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?
Congratulations on your new book, Sandra . . . what an intriguing premise. I’m looking forward to reading it.
ReplyDeleteThis is so interesting . . . .
Somehow, I seem to have missed out on most those too-close encounters with trouble . . . although there was this incident after a pick-up truck driver smashed into the side of poor Miss Phoebe. The way he carried on, you’d have thought I was the one that hit him. [Fortunately, neither of us were hurt, the traffic was moving slowly, the police arrived in a timely manner, and another driver stopped to tell them what actually happened] . . . .
Never having been in an interview position [except as an interviewee], I hadn't thought about the intricacies of the interview process. And while it might be awful to know that, as an interviewer, you’d “passed” someone who turned out to be a less-than-optimal choice, isn’t that simply proving that people can “hide” parts of themselves to gain something they desire? And I’m guessing that ferreting out such information is really the crux of the whole interview process . . . .
that was a close call Joan! Glad the forces for good arrived quickly!
DeleteWhen I was writing with a co-author who was a psychologist, he explained to me something called an "as-if personality" - that's a person who mirrors exactly what the person they're encountering expects. As-ifs are scary as can be.
DeleteAbsolutely, Joan. The interview tries to catch cues that tell you best about a person and cues that hint about something else. Sometimes it's subtle and you simply get a "feeling" that a person is "off." Sometimes they slip up and say something rude or unkind, or get upset over nothing. But sometimes Hallie is right and they are experts at "as-if." Scary is the only word. Sandra
DeleteWow. So much fodder, Sandra! I agree about all the common toxins that abound (have you ever heard Luci Zahray, the Poison Lady, speak about exactly that?). I'm looking forward to reading this book.
ReplyDeleteI worked with a guy once who was so tightly wound, I was a little afraid of him. We all knew to set up an appointment to talk with him over email, instead of walking down the hall two cubicles away and knocking. I never knew a thing about his private life, but always wondered...
At least he was right out there with his not-so pent-up rage.
DeleteExactly, Edith. Who knows what his private life really was like? Maybe something sinister, or maybe sad, maybe on drugs or alcohol. He threw up a protective wall to keep people away and it worked to some degree. A fascinating discussion as to which is worse, to know a person is troubled and toxic, or for them to be that way and you have no idea.
DeleteGood Morning, Sandra. How exciting for a new medical thriller to be available. It sounds delicious. I have had two experiences as a professional that stay with me. The first when I was still a children's librarian. The family treated one of the siblings in a demeaning and dismissive way. The child was undernourished and not as well dressed. The mother became very agitated from one of my remarks and wrote a letter to my manager. I countered in a memo, including a section about my responsibilities as a mandated reporter. Several months later the parents were arrested for child abuse, and the children placed in foster care. As I recall the undernourished child was hospitalized.
ReplyDeleteMy memo was not part of the case record. It took others to notice.
When I was a mental health counselor working in a private practice. We interviewed someone who again appeared charming, caring etc. But.. something was intangible but red flags were there for me. I was outvoted and they were hired. Withing a very short time it was discovered that the mental health worker thought sleeping with a client was part of the healing practice. They were fired. I don't know if their license was pulled.
wow Coralee, you have excellent radar...
DeleteSo good to hear they were fired right away.
DeleteNot really, Lucy, like most people who interact with the public, I saw thousands of children and parents. I interviewed lots of candidates, I only noticed two. What about the ones that I didn't see?
DeleteGood for you, Coralee, that you spoke up and were later validated for your concern. We all have those times where we wish we'd said or done something. You were like the hospital nurses who expressed concerns about Swango. A woman physician I know didn't want to hire a new recruit into their practice (another woman physician) because she didn't get a good vibe but was disregarded, and the new doctor turned out have poor professional habits, often late and slow to finish her work, and turned the blame toward others. It's hard because sometimes our instincts aren't correct (the old don't judge a book by its cover), but sometimes they are.
DeleteI once shared a high school class with a guy who later went to jail for murdering someone it was later determined he'd been molesting.
