Summer reading for #Globalsurgery

The Sacrament of the Goddess is a great “beach read” for persons who want to be transported to an exotic time ( in the recent past) and place (on the far side of the planet from Boston).

It’s a way to learn the boots-on-the-ground of #Globalhealth and #globalsurgery without wading through a textbook. The story of working in a remote hospital in the Himalaya is told through the eyes of an international crew of medical volunteers working with a team of Nepali and Indian doctors.

Doing surgery is hard enough and it is not the usual experience to be around sick people every day. Taking your skills and offering them to people of another country during a civil war will take the challenge to a new level. Soon you are thinking about commitment, courage and sacrifice in a different way.

This book is available on Amazon.




The Sacrament of the Goddess on the web

We are counting down to May

The book will be released in May, and you are all invited to the launch party in Charlottesville Virginia on May 10th. Q. Why Charlottesville?  A. Why not!

what is it about?

ummm, lots of interlocking themes. the experience of working in health care in Nepal can not be boiled down to just one small thing. It’s about hospitals; the civil war; the culture of Nepal; love and belonging; collectivist culture vs individualist culture; the legacy of colonialism; death and eternity.


An early reviewer noted that it fits about ten genres. It’s a thriller but it’s also a love story but it’s also a historical novel of the Nepal Civil War and it’s got a lot of ethnography in there.

The book is to be found on the web…

nowadays you need to have a social networking presence. so-o-o-o,



(note: we are running a free book giveaway contest on Goodreads. add your name and you may win a copy. hooray!)

Amazon: it’s on Amazon, now that the cover design is finished. (it’s a gorgeous cover, by the way….)  click here and you can find a way to  pre-order the book.

Going to the beach this summer? this will be the number one beach read for summer 2014.

YouTube: I have a YouTube channel, but I have not video’ed something for that site, yet. hmmm….. maybe I should….


What about Nepal? it’s a book about Nepal, will it be available there?

we will specifically have a second book launch in Kathmandu, sometime in June or July. This is not finalized yet. The Kathmandu edition will be priced in such a way as to make it affordable in Nepal.

learning and growing as a writer Dec 28 2013 part 3

being a medical person working overseas is not what you think it is.

So the first parts of this blog mini-series dealt with the idea of my first book, and the limitations when a person starts out to write in the long form. Also the idea of how to get motivated to start another book when you know what you went through the first time. Oh, and the idea that it takes so long and there is no guarantee that you will finish or have anything useful at the end – did I tell you about that part?

“Write the book you want to read, the one you cannot find.”
―     Carol Shields

The above is also attributed to Toni Morrison. There are variations, but you get the idea.  When I was first going to Nepal, to work at a hospital run by missionaries, I tried to read up on what to expect, but I was not satisfied.  (I made a listmania on Amazon, go there if you want a bunch of book reports.) And since I have returned, I still think that way.

The problems

If the book is written by a Christian missionary, there seems to be an unwritten convention that it has to be relentlessly upbeat. Which means that it will never tell about the challenges and failures directly.

Too many Biblical references to wade through. Sometimes this genre is full of Biblical references, and this slows you down. It also gives you the idea that Missionaries mainly pray all day.

on the other side of the pendulum, research articles don’t cut it either. Here is a problem: most people who want to go overseas need funding. so they make a research proposal on some tropical disease, and when they return that is what gets published. But what they really learned was more practical: how to live in a foreign culture; how to deal with the everyday medical problems of people in a low income country ( i.e., poverty); how to be a member of a small team doing intense work. But the academic writing process does not allow any of this to be told. All references to the interpersonal nature of the experience are relentlessly edited. Often by somebody who has not actually done a similar thing themselves.  So – this is not the one-stop shopping source of information either.

conflict  is not good. Not often written about, because it requires critical reflection. The person writing the memoir has to preserve their self-image, even though not everything goes well.

Colonialism and neo-colonialism

I think every book on the topic of cross-cultural exchange in health care needs to address issues of colonialism and neo-colonialism – also known as western patrimony. In real life, any person who goes overseas must overcome the idea of their innate superiority  because of being born in the USA or UK.  In USA we love the myth of the Lone Ranger as the hero. ( think of Lawrence of Arabia or Indiana Jones. these are good examples of the genre. The-white-guy-is-the-hero. And we perpetuate this. In 2013 there was a media controversy when somebody tried to claim the Jesus was a white guy.

hint: Jesus of Nazareth was not a white guy. He did not speak English. But His message is what was important, not the color of His skin.

I think every book on this topic can be analyzed by this standard. There is a spectrum. Oh, it’s easy to have a hero in an adventure story; but most of the time that is when you are clearly in the realm of fiction.

