Behind the white coat a writer is bursting to escape.
Professor Rod Griffiths, retired director of public health for the West Midlands, is here to tell us about his debut novel: The Rag Doll Falling.
Rod Griffiths has a propaganda following, and a reason to write his book. Allegations of neglect and incompetence on Ward 87 of City General Hospital, Stoke-on-Trent was taken to the attention of Prof Griffiths by Dr Rita Pal who was a house officer at the time. Griffiths was the then Regional Director of Public Health, and ordered doctors beneath him to carry out an investigation but they could not find any evidence to support Dr Pal’s allegations.
What happened next was a little messy, and had it not been for the then recent case of Dr Shipman the media would not have picked up on it, but they did and it led to a lot of bitterness and mudslinging. But finally, independent assessors at the GMC found no case to answer and the case was closed. Subsequently, money is now being spent on building a new hospital: http://www.uhns.nhs.uk. Had Dr Pal not brought up these issues, maybe this wouldn’t have happened?
Rod Griffiths qualified from Birmingham medical school in 1969 and worked in General Practice for about five years before going into Public Health. He received an CBE in 2000 for services to public health. He retired from the profession in 2007.
Drug companies have been fined over four and a half billion dollars in the USA for offences related to marketing drugs.
This 95,000-word medical thriller gets behind the motives that underlie such behaviour. This is fiction but the author has twenty years of medical experience at high levels in health care management in the UK.
The story centres on a new cancer drug with a potentially lethal side effect. In any circumstances it would be hard to diagnose the problem; but for professor Jim Brogan, the epidemiologist running the trials of the drug, things are made much more complicated.
Jim’s girl friend Val, is with Danni Foster when she crashes while skiing and remains in a coma, unable to explain that she has taken the drug.
Things get worse when Val’s daughter develops Hodgkin’s disease. Val desperately wants Danni to recover and Mary to have the new drug, and that puts pressure on Jim, particularly when he tries to explain to Val that until the trial is ended he doesn’t know if the drug is safe or effective.
The company that make the drug gets a large injection of American money, but unknown to Jim the people behind the money are crooked. They plan to make a fortune from selling the drug and launder their money at the same time. It gradually emerges that Danni, still in a coma, was also involved in this scheme.
Danni’s collapse disjoints the American’s plans and they hire Fiona, an ex escort to try to work her way into Danni’s networks and from there on things get very complicated as the different motivations of the key players interact.
Jim Brogan’s ethical stance and good nature is stretched in all directions. Al Vincent, the American Godfather behind the money, develops agendas of his own; settling old scores, and using the drug’s side effect as a murder weapon.
Somehow, Jim Brogan must save Danni, make the drug safe and get Mary cured, before Al Vincent does too much damage. The final surprise comes from Fiona as the part that Al played in her tragic past becomes clear.
Hi, Rod and thank you for allowing me to interview you and A Rag Doll Falling. Tell us more!
Sure, this 95,000-word medical thriller that centres on a new cancer drug with a potentially lethal side effect, which is only triggered by certain conditions. In any circumstances it would be hard to diagnose the problem; but for professor Jim Brogan, the epidemiologist running the trials of the drug, things are made much more complicated.
The story begins when Danni Foster, crashes while skiing and remains in a coma, unable to explain that she has taken the drug. Val, Jim Brogan’s girlfriend, is with Danni when it happens. Things get worse when Val’s daughter develops Hodgkin’s disease. Val desperately wants Danni to recover and Mary to have the new drug, and that puts pressure on Jim, particularly when he tries to explain to Val that until the trial is ended he doesn’t know if the drug is safe or effective.
It sounds pretty distressing. What made you want to write about something so unpleasant?
I spent my life in medicine, for most of the time responsible for how the system worked. I did a lot of radio and TV interviews often having to explain complex issues or deal with situations where people’s expectations were not met. Sometimes that was because the service got something wrong and I had to make it was fixed. In many ways that’s the easy part, we have the tools and I had the authority to at least make people sit up and listen. The hard part is dealing with unrealistic expectations and a lot of those are created by the media, and sometimes by companies wanting to sell products, all the usual things that produce hype. If you have cancer, or some other awful disease then you don’t need hype, you need honesty and everyone’s best efforts directed at helping you.
As I got nearer to retirement I had the idea that fiction might be a way into the problem. If I could write thrillers that had a challenge to some of the worst hype embedded in the plot, it might redress the balance a bit. They’d still have to be good thrillers, but driven by some underlying concept.
Is there any lightness in the book?
