I'm pleased to welcome Marschall Runge to Cozy Up With Kathy today.
Kathy: In Coded to Kill Drexel Hospital’s cutting-edge Electronic Health Records system is about to become the national standard and revolutionize health care. Is this based on real world technology?
MR: Yes and no – this is fiction, so I got to make some stuff up! As most people know, hospitals and doctor’s offices have adopted Electronic Health Record systems during the last 10 to 15 years – it’s why a doctor visit nowadays can seem like a tennis match, as the physician goes back and forth between looking at the patient and a screen containing the EHR. While most patients are told about the wonders of these system – which do allow doctors to input and review a wealth of information – I wanted to highlight some of the current and potential future dangers of EHRs in Coded To Kill. As some of my fictional doctors note in the novel, the paperwork and distractions caused by EHRs are an important contributor to physician burnout, which is a real crisis in healthcare. EHRs and other technology have also led to the rise of ransomware attacks on hospitals, in which hackers, like those in Coded To Kill, steal patient information which they typically hold for ransom or sell on the dark web. Where I took some liberties was in imagining the rise of a national EHR that would gather and store every medical record in real-time; the moment your physician makes a notation it appears both in your personal record and the national database. Knowledge is power and I believe such a database is possible because this tsunami of information would certainly help the medical community identify emerging threats and devise better treatments for many ailments. But, as Coded To Kill makes clear, it would also raise grave privacy concerns and create even greater jackpots for criminal hackers.
Kathy: Hugh Torrence is a former NSA honcho who sees the system as a tool for unimaginable and unaccountable power. Tell us about that.
MR: The writing I like operates on two levels, the literal and the symbolic, and I tried to do both with Mr. Torrence. On the one hand, he is the straightforward villain of the novel – and not merely because he attended Michigan’s rival, Ohio State. He is, to put it bluntly, a stone-cold killer who wants to hijack the national EHR for power. But he is also convinced of the righteousness of his cause; he truly sees himself as a force for good. Through this conflict – how we see him and how he sees himself – I also tried to make him a symbol of our relationship to technology. It is almost always created by people with the best of intentions – it’s all upside in their book – when, in fact, there is almost always a darker side at play. The airplane, for example, was seen as a tool of freedom, until it was quickly used as an instrument of death during World War I.
Kathy: What first drew you to thrillers?
MR: Thrillers are a form of controlled excitement; they allow you to leave your normal life and go on wild and dangerous adventures with heroes you can root for and villains you can watch out for and then return to your normal life. They are like taking a trip without all the hassles of the airport and jet lag!
Kathy: Do you write in any other genres?
MR: I write many emails, op-eds and a few prescriptions. I hope they are all nonfiction. The closest prior writing I’ve done to Coded To Kill, is probably the patient medical histories I’ve taken down as a cardiologist. They require you to enter into the lives of other people, to figure out who they are, how they live, where they are coming from. At their best, they require a deep level of empathy which is also the basic challenge in trying to create believable characters that feel like flesh and blood on the page.
Kathy: Tell us about your book.
MR: Springboarded by my own observations as a physician and hospital administrator and my love of thrillers, Coded To Kill explores the promise of peril of cutting-edge medical technology. It raises urgent questions about the vulnerability of our healthcare system to hackers and threats to patient privacy through a fast-paced story filled with mayhem, murder and even a little romance.
Kathy: Do you have a favorite character? If so, who and why?
MR: Ouch, that’s like asking me to name my favorite child. While I love my main hero, Dr. Mason Fischer, in no small part because he got to live my boyhood dream of playing football for the University of Texas, I would probably have to go with Dr. Carrie Mumsford, Mason’s romantic interest and eventual ally, because she is the most conflicted character. She cares deeply for Mason, but also for her father, the president of the hospital where the action takes place, Derrick Mumsford, who suspects Mason of being responsible for the deaths taking place at Drexel Memorial. It was quite a challenge to depict her inner battles, between her heart and her mind as she wrestled with fundamental questions of loyalty.
