Indie Publishing with Alexandra Sokoloff

James O. Born

Today we have a special guest, Alexandra Sokoloff.  I’ve known Alex for many years and think she is a terrific writer.  She’s also a smart business person and in this blog you’ll see why.  It is so good the second part will be on Thursday next week.

Alexandra Sokoloff 

Jim asked me here today to talk a bit about my indie publishing experience. Always happy to hang with naked authors. I mean, the Naked Authors.

So here’s the story. In the summer of 2012 I made the leap: I decided not to go for a traditional publishing deal for my thriller, Huntress Moon.  I put it out as an e book instead. I made more money in the first month of release than I’d ever made for a traditional advance, and the book was nominated for a Thriller Award in the ITW’s brand new Best E Book Original Novel category.

Many factors went into that decision for me. First of all, I’ve made my living solely from my writing since I was twenty-five years old. Making writing pay is not optional for me. And a huge component of making a living as a professional writer is paying attention to changes in the business. Looking back over my career, I can see that every five or ten years I have moved from one medium to another, always incorporating what I’ve learned from each previous incarnation.

I started out in theater but quickly realized that if I wanted to make a living as a writer, playwriting was not the most viable way to do that. Then I did eleven years as a professional screenwriter before I snapped and wrote my first novel. People thought I was insane to start writing books when I was making a good living as a screenwriter. That’s everyone’s dream anyway, right?  But I saw the film business model changing before my eyes, studios squeezing writers for more and more script drafts for less and less money, and as bad as I am at math, I could see that in a few years I wouldn’t be able to sustain a living simply because of the work time added without compensation.  Add to this the fact that I’m a woman. In a good year women get a whopping 20% of the writing jobs in Hollywood.  I had to do something else.

So I wrote a book, and I sold it to a Big Six publisher, and then sold the next, and the advances were not enough to live on, but the foreign sales and some film options made it doable. Barely.

In the meantime, though, I was learning the book business. And it wasn’t looking good.

I was lucky, because early on Joe Konrath, well-known (or infamous) as a self-publishing guru, lectured me on bookstore co-op. And on e books, too, back before anyone was talking about e books, but it was Joe’s rants on co-op that really got me thinking. I didn’t particularly want to hear it, but you can’t unhear something like that.  Co-op means that in publishing, the odds are stacked against everyone but the bestsellers.  The publishers pay bookstores for placement to improve on the success of their biggest cash cows, at the expense of all the rest of us. The chances of breaking out of that hierarchy are astronomical.  I was working my… brains off at promotion, getting nominated for major mystery, thriller and horror awards, but I was quickly learning none of that meant anything to my publisher. By my fourth book I was done with being crippled by someone else’s mediocre expectations. And by then, there was the option of indie publishing. A scary option, but a real option.

So when I started to write Huntress Moon, I also started studying e publishing. What authors did and didn’t do. What Amazon and Barnes & Noble did or didn’t do. I read Konrath’s blog. I read the Kindleboards. I watched friends who were self-publishing, like Blake Crouch, Barry Eisler, CJ Lyons, Scott Nicholson, Ann Voss Peterson, Elle Lothlorien, Brett Battles, Rob Gregory Browne, JD Rhoades, LJ Sellers, Diane Chamberlain and Sarah Shaber.

Because of them, I knew e publishing for a living was not only doable, it was becoming potentially a far more viable option for me than traditional publishing. So I studied, and I wrote, and I put out a non-fiction e workbook based on my Screenwriting Tricks for Authors blog,

 which taught me all the technical things I needed to know about self-publishing.  By the time I had finished writing Huntress Moon, I was already hearing things like “It’s too late.” “That e publishing ship has sailed.” But that wasn’t what I was seeing, from people who were doing it right.  I took all I’d learned and put out the book as an e book original. And prayed.

In the first three months Huntress Moon was out, I made enough money on that one book, just in e-format, to live comfortably for a year. I got flooded with e mail from new readers who had never heard of me but who loved the book and were now buying all my others. My Facebook followers jumped from 500 to 20,000 and kept growing —going on 110,000 at this writing. 

