Josh Bazell has a BA in writing from Brown University and a MD from Columbia University. He has worked as a screenwriter, and while in medical school investigated suspicious deaths for the Chief Medical Examiner of the City of New York. He is currently a medical resident at the University of California, San Francisco, and is working on his second novel. We recently read and enjoyed his fusion of medicine and the Mob, debut Beat the Reaper (review), and we chatted with him about his writing and the US medical system.

For our traditional opener: are you a bookgeek?

Books have been important to me my whole life, but after reading Nightmare Alley I’ve stopped referring to anyone who doesn’t actually bite the heads off chickens as a geek. Which I guess makes the answer “Yes.”

When you are writing do you have an audience in mind? Is it a person, real or imagined, or a group?

Obviously the goal is to not think about the audience at all — to not try to Esperanto-ize the jokes for the international audience and so on — which does get harder when your work goes out in the world. I’m lucky enough have a great editor whom I fully trust to tell me when something I’ve written is absolutely socially unacceptable, which confers a lot of freedom from self-consciousness.

What gave you the idea for combining medicine and the Mafia in Beat the Reaper?

Since the book is about the extent to which it’s possible to change your identity, it made sense to have a character who’s going to end up as a doctor start out as a killer. And I know a bit about the mafia because I grew up in New York and because I am American and The Godfather is our Magna Carta. Though I also did a fair amount of research.

How concerned were you to keep Pete Brown as a sympathetic lead character?

To me this was one of the fundamental challenges of the book. There are any number of great crime (and non-crime) novels about unsympathetic characters — Patricia Highsmith, Massimo Carlotto, early Orwell and so on — and I personally love that subgenre, but it does tend to be a bit of a boutique item, and even I can’t take and endless stream of it. So I didn’t want to spend the time it takes to write a book thinking about a character I couldn’t for the most part admire, and the result is obviously probably accessible to more people than it might have been otherwise.

You don’t pull any punches with the medical elements of the story – did you have any worries about portraying American public medicine quite so bleakly?

No. There are an abundance of well-meaning people in American medicine, but the system itself is fucked. More than half of bankruptcies in the U.S. are caused by medical bills, and most of those are people who thought they had been adequately insured beforehand. Meanwhile, for-profit entities from the pharmaceutical, insurance, and (to a lesser but real extent) legal industries siphon off as much money as they can from the system in as oblique a manner as possible, and use some of that money to pay politicians to prevent meaningful reform. Barack Obama’s first choice for Secretary of Health and Human Services, Tom Daschle, turned out to be taking more money from these industries than he would have made working 60 hours a week as a general practitioner. And the only reason he wasn’t confirmed was that, in an unrelated event, he turned out to be tax-dodger! Patients and doctors are frustrated and angry, and should be. I have yet to hear from any doctor or patient that I’m being unfair or should not be drawing attention to these issues.

Beat the Reaper has a recurring theme of deception and false identity – was that something you consciously set out to explore?

Absolutely. I liked how Pietro’s attempts to obscure his identity make him complicit in the noir trope where everything turns out to be different (and worse, in an organized fashion) than it at first appears. It’s like in trying to change himself he’s given up any hope of stability.

What’s next after Beat the Reaper? Will Pete Brown be back?

Even in a noir universe, that one thing will be stable. I’m going to work that guy into the ground.

What is the best piece of writing advice you’ve been given?

Always thank anyone who thinks it’s worth their time to interview you.

Josh Bazell, thank you very much!

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