Dear Reader,

As you might imagine, I’ve been fielding some questions about the origin and content of Doctors and Friends. I’m happy to address the most burning issue on everyone’s mind: namely, whether or not Wally’s Molestache is listed in the official beard categories recognized by the CDC.

The CDC does in fact publish a facial hair infographic with delightful names like French Fork, Chin Curtain, and the Zappa. Sadly, the Molestache is not depicted, but I think we can all agree it should be.

Now that that’s settled, let’s turn to the issue of this novel’s origins.

It is not based on COVID.

I’ve been mired in my own personal pandemic since 2018, when I had an idea inspired by my father. My dad wasn’t a doctor, but he was a brilliant, MacGyver-ish guy (much like the protagonist of The Martian, if you ever read Andy Weir’s fantastic sci-fi novel). He could invent anything, build anything, and understand anything . . . with the notable exception of fashion, which baffled him. There’s a scene in Doctors and Friends where Kira intervenes just as a colossal water tank is about to burst at a party. This actually occurred at my wedding. My dad happened to have duct tape and a siphon on him (because who doesn’t take duct tape and a siphon to a wedding?), and he saved the fancy club from flooding. Like my father, infectious disease docs are innovative and scientifically minded. Since I write medical fiction, I decided I’d make my new protagonist a fashion-challenged, globe-trotting ID doc . . . in the midst of a brand-new worldwide viral pandemic.

To the irritation of everyone around me, I became obsessed with virology. These days it is not unusual to wander into a grocery and overhear a conversation about the latest mutation in a protein spike, but back then people could only listen to me babbling about nanobodies and nucleocapsids for so long before their polite smiles would fade and they’d begin desperately edging away. In my defense, real events inspired my obsession. The inspiration in this case, however—and I cannot stress this enough—did not include COVID-19. At the time I fired up the first draft of Doctors and Friends, we were all still running around with naked faces, blissfully ignorant of what would befall us in 2020.

Instead, media accounts of other epidemics prompted my interest, especially the 1918 influenza pandemic and the 2014 Ebola outbreak in Western Africa. At first, work on the novel advanced slowly as I was consumed by research.

Then, sometime in mid-2019, I read Richard Preston’s Crisis in the Red Zone, a fascinating work of nonfiction detailing an aid camp in Liberia where two medical workers contracted a highly lethal strain of Ebola. At the same time, a dose of an experimental medication—one of only a few doses in the world—became available to the medical director of the camp. (If you’re wondering how that happened, you’re gonna have to read the book.) He faced a brutal decision: which of his two dying colleagues to treat—or whether to try the antibody drug at all, since at that point it had never been administered to a single human being. If he did nothing, both people almost certainly would die. If he administered the drug, he’d have to choose between them—and the drug itself might kill the recipient.

Upon reading this account, I immediately thought My gosh, what if those two people had been his children? Lest you worry I’m a psychopath, the mantra of all fiction writers is to create the worst plausible moral dilemma for our characters. Think about it: have you ever read a novel where nothing bad happens? This idea maximized Kira’s ethical quandary, but writing the ICU scenes with her children turned out to be such a wrenching process, I almost quit.

Shortly thereafter, in a bizarre coincidence, I learned of a real-life scenario not unlike Kira’s. I’d been corresponding with two physicians who practice in Chad and was astonished to learn they’d endured an agonizing saga after their children were exposed to rabies—two of them badly—and there wasn’t enough vaccine and immunoglobulin in the entire country to treat more than one child. (I won’t relay their outcome here, but the impact of these doctors is so remarkable, I hope they’ll one day publish an account of their experiences.)

In addition to the physicians in Chad, I corresponded with more than four dozen infectious disease doctors, virologists, epidemiologists, ob-gyns, neurologists, and ER doctors, who helped guide me through their specialties. (Also, I’m happy to report that I was able to travel to Spain and Morocco with my own girlfriend gang from med school, where we met several pleasant and presumably disease-free camels.)

Even with all this forewarning, I certainly didn’t anticipate COVID. For one thing, I never could have imagined how politicized the response to medical science would become in 2020. During edits, I made a conscious decision not to address our real-world pandemic response, even though anyone reading Doctors and Friends now is likely to apply the filter of their own experience to the fictional events in the book. Allow me to stress: the government in the novel portrays an idealized scenario I envisioned back in the good old pre-COVID days. The virus in the book is equally imaginary. It possesses different transmissibility and clinical characteristics and lethality than any existing virus. With some exceptions (such as the Zoom videoconferencing I added later), the political and societal and virological depictions in this book are not reflective of the COVID pandemic. I made up that stuff, much of it long before I had a clue we were barreling toward an actual pandemic.

However, I did make some structural changes in response to COVID. My editor had a request: could I shift the story line so its focus included more of the other physicians in the book? Thus Compton and Hannah became point-of-view characters. Originally, so was Vani, but I loved her so much I decided to save her for a book of her own. Compton’s was the easiest perspective because of my own background as an emergency medicine doctor; her scenes, initially told in conversation, became much more compelling when shown from her mindset. In light of everything nonfictional ER doctors experienced during our real pandemic, I’m glad I included these scenes—but again, they are imaginary.

Finally, what’s not imaginary is that I contracted COVID myself in mid-2020. To be clear, millions of people around the globe suffered the loss of loved ones as well as medical and economic devastation during COVID. I was comparatively fortunate, but I did develop multiple long-term symptoms, the most impactful of which has been parosmia. (If you’re not familiar with parosmia, it’s disgusting. Look it up.) In a freaky coincidence, this occurred long after I’d written the AAROD scenes in the book. Not surprisingly, I’ve given a lot of thought to the irony of writing a novel focused on a bizarre side effect during a new pandemic, only to promptly develop a bizarre side effect during a new pandemic myself.

For my next novel, I think I will write about world peace.