That chunk of money and the steady income stream that followed has given me plenty of stress-free time to write the second and third books in the series. Every book means more royalties, at seventy percent per book sold. The royalties keep coming every month.  I know exactly what I’m making. I know when I have to adjust, when I have to do a promo.  I know by when I have to make another lump sum to carry me through the next fiscal year. The clarity, compared to traditional publisher royalty statements, is breathtaking.

No longer do authors have to hold to the glacial timetables of their publishers, or worry about the possibility of the publisher deciding not to publish at all (which has happened to several of my friends, recently).

I know that if I work hard, I can put out two books out this year, with a guaranteed income. What that income will ultimately be, well, I don't know, but traditional advances are way down and, much worse than that, most publishers are demanding e rights in perpetuity in traditional contracts, which seems to me an insane thing for authors to give up in the current climate. That alone pushed me in the e publishing direction.

And Amazon is constantly innovating and presenting new ways for authors to make money by self-publishing. I just finished an audiobook of Huntress Moon with Amazon’s ACX program, and added a really nice income stream to my monthly earnings.

Sounds good, right? But you have to ask yourself:

IS INDIE PUBLISHING FOR ME?

Find out the answer next week.

Our Audacious Creativity

and may there be much more of it!

from Jacqueline

There’s not a lot to write about while recovering from an accident – well, not much that people want to read anyway.  Two breaks in the clavicle, one cracked scapula and a couple of cracked ribs, means that even if I’m not confined to quarters, I’m not exactly out and about on an adventure. 

And why does "clavicle" sound like a musical instrument, probably from the harpsichord family?

Writing is hard right now – geez, would you believe how much pressure goes on your collar bones every day, even when you’re using the opposite arm?  And I’m not great at the whole hands-free-voice-recognition thing – I think with my fingers.  So, I haven’t been very productive, though I am working my way through the copyedits on my next novel – but sitting in a chair is no fun, and I cannot work lolling around on the bed.  However, as the saying goes – be grateful for small mercies, because it could have been a lot worse, and at least my little collection of broken bones will heal.

One thing I have tried to do since my accident, is to keep up with my acting class. I know – that felled you, didn’t it?  Trust me, I am no Dame Judi, but I am really enjoying myself.

I love learning new things, love to take classes and workshops, particularly in the arts – and I’ve discovered that it has a positive effect on my writing.  Some years ago, at a point when I’d published my first novel and was terrified of my second (I was sure I was going to be found out – I had clearly written the only novel I had in me), we moved some 400 miles away to a new area where I knew just about no one.  I was fed up, lonely, scared by my audacity to have thought I could write another book, and wondering how I could really get to grips with myself. I was working “virtually” for my company – which was a very good thing, because I felt much safer having that job.  Knowing how at sea I felt, one of my old friends, who lived about an hour away, suggested I join her in an art class at her local community college – one semester, two nights a week.  I signed up. I also signed up for a class at UCLA Extension – “The Illuminated Writer.”  If ever a writer needed some illuminating, it was me, and the almost 2-hour journey each way was worth it.

Now, I am no more am artist than I am an actor, but I loved that art class – “Working With Acrylic” – and it was intense!  But something happened that was not lost on me – the class was on Tuesday and Thursday evenings, and ran from 6-10pm.  On Wednesdays and Fridays I wrote like a dream – the words flowed and it was as if I had accessed a vein of words/phrases/images I didn’t know I had in me.  Both classes seemed to kick-start my creativity, and soon that book was coming along nicely. My classmates voted me the “most improved student” (my prize - a tube of cadmium red) – mind you, I was so inept, there was only one way for me to go!  And in the Illuminated Writer, we played with memoir, short writing exercises, bits of poetry, you name it – it was a blast!

