How do you get ideas?

How do you start a novel? Where do your ideas come from?

Novelists often field questions like these.

The answers given vary from calculated to mystical, with the process shrouded in its own cloak of mystery. Walter Wellesley “Red” Smith is quoted as saying, “There’s nothing to writing. Al you do is sit down at a typewriter and open a vein.”

Perhaps a nice metaphor, and a physiological one at that (we surgeons love that sort of stuff…blood and viscera, but I digress), but not a very helpful one for someone looking for a formula.

Beginning is one of the most difficult parts for me. No matter how many times I’ve climbed this mountain called the novel, the length of the journey is daunting. So I prepare. I never start down the path until I’ve planned the path. I know the big picture. I know the chief conflict, the obstacle that the protagonist needs to overcome in order to bring the needed change to the main character. It’s the little things along the way that I fill in as I go.

But where do the ideas come from?

For me, it begins as a seed, sometimes as small as a phrase or an image. For the novel I’ve just completed, the tale of a cardiothoracic surgeon who returns to Africa to start an open-heart program, it began with a single word: CRYSIS. Yes, I know it’s misspelled. But that’s how it was written on the t-shirt of a young man. I was in Melindi, Kenya, a coastal town on the Indian Ocean, out on a dive boat with my sons, preparing for a scuba adventure. I looked at the young man sitting across from me and read the words on his shirt. The font suggested something dark, perhaps even evil. Something clicked. I started to imagine a surgeon who heard the cry of his dead sister, long departed. “Come back to Africa.” I got excited and the process started all over for me. A word becomes an idea which is noodled, and back-burnered until I open a new computer file to record my expanding ideas. This process can take months. Ideas grow. I do research. I ask questions. Sometimes I draw diagrams linking characters to each other. Then I search for other ways that the characters may be linked beneath the surface.

I wrote that novel under the name, Crysis. My sons informed me that it is the name of a video game (hence the young man’s shirt emblazoned with the word). I liked the title, but my agent felt it needed to go. So as of now, she’s shopping for a home for the manuscript under the title, “Open Heart.”

Another time, a focused gem of a story occurred while I was sitting in church. My pastor told a true story about a missionary in Congo who had saved his family during a house-to-house slaughter of westerners. He killed a few chickens and spread the blood around the kitchen. When the rebels seeking to purge the village of westerners arrived, they saw the blood and passed over the house as the missionary hid with his family. I loved the illustration and started to ask, “What if…” and the process began again. I left church knowing I had an image that would carry my next novel. That book is coming out next week with Simon and Schuster and is called, The Six-Liter Club.

My first novel was borne out of an idea I had after doing emergency C-sections during a rotation in Kenya. I had no anesthesiologist to work with and when the baby needed to be delivered STAT, I simply numbed up the skin and made an incision. Moments later, just before opening the uterus, I had an assistant give an IV dose of an anesthetic and then raced forward to snatch the baby before the medicine would circulate to the child.

After experiences like that, I kept thinking, “What if a pregnant girl comes into the ER after an accident and she is dying in front of me? Would I operate quickly to save the baby if the mother was going to die anyway?” That image wouldn’t leave me. I started thinking of scenarios where the life of the baby could cause a lot of problems…perhaps the baby was the product of a clandestine affair with a politician, a politician who is relieved to find out that his young lover has been silenced and didn’t know that the “evidence” of his affair survived. That idea stuck with me until I had to write it down. I was so naïve. I didn’t know the first thing about writing a novel in those days. All I knew was that I had the stone of an idea that I wanted to polish into the gem of a novel. I started outlining it on the back of an operative note at the Veterans Administration hospital in Lexington, KY. That became my first novel, Stainless Steal Hearts.

A few years later, I became interested in the idea of using a quadriplegic as a protagonist. I wanted to contrast the lives of two people: one person with everything that “the world” associates with a full life. Success. Money. Powerful position. Making a contribution to society through successful research. The second person would be the quadriplegic and this character would have nothing that the first character had. No special abilities. No job. Can’t even brush his teeth or go to the bathroom without help. For the first character, I chose a neurosurgical chairman. I wanted to bring the two men into contrast to teach the reader that worth is determined by being made in the image of God, not by accomplishments. The quad was the “chair man” (always in a wheelchair) and was contrasted to the neurosurgical chairman. That idea became the novel, The Chairman and was the first novel I sold to a publisher as an idea. I told a publisher my idea and he offered me a contract. That’s how most novels are written, by the way, but for me, it was new and exciting territory.

Ideas for novels come from everywhere. Just keep your eyes open. Remember, in simple terms, a novel is just a story about a person with a problem. The original idea may be the person. Or it may be the problem. Keep a notebook or folder for ideas on your computer. Go back to it periodically and see if the light goes on. For me, I just get an excitement, a feeling that this idea is going somewhere. Sure, I’ve followed rabbit trails that deadended, but who hasn’t?

It may be one word. It may be a powerful image (like an emergency C-section in an emergency room). Be open to letting your imagination flow.

Step two is asking, “what if….?”