ReplyDeleteAlso, four players I coached (at separate times) were all involved in a murder years after I was there coach. The only one who went to prison though...gawd was he a stupid criminal. Swore up and down that he wasn't where the murder happened (despite the extensive video) and when the cops picked him up and drove him back to the place so he could be identified, he said "I think I left my phone inside, could you get it for me?" The cop, who I can only imagine had to hold back a volley of laughter, supposedly replied, "Son, you ain't gonna be needing that phone anytime soon."
Sadly, because of the crappy area I live in and the laughable state of parenting, over the years I've known former players who have become major players in the drug trade, been involved in stabbings, car jackings, DUIs, rapes and probably every other crime in between.
One of my fellow coaches and I used to check the police blotter every week to see which of our former players were in trouble. And though it wasn't every week, we saw plenty of them listed.
You try to set an example and hope they follow it but since the last time you spent with any of them is usually when they were 14, they have a host of other people influencing their lives from that point on and as you can read above, not always for the better.
"their coach". I can't believe I didn't catch that error of grammar.
DeleteI bet you made a difference in a lot of those lives Jay
DeleteJay, you just never know when you'll say or do something to change someone else's lives. I agree with Roberta.
DeleteThanks for sharing your story, Jay. You may be the expert here in seeing the path young people might take under difficult and damaging circumstances. And the others are right -- your guidance is likely to have helped some of your students. We try to do our best and often never know what positive seeds we sow because the negatives get more attention.
DeleteAs do I, Jay. Ross used to occasionally have a strapping young man stop him at the supermarket or while running errands and thank him for everything he had done. Which was working with the kid in special ed sometime between kindergarten and fifth grade. The ones who stopped him had gone on to academic success and were looking forward to college or trade school. They credited Ross for setting them on that path.
DeleteIt might only be one or three or five boys, but for some of them, you will have been that man, Jay. And really - that's a better accomplishment than most of us get to claim.
Thanks for the feedback everyone. I was just sharing info that pertained to the question.
DeleteI've had plenty of former players (both the boys and girls) that are doing well. Though realistically, almost, if not all of them, are due to their own drive rather than anything I might've done. Some coaches, some nurses, a teacher, a social worker. Heck, one of the DUI guys (who actually paid me a big compliment after our season ended in a championship saying it was the first time he'd ever been on a team where it was about being a TEAM) straightened himself out and is running a youth program now.
Again, surely due to their own drive but at least I don't have to read about them in the police blotter which is A-OK by me.
Case in point: This was a headline in yesterday's Washington Post: Texas nurse killed 4 patients, prosecutors allege: ‘A hospital is the perfect place for a serial killer to hide.’
ReplyDeleteThe article begins, "William George Davis’s modus operandi was simple. The East Texas nurse would inconspicuously go into patients’ rooms, inject air into their arteries and slip out before any other night staff noticed, prosecutors allege. Moments later, the patient would 'code.'" So scary.
Hallie, that's chilling. We had a serial killing male nurse in Cincinnati who killed somewhere between 37 and 57 patients, at several local hospitals. The press called Donald Harvey the "Angel of Death" because he largely murdered terminally ill patients.
ReplyDeleteSandra, you have to have a finely tuned b.s. detector, don't you, to hire people. I'm sure you have heard other colleagues' stories in your profession.
In the early 1970s I worked in the back offices of a chain of retail stores, as a buyer. My department also kept track of sales for all nine stores, by hand, on walls of inventory control files. I usually had a college student, always female, helping me with that for a few hours a week, hired by the owners. One girl scared me. She was built powerfully, tall and hefty, but that isn't why. She spoke normally unless she was on the phone with her (very controlling) mother. Then she turned into what sounded like a toddler, with a high, light voice, an octave higher than her normal speaking voice. It gave me chills.
Interviewing and hiring is one of life's great humbling experiences. It's SO HARD to see past a good facade, and when you talk to their current or past employer they're often trying to cover their a** and make sure that person never comes back to torture them.
Deleteahhhhh— that is terrifying!
