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.




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!

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.


Backstory about the Nepal Civil War as related to the book

The Nepal Civil War
What the reader needs to know. Quick summary of basic points.

There is a long Wikipedia article on the Nepal Civil War.  It is as good a place to start, as any.

Note: not everyone will agree with everything written below. An exhaustive history of this civil war has yet to be written.

The book, “The Sacrament of the Goddess,” makes use of point of view. It is written in third person, but there is no disembodied all-knowing narrator to provide an exhaustive store of immutable facts. As such, the book does not devote much time to the backstory of the Nepal Civil War. In order to keep the story moving, the book shares only the level of information known by the main characters at the time of events. The ins and outs of Nepal politics have been so Byzantine as to be incomprehensible to a casual observer.

Nonetheless, early readers asked for a simple explanation of the civil war, which lasted from 1992 to 2006 and took the lives of 16,000 people in Nepal. This conflict was characterized by widespread hit-and-run terrorist actions and an escalation of counter-terrorist strategies by the central government. Later in the war the tactics evolved in to pitched battles between more conventional armed forces. The battle of Beni was among the largest such battles in the war.

Please note: some details of the battle of Beni are from contemporaneous accounts; others have been added to heighten the narrative of this work of fiction.

The civil war ended with the signing of the eleven-point agreement in 2006. Some speculate that the Maoists only came to the table because they ran out of money to fund their army. The King abdicated in 2007. The political chaos continues since the signing of the eleven-point agreement. Events after 2007 will serve as the backdrop for a future book.

The basic problem – wealth in Nepal is concentrated in the Kathmandu Valley. There is tremendous disparity between the Valley and the rural areas. In western Nepal there was an ongoing famine. The country is overpopulated and is a net importer of food. Health statistics are dismal, there is a land-based economy, and the role of women leaves much to be desired. In every respect, conditions were ripe for revolution.

The Government – during the period in the book, Nepal was “the last Hindu Kingdom on earth” ruled by King Birendra and then King Gyanendra. Since the 1950s, Nepal was allied with the American CIA in a covert war in Tibet against the communist Chinese. Western Nepal served as a training base for Tibetan Freedom Fighters (guerillas) sent across the Himalaya to Tibet. Not one ever returned alive.

The Gurkhas – please note that the most famous fighting force associated with Nepal is the Gurkhas, but they have no role here. They are mercenaries, employed by foreign governments such as Singapore, India and the UK. Western Nepal is the prime recruiting territory for this group.

The Military – The military is composed of the Royal Nepal Army and the Armed Police Force. The Armed Police Force was given better weapons and training as the Civil War progressed. The RNA used more conventional weapons as well as helicopters. There are also local police.

The People’s Liberation Army – was headquartered in western Nepal, a vast area with no paved roads. In the book, the name is interchangeable with the idea of “Uniformed Maoists.”  Paradoxically, many leaders of this group came from Kathmandu.

Maoists – the clandestine civilian revolutionaries ( terrorists, depending on your point of view). Not associated with or supported by the Chinese. The name comes from the strategy of enlisting peasants in a revolt, as opposed to waiting for an industrialized middle class to emerge from the proletariat (which would have been “Leninist”). The Maoist program included better health and education, redistribution and decentralization of wealth, and equal rights for women. It also included recruitment of child soldiers, use of women soldiers, extortion of money, and seizing land from owners.

The terrain – Nepal is landlocked, and consists of three major zones. The first is the Himalaya, highest mountain range on earth. The second is the hill country. The steepness of river valleys and difficulty of travel here can not be overstated. In western Nepal there is a vast area with no paved roads. Fine territory for the headquarters of an insurgent group. The third area is the Terai, a large flat valley that runs along the southern border with India.

The weather – 80% of the annual rainfall occurs in the summer monsoon, one of the truly epic weather events of this planet. Rainfall plays a factor is making roads impassable.

every book needs a back cover blurb

How does the physical appearance of a book entice the potential buyer?

In a bookstore, a patron looks at the cover, then reads the back cover, then the first few lines of the first page. or so they say. The blurb on the back needs to tease the casual browser into exploring further. It’s also used in a summary on Amazon and other places where a tease is used.

Back cover blurb #1


Heart-pounding medical thriller from the majestic Himalayas

As a college student on a trek during summer break, Matt was wounded in the crossfire of a mountain ambush during the civil war in Nepal.  A team of missionary doctors heroically saved his life.  While he recuperated in a remote hospital, he tutored Kali in English.  Soon it became a courtship that transcended cultural barriers to culminate in a night of passion.

He lost contact when the CIA sent a helicopter to bring him to safety.  Unable to get her out of his mind, Matt returns to Nepal years later, determined to find Kali or her story since she seems to have disappeared without a trace.

Something happened during the battle that swept through the town, and Matt must unravel the mystery.  He is now a missionary surgeon, working alongside the doctors that saved his life, earning their trust.

As Matt searches for Kali he is challenged to the utmost level of his skill and courage.  Will the consequences of Matt and Kali’s first meeting shatter the lives of everyone on the team?

naturally, the idea is to convey what a gripping page-turner this is.

At the same time, not to reveal the ending.

Oh heart break! O unrequited love! O destiny!