Wikimedia Commons Image
Today we have an anonymous submission from a gutsy author, titled Inside Moves. Read and enjoy. I’ll be on the flip side with my feedback. Join in the discussion with constructive criticism for the author.
Chapter One
The ambulance screeched around the corner—its light bar flashing and siren screaming—toward Santa Barbara General Hospital’s emergency-room entrance.
An older couple sitting on the bus-shelter bench at the corner was startled by the sounds of the vehicle, along with the knowledge of what that meant.
The man looked to be in his midseventies. He took the woman’s hand in his; she had been startled more severely than he was. “Sweetheart, since we’ve lived in Santa Barbara nearly all our lives, I’d say there’s a very good chance we might know whoever’s in that ambulance.”
But they didn’t.
Desperate to keep the man alive, EMT David Ortega kept his eye on the heart-rate monitor for any changes to Bobby Wainwright’s vital signs.
“We’re losing him!” he yelled to his partner, Tom, who pushed the accelerator of the ambulance.
David felt the ambulance lunge forward. Tom liked to drive fast when the siren and flashers cleared his path. Regaining his balance, David prepared to do CPR while speaking to Dr. Richard Kiersten through his headset. The doctor was standing by in the OR, awaiting their arrival at SBGH.
“Give him Narcan IC,” he instructed David.
David hated giving intracardiac injections because they could produce complications. Besides that, just the idea of stabbing someone in the heart with a long needle was ugly. But he did it anyway. With nothing to do but watch the monitor and the patient, David read the notes Tom had taken at the accident site.
Bobby Wainwright. Just a few years older than me. Huh? Owner of Wainwright Erectors. Not from around here. Bet he makes a ton more than me. Accident on the job…Man, something really big fell on this dude. Goose bumps jumped out on his arms. No matter how much he makes, I sure don’t want to be him right now.
At the emergency entrance, David and Tom prepared Bobby for the operating room and Dr. Kiersten. As David jumped out of the ambulance, he saw an elderly couple at a bus shelter watching him. The old lady looked scared to death. Dear God, don’t let her suffer a heart attack before I get this guy into the OR.
The first responders had brought Bobby to the hospital closest to the construction site where he had been injured. Right now, it didn’t appear that this hospital was close enough.
FEEDBACK
There is nothing like a speedy ambulance ride to start an exciting action scene and get the blood pumping for a reader. This author’s instincts to begin the story there has merit, but the omniscient point of view (or author intrusion/head hopping) had me distracted.
A.) POINT OF VIEW – From the first line, I’m wondering who is watching this ambulance as it screeches around a corner. The older couple waiting for a bus seem almost caught off guard and startled by its sudden appearance. From their reaction, more author intrusion follows when an unknown narrator estimates the older man’s age. After his dialogue line, this unknown narrator answers his remark of “…we might know whoever’s in that ambulance” with the line – But they didn’t. The action and pace of this intro is diminished by the insertion of this couple too. They add nothing to the scene.
From the point where the older couple are left behind, the author tried to stay in the POV of David but veered out big time when David, the EMT riding in the ambulance, can somehow “see” the doctor he’s listening to on his headset with this next line – The doctor was standing by in the OR, awaiting their arrival at SBGH. I suspect that rather than this author deliberately using Omniscient Point of View, there is more “head hopping” going on here.
Recommended reading on POV – Here is an excellent prior post from TKZ’s Joe Moore on Narrative Voice that explains more about Point of View and the author’s voice.
B.) WHERE TO START – I would recommend this intro start with David the EMT and stay within his head, whether he’s a main character or not, at least until we get through the action and settle into the story. Begin with the line, “We’re losing him!” he yelled to his partner, Tom, who pushed the accelerator of the ambulance. Get the reader to feel the jostling ride as David is on his headset talking to a doctor at the hospital, as his patient is dying.
C.) RESEARCH – There is no short cut for research. If the scene calls for medical knowledge, any reader knows some jargon and can discern what is believable. Leaving out the details only highlights that the author has not done the research.
1.) Get the medical right – I would advise giving more medical detail on what David sees. Are there broken bones, collapsed lung, patient in shock, etc? David is an EMT and would know more than is shown. His objective should be to stabilize the victim enough for the ride to the hospital. There appears to be an accident but a medical person would look at the injuries and not be focusing on the accident so vaguely. This is obviously an attempt to introduce backstory in a “telling” fashion. If these details are necessary, it would be best to include them in dialogue, maybe as the EMT speaks to the doctor. But focus on the resulting injuries. I’m no medical person, but I can’t imagine that CPR is how an EMT would describe resuscitation. They have drug remedies (medical therapy), airway management, or equipment to use, like defibrillators.
2.) Mystery elements draw readers in – I’d suggest revealing the patient’s condition through dialogue, with David being the POV character. (One POV per scene is highly recommended, otherwise it reads like head hopping and would be a red flag to editors and agents.) Is there conflict between the EMT and the doctor? Is David resentful of the man? Does David see ambiguity between the patient’s condition and “the accident” explanation? Readers can be drawn into a story by elements of mystery. Have patience with laying these out. Raising the mystery is enough and it will foreshadow things to come.
3.) Drama builds on the risky stakes and tension – Where is the drama when the heart stopped and flat lined? Too much is missing and it is apparent that the author has avoided the details needed for this scene to be believable.
4.) Suggestion – I would do the research and include some details in David’s dialogue to make this work, but if the author didn’t have a desire to do this, I would suggest having the POV be in the head of someone who is brought on the ambulance who is an unreliable narrator and doesn’t have a medical background. This could be a loved one or a co-worker, but if David is a main character, I wouldn’t make the first scene about a secondary character that won’t be important to the story.