DeleteI probably should take a moment to point out that, in the big picture, these events are quite rare. Most hospitals do NOT have a killer lurking in the hallways, but how do you get that out of your head once you read about these killers? Experts worry greatly about long-haul truckers who pick passengers up in one place and dispose of them far away ... so don't hitchhike.
DeleteCongratulations on Where No One Should Live, Sandra. What an interesting and frightening what if.
ReplyDeleteIn my last working years, a new employee came to the office next door. Her job didn’t need a lot of interactions with me .
At first, she seemed nice and we tried to integrate her to the staff. I thought it was working when she became jealous with an other woman with which I had interactions in my work and with whom I had maintained good relations for twenty years.
She started sulking and making noises for nothing, then insulting me, casting aspersions then yelling at me when no one was around. I acted with her as with everybody else, trying to smooth things at first but there was nothing to do. There was nothing to do with her, she thought there was a conspiracy against her.
This period have been a real nightmare for me and for many others of the staff.
There are people out there who aren't happy until they've created a firestorm. They start out great and then... start stirring the pot.
DeleteThis kind of paranoia is extremely hard to manage without professional counseling for that employee. Suggesting that feeds the paranoia. "Nightmare" is a good description. The person cannot respond to logic or reasonable intervention because their view of the world is too deeply entrenched. Few people have the training to deal with serious mental disorders -- most managers like you are kind and try hard to make things work better, often without any success. I hope you've been able to move on, but it will always color your outlook.
DeleteCongratulations on your new release!
ReplyDeleteI'm very suspicious of doctors when they start the "it is imperative, you must" diatribe without explaining WHY. At the very least, give me some recent peer-reviewed journal articles to read before we make a decision.
Yes, the paternal-authoritative physician! A few patients respond to this approach, but not so much any more. Hopefully there's less of this now than back when I trained in the '70s. And telling a patient to do something is a small piece of the equation if you don't also assess their ability or willingness to do it, what their barricades are. Never hesitate to ask a physician why, or what their evidence is for a recommendation. If they get prickly, that's not a good sign. The glut of online medical information is both a blessing and curse: the accurate info is empowering and the inaccurate info is dangerous. And sometimes it's hard to tell which is which. Your relationship with your doctor should be collaborative.
DeleteI was living in Columbus, Ohio, when Swango was on trial for the murder of one of his patients when he was an intern at OSU. There's an article in the OSU campus paper, The Lantern, from 2000, which talks about how the hospital conducted an internal investigation and three doctors recommended he be given a permanent license even though his residency had been terminated. He practiced under different names, in different states, and finally in Zimbabwe. It makes your story all the more believable, Sandra, and chilling. I'll be looking for Where No One Should Live.
ReplyDeleteThanks, Flora, for that personal story about Swango. It's a bit astonishing that most people in the US have not heard of Swango -- it's estimated he killed at least 60 people, some when he worked at a mission hospital in Africa. I highly recommend the documentary book about Swango titled BLIND EYE by James Stewart, a riveting piece of investigative journalism. He fooled many physicians.
DeleteI love reading about these things in my fictional world, not so much in the real world. many, many scary things out there!
ReplyDeleteSo true, Judi! Fortunately for humanity and the world, most people are not psychopaths or even sociopaths. We tend to focus on them because we're curious and it's horrifying, but the chance of actually being involved with one is quite low. But we all would probably do well to steer away from those who have trouble showing empathy or who are repeatedly dishonest.
DeleteCongrats on the book, Sandra. I can well imagine that a murder is easy (or at least easier) to carry out in a hospital setting. But having heard Lucy Zahray talk at Malice Domestic, I think any kind of poison would not be impossible if you thought about it.
ReplyDeleteI just finished being part of an interview team at my day job. Fortunately, no candidates who set off any bells.
Thanks, Liz. Yes, we're pretty much surrounded by toxins. Remember the novel WHITE OLEANDER? Chilling. All the way back to "Arsenic and Old Lace," when arsenic was much easier to obtain. On my desert walks I often ask people if they know about the datura plants around them and most have no idea. Probably a good thing ...