I guess there are some amusing pieces. I’ve always been very wary of trying to write comedy. I think there are two reasons for that. The first is that I am somewhat intimidated by Terry Pratchett, I laugh out loud when reading his books, yet I can’t really work out how he does it. The second is that although I use humour a lot when I’m giving a lecture, and I used to do a lot of talks, I’ve always made it up as I went along, using the audience reaction as a guide. Writing a book feels so different, and the audience may not read it for years.
Why the title “Rag Doll Falling”?
You would need to read it to understand why a rag doll is important. My wife made one and we threw the poor thing down the stairs a few times and photographed it and from those she drew the picture. OK so it’s no doubt very amateurish, but it was fun.
How much research did the book involve?
I knew a lot of the relevant stuff before I started and I wrote the first draft without looking anything up. I took a laptop with me on a skiing holiday and wrote when the weather was bad and in the evenings. At the end of that week, I had most of a first draft, about 40,000 words and after that came a lot of editing and some big surprises as some of the characters grabbed pieces of the action. Some of the scenes in that first draft were just quick sketches, so when it was all joined up it came out as 95,000 words.
I do quite a lot of research at my desk, but mostly keeping abreast of stuff that I already have some background about. My job was in public health and for that you have to be a generalist. Almost anything could come up, I often had five or ten meetings in a day and all of them would be about a different topic. You could be talking about TB before coffee, housing before lunch, diabetes, bronchitis, and blood pressure with different people through the afternoon. I had to have a broad grasp of most of medicine and learn the knack of picking up crucial new details quickly. I belong to various email groups and bulletin boards that send regular updates on all sorts of things. I have a folder in my MAC called interesting reading; currently it’s up to 372 megabytes. I don’t think I’ve read all of it, but you get the idea.
How does Rag Doll Falling compare with other thrillers?
Most medical thrillers seem to involve pathologists. All the detective work is done starting with a dead body, or cunning stuff with DNA and the like. In my book the hero is an epidemiologist, someone who looks at the patterns of diseases in populations. The word has the same derivation as epidemics. These days epidemiologists look at almost anything that affects the health of populations as well as things like trials of new drugs and effectiveness of treatments in general. I tried to give some of that flavour in a quote from the hero, professor Brogan: ‘If you find one body get a detective, if there are a dozen you need and epidemiologist.’
What audience is the book intended?
It’s aimed at adults, though pretty much anyone could read it. There are only a couple of places where anyone takes their clothes off. On slushpilereader.com, one of the few sites that gives a breakdown, my audience is 60% female and about 80% are over 45.
How long did it take you to write it, and how many drafts?
I have been working on this and several other books on and off. I write a draft then leave it for a while and then do some work on it again for a while and repeat the process.
If you count versions by significant changes in the plot, or the relationships between the characters then the version that is on Kindle is the third. If you count revisions the way that Word does then it’s hundreds.
Will you be interested in writing another genre?
I’m working on one that is probably YA. It’s now in it’s third draft. It’s about telepathic triplets, two boys and a girl, who are separated at birth and adopted by different families. The book is about them as teenagers setting out to find each other. I think the idea is strong, but I’ve struggled to find the right voice. I wrote a complete draft third person and it felt wooden. The second draft was first person by the adoptive mother of the girl. The teenage girl is the voice for draft three.
Trying to get the voice of a teenage girl has been really challenging but I’ve loved doing it. I still have a few chapters to go.
Do you have a favourite scene in the book?
I don’t really have a favourite scene, if I thought one bit was better than the rest I’d want to keep working to get the rest to be as good as that bit. There are some scenes that are more emotional.
Are you a full time writer now?
At the moment, I still teach a couple of weeks on the Masters course in public health (next week and in 3 weeks’ time as it happens). I don’t do anything else. I retired recently with a good enough pension that I could sit and do nothing, but that would be a lot less fun than writing.
Do you have any writing experience?
I’ve written hundreds of reports and academic papers, which probably counts for little in creative writing circles. I did a two-term course with Birkbeck, really in order to find out if I was hopeless. I got 65%, which apparently was a merit, so I relaxed a bit. I’ve been on a few other short courses and I’m in a local writing group.
Have you always been interested in writing?
I’ve always been interested in writing and communication, done lots of radio and TV and written academic papers and more ‘popular’ reports on various public health issues. I won a national prize for the best annual report one year – mostly because the graphs were dead clever as well as the prose being accessible.
All that lot means I saw a lot of fascinating stuff most of which the public know nothing about. I started to think, about 5 years ago that some of these things might make good fiction so embarked on trying to write novels.
It’s a bit different from the sort of stuff you have to write when you are a public servant and briefing ministers etc. Suspense is frowned on in those sort of documents, but it seems pretty important in novels.
I did some creative writing course and workshops and started writing. Well actually the other way round I started writing, completed a draft novel, put it in a drawer, got it out 3 months later and realised that it was pretty wooden. Then I decided that I’d better do some courses etc.
