
What do you see as some of the major ethical issues in transplantation? In your opinion, how should these ethical issues be addressed and/or resolved? From within the medical profession? By governments?
There are two key ethical issues: (1) When is an experimental procedure ready for human application, and (2) How far should a person be allowed to go to get an organ for a loved one? The book revolves around a businessman of infinite money, power, and influence, who tries to coerce a prominent heart surgeon to perform a forbidden procedure. I do not think that we in the medical profession can resolve these ethical issues without help from the general public, from lawyers, from ethicists, and from government and the clergy. Witness the recent media hoopla about the cuckolded husband who wants his kidney back (the husband happens to be a doctor). Is a donor entitled to have an organ back? Who knows? I am sure we will see this type of problem resolved in the courts and in Congress.
Do you think the fictional scenario in your novel could really happen? Do you see it as inevitable?
I think it absolutely could happen. I do think it is inevitable. An interesting, and somewhat frightening, possibility is that TRANSPLANT itself may catalyze the same scenario transpiring in real life.
How do you feel about that possibility? What responsibility, if any, does an author have when he/she creates a fictional event that might well inspire copy-cats in real life?
I am indeed concerned about the possibility that the novel might inspire someone to pursue the fictional scenario in real life. Of course, I would feel some responsibility in such a case, as the author of the fictional work. However, perhaps this sense of responsibility will be offset by knowing that the novel itself has given the public an awareness of this potential issue, as well as time to reflect on the ethical issues inherent in heart transplantation.
You chose to include didactic materials at the back of your novel. What made you decide to do this?
I wanted to make the book exciting - with intrigue, action, medical tension, kidnapping, and a very hot love affair (with a thinly disguised object of affection for my generation of males) - but at the same time, I wanted to teach about medicine, the heart, heart failure, and transplantation. There is a lot of effortless learning that goes on during the action in the book. For the reader who wants to delve further, I included the straight didactic materials. The glossary should help any reader who wishes quick access to definition of medical terms, which I have kept deliberately to a minimum.
How is it different when a real-life doctor writes medical scenes, compared to a non-physician?
In the fiction arena, I am an eager neophyte. But, in terms of the medicine, that's my job. I operate on someone's heart each and every day - probably at least 5,000 major heart procedures during my career. I can assure you that the medicine is real. Non-physician authors have the opposite balance, it seems to me. They are professional crafters of fiction, but they depend on research and others to teach them the medicine.
Who are some of your favorite authors (both of medical thrillers and otherwise)?
I grew up reading Robert Ludlum, Michael Crichton, and Robin Cook. I read a lot of hard science - physics, genetics, astronomy - that is filtered down for the advanced lay reader (that's what I am when it comes to the hard sciences).
What's next for John Elefteriades? Are you working on another novel? If so, will it be a sequel to TRANSPLANT, or a stand-alone? Tell us a little bit about it, if you can.
I am thrilled with the positive response to TRANSPLANT. I had no idea what to expect. I like the character, Carras, because he is strong and principled, but flawed as well. He is confident, but vulnerable at the same time. The surgeon hero is a different protagonist concept for fiction. I would like to see Carras in action again. What he does - operating on people's hearts - that is my "day job" and easiest for me to write about meaningfully.
The next novel takes Carras to the island of Santorini, where an accidental, but exhilarating genetic finding is made. The mythology about Santorini - that it may represent the lost continent of Atlantis - is simply fascinating. Also, Santorini is arguably the most beautiful physical place on earth. The fictional story takes place in two time periods, separated by 3000 years. The stories in each time zone are centered around a doctor, and his work and loves. Both doctors, it turns out, have similar strengths and frailties.
Another book in preparation is called EXTRAORDINARY HEARTS. It tells the stories of twelve very different patients who enriched my life by virtue of my taking care of them. They are twelve unrelated but uniformly inspiring individuals. Each one has an extraordinary and dramatic physical problem with the heart, but also a very special "heart" from a personal and emotional point of view. Each chapter tells the story of one of these individuals - their life and their illness, and, usually but not always, their recovery. Each chapter has photos of the patient (all real) and one teaching figure concerning the medicine involved in that particular case. These individuals moved me. I hope they move the reader.