Now, with a travel schedule that encompasses long book tours, and trips to the UK to visit my mother, I don’t really have much of an opportunity to attend regular classes, however, during a visit to see a production by the local theater company last December, I saw a line in the program about the new classes for adults.  I looked it up online as soon as I got home, and signed up for “Improv 1.”  I couldn’t make every class, but we were all working adults, and everyone missed one or two sessions.  It was so much fun, I signed up for “Improv 2” and now I’m in Acting 1.  And I am learning more about character than I ever knew I needed to learn.  OK, so I can feel you acting experts out there shaking your heads, “You mean she never knew that???”  Well, of course I knew actors studied character - I loved theater in school and it’s one of my passions; I go to as many productions as I can – but I didn’t realize the depth of preparation (we’ve studied Meissner and Uta Hagen, for the initiated).  And what’s great is that we’re such a mixed bunch in terms of our day jobs, the class is brim-full with different perspectives, different ways of looking at the world.

Has it impacted my writing?  It’s certainly made me think about how I approach my work – character development drives both my own writing, and what I’m drawn to as a reader.  And I also believe that to really find reward in the process of creating a story, you have to try something new with each endeavor, you have to be prepared to go deeper with your writing – oh the joyous terror of taking risks!  Sometimes thinking outside the box demands you step right out of the box – and I’ve a few works of (ahem!) “art” around the house to remind me that nothing life-threatening happened as a result. Perhaps we all sometimes need that reminder.  And with reference to Jim’s post yesterday, there’s a certain type of troll-like critic who might try to put you down when faced with your audacious creativity, but remember, you are the one with paint on your hands, ink on your fingers, or a script in your hand, and giant smile on your face … rather than a miserable frown. 

Have a great weekend !!

F***ing Critics

James O. Born

Sometimes I have a hard time with critics. Not literary critics. Not even for critics on Amazon. I'm talking about the sort of critics that want to stunt our growth as humans and nitpick our efforts to better ourselves. In fact, it would be my guess that everyone feels exactly the same way, except the assholes who do it. How many subjects can you say people would agree on? No one is in favor of child abuse. No one thinks it's okay to kill a manatee. And no one likes someone who sits back and critiques your effort. I'm not talking about the results. I am not saying people shouldn't be able to talk about how bad a movie or book is. What I object to is someone criticizing the effort we make in creating a book or movie.

We've all heard it. “Why do you waste your time at that keyboard?" Or, "Do you think you're the next Hemingway?" It's hard to explain why you're writing before you're making any money at it. All you can do is look at them and say, "I like to do it." Or you can spit in their food later. The choice is really yours.

Let's turn the tables on these bullies. Come back with, "Why do you feel the need to criticize my effort?" Unless the time I spend writing is taking away from time I should be doing something for you, it's none of your business. Perhaps, early in my writing career, my wife could have been a critic because. arguably it took time away from her and some of the things I could've done around the house. But she never said anything. And that's not just because we don't talk to each other. I made great effort not to allow my writing to interfere with things and she's not the type of person that would criticize effort.

Why would someone criticize effort? My guess is that they are jealous. They find themselves with free time and no interests. Or, they resent the fact that you are embarking on one of your dreams, which in this case were talking about writing a book, and they are not. You cannot let those kind of critics get their way. Ever. No matter what the results of your publishing life, if you love to write, you should continue to do so. And the more someone complains about it or criticizes it, the more you should do it.  (I will point out that I made that same suggestion to Israel about their problems with Gaza and perhaps it hasn't worked out as well as I thought it would.)

We need to rise above the doubters and not become one. If you are destined to write then get ready for the ride.

I got the idea for this post while I was in a class. It is the first time that the quote actually inspired me to write the blog.