Kathy: Did you have a specific inspiration for this book?
MR: Two emotions: aggravation and imagination. Like many physicians, I found the transition to electronic health records to be problematic because they increased our paperwork and diverted some of our attention from patients. As a hospital administrator, I became aware of more systemic problems, especially how EHRs could lead to medical errors and weaken patient privacy. With these ideas swirling in my mind, and having read too many thrillers, it occurred to me that a novel hinged on the promise and perils of emerging medical technologies would be a fun and effective way to share my concerns with the public.
Kathy: What made you decide to publish your work?
MR: I began writing the book just for fun, with no expectations. Once I got going on the book, the creative process was intoxicating. I usually write in the evening and once I got going, I couldn’t stop. I loved the characters and believed the premise about the promise and perils of technology was important. Once I shaped it into a novel, I thought Mason, Carrie and the others deserved an audience who, I hoped, would care about them as much as I do.
Kathy: If you could have a dinner party and invite 4 authors, living or dead, in any genre, who would you invite?
MR: I would invite: Michael Crichton, John Grisham, Frederic Forsyth and Tom Clancy (all thriller writers). Though I never met them, I have had a long, one-sided relationship with each of them. At first, I was just a fan, happy for them to take me on their spine-tingling adventures. Then, as I got the writing bug, they became my teachers. I started reading their books with an eye toward how they got it done – the twists and turns of their craft. They also pushed me to stretch my imagination in the impossible hope of somehow matching them. I would start the evening with a toast, thanking them for inspiring me. Then I would let them take the conversation wherever it would lead, as I once again became a star-struck reader and placed myself in their able hands.
Kathy: What are you currently reading?
MR: I often read two books at the same time – alternating depending on my mood. I’m currently reading The Hellfire Club by Jake Tapper and The Mustangs by J. Frank Dobie.
Kathy: Will you share any of your hobbies or interests with us?
MR: My main hobbies/interests revolve around my family – I’m married and have 5 adult children and in-laws and 5 grandchildren. One of my most favorite things to do is go off with my family to a very isolated ranch in Texas – which has been in my family since the 1850s. There’s lots to do with the grandkids and it is very peaceful – very limited phone and internet availability. Actually, this location is not too far from the ranch scene described at the end of Coded To Kill.
Kathy: Name 4 items you always have in your fridge or pantry.
MR: As a cardiologist I know what I ought to eat and I’d say about 80% of the time I follow the doctor’s orders. 1) fruit – my favorites are summer fruits (cantaloupe, watermelon, grapes, etc.) 2) pita bread and hummus; 3) cheese (not my healthiest habit); and 4) canned soup (our favorites are Progresso “light” soups).
Kathy: Do you have plans for future books either in your current series or a new series?
MR: Of course! I have outlined several other books in this series with many of the same characters. I believe that I have just scratched the surface of who they are, their strengths, weaknesses, motivations and complexities in Coded To Kill.
Kathy: What's your favorite thing about being an author?
MR: It is very similar to the pleasures of being a doctor. At bottom, writing and caregiving are all about human relationships, getting outside yourself to know and serve others. It is no surprise that many doctors – including Anton Chekhov, William Carlos Williams, Sir Arthur Conan Doyle, Robin Cook and Michael Crichton – were also writers. When I write, I try to serve my characters, to help them be the best they can be, just as I do with my patients.
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Blurb:
Is medicine’s greatest breakthrough also the world’s most efficient killing machine? After a decade of development, the cutting-edge Electronic Health Records system is about to become the national standard. Housing the real-time medical records of every American, the EHR system will enable doctors to access records with a keystroke and issue life-or-death medical orders with a finger swipe.
No one wants the EHR to succeed more than Hugh Torrence, a former NSA honcho who sees the system as a tool for unimaginable and unaccountable power. The only thing standing in his way is a loose-knit group of Drexel employees with conflicting agendas and questionable loyalties. While they search for answers, the suspicious patient deaths keep mounting…and the target on their back grows larger.
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