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HALLIE EPHRON: Sandra Cavallo Miller sets her fiction in Phoenix in the summer where temperatures climb to 110 and beyond, where you could bake cookies on your dashboard. Her new book is aptly named, Where No One Should Live, and it poses a very scary what-if.
SANDRA CAVALLO MILLER: This might be the first novel with the main female protagonist as public health physician. Add to that how little fiction is set in modern Phoenix during the summer and let the adventures begin.
It’s hard to live and work through a desert summer, and it’s worse when unexplained illnesses begin plaguing a medical clinic that trains doctors. One physician in particular seems targeted.
How did I come to write this?
During an interview, though, it’s challenging to assess character and ethics. People are on their best behavior. If you have ever hired people, you know sometimes the most outgoing, likable candidates turn out to have the most problems; sometimes the quiet, humble applicants are better workers.
Nearly everyone has stories about difficult and concerning co-workers who seemed normal at first. Feel free to share. It can get scary.
Then I read Stewart’s book Blind Eye, a documentary about Dr. Michael Swango. Swango began as a serial poisoner and progressed to a serial killer who likely murdered sixty people.
No one wants to think about that, especially in the healthcare setting. But while rare in the big picture, the reality lurks. Most are nurses and a handful are physicians. Most are male, but females aren’t spared. And no one knows how many are never discovered.
The FBI estimates that about fifty serial killers operate in this country now. Other experts feel the number is much higher, well over a thousand. Considering that only sixty percent of all murders are solved, that leaves a huge number of unexplained cases. Medical settings are especially tricky because underlying disease easily cloaks poison symptoms. Physicians don’t suspect foul play, so they don’t look for it.
This happened with Michael Swango, when worried nurses reported unexpected patient deaths whenever he took call. The hospital administration wrote off the nurses’ complaints as silly and hysterical. But the nurses were right.
Could it have happened with me—missing dubious symptoms or a suspicious death?
I certainly hope not and probably did not, but I always wonder if I unknowingly might have interviewed such a psychopath. Would I realize something was off? They can be charming and agreeable. If they became a colleague, would I have recognized the patterns? Or become a victim?
Swango (convicted in 2000), Christopher Duntsch (convicted in 2011), and Kermit Gosnell (convicted in 2010) all interviewed for residencies in the U.S. and were hired.
Thoughts like this can drive us to write fiction. To play out our fears. In the novel, Dr. Maya Summer goes about her daily business, dealing with rabies and infectious mosquitoes and parasites in swimming pools (to name a few), at first unaware of the covert danger.
It needn’t be with medical drugs, either … we’re surrounded by toxins. There are pesticides and herbicides in my garage. One year we had rodents, so there was rat poison. Oleander grows in my backyard, and the park where I hike sprouts many datura (jimson weed) vines; both plants are deadly. Other areas of the country grow wild hemlock, nightshade, and castor bean plants. Be careful.
Where No One Should Live is a mixed-genre novel, combining the complicated tasks facing a public health physician (written pre-Covid) with an alarming and escalating series of illnesses in clinic staff.
It was highly entertaining to write and I hope you enjoy it.
HALLIE: This is reminding me of when I was a college professor and we were interviewing a candidate for an opening. Something about him felt... off. And I argued vigorously against inviting him back.
Later I found a news article about how he'd been fired from his previous position. As I recall, it was for erratic behavior; he was suing. I was glad I'd ruled him out based on the interview and his resume alone, but I've often wondered where he landed.
Like an MD physician, a PhD professor has unfettered access to vulnerable young adults.
Anyone else had what, in retrospect, seems like an all-too-close encounter with trouble... hopefully not a serial killer. Or maybe someone got your hackles and then turned out to be harmless?
HALLIE EPHRON: Recently I had the pleasure of being on a panel
for an event with Arizona State University with retired physician Sandra Cavallo Miller. We spotted each other across the virtual dais as kindred spirits.
I am so delighted to have her as a guest today, talking about her trilogy featuring a young woman physician and set against the magnificent backdrop of the Grand Canyon.
Like me, she embraced her inner writer relatively late and after a virtual lifetime of experiences.
SANDRA CAVALLO MILLER: Old age always seems like a long way off. Then suddenly it’s here.
Technically speaking, we abruptly become geriatric at 65, whether we agree or not. We’re officially labeled “elderly,” no matter how annoying and untrue that feels. This happens regardless of how sharp or not we find our brains, how fit or not we find our bodies. Medicare coverage starts. Pilots and air traffic controllers must retire. So it’s easy to start feeling old.
But wait. Our president is 78, and a brilliant popular epidemiologist is 80. Okay, now I feel better. Especially since I started this new venture at age 66: writing novels. So maybe “geriatric” is not old, but liberating. I finally have time to create new worlds!
All I need is my imagination and a pen, literal or virtual.
Older new writers (is that confusing? should it be newer old writers?) have advantages besides more time. Experience. Perspective. We’ve seen a lot. I don’t think there’s a human on this planet without a unique story.
And we’ve been through a lot: when I started medical school, fewer than one out of ten students were female. When I became a family physician in Phoenix, Arizona, only two of us women held that role. Two, in the entire city. Now over half of medical school classes are women. Yeah, we’ve come a long way. People in those days who saw me in a white coat would ask me what kind of nurse I was.
But age is relative, and living in Arizona provides some unique outlooks. I might be old, but the place is really old. The earth cracks open at the Grand Canyon: the Kaibab limestone layer at the top boasts being 270 million years old, and the Vishnu schist at the river formed 1.7 billion years ago. So where better for an old woman to put a novel? Despite being one of the seven natural wonders of the world, only a handful of novels have been set at the Grand Canyon. It’s irresistible.
I love our planet, our natural world and our universe. I can’t get enough of old rocks and the stardust that makes us up, and how our species—imperfect and challenged as we are—came to be. Our urges to explore, to push ourselves, often at our peril and even our demise. We are seekers, although we don’t always understand what we seek. Adventure. Fulfilment.
So here I find myself, an old retired family doc writing fiction about medicine on the brink of geology. If that sounds too
noble, don’t worry . . . my novels include light, playful stuff with some real science and quirky characters thrown in. I’ve rarely found pure medical themes compelling enough to make a good story. You need plot to keep things going: some mystery, some romance, good and bad people trying to get somewhere. Even though I don’t know what I’m doing, don’t know the formulas for genres, it’s all there somewhere. Maybe a little mixed up.
But I keep getting better at it, and I have never had so much fun in my life.
Right now I have a trilogy about a young woman physician who works at the Grand Canyon Clinic on the South Rim. Each book stands alone, and the third novel, What the River Said, comes out in May. The middle book takes place mostly at Yellowstone—like the Grand Canyon, a place that’s a geology fever dream. And I’m thrilled to announce that my publisher (University of Nevada Press) will release my newest novel this September. Where No One Should Live champions a public health physician, set in Phoenix during a brutally hot summer. Although written pre-Covid, I must have had a premonition that public health doctors would become more visible in our society!
Sandra Cavallo Miller is a retired academic family physician. Little fiction has been written about family medicine or women doctors, and she is on a mission to change that. When not writing, you might find her hiking with a dog, riding a horse, or sitting under a tree studying her favorite hobby, volcanology. Her writings and poems have been published in JAMA's "A Piece of My Mind," Pulse: Voices from the Heart of Medicine, Under the Sun, and Embark, among others. She lives in Phoenix, Arizona. Her trilogy about a woman physician at the Grand Canyon Clinic, published by the University of Nevada Press, combines science-based medicine with adventure, geology, and romance.