These are two of the quotes we should follow at all times, not just in writing:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” ----Theodore Roosevelt

“To each there comes in their lifetime a special moment when they are figuratively tapped on the shoulder and offered the chance to do a very special thing, unique to them and fitted to their talents. What a tragedy if that moment finds them unprepared or unqualified for that which could have been their finest hour.”  ―Winston Churchill

THE BENEFITS OF RESEARCH

I was able to talk the lovely and talented Lisa Black into supplying a post. -Jim Born

The Benefits of Research by Lisa Black

One of the best and worst parts of writing a book is doing the research necessary to bring authenticity and realism to your plot. The worst, because we left school behind (sometimes) long before and yet here we are doing homework. The best, because we can do something other than write and still feel that we are virtuously working toward a great tome—and because we pick up some really interesting facts. Over the years I have read about life during the Great Depression, the history of video games, and how to mix up plastic explosives in your own garage. Good stuff.

In the next book I decided to make my main character a former foster child. (This may be becoming a trend, just as all detectives used to be recovering alcoholics, Vietnam war vets, or children of murdered parents.) So I dutifully began to research foster children. This is unusual because—full disclosure—I do not like children. I bear them no ill will, but they make me nervous, which is why I never had any. Well, that and because my husband is a child and trying to raise one with him would have committed me to twenty years of daily battle.

It will come as no surprise that the foster child care system is a mess. What may come as something of a surprise is that this is not really anyone’s fault. Social workers can be overworked, underpaid and burnt out. Foster parents can be all over the board in terms of what a child needs and whether or not they can provide it. Foster children can be ungrateful and unrealistic. Biological families can be irresponsible and irreparable. But even if each cog in this system worked to the utmost of their ability, the situation would still largely stink, because no matter what else occurs a child’s life and attachments have been disrupted and that creates a very lasting wound.

Obviously the most important goal is safety. But only about 25% of children are removed due to some sort of abuse; the other three-quarters are removed for ‘neglect’ and the case can be made that neglect is simply another word for poverty. There may be cockroaches in every corner, nothing but junk food in the house and the kids haven’t taken a bath in three days, but, a parent could counter, they grew up the same way and they survived. It may not be the way we think a child should be raised—and we all, myself definitely included, think we know the way a child should be raised—but it’s hardly grounds for removing the child from the home. Or take a single mother who leaves her three- and six-year-olds home while she works. She’s not out at a rave or taking drugs, she’s working to keep them fed and housed. Yet three and six are too young to be home alone, period. So, what to do.

Foster parents, meanwhile, and contrary to popular belief, very rarely take on the role ‘for the money.’ There is not nearly enough money involved to make it worth it. Most begin this work because the children were relatives and they couldn’t let their kin go to strangers, or they do it because their parents did it and they know the importance of maintaining their community, or they do it because it’s the right thing to do. It’s a hell of a risk, bringing a total stranger into your home. Even if you have a perfect nice set of foster parents and a perfectly nice foster child, a removal can occur because of personality conflicts, space problems, because the child has some sort of special need and has to move to another agency or district, and so on, and each move reinforces to the child that they are unloveable and unwanted. They quickly learn not to get attached to anyone or anything, because it could all change in the next hour. And if a child can’t form attachments, a process vital for their development, then foster care has no purpose—they might as well be in an orphanage. Yet foster parents are often told by the agency not to get ‘attached’ to the children. That can lead to conflicts with the agency—the foster parents think they know what’s best because they’re with the child every day, while the social workers are more objective and have historical information (sometimes purposely) not given the foster parents. Both sides can be right, wrong, or some combination in between.

I don’t see a solution and neither does anyone else. No policy or structure or social planning can change the fact that human beings are messy, complicated, inconsistent and unique.

All we can do is try.

 Lisa Black spent the five happiest years of her life in a morgue. As a forensic scientist in the Cleveland coroner’s office she analyzed gunshot residue on hands and clothing, hairs, fibers, paint, glass, DNA, blood and many other forms of trace evidence, as well as crime scenes. Now she’s a certified latent print examiner and CSI for the Cape Coral Police Department in Florida. Her books have been translated into six languages and one reached the NYT mass market bestseller’s list. For more information, visit http://www.lisa-black.com.