DeleteAnd most people interviewing for jobs are "normal." But after reading BLIND EYE, I was never quite the same interviewer.
This is so disturbing and so scary! Now I am going through the inventory of people I have interviewed and come across to see if anyone meets those criteria… I had a completely psychopathic executive producer once, and every Tuesday at 2 PM, she would disappear. On the dot. And we never knew where she went. And everyone was afraid to ask. She made it incredibly mysterious, I mean, if she had a recurring doctors appointment, maybe she might not want to say so. But it was somehow kind of terrifying. But we always used to look forward to Tuesdays at two, because we knew she would be gone.
ReplyDeleteWhat a terrific idea for a book! It sounds absolutely chilling. And I mean that in a good way :-)
Thanks for sharing that, Hank. We just never know what underlies some peoples' actions, do we? But you've just laid out a very intriguing premise for a new book! I can just imagine her workers looking for clues about her and what she might be doing, going down all sorts of blind alleys, pouncing on new information. Different points of view. Could be fascinating.
DeleteWhat an interesting premise, Sandra. Congratulations on your book's release! I'm off to investigate it.
ReplyDeleteEvery time I've interviewed anyone, I have always had lurking in the back of my mind 'I wonder who this person REALLY is?' Call me skeptical...
Thanks, Amanda. I always appreciate a skeptic. It can be a self-protective trait, I think, though I sometimes have to remind myself to be a little less skeptical. But maybe we skeptics have been burned. Or maybe it's part of an active imagination ... at least, that's what I tell myself!
DeleteThat said, "skeptical" is actually part of my website name (www.skepticalword.com). Someday I should analyze that.
Great website name, Sandra. i'm off to explore that now! #SkepticsUnite
DeleteSandra, I've actually thought about planting a poison garden, because it seems so appropriate for a mystery writer. But I also hope to have grandkids visiting me some day, and there are the dogs, so... probably not.
ReplyDeleteThe kind of "everyday sociopath" I've run across has been the female acquaintance who starts out great, but soon her life devolves into one crisis after another. She has been done wrong by people who were cruel to her. She needs a ride, she needs you to watch the kids, she needs you to do shopping for her. For a while, you're happy to help out, but then you start to notice the help is never reciprocated and the drama in her life never, ever ends.
There are people who, for whatever reason, constantly create chaos around them without ever realizing they're doing so - or taking any responsibility. And when you finally break free of the relationship, you become the cruel person in the story she tells to her next victim.
Julia, I can so relate to this. When I was in grad school, I mentored then was friends with a young woman. It took me a long time to realize the trail of people who had 'wronged' her would eventually (and did) include me.
DeleteI can't help but enjoy the idea of your poison garden, Julia, but of course agree that it's extremely impractical and unwise for the obvious reasons you state. Maybe you could make a mock garden with artificial plants!
DeleteThat's a tough story, about your friend. Not to overly psychoanalyze with little information (to be taken with a grain of salt, therefore), but the person you describe sounds like she might suffer from a borderline personality situation. In her view, others are either very good or very bad, without any gray shades in between. I hope she finds help, and I hope you've been able to move on. It has probably made you wary, though.
Julia, I had a friend like that. So charming, so needy, so easily wronged. And she did turn on me eventually, too.
DeleteOh, dear, the idea of that 'friend' just gave me chills. One woman with whom I had a long and close friendship suddenly tried to force me to choose between her and my really longtime best friend, over something that had happened years previously. And that my other friend had nothing to do with. It was the straw that broke the camel's back, on top of lots of many other weird things. It burnt me badly.
DeleteHere's an interesting blurb taken from the website of NAMI (National Alliance of Mental Illness)about BPD or borderline personality disorder:
DeleteIt’s estimated that 1.4% of the adult U.S. population experiences BPD. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression.
