Sometimes it’s a character that pops into our heads.  Sometimes it’s a news story about a shocking crime, or it’s an incident we hear from a friend.  I’m often asked where I get my inspiration from, and I have to admit I’m an idea slut — I’ll take ‘em wherever I can get ‘em.

But sometimes, books are launched by the sheer hunger to know more about a subject, by the drama of something so significant in the course of human events that you just want to bring it to the page. 

Here’s what inspired THE BONE GARDEN.  (It’s a somewhat shorter version of what’s posted on the BONE GARDEN website  page.)  It was a piece I wrote specifically for booksellers, but I thought that my readers (and bookclub participants) might be interested in getting a peek at the true horror stories behind the book:

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It was an era of filthy knives and infected hospital wards, an age when doctors committed gruesome atrocities — all in the name of healing.  Although I’m a doctor myself, I was not well acquainted with this dark and tragic history of medicine.  But several years ago, while preparing for a speech about Mary Shelley’s novel Frankenstein, I discovered that the author’s mother had died of “childbed fever,” which was rampant in maternity wards during her time.  Curious about the disease, I delved deeper into the subject of childbed fever. 
            What I learned horrified me.
            In the early 1800’s, a pregnant woman admitted to a hospital’s lying-in ward knew there was a good chance she might not survive the experience.  Childbirth alone was a risky and frightening prospect, but even if a woman delivered safely, the danger was not yet over.  Soon after giving birth, the new mother might develop fever, chills, and a foul uterine discharge.  Bacterial gases would cause her abdomen to swell until her belly was taut as a drum and the pain was so excruciating that just stroking her skin elicited shrieks.  For days she might linger in agony, vomiting and shaking, her bed sheets soaked with sweat, until circulatory collapse at last led to death.  During epidemics of childbed fever, women died so quickly that coffin-makers couldn’t keep up with the corpses, and victims had to be crammed two to a casket.  In some hospitals, 25% of all new mothers died. 
            The most disturbing fact of all: The disease was unwittingly spread by doctors.
            Scientific articles written during the early 1800’s reflect the primitive state of medicine at a time when the standard treatment for almost every illness was to slit open the patient’s vein and bleed her.  Ignorant of the existence of microbes, a doctor might rush straight from the autopsy room to the lying-in ward without washing his hands.  Working his way down the row of beds, he’d examine patient after patient with his bare hands, spreading contagion – and death — through the wards.  Most doctors refused to believe that they themselves might be responsible for so many deaths.  They were gentlemen, and gentlemen did not have unclean hands! Instead they blamed the epidemics on “bad air” or weak constitutions or even “the ladies’ wounded modesty”. Only an enlightened few realized that the fault lay with the doctors.
             In America, it was a brilliant young doctor named Oliver Wendell Holmes who first realized how the contagion was spread.  In 1834, at the young age of only 34, he wrote a scientific paper urging his fellow physicians to wash their hands.  Today his recommendation seems obvious, but in Holmes’s day, it was revolutionary.  In the decade that followed, some of the most distinguished doctors attacked Holmes and his theories.  They were outraged that any such contagion could be blamed on physicians.
            I began to wonder how, with so many experts arrayed against him, Holmes had arrived at his startling conclusions.  What inspired his theories?  Had there been a particular case, a particular incident that made him suddenly realize infection was transmissible? 
            In my search for the answer, I explored a nightmarish era in medicine.  I read of medical students who secretly dug up half-rotten cadavers to study anatomy.  I read of autopsy rooms that stank so badly students desperately puffed on cigars to hide the smells.  I read accounts of battlefield amputations performed on fully conscious and screaming patients.  Consider this how-to guide for thigh amputations, published in a 1809 surgical textbook written by Dr. Samuel Cooper — a book which was still in use during the Civil War:
            “The patient is to be placed on a firm table, with his back properly supported by pillows. Assistants are to hold his hands and keep him from moving too much during the operation. The ankle of the wound limb is to be fastened, by means of a garter, to the nearest leg of the table…An assistant, firmly grasping the thigh with both hands, is to draw upward the skin and muscles while the surgeon makes a circular incision, as quickly as possible, through the integuments, down to the muscles…”


             Or consider this matter-of-fact set of instructions on how to amputate a leg below the knee:
             “The leg being properly held, the integuments should next be drawn upward by an assistant, while the surgeon, with one quick stroke of the knife, must divide the skin completely round the limb. Some recommend the operator to stand on the inside of the leg, in order to be able to saw both bones at once.”


             In any such surgery performed on a conscious patient, speed was of the essence, and a skilled surgeon could complete a simple amputation in less than ten minutes.  If the fully awake and shrieking patient survived this horrifying ordeal, there were other dangers ahead, including gangrene and lockjaw, which Dr. Cooper so dispassionately describes:
             “A stiffness is first experienced about the back of the neck.  The muscles of the lower jaw next become hard… At length, the patient cannot open his mouth at all.  All the muscles of the neck, back, and indeed of the whole body, become successively affected with the most rigid spasm.  The limbs are stiff and immovable, and the muscles of respiration, being prevented from performing their office, the patient dies.”


             To be a doctor in Holmes’s time was to see death and pestilence at every turn.  This is the era in which THE BONE GARDEN is set, a grim world where a twisted killer is at large, butchering the very people who are trained to heal.  It’s a world where the horrors committed by the killer known as the West End Reaper are matched by the gruesome horrors of the operating room.
            While THE BONE GARDEN is a crime thriller, it’s also a journey into a frightening time when doctors killed as many patients as they cured, and when brilliant men like Oliver Wendell Holmes were just beginning to understand contagion.  I wanted to give my readers an inspiring look at the first glimmerings of microbial theory.  When you read THE BONE GARDEN, I hope you’re more than merely entertained; I hope you’ll also be enlightened by this glimpse at one of the brilliant men who changed the face of modern medicine.