On the one hand, there is the associate professor of surgery at the Moores Cancer Center of the University of California, San Diego. A specialist in prostate cancer, benign prostatic hyperplasia, bladder cancer, and kidney cancer, he has published numerous scientific articles and served as an editor of four textbooks, including Handbook of Urology (Wiley- Blackwell, 2013) and Prostate Cancer: Principles and Practice, 1st edition, which weighs in at more than 1,000 pages. He has been course director for the urology sub-internship course at UCSD Medical School, a faculty presenter on renal cryosurgery, and an invited lecturer on preventing benign prostatic hypoplasia at Slovak Medical University and the University of Padua. He also found time to serve as president of the San Diego Urological Society. Meet J. Kellogg Parsons, M.D. ’97, M.H.S.
On the other hand, there is the author of a gripping medical thriller with a major publisher, St. Martin’s Press. In Doing Harm, Dr. Steven Mitchell, chief resident in surgery at a fictional hospital, hopes for a job offer at the famous medical school that runs the hospital. Then things begin to go horrifyingly wrong. A patient that Mitchell operated on dies unexpectedly, shocking the confident – indeed, sometimes arrogant – Mitchell. But it turns out that the death was not the result of a medical error. A friend on the hospital’s Safety Committee grudgingly reveals that the concentration of potassium in the total parenteral nutrition that Mitchell had ordered for the patient “was at least a hundred times greater than the amount you had ordered for him.” In short, murder – but who did it and why? It is just the first of the deaths that disrupt the hospital and have Mitchell wondering about his own future. Only an insider – someone who knows the daily life of a hospital, who knows the ambitions of the medical professionals and the hopes and fears of their patients – could have created this evocative mix of characterization, specificity of place, and increasing sense of tension. Meet Kelly Parsons, novelist.
In 2014, J. Kellogg Parsons published an article on prostate cancer and the therapeutic benefits of structured exercise in the Journal of Clinical Oncology. He was also lead author for an article in Contemporary Clinical Trials on one of his continuing research interests: whether diet can substantially alter the initiation and progress of prostate cancer. That same year, Kelly Parsons published the 351-page Doing Harm.
A Surgeon, Right Where He Wants to Be
When we first meet Steven Mitchell, he is nearly living the life of his dreams. His marriage is happy, he has two adorable daughters, and his work is going well, despite the often difficult hours:
I love being a doctor; I especially love being a doctor here.
Who wouldn’t? A sprawling, eclectic complex of sleek, modern high-rises interconnected with squat and sturdy nineteenth-century edifices located in the heart of Boston, University Hospital is the primary teaching hospital for uberprestigious University Medical School, and year after year is consistently ranked among the best hospitals in the world. . . . Not a day goes by when I don’t think about how special it is to be part of this place, or remember all of the years of soul-crushing academic labor it took for me to get here. . . . Only the best of the best are chosen to train here.
And I’m one of them.
In a scene that is a touch reminiscent of the famous statement by Lt. Col. Kilgore in Apocalypse Now (“I love the smell of napalm in the morning”), Mitchell describes one of his operations:
As the tissue at the point of contact between the Bovie’s metal tip and the patient vaporizes, it produces a wisp of bluish-tinged smoke that carries a singular odor.The odor of burning human flesh.
I pick up the Bovie and cauterize the bleeding vessels. The heat from the Bovie cooks the fat, and I inhale the familiar smell.God, I love operating.
I can’t believe they pay me to do this.
Here as throughout, Parsons pays close attention to details, aware not only of process but of colors and smells. As he has said, “The diseases, surgeries, and complications are about as real as I could make them.” But, as readers will expect, Mitchell’s world will soon change dramatically. Doing Harm has two halves. In the first, Dr. Mitchell tries to find out who the killer is and how the killings are done. In the second, once he’s discovered the ingenious killer’s identity and – however irrational – motives, Mitchell must try to bring the killer to justice while preserving his marriage and keeping his family safe. No small task! And his computer skills will come in handy. According to the reviewers’ sacred code, however, one cannot reveal too much more of the plot.
When Surgeons Must Do Harm (from Doing Harm)
Primum non nocere.
I first heard it spoken during my first year of med school from one of my older professors who had a proclivity for bow ties and Grecian Formula. He spoke the words with great flourish, reverently lingering over each syllable, caressing the Latin pronunciation as lovingly as he would his children. . . .
Primum non nocere.
First, do no harm.
Well, when a surgeon operates, he or she is doing harm. Sometimes massively so.
Surgery is a violent art. It’s the act of healing through deliberate injury to the human body. Scalpels slice through healthy skin to allow access to the diseased organs hidden underneath. Otherwise robust muscles are unceremoniously pushed and pulled and shoved out of the way and held out of the surgeon’s working space – the “operative field” – for hours at a time with blunt metallic instruments called retractors.
Normal blood vessels are burned and strangled with fine sterile threads called sutures and cut with scissors, innocent bystanders felled by the surgeon’s relentless march through the healthy parts of the body that invariably stand between the outside world and the site of the patient’s disease.
In a way, then, the very act of surgery itself is a violation of one of the most fundamental ethical principles in the practice of medicine. . . . The surgeon wields the scalpel with the intent to heal. The violence wrought is controlled, calculated, and precise. But it’s still violence, nevertheless – pure and simple and primeval.
