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?
In my work at a family medicine residency (teaching new physicians), I often interviewed medical students—a rewarding task. I loved helping new doctors prepare to practice.
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?