Contributing editor, Julie Compton, originally hails from St. Louis , Missouri Wilmington , Delaware Florida
There are two key ethical issues: (1) When is an experimental procedure ready for human application, and (2) How far should a person be allowed to go to get an organ for a loved one? The book revolves around a businessman of infinite money, power, and influence, who tries to coerce a prominent heart surgeon to perform a forbidden procedure. I do not think that we in the medical profession can resolve these ethical issues without help from the general public, from lawyers, from ethicists, and from government and the clergy. Witness the recent media hoopla about the cuckolded husband who wants his kidney back (the husband happens to be a doctor). Is a donor entitled to have an organ back? Who knows? I am sure we will see this type of problem resolved in the courts and in Congress.Do you think the fictional scenario in your novel could really happen? Do you see it as inevitable?
I think it absolutely could happen. I do think it is inevitable. An interesting, and somewhat frightening, possibility is that TRANSPLANT itself may catalyze the same scenario transpiring in real life.
How do you feel about that possibility? What responsibility, if any, does an author have when he/she creates a fictional event that might well inspire copy-cats in real life?
I am indeed concerned about the possibility that the novel might inspire someone to pursue the fictional scenario in real life. Of course, I would feel some responsibility in such a case, as the author of the fictional work. However, perhaps this sense of responsibility will be offset by knowing that the novel itself has given the public an awareness of this potential issue, as well as time to reflect on the ethical issues inherent in heart transplantation.
You chose to include didactic materials at the back of your novel. What made you decide to do this?
I wanted to make the book exciting - with intrigue, action, medical tension, kidnapping, and a very hot love affair (with a thinly disguised object of affection for my generation of males) - but at the same time, I wanted to teach about medicine, the heart, heart failure, and transplantation. There is a lot of effortless learning that goes on during the action in the book. For the reader who wants to delve further, I included the straight didactic materials. The glossary should help any reader who wishes quick access to definition of medical terms, which I have kept deliberately to a minimum.
How is it different when a real-life doctor writes medical scenes, compared to a non-physician?
In the fiction arena, I am an eager neophyte. But, in terms of the medicine, that's my job. I operate on someone's heart each and every day - probably at least 5,000 major heart procedures during my career. I can assure you that the medicine is real. Non-physician authors have the opposite balance, it seems to me. They are professional crafters of fiction, but they depend on research and others to teach them the medicine.
Who are some of your favorite authors (both of medical thrillers and otherwise)?
I grew up reading Robert Ludlum, Michael Crichton, and Robin Cook. I read a lot of hard science - physics, genetics, astronomy - that is filtered down for the advanced lay reader (that's what I am when it comes to the hard sciences).
What's next for John Elefteriades? Are you working on another novel? If so, will it be a sequel to TRANSPLANT, or a stand-alone? Tell us a little bit about it, if you can.
I am thrilled with the positive response to TRANSPLANT. I had no idea what to expect. I like the character, Carras, because he is strong and principled, but flawed as well. He is confident, but vulnerable at the same time. The surgeon hero is a different protagonist concept for fiction. I would like to see Carras in action again. What he does - operating on people's hearts - that is my "day job" and easiest for me to write about meaningfully.
The next novel takes Carras to the island of Santorini, where an accidental, but exhilarating genetic finding is made. The mythology about Santorini - that it may represent the lost continent of Atlantis - is simply fascinating. Also, Santorini is arguably the most beautiful physical place on earth. The fictional story takes place in two time periods, separated by 3000 years. The stories in each time zone are centered around a doctor, and his work and loves. Both doctors, it turns out, have similar strengths and frailties.
Another book in preparation is called EXTRAORDINARY HEARTS. It tells the stories of twelve very different patients who enriched my life by virtue of my taking care of them. They are twelve unrelated but uniformly inspiring individuals. Each one has an extraordinary and dramatic physical problem with the heart, but also a very special "heart" from a personal and emotional point of view. Each chapter tells the story of one of these individuals - their life and their illness, and, usually but not always, their recovery. Each chapter has photos of the patient (all real) and one teaching figure concerning the medicine involved in that particular case. These individuals moved me. I hope they move the reader.
Contributing editor, Julie Compton, originally hails from ThrillerFest
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