Interview with Carol Cassella

Carol Cassella is an anesthesiologist and writer. Her first novel, Oxygen, published by Simon & Schuster, explores the tragic consequences of an operation gone awry. The novel is an Indie Next List pick for July, 2008. Before committing to fiction, Cassella wrote articles about global public health projects for the Bill & Melinda Gates Foundation. She continues to practice medicine in Seattle, Washington and lives on Bainbridge Island with her husband and two sets of twins.

Plug time. What new book or project do you have coming out?

I am hard at work on my second novel, which also features a woman physician as the protagonist. Claire Dalouise is a family practitioner who dropped out of her medical training program in order to raise her daughter. When her family’s finances collapse she has to regenerate her career, and goes to work in a public health clinic in rural eastern Washington. There she meets and befriends Miguella, an illegal immigrant from Nicaragua. The two women’s lives intertwine with some surprising twists and turns as they try to cope with the inequities of fortune and the personal ramifications of global politics.

How did you come up with this story? Was there a specific 'what if' moment?

I am constantly scanning my world for story ideas. The central plot concept for Oxygen came to me in 1992, during the first week of my anesthesia residency. We were attending lectures about medical ethics and morality, and my writing mind began to play with fictionalized possibilities of the facts I was learning.

Over the next few years I jotted down some of the metaphorical passages that open the novel, and the character of Dr. Marie Heaton began to emerge. Along the way there were many ‘what if’ moments. I often knew where I wanted the story to go, but had to come up with a plausible ‘what if’ to drive it in that direction.

Tell us about your publishing journey. How long had you been writing before you got a contract? How did you find out and what went through your mind?

While my path to writing was occasionally torturous and slow, I would say my path to publication was relatively easy. I had been a ‘closet’ writer most of my life, but I didn’t fully apply myself to the task until I was in my forties. I think hitting middle-age scared me into the self-discipline serious writing requires!

In about 2000, David Guterson founded Fields End, a writing community here on Bainbridge Island. I was probably the first person to sign up for classes. Three years and many classes later I worked with the writer Michael Collins, who encouraged me to sketch out the first few chapters of Oxygen. Three years after beginning the novel I had finished the first draft.

I met an agent at a writing conference who made a valiant but futile effort to sell the book, so I did the most reasonable thing any serious writer would do: I started burning it in our fireplace. But I kept a digital copy and continued revising and editing until I could barely stand the sight of the novel anymore. Just before I completely abandoned it for my next book I sent it off to another agent. Four months later—long after I had assumed Oxygen was dead in the slush pile—I got a phone call saying the agent wanted to submit it for publication, and two weeks later he sold both novels to my editor at Simon & Schuster.

I have had a lucky life thus far, and many splendid moments will come back to me when I hit the end of the line, but hearing that my novel would be published ranks up there near pregnancies, my wedding, and getting into medical school. I beamed for weeks!

Do you ever struggle with writer's block? If so, how do you overcome it?

I never struggle with ‘writer’s block.’ ‘Writer’s stone wall,’ ‘writer’s narcosis,’ ‘writer’s coma’—those I struggle with!

I am convinced that if you call it ‘block’ you will breathe life (or death!) into the words. The longer I spend away from my material, the longer it takes me to reengage with the words. To overcome that, I have to write more garbage before the better stuff flows. But if I got up and walked away the ‘block’ would win.

My advice? Let your fingers fly, the faster the better. At some point you will recognize the word or phrase or sentence that feels right, and become friends with the page again.

What is the most difficult part of writing for you (or was when you first started on your writing journey), i.e. plot, POV, characterization, etc?

Plot is the most difficult, without a doubt. I can absolutely lose myself in the sentence or paragraph, moving words around until the writing hums. It becomes an exercise in Zen meditation for me. But moving the story forward at the right pace, and knowing it has somewhere to go, takes conscious thought and preparation.

I think readers deserve to be entertained as much as they deserve a well-turned phrase or life-illuminating metaphor. That means the story needs to have traction and momentum. It would be easier for me to wander down the alleys and pathways of my personal cogitations, but I’m not sure many would be travel with me—certainly not for the price of a hard back book.

Where do you write? Do you have a dedicated office or a corner or nook in a room?

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I write wherever I can, whenever I can. I have set up a writing studio in our basement where I try to ignore the sirens of housework and weeding, but just as often I write in my bedroom, on my living room sofa, in the local library, coffee shop or on the ferry that takes me to my job in Seattle. I am rarely without my laptop.

Here in the Northwest we follow the sun like human heliotropes, and sometimes I just look for the fall of sunlight on any hospitable seat. Alas my basement office is pretty dim. I try to counter that with full spectrum lights and a stick of incense.

Do you have a word or page goal you set for each day?

