Death’s Pale Flag follows a neurosurgeon haunted by apparitions of the dead who navigates the line between reality and the paranormal while tending to patients and searching for answers to his haunting. What was the inspiration for the setup of your story?

Well, to start with, several decades of practicing neurosurgery at Level 1 trauma centers. All the depictions of neurosurgical cases – from their origins, to the conduct of their surgeries, to their ultimate outcomes – although fictional were accurate and without hyperbole. And I think you can see, it can be pretty hair-raising. I wanted to give the reader a realistic taste of that world. Then, I have spent many years studying what effects constant exposure to death, dying, mayhem, tragedy, and human suffering has on healthcare practitioners, and have co-authored three non-fiction books on the subject. It feels plausible to me for someone in said environment to become untethered from reality, and start seeing ghosts. I certainly know the wreckage it can cause in practitioners’ psyches, home lives, and marriages. Finally, I grew up in a house with a Scottish mother and grandmother. They firmly believed in ghosts and had their own experiences with the undead. So tales of the paranormal are embedded in my soul. If a spirit world exists, I felt it logical for its members to be attracted to someone who so often spends his time in the no-man’s land between the living and the dead. And, I thought the juxtaposition of the supernatural world with the very “natural” world of modern biomedical science would be an interesting contrast. 

Ryan Brenan is an intriguing and well-developed character. What were some driving ideals behind your character’s development?

I wanted to portray a decent, conscientious, “normal” guy (who happens to have a knack for his craft) who must exist in the relentless, hyper-critical, hyper-intense world of a high-level modern medical center. We suspect from the losing of his fighter pilot father in his childhood, that he might be prone to trying prove himself and aspiring to a hero’s role. And acquiring such a status in war is not enough for him. Neurosurgery affords him the opportunity, however, to validate his heroism every day with every patient. But it comes at a cost. First, he must repeatedly face his inability to heal some or perhaps many of his patients. In fact, he must face that he – like all neurosurgeons – is an “accidental killer and accidental maimer” in some cases. And, he must routinely tear himself away of the true epicenter of his happiness and fulfilment, his wife and daughters. He is certainly dedicated and caring and committed to his patients, but he is far from perfect. His emotional intelligence is dramatically listing. He has completely lost track on what is most important to him in life. And, he somehow believes he’s immune to emotional (and physical) distress and injury. He’s maddeningly stubborn about attending to his own needs and ailments, and listening to the good counsel of his family and friends. And, he takes his wife and family for granted, expecting them to “patch him up” each night inpreparation for the following day’s onslaught.

What themes were important for you to explore in this book?

I definitely wanted to give the reader a peek behind the curtains of the neurosurgical world. There are great non-fiction books on this subject, but I hoped a nonfiction work by an actual neurosurgeon would be more immersive, more thrilling, and more frightening. I wanted to challenge the reader with the question of Ryan’s sanity. Could the ghosts be the real, or was Ryan simply losing his mind (or both). I wanted the book to be chilling, with some nice scares. And I wanted this to lead the reader to consider what was actually more frightening, the paranormal world, or the very real world of brain surgery. I also was hoping to distort the reader’s sense of reality, calling into question at times whether they were experiencing supposed ghosts or real life situations.  

I wanted to explore the concept that many physicians – particularly surgeons – occasionally actually hurt and perhaps even contribute to the deaths of their patients through their medical/surgical administrations. And the effects this must have on the physicians.

Clearly, I was also exploring the effects of workaholism and overcommitment – even towards a noble cause – has on the practitioners AND their families and friends. 

And, I wanted to underscore just how arbitrary and random (and sudden) awful events, injuries, and illnesses can be in peoples’ lives (although we all can contribute to them by foolish or unthinking acts). I wanted to reveal and celebrate the preternatural bravery and grace of our fellow beings – the patients in the book (and in the real world) who face god-awful occurrences in their lives. I also wanted to toy with the religious implications were paranormal phenomena to be real, and the interface of science and religion in the world of the mortally ill.

What is the next book that you are working on and when will it be available? 

Well, I have a completed YA novel in the computer that I have rewritten a number of times and will be heading into another rewrite as soon as I get Pale Flag off the ground. It’s the story of an obsessive but unheralded young soccer player who overcomes some shocking, and some routine, teenage adversity to start realizing his dreams. Although I believe young women will like it (I’ve tested it on some), I am hoping to rope in some male readers. I think we really have to push our young men to get off the games and do more reading.

Then, I am laying out the framework for a kind-of post-apocalyptic novel with a unique twist – that I won’t reveal quite yet.

And, as always, I have some non-fiction material I want to put together in the realm of burnout. I fear we are burning out our next generation of physicians long before they get to medical school. So, time permitting, I want to joust that windmill.

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