A warm summer’s day. A swim in the lake. Kids splashing in the water. Sounds idyllic, doesn’t it? But consider the frightening aftermath. A few days after your swim, your head is aching and your eyes are so sensitive to light you can’t bear to open them. You throw up. You shake and shiver from a high fever. Soon you can’t focus, and your body is racked by seizures. In a week, you are dead. The disease is amebic meningitis, and it’s caused by a microorganism called Naegleria fowleri, which can be found throughout the world, living in freshwater lakes and ponds, in hot springs, even in swimming pools.

Remember that pleasant little swim in the lake? Maybe you inhaled some water. The deadly organism entered your nasal passages and traveled through semi-porous barrier called the cribriform plate, to invade your brain. Of the more than one hundred reported cases of amebic meningitis, only four survived. Most of the victims, strangely enough, are healthy children and young adults — precisely the population you’d expect to be most resistant to disease. But this is one infection where the elders hold the advantage. As you grow older, your cribriform plate seals over, making it an effective barrier against invasion by Naegleria. Children and teenagers don’t yet have this protection. For them, a swim in warm freshwater may prove fatal.

A similar infectious pattern occurs in Tess’s medical thriller BLOODSTREAM. When the children and teenagers of a small Maine town suddenly turn violent and begin to kill, Dr. Claire Elliot suspects the reason for their frightening behavior lies in the waters of nearby Locust Lake. What is the source of the lake’s mysterious green glow? Why is her own son beginning to act strangely? And why did a similar epidemic occur fifty years ago in this normally peaceful town? The answer to this mystery lies in the past. The ancient past.

Mad Cows and Englishmen

In 1913, in the town Breslau, Germany, a young physician named Hans Creutzfeldt was confronted by a most unusual medical case. His patient was a twenty-three-year-old maid in a convent who had suffered a bizarre and abrupt personality change. She had stopped bathing, stopped eating, and had become dirty and emaciated. She suffered from sudden fits of giggling and laughter, alternating with shrieks of horror and claims that she was possessed by the devil. Her eyes twitched, her arms jerked, and she was unable to walk without falling. Over the next two months, she suffered repeated seizures, eventually lapsing into a coma. She died only two months after the onset of her first symptoms.

At autopsy, a stunning abnormality was found on microscopic examination. Her brain tissue was riddled with so many holes it resembled a sponge. The term “spongiform encephalopathy” was born. This was the first recorded case of what later came to be known as Creutzfeldt-Jakob Disease, or CJD. Occurring sporadically, CJD strikes one person in a million, both men and women, usually around age 60. The first signs are of rapidly progressive memory loss and impaired judgment, often accompanied by wild mood changes and frightening hallucinations. The patient twitches, stumbles around, and often falls. Within weeks to months, he is dead. There is no cure.

For years, no one knew its cause.


In 1957, physicians on the island of New Guinea struggled to make sense of a baffling epidemic among women and children of the Fore tribe. Hundreds were dying of a disease that caused its victims to shiver, to laugh wildly and fall twitching to the ground. All the afflicted died. Biopsies of their brains revealed tissue that had so many holes, it looked like a sponge. You guessed it — the victims were dying of Creutzfeldt-Jakob Disease. But why were there so many cases? And why were the men unaffected? What were the women and children doing that the men weren’t?

The truly creepy answer: They were eating their dead relatives. That’s right. Feasting on grandma and grandpa, on dear old mom and dad. If your husband died, you, as the surviving spouse, got first dibs on your favorite body part.

Late at night, after a death, the women would take the corpse into the fields. There they would expertly butcher their dear departed loved one, disjointing the flesh to be steamed over cooking fires. They dined on every part of the body, distributing the meat only among the women and children. The men, poor things, were not invited to these feasts — unless they were the main course.

Alas, the eating of human flesh has its drawbacks. What the women had ingested, along with human brains, was the infectious agent for CJD. As more and more women died, and were in turn consumed, the disease spread until there were twice as many men alive as women in this tribe.

It was the controversial Dr. Stanley Prusiner who finally identified the infectious agent. it is neither a virus nor a bacteria. In fact it is not, strictly speaking, even a living organism. It is a protein. Prusiner dubbed them “Prions.”


In 1990, a pet cat in England began to twitch and stumble. When he was finally euthanized, and his brain examined, veterinarians declared him the first case of feline CJD ever reported. Over the next four years, sixty two more cats died of the same disease. All had been fed pet food derived from English beef.

“Mad Cow Disease,” the bovine form of CJD, had in fact been identified years earlier in English cattle. Its spread through the herds in England may have been caused by the routine use of “downer cow” remains in cattle feed. (“Downer cows” are those found dead of unknown causes.) In order to speed up the growth of veal calves, farmers would feed them extra sources of protein. In this case, the protein source was dead cows. Bovine cannibalism had proven just as unhealthy as human cannibalism.