So, why do you write?
Why am I writing? Not to make money, I have a decent pension. Not for fame, I got a CBE and met the queen, which convinced my mum I must be famous. Really it’s because I can’t seem to stop doing it and I just love having these characters running around in my head surprising me. OK it’s a form of madness. I have concluded that if you hear voices and they are telling you what to do, then you should take medication – if on the other hand they are getting on with having a more interesting life then get a pencil and write.
Why did you go down the e-book route?
I went down the ebook route after sending to a bunch of agents and after a really dumb interview with one at the York writing festival. Of course that probably wasn’t typical, but one learns so little from the process that I thought I might discover more from putting it up as an ebook. I had this fantasy that someone might email me with a comment or write a review or something.
I’m not desperately worried about agents turning it down because it has been an ebook – they seem to have plenty of other reasons available without saying what they are either. I’m writing a sort of sequel and I have a full length draft of what is really a prequel, so I can always go down the more conventional channels with them when they’re ready. I may well produce version 4 at some stage, because as I work on the sequel I keep thinking of cunning things I could have put in the original that would hook forward into the sequel.
You mentioned meeting an agent at the York Writing Festival, did you go there to meet agents?
Part of the conference fee included two 15 minute appointments with an agent or a book doctor. You had to send in a sample, pretty much the way you would send a submission if you were trying to approach an agent. One of the attractions of going to the festival was that part of the package. I thought it was important to get some sort of a fix on how agents think. There were a lot of other sessions that were interesting so the conference was still worth going to.
How did you approach them? Were you intimidated?
The approach was effectively packaged by the conference. You were told when and where to go. It was a bit like doing an oral exam at university, a room full of little tables and these serious looking people sitting waiting for you. It’s a while since I did that, mostly in the last twenty years I’ve been an examiner, not the other way around. At one level I did feel a bit intimidated, mostly because my all but one of previous contacts with agents was through getting rejection letters. I was expecting my writing to be pulled to pieces.
Throughout my professional career I had to deal with difficult people some of the time, so I felt confident that I could hold my own at a personal level, but that’s not the same as coping with whatever they might say about my writing.
What do you mean by “dumb” interview at the festival?
It was dumb because the agent concerned simply said that there was no way that he could represent my book because it might undermine people’s confidence in their doctors.
In some respects it was a useful learning experience, in that when someone says ‘this is not for us’ you have no idea what they mean. It’s easy to assume that you are being rejected because your writing is bad, when there might be another reason that you can’t even guess at. Of course, it could be that my writing is rubbish, but the guy didn’t have the bottle to tell me. Either way I thought it was dumb because in that setting I thought the deal was that that the agents would try to give the participants some objective advice. I didn’t think I got that.
What’s more I have to say that my reason for writing the book was to try to expose some of the bad doctoring that sometimes goes on. No different from someone like Ben Goldacre who writes the bad science column in the Guardian. I reminded the guy that ‘The Constant Gardener’ did OK as a book, and that isn’t exactly full of confidence making stuff about doctors or drug companies. That didn’t cut any ice either.
You’ve a CBE. What was it like meeting The Queen?
It was back in 2000 so I’m sometimes a bit hazy about the details. I remember opening the letter that said something like – the Prime Minister has it in mind to recommend to The Queen that you be given a CBE, would you accept if he did. You have to sign it and send it back. I remember being so shocked that I didn’t see the bit at the bottom where you have to sign. I put it back in the envelope and set off to the post office. About half way there I said to Lois, ‘You know I bet you have to sign that form somewhere.’ So we drove back home and steamed it open and sure enough there is a little box at the bottom that you have to sign. It gives some idea of the state of shock I was in. The actual day is brilliant, so well organised. I actually almost didn’t make it because they first date that they gave me for the ceremony I was in Australia giving a lecture at a conference. I asked for a different date and luckily there was one.
I think I rehearsed in my mind everything I thought the Queen could possibly ask. When I got there for my 30 seconds, shook hands and she said ‘Glad you could make it.’ I was completely dumb stuck and couldn’t think what she was talking about. ‘You couldn’t come the first time,’ she said. I was amazed, what a system to manage to note that and feed her the line when I got there. I mumbled something about being in Australia and it was all over after that. I think the best thing was being able to take my mum, though by then my dad had already died. He would have been bursting with pride. Yes I am proud of it. They don’t give them away for nothing and its good to be appreciated.
Can you talk a little about Ward 87 and your long-running dispute with Dr Rita Pal?