Is there something wrong with allowing Hindus and Buddhists to be who they are?

Trying to spread Christianity has gone hand-in-hand with colonialism for centuries.  I’m not saying we should completely pull out of the low income countries of the world – far from it. But I think everyone needs to get hip on the issues. Read some of the classic books – The Wretched of the Earth or The Pedagogy of the Oppressed – to get some idea of what you are getting into. Do more than just read up on diagnosis of tropical disease!

back on track –

I could go on this tangent for a bit, but let’s get back on track. If you are  a medical person ( doctor, nurse, therapist) you will be going on the experience to provide medical expertise. How is that experience different from what you do in USA or UK? that’s what I wanted to write about.

So the idea is to have characters the reader can identify with. and that is what I tried to do with The Sacrament of the Goddess.

I need to move along, I will edit this later. and add to it.

learning and growing as a writer dec 24 2013, part 2

continued from part one yesterday

To sum up yesterday, quite a bit of the motivation for writing my first book was – therapy.  after the first summer in Nepal I was trying to process the experience and I just couldn’t. so I began to write. the first prerequisite of writing at book length is – to have something to say.

To actually write the book was a learning process. I learned the second prerequisite of writing a book – you have to know how to write! I think there is the non-writer’s dismissal of the writer – of course I could do that if I wanted! all I need is the time! and I started off with that same lack of understanding. I learned a lot during that process.  by the end of writing, I was done – the fire to write was quenched. I felt I had said what needed saying. I didn’t think I would do that again.

then again, after 2007, I didn’t think I would return to Nepal again either. but I did go back in 2008, partly to answer some questions I had – was it really like that? did things really work that way? was my 2007 experience there real, or some sort of dream?  in 2008, the answer to these questions was yes. within 36 hours of arrival, I had picked up where I left off, I was doing the same activities I had been doing when I left in 2007, as if the intervening eight months was just a long weekend.

2008 was the summer I was meant to have in 2007. People were friendly; I knew what to expect; I had taken a burn course in Honolulu and was more prepared for the burn unit. probably if this had been somehow transposed into the first summer, I would have never written The Hospital at the End of the World.


And similarly with 2008, I returned in 2009. fast forward to 2012.

My trip in 2011 was different inasmuch as I felt I had more to offer than just helping out at the nursing school in Tansen. I think TNS is one of the top nursing schools in Nepal, I really do. But I wanted to work on critical care skills and to reach a wider audience, so that meant working out of Kathmandu, the biggest population center.  I started this blog then. made new friends and shared my knowledge with 190 nurses. I travelled outside KTM valley to offer my course, and every day I talked with people about hospital care in Nepal. I didn’t know it then, but I was gathering material for my next book.

available on Amazon. In Kathmandu you can get this at Vajra Books on Jyatha Marg in Thamel, or Tibetan Books on Tri Devi Marg.

available on Amazon. In Kathmandu you can get this at Vajra Books on Jyatha Marg in Thamel, or Tibetan Books on Tri Devi Marg.

It took awhile to get motivated to write. That’s the first step – having the desire to embark on a long quest with no certain end in sight. In fall 2012, though, I was willing.

Why a novel? why fiction?

This time around, I made a series of decisions. The first was to write fiction as opposed to nonfiction. There has to be more to a book than simply a series of war stories. we need a story arc, with a plot and a climax, in order to keep the reader’s interest. this was the first. I knew that my level of background info about Nepal was inexhaustible – by this time I had spent five years studying it and living there.  And I wanted to educate and inform the reader about issues of health care in low income countries. There are many examples of books where the setting of the book is important. The reader stays with the story because of the plot and characters, and can’t help but learn about the setting. so -it would be a “historical novel” – that’s the genre.  Furthermore, from the very beginning I knew what the climax of the book would be.

Oh, and I decided not to have the “page 42 problem” in the second book.   Finally I had a better idea of who the ideal reader would  be.

I also knew a lot more about the writing process, the “craft” of producing something people wanted to read. And so  – I started to write The Sacrament of the Goddess.

tomorrow -part three!

learning and growing as a writer Dec 23 2013, part one

(updated for republication, Dec 2014)

Merry Christmas to every one (2013).

Now that I finished the manuscript for my second book, it’s time to pause and reflect. if I was still in the State of Maine I would sip on a cup of cocoa by the woodstove, dog at my feet, listening to the wind howl or perhaps the freezing rain as it grew a layer on every twig and branch. But – I am not there.