Yes—always. And I never meet it—never. I prefer to set the goal as a particular scene or plot element that needs untangling. Sometimes one page is more time consuming and difficult than a whole chapter, so word goals feel less valuable.

What does a typical day look like for you?

Here is my ideal day: Go to bed at 9:30 or 10 so I can wake at 6, make the coffee, and start my writing day before anything can interrupt me. I write for three or four hours, fully consumed by my imagination and the subconscious flow. I break for a three or four mile run outdoors while listening to inspiring music, then return for another two hours of highly productive writing time. After that I am totally free to focus on my family.

Here is my actual day: I finally fall asleep at 11:30 or 12 after shoving some more laundry into the drier, if it hasn’t mildewed yet. At 6:45 I begin making breakfast and looking for missing shoes or homework assignments or field trip forms that are already overdue. Once the kids leave I shower and start writing around 9. By 10 or 11 there is someone at the door or on the phone that I can’t ignore, or a school play to attend, or a dentist’s visit or a nurse calling about a sick child. Next thing I know it’s carpool time—to piano or ballet or soccer or tennis. But, my ever present notebook or laptop is with me so I can at least make a note of all the ideas flying through my mind that I didn’t get to write down.

Then there are my hospital work days, when I can’t write at all. And of course summer vacation, when I write with earplugs in so I can only be disturbed when the noise level suggest personal injuries.

Take us through your process of writing a novel briefly—from conception to revision.

I certainly hope my process will evolve into something more streamlined by novel number five or six. I started Oxygen without much of a roadmap. I knew the first scenes, and I knew the major plot twists, but I had to figure out much of it chapter by chapter, so I wrote in a fairly linear format but often discovered myself in a blind alley, forced to unravel polished chapters in order to make the plot flow. After three years I finally had a finished novel! Once I sold the book I began a major revision process with my editor, which took another four months. She helped me streamline the story and keep the more extraneous passages relevant and tight.

A novel is a single, huge creation built from a million small decisions. To make all those decisions cohere as one artistic entity I need to write and rewrite in layers. I discover so many details about my characters and my themes in the each draft that I need to go back to the very beginning to add the subtleties and nuances that make the novel gel into a complete, emotionally resonant story.

What are some of your favorite books (not written by you)?

Lolita by Vladimir Nabokov, Anna Karenina by Leo Tolstoy, A Fine Balance by Rohinton Mistry, All the Pretty Horses by Cormac McCarthy, Middlemarch by George Elliott, Snow Falling on Cedars by David Guterson, Cold Mountain by Charles Frasier.

Ask me tomorrow and the list will change. How wonderful to know that I could live for a thousand years and never run out of great books!

What’s the best writing advice you’ve heard?

“Just do it!” (Oh, sorry, that was Nike!)

But in truth that is what it comes down to. The hardest part of the job is sitting down and keeping my fingers on the keyboard. It is interesting to me that I love, actually need to write, but still find it so difficult to plunge in each day. I think it is important not to intimidate yourself with the image of perfection. Sometimes perfect is the enemy of good.

I heard Sena Jeter Naslund say that she always tries to end her writing day in the middle of a scene, so it is easier to pick up the thread the next day, and I have found that advice very helpful.

What do you wish you’d known early in your career that might have saved you some time and/or frustration in writing? In publishing?

I wish I had believed in myself more. I wish the world at large did not discourage so many aspiring writers from pursuing their passion—not just as a hobby but as a serious goal. I was told over and over that it was impossible to get an agent without being published, and impossible to be published without an agent. But agents and publishers need to discover and foster new writers if they are to thrive.

If you want to write, if reading finely crafted pages makes you ache inside, do not let go of that desire. Publishing need not be the ultimate goal, or the stamp of victory—the writing process can fulfill you without publication—but do not let your peers tell you it is hopeless.

How much marketing do you do? What have you found that particularly works well for you?

I am extremely fortunate to be with a publishing house that has a top-notch publicity department. I just do my best to follow their suggestions. Certainly the Internet has opened up a new universe of publicity and marketing channels, and blogging and web sites seem to be almost mandatory these days. I think the most important element of marketing is to be honest and open with whoever wants to discuss your work and your writing life. Books sell best by word of mouth, and sharing yourself as an author can bring an audience to your doorstep.

Do you have any parting words of advice?

For so many years I thought that writing should come easily if I were truly gifted. I have a dozen lovely blank books containing only half a sheet of crossed out words before I abandoned them. Remember always: the most succinctly eloquent and readable pages are often the result of a thousand deleted words and painfully reworked sentences.

Even when you can’t write—when you don’t have time—keep the voices alive. Every time something catches your attention or makes you pause, ask yourself why. What connection to your life was made? Write that down in a special place and come back to it when time allows. If that event or phrase or action or object meant something to you, there is a reader out there who wants to hear about it too. We are all more connected than we know.