I’m glad that Rita and I have found some way of getting past all that, and we have since corresponded enough to find quite a few things we agree about. Rita writes very well and has done some excellent work raising health issues. Being on the receiving end of her attacks is no fun at all, but the experience did give me some things to draw on as a writer. Actually I rather admire Rita. Most people in her position do not have the bottle to go after an issue the way that she did. As a result of her raising the issue some changes were made, maybe not as much as she or I would have liked but certainly some movement. Millions are now being spent on building a massive new hospital; if you go on their web site http://www.uhns.nhs.uk/ you can see pictures of it. That didn’t arise only because of Rita, but what she did must have helped.
In any dispute like that there will be times when you wake up in the middle of the night thinking ‘why did she say that?’ I’ve certainly had nights when I’ve spent the small hours going over and over things in my mind. That kind of thing could happen to any character.
In an earlier version of Rag Doll there was a long scene in which Val wakes from a nightmare, seeing Danni’s skiing accident over and over in her dreams. She spends an hour wandering around the house nursing a cup of coffee trying to remember some detail that might explain why Danni is still unconscious. In the end I cut that scene because I found a better way of moving the plot along, but I’m pretty sure I know what my subconscious was drawing on.
OK, so time to give us a snippet of A Rag Doll Falling?
Standing at the end of the bed Jim watched for the slightest flicker. Guillain-Barre syndrome can paralyse the nerves to the eye muscles just the same as it knocks out all the nerves in the body but the nerves to the eye muscles are short and the muscles are very small, if anything can keep going, those are the muscles to look for.
It seemed to take an age. Around him the sound of the machines breathing for Danni and all the other patients went on as rhythmically as ever, but none of the watchers were breathing. Jim leaned forwards, bending down slightly to be able to look at a better angle; surely the shadow under her top eyelid had got wider. Another millimetre and there’d be a hint of white. He could feel everyone else willing it on, and then he saw a glimpse of a tiny circle of colour; the smallest hint of Danni’s blue eyes.
Jim could only see the back of Val’s head, but the stiffening muscles told him she’d seen it too. He felt everyone around him breathe again.
‘Danni love’ said Val, ‘if you can see me try to blink. I know it’s silly asking you to shut your eyes when you’ve only just opened them, but try love. We need to know you’re awake in there, don’t be frightened, we know what’s wrong, you’re going to get better, just blink for me love, blink now if you can see me.’
Jim didn’t need to see Val’s face to know there were tears running down her cheeks, but that didn’t matter; all that mattered now were two eyelids.
No one in the room moved a muscle, time slowed down and very, very slowly, moving almost languidly, Danni’s eyelids fell, but would they open again? Her long lashes flickered and the tiniest crack appeared and then it got wider, very slowly the tiniest hint of white appeared below the lid and then blue and more blue and a dark pupil in the centre and suddenly the world was a different place. Two bright blue eyes looked at them all, and moved, slowly scanning from side to side. Val collapsed forward falling on to the bed to hug Danni, her voice muffled as she buried herself in the bedclothes, her arms reaching around Danni. The two blue eyes rolled around, moving from the crowd and dropping down to gaze at Val.
Bit by bit the world came back to normal speed. The nurses smiled to each other and moved away to work on other patients. The two junior doctors turned to pick up notes and pieces of equipment and Dr Ward turned to Jim.
‘Seems like you were right Jim, but we’d better do the tests. Can you and Val explain what these two are going to do, or do you want to wait a minute or two and just talk to Danni.’
‘Give us five minutes,’ said Jim, catching the eye of the juniors as he turned back towards Danni. ‘We’ll try and explain to her what’s going on. Give us five minutes.’
He walked around to sit on the edge of the bed on Danni’s left side. He put his hand on Val’s shoulder and she sat up. It felt uncanny, the two of them sitting together with Danni looking at them.
‘Danni love, let Jim explain what’s happening, it’s so good to see you awake.’
‘Danni, I’m going to describe what’s been happening to you, it’s quite complicated so I’ll go one step at a time. Can you try to blink once if you understand each time I stop.’
‘Great, that’s the way. You had a bang on the head when you were skiing with Val in Meribel. Do you remember skiing?’
Danni’s eyes drifted across to Val and then turned back to Jim. Blink.
‘You were knocked out cold and had to have an operation on your head to deal with a fracture.’
‘We think you fell because you had a rare nerve condition coming on. That’s why your legs gave way and that’s why you can’t move. It’s temporary; it gets better.’
As Jim concentrated on Danni’s face and there was a hint of a frown, just a suspicion of movement in the muscles of her face.
‘You are on a breathing machine because your muscles can’t move, it’s all part of the same thing.’
The blue eyes looked across towards the sound of the ventilator, struggling to look behind her head; again there was a tiny movement in her face.
Go to Professor Rod Giffiths’ blog and find out more about A Rag Doll Falling.