Of all the things to reflect on, I choose to think about my growth as a writer.  I think I have improved as a writer, since 2008. This is not a path I would have thought I would go down.  I love doing nursing, I love teaching, and I have lots of things to occupy my time. But I have found that of all the people who go to Nepal to do volunteer work, hardly any body writes about it, and those who do tend not to give a picture that is useful for other who wish to follow them there. So I think I am filling a gap.


Do you know the old saying “if it’s worth doing it’s worth doing well?” – a handy aphorism. something to help us become dedicated to our work and live up to our potential.

I have a corollary. “If’s it’s desperately worth doing, it’s worth attempting even if you do it badly.”   and I am sure people will cringe to read this, but it is also true. There are challenges in life that have not been tamed. The first few who take on a new challenge, will fail. But that does not mean they should avoid a challenge. Because of this, the first saying needs to be clarified and re-interpreted. “If it’s worth doing it’s worth dedicating ourselves to the best we can possibly do” – and not “if it’s worth doing it’s worth doing well therefore don’t even bother unless you can be perfect the first time.”  (there are people who interpret it this way).

The first book was The Hospital at the End of the World. I don't end it was perfect.

The first book was The Hospital at the End of the World. I don’t end it was perfect.

That kind of sums it up with my writing at book-length. The first book was not perfect and was never going to be a best-seller. I wrote it while I was having deep “re-entry shock”  into USA. I could not answer the simple question “Was this a success or a failure?” I was coming to grips with my first exposure to a low income country and the limitations of health care there.  I needed to reflect on the experience, and writing was my way to do so.

Snakes and snakebite

My process of writing The Hospital at the End of the World started in a simple way. I composed a series of looooong emails to friends and family to describe some of the events that happened to me in Nepal. I felt better to have gotten things off my chest. After awhile I counted about 40,000 words on the page. If I sequenced these into the proper order, and filled in the time gaps, I would have a book (usually considered to be about 80,000 to 100,000 words).


In The Hospital at the End of the World, the snakebite story came first. That episode was a howling and unexpected success and vivid. I wrote it in ninety minutes and the final version as it appears in the book is about 95% the same as the very first draft. At the time it happened, I knew it was a “lifetime story” and I also knew that a strange series of coincidences brought me to that situation. In retrospect I should have somehow ended the book there, because it was a “happy ending” and very upbeat. But, it happened very close to the beginning of the summer. What came after was more important but more difficult for me. If I was a better writer I would have found a way to position the snakebite story at the end, somehow. But – I was not.

page 42

In the first book, I also find that I have the “page 42 problem.”  I have since learned that I am not the first newbie writer who ever did this, but that is small consolation. Here is what happened. On Page 42 I described something that was a true event – the day that three children died in a short time span, and how we responded, and what happened.  Exactly what happened.

It was deeply upsetting at the time. Strangely enough, we never ever de-briefed about it.

Never discussed it.


It was actually one of the things I wrote about last. It was traumatic at the time, and it was at the core of my experience in Nepal in 2007, a turning point. In truth, I spent about six hours writing the three-paragraph description of what happened. If you had watched me during that time while I was writing,  you would not have seen me doing much typing. I was frozen at the keyboard, staring into space and truly trying to think about what happened, making sense out of it. Should I simply skip it? how should I write it? what did it mean to me?

I did write it.  And what I found was, many readers who might not have had a medical background, got to that part and decided to not read anything else in the book. They just stopped. Oh, maybe they picked it up again a month or two later. But for many – no.

I spoke to a person who put it down for a month then picked it up and did continue reading.  She told me:

“When I got to that part I had to re-read it three times before it registered with my brain. Was I reading what I thought I was reading? I had to overcome denial. Do such things happen in real life? You described the most horrible action, along with the most humanitarian action, and – it was two irreconcilable descriptions of the very same event done by the very same people.”

True that.

Yes folks, it was upsetting to me, even though at the time I had fifteen years of critical care nursing experience. But it was really upsetting to the readers. I wanted to portray the reality; but this was simply not something people can deal with. not possible. Not if I wanted them to continue reading. Again, I was not good enough of a writer.  We are left contemplating the mystery of when bad things happen that have no social redeeming qualities.

I don’t want to sound flippant, but I have since learned that there is an unwritten rule that says, if you want to sell books, don’t ever write about the death of a child. Louisa May Alcott could get away with it. Maybe she is the only one. One of the Harry Potter books approached this taboo as well – the scene took place after a contest going through a maze and meeting the Dark Lord.  I do not have the skill of Alcott or Rowling. Alas.

beta readers

One takeaway for me was to carefully gauge who the intended reader of a story may be, and to see how it is perceived. For the second book, this is what propelled me to enlist the aid of two dozen “beta readers” – people who would test drive the manuscript.