Years ago we'd just moved to Ohio from the Texas panhandle. I needed to find a job but it was the depths of the rust belt depression (early 80's). I saw an ad for a tax prep service so I called and made an appointment for an interview. What a weird place. The boss was in a glassed in corner office. Everyone else was in the bullpen. No privacy for clients. I sat and waited a good 40 minutes. In the meantime I managed to talk to the receptionist and get an idea of what it was like to work there. Most people were seasonal temps. Work space was chaotic. The boss had a temper. I never met and talked to him. He sent word to the receptionist to get me a desk and put me to work. I declined and left. A few years later he was in the newspaper. He'd been involved in a shooting. He was the shooter. I don't remember details except it was personal, not work-related. Then there was the strange, hopefully harmless person who fixated on me in college. He saw me at the bus station, returning from a weekend in Houston with a friend. Then he saw me again on campus (he was not a student), pulled up a chair to our table, and tried to join in the conversation. We left and lost him. Never saw him again but I just remember he had strange eyes. I don't remember why I thought they were strange. Perhaps they just matched his personality.
ReplyDeleteThanks for sharing those rather alarming stories, Pat. It seems you've been able to dodge several concerning situations, which are both haunting. What if you'd made different decisions and engaged with either of these scenarios? It's those "what ifs" that sometimes drive us. Your descriptions are vivid and it looks like these could be good material for writing, though.
DeleteSandra, this is fascinating! I had no idea there were so many medical serial murders. Terrifying, really. And I love the idea of setting a book in Phoenix in the summer when the heat would be a character in itself. Congratulations!
ReplyDeleteThanks, Deborah. Despite having a greater population of over 5 million and being the 5th largest city in the country, there's very little fiction set in modern Phoenix. Not sure if putting it in the summer will make anyone want to visit, but it does make it unique and that explains the title.
DeleteScottsdale here. I can testify that the summer heat can drive you to murder - jk. What a fabulous premise for a book, Sandra. I can't wait to read something set in the Valley. Phoenix never gets enough literary love!
ReplyDeleteGreat to hear from a fellow Phoenician, Jenn. I searched with a librarian and we found one literary novel (published 10 years ago) and a crime series (author Talton) set in Phoenix. There must be more, but that's all we could find. I call my mixed-genre stories "science-based medical adventure," about medicine with a mystery and a little romance. I hope you enjoy it.
ReplyDeleteSandra, planning to read this new book curious because of your comment, “highly entertaining to write.” How wonderful to see someone entertained by her work.
ReplyDeleteThanks, Elisabeth. I just love discovering new ideas and knowledge, and creating characters to play that out. We all have our strengths and flaws, and how we manage them and move forward is what I enjoy exploring. As an older writer, I also always feel my clock ticking, which gives me more drive. The next novel isn't going to write itself, and I'm already busy...
ReplyDeleteChilling, indeed, is the word for these stories. In the 70s I worked in an office in Northern California with six or seven other women. A new hire joined us, and in the getting-to-know-you process she enthusiastically told us all about her nine year old son, Gary. Each week she had a story to relate about how Gary was such a good boy, doing well in school, etc. I particularly remember the small, 2 x 3 school photo she proudly showed us. It'd been taken a year or so ago she said, she didn't have a current one. Gary looked like an average first grader, big smile for picture day, with a mop of dark hair.
ReplyDeleteOne day sheriff's deputies arrived to arrest her for her son's murder. Turns out that for the better part of a year she and her boyfriend had been starving Gary, keeping him chained to the toilet underneath the bathroom sink. To say we were all stunned would be a gross understatement. Talking it over, none of us had the slightest suspicion anything was wrong. She'd seem like a pleasant woman, a loving mom.
I don't remember her or her boyfriend's names, only Gary's. The memory of Gary, and his school photo, haunt me to this day.
Oh Lynda. We can never be the same after experiencing such a trauma, even when it's peripheral. That these monsters exist is terrible indeed, worsened by their deceptive outward demeanor. We keep striving to define it and understand it, through either fiction or nonfiction, but we probably will never come to terms with such reality. Take care of yourself.
ReplyDeleteThank you for your kind reply, Sandra. I like your word, peripheral. It helps to remember the situation was most certainly not about me, but that it did have an effect on me.
DeleteVery best wishes with your book.