Her new novel is Close to the Bone

Close to the Bone hits forensic scientist Theresa MacLean where it hurts, bringing death and destruction to the one place where she should feel the most safe—the medical examiner’s office in Cleveland, Ohio, where she has worked for the past fifteen years of her life. Theresa returns in the wee hours after working a routine crime scene, only to find the body of one of her deskmen slowly cooling with the word “Confess” written in his blood. His partner is missing and presumed guilty, but Theresa isn’t so sure. The body count begins to rise but for once these victims aren’t strangers—they are Theresa’s friends and colleagues, and everyone in the building, herself included, has a place on the hit list. 

Showering with your cat and other bad ideas

Patty here…

BAD IDEA #1: SHOWERING WITH YOUR CAT 

Tigger-boo was my first feline and being an animal lover in general and a zealous new cat guardian in particular, I wanted to do right by him. I brushed him daily and said, “I LOOOOOVE my little pussy cat” in my sexiest Barry White voice because he seemed to like low tones. I bought him expensive toys that he never played with and a deluxe cat bed that he completely shunned, preferring to sleep with my Westie, Dottie (the tart). He was an inside cat and always smelled of hand lotion from being petted excessively.

And then one day I was having a conversation with a cat-expert acquaintance of mine and mentioned that I never bathed the Boo. She looked at me as if I were Fagin in Dickens's novel Oliver Twist. “That’s bad,” she said. “Really bad.”

I’d committed a faux paw without even knowing it. But errors can be corrected, so I began plotting a sudsy afternoon for the Boo. The kitchen sink didn’t seem like a sanitary place to do the deed, so I opted for the shower. After all, it was made of glass so he wouldn't get claustrophobic and enclosed so he couldn’t escape. And I'd be there to cheer him on. What could go wrong? Cat people everywhere already know the answer. I thought I’d need a blood transfusion when it was all over.

Tigger-Boo

BAD IDEA #2: READING AND INTERNALIZING CRITICISM ON THE DAY IT IS RECEIVED

Every writer I know invariably digests negative comments from editorial critiques or reviews while often ignoring positive ones. When I receive critiques on any Work In Progress, I make a practice of listening to the criticism but also writing down every word. Then I put my notebook away and don’t read the comments until the next day. The criticisms are generally more palatable in the bright light of morning and the suggested changes are often more minor than I’d remembered. Plus, there are always encouraging comments I’d failed to hear.

This waiting-until-later tactic is even more essential when you think your manuscript is finished. At this point in the process, many writers stop asking people to read the book because they think it’s perfect. It never is. Attracting an agent and a publisher isn’t easy. If, after several reads by friends, I still have doubts about the manuscript, I send it to others who can and will uncover any additional flaws.

My first book-advance check after polishing the manuscript until it was ready

BAD IDEA #3: MANAGING TWITTER WITHOUT HELP FROM YOUR FRIENDS

When I first opened my Twitter account, I was told by social media mavens to follow everybody who followed me. As you can imagine, doing that produced a lot of messages that didn’t interest me much. And the messages I did want to read were difficult to find in my fast-scrolling news feed.

I had pretty much given up on Twitter until recently when a fellow author with over five thousands followers compared to my measly 180, told me if I wanted to maintain my sanity, I needed to download a free app called TweetDeck that would allow me to sort messages into topics like: Showering With Your Pet or Surviving Criticism or whatever. 

So I downloaded the app and with a little bumbling around, I arranged my Tweets into columns by topic. Then I actually had a conversation with a stranger and was able to follow the thread because those notifications were highlighted in a separate column. My Tweeting life has been saved and I feel damn good about it. Next, I will attempt the death-defying trick of scheduling a Tweet to post when I’m in the shower with my cat. ME-OUUWWWW!

TweetDeck Screen Shot

HAPPY MONDAY!

When You Get What You Asked For ....

from Jacqueline

It is a truth universally acknowledged by people like this ...

That if you indulge in something like this ...