In 1993, the epidemic passed over into humans when two English farmers died of CJD. By 1996, a dozen Englishmen and women were dead of the disease. The source of their infection? English beef. For the first time we had incontrovertible proof that prions could be passed from one species to another. And if humans could catch it from eating beef, why couldn’t we also catch it from milk or butter or even that old childhood favorite, Jell-O, which is derived from beef products? If cows, cats, and humans can catch CJD, what about other mammals? The list, in fact, keeps growing, with reports of “mad mink disease” and “mad squirrel disease.” Every mammalian species may, in fact, be susceptible.

Yet another cause of worry is the fact that scientists do not yet know how many people have been infected by eating beef. Since the latency period for CJD may be as long as ten years, England may be incubating a silent epidemic that is yet to make itself apparent. The British are now launching a study to find out just how many undiagnosed cases of CJD they may have brewing. They will search for prions in hundreds of surgically removed tonsils and appendixes which have been kept preserved and stored over the years. (And you thought you collected weird things!)


Finally, one last bizarre tidbit of information. In 1997, a dozen people in Western Kentucky died of CJD. In the valley where these victims lived, a favorite local snack was … squirrel brains. A traditional gift to present your hostess when you went visiting was a sack of squirrel heads. The hostess would prepare the delicacy by first shaving off the fur, then frying up the heads in a cast iron skillet. The diners would then crack open the skulls and suck out the brains. It’s rumored to be quite a tasty snack. Yum.

In Tess’s medical thriller LIFE SUPPORT, an E.R. doctor tracks down the source of a mysterious outbreak of Mad Cow Disease among rich men in Boston. The solution to the mystery lies with a pregnant teenage prostitute who carries, in her womb, a secret horror…

Sometimes only pen and paper will do

What’s your vision of how a writer writes?  You probably see her sitting at her computer, tapping away at the keyboard as words materialize on the screen.  Maybe she pauses to delete or change a word here and there.  (As I just did while I typed this.)  Maybe she’s forced to sit and think for a few minutes before the next sentence comes to mind.  But at the end of a long writing session, she gives a satisfied sigh, hits print, and heads off for her afternoon martini.

Heh.  I wish it was that easy.

I’m going to reveal the truth: I don’t compose my novels on a computer.  Or a typewriter.  Instead, I pick up my Bic pen, reach for a fresh sheet of unlined paper, and start writing.

People always seem amazed that I go at it in such an old-fashioned way.  I’m a pretty fast typist.  I’m typing this blog right now.  In fact, when I write articles about writing, I’m perfectly capable of composing the whole piece at my keyboard. 

But fiction is a different matter. 

Believe me, I’ve tried to write novels on the computer.  I’ve sat staring at the screen for hours, struggling to make even a single sentence come out right.  I’ll revise the same damn paragraph again and again.  And at the end of the day, I’ll have written only fifty words — and they’re usually stilted and uninteresting, because I’ve spent too long “perfecting” them.

I don’t know how many other novelists have this problem.  Maybe it’s a generational thing — unlike the kids of Generation X, who could type as they came out of the womb, I grew up writing with pen and paper.  I like the feeling of leisurely setting down words, of deleting them with a single swipe of the pen.  I like knowing that once the ink’s on the page, it can’t magically disappear when the power goes out.  I like being able to write notes to myself in the margins, to have an inserted sentence curl up the side of the page.

I like knowing that NO ONE ELSE can read my atrocious handwriting, because my first drafts always stink anyway.  The story stays a secret, just between me and the page, so it doesn’t have to be perfect.  It can go anywhere it wants, be anything it wants.  Yes, it will get whipped into shape during later drafts.  But for now, while it’s still just a whisper of an idea, it has complete freedom to grow in any direction.

That’s the point I’m at now.  I’m starting on my new book, which I’m not going to talk about yet, because gestating stories are such fragile things.  They shrink from too much scrutiny.  For the moment, the next book is just ink scratches on paper.

p.s. — for the next few days, I’ll be in Chicago, where King Tut and the Field Museum await!

 p.p.s. — yes, I know the “Creepy Biological Facts” page is messed up — it will be fixed soon!

Still a doctor after all these years

So some of you are wondering what the heck I was doing at a medical conference.  The truth is, I don’t really attend too many of them anymore, since I’ve long since let my medical license lapse, and I no longer need those continuing medical education credits. 

But sometimes, I come across a conference topic that’s just too intriguing to pass up.  (And believe me, it’s not going to be “advances in colo-rectal imaging.”)  What lured me out to Santa Fe last week was a program called “Wilderness Medicine.”  Now, I’m no jock, and you’ll never get me to go rock climbing, but I do like to get out in the woods here in Maine.  And every so often the thriller writer in me has a nightmarish flight of fancy: what if civilization suddenly shuts down?  What if there are no functioning emergency rooms?  What if bird flu takes off, and hospitals are turning away patients, and my next door neighbor suddenly fractures her femur?

