Where did you learn to write?

It was piecemeal. Trial and error. But I can point to a few significant places.

I had a very demanding high school course called Analytical Composition - "Anal Comp" - that was, well, anal. By about six weeks my teacher had gotten me to where I couldn't finish a sentence, much less a paragraph, because I was over-analyzing everything. Then, gradually, he got me back to where I could say what I meant. With some clarity.

Then, at Stanford, I had a biology final that required essay answers to physiology questions that had to be 100 words or less. That was a very interesting exercise. It got me to look at economy in my writing; again, you say what you mean. Then get on with it.

Then, in writing the book itself, because I had to take long breaks in doing the first draft - six months to a year sometimes - I would have to start by reading what I'd last written, but with a fresher eye - or ear. Often it was crap. So I'd pull out whatever idea was buried in there and redo it. And it turns out that's what writing really is, anyway.

How much of Malcolm's story is you?

Not much. I never had an affair with a professor, that's for sure. Nor did I ever get kicked out of anything. I got the idea for that when I was Department Chairman at Emanuel and was in on a committee meeting to review the potential expulsion of a surgery resident, but it was over competency issues, not sex and drugs.

I did spend a year traveling and working in ERs but it was by choice. And it wasn't always in small towns. I got booked for four weeks, for instance, at a big hospital ER in inner-city Pittsburgh. That got stretched to ten weeks - they liked my work. Great experience.

Also, I used a lot of actual cases I've seen as anecdotes within the book. They provide parallels to the main story lines. But the main characters and the main story line are entirely fictitious - without being unreal.

How long did it take you to write Lie Still?

About 16 years from starting it to selling it. I gave up on it at least a dozen times - I was too busy; I thought - as any writer does - it was never going to be any good; people would be sick of medical stories after "ER" on TV - but I kept having ideas about it, so I had to finish it.

It was that long process, though, that made me forge into something I believed in.

How real is the medicine in the book?

All the medical detail in the book is textbook-accurate. I was convinced way before "ER" - especially after seeing some horrible, laughable stuff on TV - that only something really true would have staying power.

Should we be afraid of doctors?

Not at all. The issues of medicine being a self-policing profession are real, but the occurrence rate of problems is very small. I've known of only a very few with problems, and they're not practicing now, as far as I know.

Our biggest problem in self-policing comes up with lawsuits over restraint of trade. Oregon, years ago, had one of the seminal cases in the area. We now have a mechanism to try to get around anti-trust issues while being fair to all. It's never going to be straightforward, though, and I guess that's one of the points of the story - whether a doctor is competent is never black and white, though patients' outcomes are.

Your agent is Henry Dunow, one of the hottest agents in the business. How did you get him to represent you?

I got a couple of books at Powell's - how to get an agent, how to sell your novel, that sort of thing. There's a whole process. It's not that hard, but you have to know the rules.

I got Henry's name along with a bunch of others from a writer-acquaintance. I knew everyone on the list was going to be good, but not much beyond that. When I signed on with him, no one but he had ever heard of The Lovely Bones. Beyond that, he really liked the manuscript. You're not going to get a good agent without a good book. He said he's known for representing literary work and was drawn to Lie Still for its literary qualities. He's been great.