Plot and Prose Draw Attention
The most eye-catching bit of praise for Doing Harm comes from an author whose books have rarely skimped on corpses and violence, Stephen King. In a tweet dated April 14, 2014, he wrote: “DOING HARM, by Kelly Parsons: best damn medical thriller I’ve read in 25 years. Terrifying OR scenes, characters with real texture.” The book jacket comes with advance praise from such well-known novelists as Harlan Coben and Ridley Pearson. Publisher’s Weekly notes a “deft initial setup reminiscent of [John] Grisham’s The Firm.” Given such a reception, what are the chances of a movie deal? The author’s response: “The movie rights have been optioned, which is the first (and most important) step on a long and convoluted path to a movie. I’m delighted to have made it this far and cautiously optimistic we’ll make to the end.”
The author’s attention to detail is evident in the description of how hospitals run, how surgeons do their extremely skilled work, how the politics of hospitals and medical schools can affect the people. But it does not mean the prose is entirely straightforward reporting. Here Parsons describes the beginning of the operation on Mr. Bernard: “I slice through the skin and enter the bright yellow fat lying immediately underneath. The scalpel is sure and sharp. As I cut through the fat, which is packed full of small blood vessels, the bleeding starts, and my white gloves are immediately dappled with irregular splotches of bright red blood, which transform my hands into something resembling two moving Jackson Pollack canvases, working in sync to open Mr. Bernard’s belly and expose its contents to the outside world.” Later in the novel, the narrator ruminates on a different kind of surgery: “In minimally invasive surgery, we make small incisions through which we insert long, thin surgical instruments shaped like oversized chopsticks. . . . I think of it as high-tech robbery, stealing valuable objects out of patients without touching anything else, making clean getaways from the insides of their bodies as if we’d never been there.”
Parsons has a knack for describing the characters by their looks – and their inclinations. The chairman of surgery, Dr. Collier, is described as the spitting image of the actor Charlton Heston, the “older, crankier, more blustery” version. “About the only non-Hestonesque thing about him is his musical preference in the operating room: show tunes. . . . Imagine watching Colonel Taylor from the original Planet of the Apes cut out somebody’s kidney while humming along to ‘I Feel Pretty,’ and you’ll have some idea of what it’s like to operate with Dr. Collier.” In contrast, Dr. Lassiter, a former All-American linebacker in college, is Mitchell’s mentor and favorite professor – at least until Mitchell makes a costly surgical mistake on one of Lassiter’s patients. Lassiter is partial to Led Zeppelin. The pounding rock of “Kashmir” contrasts with the ditty from West Side Story.
The Long Journey from Idea to Book
Speaking about the origins of Doing Harm, Parson reports that he kept an informal journal when he was a resident – “not because I envisioned writing a book someday, but because writing helped me mentally and emotionally process the intense experiences of being a house officer. It was a healthy outlet. It helped me bring perspective to my work. The itch to write a novel developed toward the end of my residency. I gathered my notes and started work on the material that would eventually become Doing Harm in 2003, during my fellowship.” Parsons was a resident and fellow at The Brady Urological Institute of the Johns Hopkins School of Medicine.
As Parsons tells it, he wrote a lot of stories when he was younger but stopped writing fiction in college “because I was afraid someone might tell me I wasn’t any good at it.” He grew up reading mostly science fiction, fantasy, and thrillers. He was 15 years old when he read Congo, a novel by another M.D., Michael Crichton, in one sitting, and it had an enormous impact. These days, his tastes are more eclectic, and he enjoys literary fiction and general nonfiction as well.
How does writing novels fit into the busy schedule of a practitioner and researcher in a modern health-care institution? Minutes squeezed into the working week? During vacation? “Whenever I have a spare moment,” says Parsons. “I frequently get up early, while the house is still quiet, and write a few hours before breakfast.” How does he turn from one frame of mind to another? “I don’t have any particular ritual. But I’ve found that when I’m mentally fatigued from an academic activity – like writing a paper or grant – it’s useful for me to turn to creative writing. And vice versa. It’s like flexing different mental muscles.”
Parsons has never taken a formal creative writing class, but he notes that he’s read several valuable books on writing. “I routinely recruit trusted confidants – family, friends, my agent, my editor – to read early outlines and drafts because I think it’s essential to the success of the writing process.”
Once Parsons had a draft of the novel, he entered another phase: trying to find a literary agent. “I slogged through 18 months of rejections and dead ends before I found my agent; and then I spent another two years working with him to completely rewrite the manuscript before we took it to publishers.”
The hardest part of the novel to write, Parsons notes, were the interactions between Mitchell and his wife, Sally. “I wanted their relationship to be believable.” As for Mitchell himself, Parson says: “I always conceived of Steve as a flawed guy who makes some poor choices and then ultimately ends up doing the right thing. But in my initial drafts, he was just a little too flawed, too weak, too unlikable. So I added some computer hacking skills and a little moral backbone.”
The hard work has paid off. Even his colleagues have been, says Parsons, “overwhelmingly positive.” Fortunately for them, the hospital in the novel is thousands of miles from San Diego!
Even better news: Under the Knife, another thriller involving a surgeon, will be published by St. Martin’s Press next spring. J. Kellogg Parsons, M.D., looks to be losing ground to his alter ego.