Death of children?

Then in 2007, after the snakebite incident, I spent a month supervising students doing pediatric burn care. That occupies a quarter of the book. As I say, any hopes that this book would have an uplifting message faded quickly.  I had taken care of burn victims in USA, but not victims like the ones I now met. So – the book addresses a very serious issue of health care – thermal injuries.

There were two pediatric patients in particular that we worked with a lot. It wasn’t until eight months later that a Nepali nurse-friend went out of her way to find out for me what their long-range outcome had been ( they were both still alive at the time of my departure in 2007.) and she told me in May 2008 that each of them died despite all our work to heal their burn injuries. I had finished the manuscript by that time. I decided not to include an update because I knew the book was depressing enough already.


There are other things that have gotten me more attention than I expected. Yes, Virginia, the book uses the “F word” which is a big no-no for a lot of people. three times. at the time my rationale was “that is what was said at the time.” This offended people. I decided to edit this out after original publication, but – the damage was done.

And also, the book tells about when I went to the tourist town, drank more than I should have, and – then what happened. ah yes. I don’t pretend to be perfect, or to present myself as a fake role model. I do what I do. I try to be a good person.

There was a certain readership that was okay with the death of children, but to use the F word? or to hook up with somebody? OMG!

Anyway, despite it’s flaws, the book has helped me to find the people I wanted to find, for which I am grateful.  The idea here is to launch a dialog that will help people from the west be more prepared for the experience of going to Nepal and volunteering…….

thank you for reading this far. Tomorrow, or some future time, I will continue this by describing how my experience with the first book  led to choices I made for the second book.

stay tuned for part two….. I will write about the decisions I made with book two that will make it a better reading experience…

about rural hospitals in Nepal

The setting of the book is just as important a character as the people

Much of the book is set in a rural hospital in Nepal -specifically the one in Beni. The book is fiction, however, and license has been taken as to the exact specifics of the hospital there.  I chose Beni as the setting because of the historical fact that a major attack of the PLA took place there, and the battle provides a dramatic element that electrifies the plot. Having said that, I am very familiar with rural hospitals and tried to convey a composite of the challenges.

Here is a link to the hospital in Rukum, Nepal.  It will give you an idea of what I am trying to describe.

click here > Chaurjahari Hospital

Nov 30 – finishing a manuscript about Nepal

final polishing

Today, I “finished” the manuscript for which this blog is titled. I am sending it to a retired newspaper copy editor for the purpose of finding all punctuation/spelling/spellcheck/trackchange errors.

It’s like running a marathon

Some statistics:

92,290 words. that’s the final count. I think I may have banged out 400,000 words, then edited out 308,000 to get to the remaining ones worth keeping.

seventeen months. okay, I did not write for three months while I was in Nepal. But I was researching the context, every day while there.

Innumerable revisions. twenty-four “beta readers.”  Did the way it was interpreted by the test-readers imply that what I meant to say was what actually conveyed on the page? was it believable?

writing a love story. not to be underestimated. passion, los of innocence, betrayal, joy, fulfillment, jealousy, despair. all this and more.

Dozens of methodical pass-throughs for “craft” – eliminating passive sentences and the like.

find every “-ing” word. find split infinitives. kill your darlings. write a synopsis and use it to analyze propulsion of the story arc.

solve POV problems.

travel back and forth through space and time.

write dialogue.

scintillating dialogue!

Apply Checkov’s Rule.

Apply Elmore Leonard’s rules.

character-by-character, find three-dimensional challenges for them.

and more!

trips to FedEx to get a hardcopy for purposes of keeping track.

hundreds of cups of Starbucks coffee. black. no room needed. Now I have a Gold Card.

Research part one. all kinds of odd things – the battle of Beni during the civil war of Nepal; slogans and songs used by Maoists. Nepali culture including courtship and wedding customs; Buddhism, along with spiritual practices of “Vajrayanic” Buddhists; and the deepest recesses of the human heart. Buddhist epigrams.

Research part two. medical stuff, such as “what is a Finochietto?”  and  the truth behind some of the things I was told during various events, such as mushroom poisoning and meningococcal meningitis.

a professional editor. who made two complete pass-throughs and helped ensure that the thing had a purpose and direction.

The final product?

The final product ought to give the reader a glimpse into the mind of people they would not be able to interact with otherwise.  In a place they are unlikely ever to visit. during events that I pray they will never personally experience.

Where to go from here

From here, my plan is to find the widest audience possible, and that means trying to find an agent and a publisher. I will begin sending out agent queries December 10th.