Would I know what to do without an x-ray machine and all that fancy equipment we doctors have come to depend on?

You don’t have to be trapped on the slopes of Everest to be a wilderness doctor.  If you’re stuck at the side of the road a hundred miles from the nearest town, you’re as good as in the wilderness. 

So off I went to Santa Fe.  For four days, I sat with several hundred doctors, hearing about snakebites and poisonous spiders and lightning strikes and avalanche burials.  We learned the latest about high-altitude sickness and malaria, heatstroke and encephalitis They showed us how to fix dislocated shoulders and hips by using only a few nylon straps and the force of our own body weight, how to rig up traction for a femoral fracture using a walking stick, a tin cup, and duct tape.

(That was the big take-home lesson of the conference, folks.  If you want to be prepared, always, always have duct tape on hand.  McGyver knew exactly what he was doing.)

By the time the conference was over, and we’d had our fill of gruesome slides and horror stories of what can go wrong in all the wild and remote places of the world, I decided I’m better off staying safe at home and never setting foot outside my front door again.  Because there are just so many BAD THINGS that can happen to you.

What a conference like this really does, besides scare the heck out of me, is get my creative juices flowing.  I came home with half a dozen ideas for future books. 

Plus, now I can splint your femur!  As long as I have my duct tape.



Lost in Translation?

Whoa — it’s cool that I’m getting so many comments!  This new feature is turning out to be a lot of fun, and I love reading what everyone’s been saying while I’ve been away. 

 Reader Ghasemkiani suggested that I blog about foreign editions.  It just so happens that I’ve been mulling over that very topic recently, so this is a great time to talk about it.  The foreign language market for authors can be a truly lucrative one.  Almost a third of my annual income, in fact, comes from foreign sales, and I consider them so important that I’ve been traveling overseas at least once a year on book tour.  At last count, I’ve sold foreign rights to 29 countries, and every few weeks, some newly translated edition will show up in my mail, sent to me by one of my foreign publishers.  More often than not, I have no idea which language it’s in.  I’m sorry to say that I still can’t tell the difference between Latvian and Slovakian, so I have to check the copyright page for the publisher’s city to find out the language.

Needless to say, I usually have no idea if the translation bears any resemblance to the book I wrote.

A few weeks ago, a foreign language school in my town hosted an afternoon program called “the art of translation.”  They gathered together five native speakers of French, German, Spanish, Italian, and Japanese and gave them the foreign editions of my thriller, THE SURGEON.  Each speaker read aloud from her foreign edition’s prologue, then talked about the accuracy of the translation.

Some of their comments surprised me.

Entire sentences are sometimes dropped in foreign editions — and not just trivial sentences, but sentences that I’d consider artistically important.  Sometimes, there’s a practical reason for this.  English is an economical language.  Going from English to, say, German, usually means a huge expansion in word count, and if the last sentence in a chapter spills into a new page, they may delete text to avoid having a mostly blank page. 

Another translation quirk comes into play because of feminine and masculine nouns.  The English prologue of THE SURGEON is told from the first person point of view of the killer, who refers to himself/herself as, simply, “I”.  The killer’s gender is hidden from the reader.  The Japanese translator explained that this is impossible in her language, because men and women use gender-specific words when they refer to themselves.  The Japanese first-person character will automatically reveal his or her sex — a real problem for the Japanese mystery writer who wants to keep the killer cloaked! 

Sometimes, the translator’s personality and educational status will insinuate itself into the work, changing the texture of the novel.  My villain, Warren Hoyt, is a very formal, even fussy man.  Yet one of the translations had Warren refer to the police as the local equivalent of “cops.”  Another translator changed slang-laden dialogue to a very formal exchange. 

One element, however, remained unchanged in all five foreign editions: the name of the coffee chain “Starbucks” made it through, untranslated.  Some things, I guess, are universal!

So when my foreign readers pick up a translated edition, the story they read may not be exactly as I wrote it.

The other element that can vary wildly is the cover design.  In France, the cover for THE SURGEON showed the back of a male doctor in a white coat.  In Germany, it was a lush painting by Caravaggio.  Other publishers went with scalpels, frightened women, zippers, or bloody drains.  There was one frankly pornographic version, of a woman who was either in the throes of death — or orgasm. I couldn’t tell which.  (I’ll bet that edition sold like hotcakes.)

We Americans tend to think the U.S. is the center of the universe.  But when I look at my foreign sales, I remember that there’s a much bigger world of readers out there who don’t speak English.  And I’m thrilled they’re buying books.