 ... and whilst out on your trusty steed, Oliver, he steps into a massive nest of these ...

 Then this will happen ….

And this ….

 Leading to this …

 But only in your dreams does the ER doc look like Clooney.

Then you go home and languish, and while getting really sick on the pain meds, you start wondering about deadlines and goodness knows what else, and how you’ll manage it all with a collar bone broken in two places, a couple of cracked ribs and a black eye.

Well, as you may have guessed, I am the one wondering about these things, seeing as that little list of injuries belongs to me!  

And let this be a lesson to you – remember that if you say, “I need a break,” expect the Fates to take you at your word.  I’ve been saying that for weeks – forgetting that just over 13 years ago, when a friend asked me about my new job, I told her that I would give my right arm not to be doing it.  The following day I had a very bad riding accident - broke my right arm and crushed my shoulder.  Had to give up that job - mind you, I wrote my first novel during my convalescence.

Now, having listened to this little tale, you know why I didn’t respond to your comments following last week’s post - I was in the emergency room!  My mother reckons I brought this on myself, by writing about healthcare.  Oh well. 

Have a lovely, safe weekend!

Building Suspense

JamesO. Born

We've already talked about this a little bit and you can call it by different names. Building suspense is a good title, but it could just as easily be called pacing. It's what happens in the novel. It would be an awfully short book if you just had a bomber try to kill a professor who somehow turns the table on him. Maybe eight pages.  That's why it's important to consider all the other things we've discussed.

We need to set the circumstances of the story. Is it set in a big city where there is a modern police force ready to respond? Or in a small town in Alabama where no one would suspect a package sitting on a porch contained a bomb ready to shred anyone who touches it? Let's say it's the Alabama town. It's a beautiful two-story house with the wraparound porch and oak trees shading the front yard. It's a beautiful sunny day that casts dancing shadows across the front lawn through the thick limbs of the sprawling trees. We know what's in the package. That's really what's important. It doesn't matter if the character suspects something is wrong. The reader has to suspect it. That's where the suspense comes in.

Next we might develop the characters. And see that a man sitting at a desk inside the house is a political science professor at local private university. His views have sparked a madman to put a bomb in the package. The professor also has a beautiful wife who is a doctor at the local hospital and three young children all playing in different areas of the neighborhood. The package sits unopened on the front porch. Who will get to it first? Lily, his nine-year-old daughter who's coming home from a friend’s house? His wife, Andrea, taking a break from a frantic day at the hospital? Or will the professor walk out onto the porch and noticed the package. Now we’re talking about a story.

We haven't even got into the motivation of the bomber yet, who’s sitting several blocks away and stewing over some article the professor has written. He's got other information about the professor sitting on the front seat of his Chevy Silverado. How the professor had moved from one university to another as he became more prominent. And how, three years before, an article he had written about religion had pushed the bomber's mother to suicide. Or at least that's what he believes.

I learned this lesson after I became published. My editor at Putnam, Neil Nyren, would often take the time to teach me and others valuable lessons in writing. In this case, he used the example of Alfred Hitchcock and his ability to build suspense. I can remember the conversation clearly. Neil talked about a bomb planted in a desk and how quickly the excitement is over if all that happens is an explosion. Whereas, if the reader knew the bomb was in the desk, you could get pages and pages of excitement out of it. This was all in response to my first draft of the novel EscapeClause. As with most of my novels, I try to mix up who the good guys and bad guys are. About halfway through the book I had the reader suddenly discover someone they thought was a good guy was actually a bad guy. Neil told me that was great for one or two pages but what the book really needed was someone who was bad from the beginning so everyone could root against him. What a good lesson. I would say I owe Neil lunch for it, but his tastes are too extravagant for me so I just leech off him whenever I get a chance to see him.

Once again there is no rhyme or reason in the sequence of these blog posts. It's pretty much what comes to me while I'm thinking about writing. I'm open to suggestions if you guys want me to change it up just shoot me a quick e-mail at contactjimborn@comcast.net.

