From Burned Out Oncologist to Published Novelist

Rural community hematologist-oncologist and long-time Medscape contributor Jennifer Lycette, MD, talks about her dystopian medical novel, The Algorithm Will See You Now, and how she juggled becoming a published author while working and taking care of her family.

This interview has been edited for length and clarity.

Medscape: What is your new book about and how did you come up with the idea?

The Algorithm Will See You Now is a speculative medical thriller set in near-future Seattle, where the implementation of AI algorithms to guide — and limit — healthcare turns out to be, in the end, subject to its human creators’ flaws.

For years, people have raised concerns about the problems with AI — namely, that the algorithm is only as good as the data fed into it. I started thinking about what kind of problems could come about if this kind of thing were ubiquitous in medicine — through a lens of fiction. I thought about the insurance behemoths and how those entities might take a tool like this and misuse it.

Medscape: Can you give us a synopsis of the book?

The story centers around Dr Hope Kestrel, a 29-year-old senior surgical resident at the fictional Seattle corporation PRIMA, Prognostic Intelligent Medical Algorithms. At age 11, she lost her mom to cancer, and she knew, even as a child, that her mom experienced a lot of suffering in her cancer care journey.

Hope subsequently devoted her life and career to becoming what she considers a better kind of doctor, one who could reduce suffering and wouldn’t offer false hope. She embraced PRIMA as the way to achieve that goal.

When Hope is later confronted with the possibility that PRIMA might not be everything she believes, she not only has to examine what that might mean for her career but also confront her grief over her mother’s death, something she has avoided for 18 years.

Medscape: What led you to writing?

I first began publishing personal essays. Some years back, I went through a time of burnout in my career, left medicine for a year, and eventually came back. During that time, I wrote my first essay — a narrative medicine piece that was published in JAMA Oncology. The piece reflected on a personal experience. Sadly, one of my in-laws died young of pancreatic cancer.

The experience of writing about something in the narrative medicine form ultimately helped me connect with a place of vulnerability that I think we as physicians are conditioned to suppress in ourselves and our writing. All of that led me on a journey of self-exploration that made me continue to write.

Medscape: What was your greatest challenge when writing this book?

At first, it was difficult to write medical scenes. Even though I was drawing on my firsthand experiences as a physician, I had to rewrite my opening sequence countless times. I kept receiving feedback from my beta readers that they didn’t find the scene believable — not from a technology perspective, but the characters’ behaviors toward each other. I had to learn that in writing fiction, you have to come at it through a story.

Overall, the rejection can be tough, though it is part of the business. Sometimes I laugh at myself, thinking how ignorant I was in the process, thinking, ‘I’m just going to write a novel’ and it would be finished.

I started writing the book in late 2016. It probably took about a year to draft it and another year to revise it, and during that time I was doing a lot of research. Eventually, in 2019 I applied for a mentorship program that helped me revise the book. But even after I completed the program, I still wasn’t getting any interest, and I did a full revision again. I joke with my writing friends that I think medicine prepared me well for rejection.

Medscape: What are you most proud of in your book?

The accurate portrayal of women in medicine was an essential part of the book, and I’m proud of my cast of complex female characters.

Medscape: How did you manage your time between being a physician, writer, and mom?

I do work part time, which is still probably about 50 hours a week, and I spend a lot of that working from home compared with a full-time physician who is working at least 80 hours in person.

Because my job is still pretty demanding, I’m often too spent, mentally and emotionally, to write on the days I’m in the clinic. So instead, I do long writing sprints a few days a week. It’s my creative and emotional release, so I don’t mind it this way.

My kids are older now, teens, so they sleep in on weekends, and that’s when I do most of my writing. When I first drafted Algorithm, I didn’t know it was unusual for some people to write more than 1000 words a day. Sometimes, I would write 10,000 to 15,000 words in a weekend.

Medscape: What advice would you give other physicians who want to write and publish a book but can’t find a place to start?

For someone who wants to write fiction, I would say just focus on the book. You can’t force it, and it’s something you have to enjoy. Some people talk about medicine being their calling, but somehow, writing called to me mid career.

I’d say it’s also going to take much longer than you think. For me, again, it was a 6-year journey from when I first had the story idea to publication.

Find your writing community and support, because before my mentorship program, I was doing it all on my own, and there was a lot I didn’t know and understand. It’s also much easier to deal with rejection when you have a support group.

Medscape: What are you working on right now?

I’m wrapping up final revisions on book two, The Committee Will Kill You Now, a prequel to The Algorithm Will See You Now, and will be published in November of 2023. Although each book can be read as a stand-alone, this next book features two of my characters from Algorithm in their younger years.

It essentially tells the “villain origin story” of the antagonist in Algorithm, Dr Marah Maddox, wrapped up in a historical thriller about the inhumanity of physician training in the 1990s interweaved with the true-life history of the medical rationing of the first kidney dialysis in 1960s Seattle. It will also be published by Black Rose Writing Press.

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