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How to plot a novel… with medical school

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notepad-691250_1920It has been almost four years since my classmates and I swore the Hippocratic Oath and began the journey of medical school. Now many of them are preparing to graduate (I have two more years, due to a break I took to work on a book), and I've been thinking about how one would tell the story of medical school. If my classmates were to write a novel about their experiences, what would the plot be?

In fact, what is plot? How do you write a compelling one? These are questions that often come up among new writers, and I spent a good part of the past year trying to answer these questions as I worked on my novel. The best resource I've found is Dan Wells' lecture on the Seven Point Plot. If we walk through these seven points and apply them to medical school, this is what we might get:

  1. Hook:
    • The hook is how you grab the reader's attention in the beginning of the novel. The trick with this is to know how you want the story to end and start with the opposite state of being in the beginning. In Harry Potter, for example, we start with a boy who has a sad, miserable life.
    • So if the medical school story ends with a competent medical student graduating, then it starts with an insecure student receiving their letter of admissions. Congratulations! We are pleased to inform you that you have been admitted to the Stanford Medical School Class of 2013.
  2. Plot turn one:
    1. This is when you introduce the conflict of the story -- when the protagonist gets called to adventure or becomes a role. Structurally, plot turn one occurs at the end of Act I. In Harry Potter, this is when he boards the train to Hogwarts.
    2. In the medical school story, this is when our young person becomes a medical student. This is the white coat ceremony when our protagonist swears the two-thousand year old promise to do no harm. The Hippocratic Oath.
  3. Pinch one
    1. Pinch points apply pressure; they are when we have confrontations with the antagonist. In pinch point one, we meet the villain for the first time and the protagonist is forced to action. In Harry Potter, this is when the troll attacks during Halloween.
    2. In the medical school story, the antagonist is failure. (Can we all admit that is our biggest fear?) Pinch point one is the USMLE. This is when our protagonist feels crushed by the pressure of taking the most important test of their career.
  4. Midpoint
    1. The midpoint is the protagonist's turning point from their state of being in the beginning compared to their state of being in the end. This is when the protagonist decides to take up the fight, choosing to act rather than to react. In Harry Potter, this was when Harry sees a dark creature drinking unicorn blood.
    2. In the medical school story, the midpoint is transitioning from preclinical years to clinical years. Our protagonist has passed the USMLE and is starting clinical rotations. Now our student is an active part of the medical team.
  5. Pinch two
    1. Pinch point two applies even more pressure than pinch point one. It's when we see the antagonist in their full power and the protagonist seems to be in a hopeless situation. In Harry Potter, this is when Ron and Hermione can't continue with Harry because of the chess game and the potions riddle.
    2. In the medical school story, the second pinch point is when the student faces the hard truth about medicine that sometimes we make mistakes and sometimes we can't heal. So this is a day when a beloved patient dies and our protagonist makes a mistake that causes harm to another patient. The team is frustrated with the medical student and the student feels useless.
  6. Plot turn two
    1. Plot turn two is when the protagonist learns the last key they need to overcome the antagonist. Structurally, it occurs at the end of Act II. Often the secret is that "the power is in you." In Harry Potter, this is when Harry looks in the mirror and is given the stone because of his pure intentions.
    2. In the medical school story, plot turn two is when the medical student demonstrates competence, even excellence. This is when the medical student catches something the rest of the team has overlooked and that little piece of information is the key to finding a good treatment for the patient.
  7. Resolution
    1. The resolution includes the climax and the denouement. The climax is the final confrontation with the antagonist and ultimate victory. The denouement is tying up loose ends so that the reader finishes the story with little tension. In Harry Potter, the climax is when he faces Voldemort and the denouement is winning the house cup.
    2. In the medical school story, our student is now applying to residency. The climax is Match Day when the student opens the envelope and finds out that they got into one of their top choices for residency. The denouement is graduation, bidding medical school friends farewell, and packing up to move onto the next stage of life.

I'm so proud of all my classmates who have finished their clinical rotations. I'll miss them dearly come graduation time, and I'm dedicating this blog post to them. May the next stage in their training be full of wonder and joy.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Natalia Birgisson is a fourth-year medical student at Stanford University. She is in her second year off and writing her first novel, which is described on her site. 

Photo by StanfordMedicineStaff

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