Until then, write on!

Luck is everything... My good luck in life was to be a really frightened person. I'm fortunate to be a coward, to have a low threshold of fear, because a hero couldn't make a good suspense film.

Alfred Hitchcock

I'm big on having a blistering pace. That's one of the hallmarks of what I do, and that's not easy. I never blow up cars and things like that, so it's something else that keeps the suspense flowing. I try not to write a chapter that isn't going to turn on the movie projector in your head.

James Patterson

A Testing Situation

from Jacqueline

Much has been written about the over-testing of America.  From cradle to grave, we are tested for educational, health, financial or employment purposes.  Teachers bemoan the fact that they are training kids to pass tests, not provide a well-rounded education. The college application process requires test scores – despite the fact that professors are the first to admit that testing is no indicator of academic success at tertiary level. However, I have come to believe – and many studies support this – that with regard to our health we are completely over-tested, and it is a contributory factor to out–of-control healthcare costs in the USA.  But it’s an emotional flashpoint – as well as a legal wrangle.  At a big company I worked for years ago, people talked about the CYA memo – today it would be the CYA email, sent to multiple recipients. The Cover-Your-Ass message is at the heart of so much medical testing, and it is closely linked to the propagation of fear.  Let me tell you about a recent experience.

A few weeks ago I went along for my annual “GYN” exam.  Men – do not stop reading – you have wives and daughters, and no doubt you’ve had a test or two on your crown jewels, so this sort of thing could apply to you, too.  

After the exam, the physician’s assistant looked through my notes and said, “I notice that there has been a case of breast cancer on your mother’s side of the family.”  I nodded.  It’s been there in my notes for years, without comment.  Then she said, “I think you need to have DNA testing.”  So I asked, “Why?”  And she answered, “So we can assess your risk.” 

Hmmm.

At this point I explained that my family offers an excellent statistical example – my mother was one ten kids, seven of them girls, and I have more cousins than I can count – with the majority of them female, and all around about my age, give or take a few years.  We do not exactly have a breast cancer epidemic, and there is no ovarian cancer.  “I’m more likely to have a heart attack or a stroke,” I said. “Or a thyroid problem.”  But she insisted it was the best thing to do.

“So, let’s say that there’s a result that indicates I have a high likelihood of either breast or ovarian cancer – then what?” I asked.

“Well, we would counsel you on lifestyle choices,” she replied.

“Such as?” I asked.

“Diet. Exercise. Alcohol consumption – do you consume more than 7 drinks a week.”

I laughed. “I would be hard pushed to knock back more than 7 in a month.”

“Then your diet?” she asked.

“I gave up red meat thirty eight years ago, dairy fourteen years ago,” I said.  “I eat mainly organic chicken or fish, but only three or four times a week – the rest of my diet is vegetarian.  I have to eat gluten and wheat free and I am not a sugar junkie.”

“Oh,” she said.  “How about exercise.”

“Walk the hills for an hour and a half each day, and I train in a demanding equestrian sport three hours each day, five days a week. I also enjoy a brisk sit every now and again.”

“Oh,” she said, again.

“I’ve pretty much hit the lifestyle choices already,” I added.  “I’m not overweight and I don’t smoke.  Almonds are my weakness.”  I paused.  “And if that leaves doing an Angelina Jolie – forget it – I’m not having anything lopped off out of fear.”

Still she pressed me – and I knew that fear button was the one she had her finger on.  I felt myself caving.

“How much is this test?” I asked.

“About $4000," she replied

“I can tell you now, I am not paying $4000 to be scared."
"Oh, your insurance will pay all but $400 of it," she said.

I could feel myself getting uppity – but no more uppity than the physician’s assistant was getting with me. Clearly not many people questioned the advice!

I told her I would consider. She said they would take my saliva sample anyway.

I paused. “Oh heck, you might as well go ahead with it then,” I heard myself saying.

I arrived home and I realized I was annoyed.  I was really ticked off – with myself.  I called my pal who’d had the test and asked her opinion – she was shocked that I had been advised to have the testing, as usually you have to have several risk factors (be from an African American or Jewish background, be a smoker or overweight).  Then she said, “Oh well, it’s not a bad idea to get it done.”

I called the medical office and talked it over one more time, but because I could feel the woman getting really exasperated with me, I just let it go, and have tried not to think about it.  I have an appointment for my “post-test meeting” to go over the results in a couple of weeks.

But here’s what I think. I think I have been led astray by fear itself, by an organization making money out of testing, and in a very subtle way preying on trepidation about what might – or might not – happen in the future.  Several years ago, I remember reading that, despite the emphasis on family predisposition to (for example) breast cancer, in only 3% of cases of the disease is there a family connection.  I think it’s a CYA move, and I also think someone is making a lot of money out of me providing a saliva sample, which was then sent to a laboratory somewhere – at $4000 a spit, that’s a nice little earner.

It reminded me of two other events. Some years ago, at the company where I worked, it came time for the annual visit of the various insurance companies under contract with my employer. We had to renew with our healthcare provider, and we also had to meet with another insurance provider to hear about the various supplementary insurances we might want – long-term care, emergency room supplement, and another little offering called “Cancer Insurance.”  I listened to the brief run-through of the supplementary insurances, and then declined all of them – I couldn’t afford them, for a start. The agent looked at me and said, “Not even the cancer care?”  I shook my head. “No. I don’t want that kind of paperwork sitting on my desk or in my home.”  He shook his head and with something of a flourish, rapped his knuckles on the wooden desk.  “Knock on wood,” he said. I leaned towards him and said, “What you just did amounts to intimidation. You are trying to scare me into that insurance, and I am reporting you to my employer.  You will never set foot in this building again.”   

He smirked. His error. 

In his manner, by adding fear and superstition into the mix, what that insurance representative was doing amounted to blackmail.  He never returned – not on my watch anyway.

So, I have been wondering whether to ask that physician’s assistant to keep those DNA results to herself.  I don’t really want to know, but curiosity will probably get the better of me.  Ultimately, it won’t change anything, except it might add a bit of stress – and we know how bad that is for you. Heck, I might have my seven drinks in one night!

When I was in my mid-thirties, in the Jurassic period, I was sent for heart tests – a pesky little arrhythmia along with a heart murmur had decided to make my life more interesting.  First of all the cardiac tech listened to me while I explained to her that I didn’t understand how this had happened – I was a very fit woman.  Then she asked two very important questions:  “How’s your stress life?” and “Have you ever said, ‘I’m heartbroken.’”   She had me there.  I have never forgotten those questions.

It was later, while I was running on the treadmill, that she told me she also worked in the emergency room, adding, “And if there’s one thing I know in this world  - working here and in the ER – we all come date-stamped. When your time’s up, there’s nothing you can do about it.”

OK, so I can live with that – it’s called making every day count. And you don’t do that by living in fear – whether it is a fear of not getting into the college of your choice, of not getting that job or of having yet another medical test.  Some tests are worth it. Some are essential and help us live life to the full for as long as possible.  And we mustn't forget that there are some crucial tests that people have to fight for.  However, so many are costly, requested too often, and are just there to make money for the providers.  On the other side of the coin let's also bear in mind that those providers may be afraid of legal repercussions if we are not offered certain tests.  And for us, the mortals under the microscope, sometimes the pressure comes from trying to understand what is really important and also what does not serve us – so where our health is concerned, because we’re worried and not doctors, we end up being swabbed, injected, x-rayed and MRI’d until the cows come home.  And collectively, we end up paying even more for our insurances – a whole industry built on fear and maybe.

As I left the office, having offered up enough saliva to test my DNA – while wondering what sort of Pandora’s box I’d just opened – the nurse called after me.

“Oh, by the way, you’re overdue for a mammogram.”

I nodded, and muttered to myself something that sounded a bit like “Heck.”