D.) RESEARCH RESOURCES – Below are a couple of good resources sites for medical and crime scene research.
1.) Medical – Whenever I think of medical research, one name pops into my head and I have his books in my research library. Doug P. Lyle, author. He has written many non-fiction books on forensics and medical research for writers and he’s gracious with his replies on his website. Look for his books and contact info HERE.
2.) Crime Scenes – Another good resource link is Crime Scene Writer on Yahoo Groups. It is a group of professional crime scene people of various experiences – ie crime scene techs, law enforcement, FBI, EMTs, firemen, etc. HERE is the site for the group and this is the email to contact them and request to be subscribed as a member. Send an email to: crimescenewriter-subscribe@yahoogroups.com (Be sure to read their rules of etiquette for members.)
E.) WAINWRIGHT NOTES – With imminent resuscitation or a medical crisis happening, how would David have time to read any notes on the patient? Supposedly the patient is dying, yet David is reading over notes and casually thinking about the patient’s age, job, money status, as it relates to him, etc. Very unprofessional and inappropriate timing. given the action and urgency of the scene. (Side Note – EMTs have ice water running through their veins. They have ways of dealing with extreme injuries and distancing themselves to allow them to do their jobs.)
Bobby Wainwright. Just a few years older than me. Huh? Owner of Wainwright Erectors. Not from around here. Bet he makes a ton more than me. Accident on the job…Man, something really big fell on this dude. Goose bumps jumped out on his arms. No matter how much he makes, I sure don’t want to be him right now.
F.) FORCED UNREALISTIC DETAILS – Below is a sentence that ripped me from the reading. With the scene starting at the bus stop and the elderly couple, the end of the scene with a racing ambulance somehow comes back full circle, as if they spun their wheels in place? I don’t see the point in this, but more importantly, an EMT would be focused on his patient and not looking around and down the street to get a bead on a couple at a bus stop. The urgency of the medical situation is completely deflated. Here is the sentence:
As David jumped out of the ambulance, he saw an elderly couple at a bus shelter watching him. The old lady looked scared to death. Dear God, don’t let her suffer a heart attack before I get this guy into the OR.
The next and last line has the same feel to it – that the ambulance had spun its wheels in place. It drags the reader into backstory that is out of place to the present action. Plus the POV isn’t David anymore and the reader gets another dose of author intrusion. Here is the sentence:
The first responders had brought Bobby to the hospital closest to the construction site where he had been injured. Right now, it didn’t appear that this hospital was close enough.
OVERVIEW – The fixes on POV and proper medical research can be done. That’s the good news. There are no shortcuts for solid research when the scene is a medical one. The author could find a non-medical character to insert one POV for the scene, but a better scenario would be to make the scene believable with the proper research. If the focus is on the emotion of an EMT about to lose a patient, the medical could be woven into the scene without going overboard. (Note: Less is more – a regurgitation of all your research can be tedious and boring to a reader. Moderation is key.) But get the lingo right and the sequence of events in proper order so the scene is believable. Show how the stakes are high and focus on the humanity of the EMT in a life or death situation and this author will have the reader turning the pages.
DISCUSSION:
Anything to add, TKZers? What had the author done right? What would you recommend for improvements?
If I may…
I second your comments and would add that, if the the old couple are kept, their surprise and shock are inconsistent ~ if the bus stop is near the hospital (whic in itself is confusing as it’s at the beginning AND ending of the scene), for a couple of reasons:
1. They’re near a hospital with an ED, so ambulances should be expected on occasion;
2. Sirens can be heard blocks away – that’s what they’re for;
3. Sirens are usually shut off a block or so away from the hospital – the old “Quiet Hospital Zone” signs come to mind.
This doesn’t mean the ambo wouldn’t’ve been moving quickly, but there’s another set of details that pulled me out and made me go, “Huh?” – The scene starts and implies the ambulance is near its destination, when suddenly Tom “pushed the accelerator” and David felt the ambulance “lunge forward”, all hinting that they were still a longer ways away than it seemed.
On a personal note~ the photo at the top is one of “my” ambulances, as my day job is with the Grady Health System here in Atlanta (tho not in hands-on patient care) – and I know if research is needed, contacting someone with them – or almost any large hospital run EMT service – should yield more info than you could possibly use.
Great input, George. What a coincidence about the ambulance picture. It’s from Wikimedia Commons. I didn’t read the page it waw featured on. Now I may go back. Thanks for your insightful comments.
I bow to the more experienced writers regarding the necessity of the older couple, and it WAS confusing because at first it seemed like they were at a bus stop somewhere earlier in the ambulance’s journey, then as if they magically appeared near the hospital at the end of the scene. When I read about them again at the end of the scene I was thinking “Is the ambulance driving in circles?”
But while I agree about the general idea of not head hopping, I’m not opposed to omniscient POV and I liked the brief couple of sentences about the elderly couple at the beginning (not the end)–not because it had anything to do with the ambulance patient, but because to me it was a visceral telling detail about Santa Barbara the place–showing us in that brief bit the wide variety of people there–the seemingly old school side and the active business side. We may not have had time yet to learn much about the characters, but that gave a solid sense of the place’s character.
Is there typically only one person in the back of the ambulance? It would certainly ratchet up the medical emergency if David had an opportunity to ping a rapid back and forth medical emergency conversation off someone. If Tom’s driving, he can’t be the guy. I don’t think David would have time for the extraneous thoughts about economics, etc. in the midst of that emergency.
Last but not least, I was confused about Wainright. He is described as being the owner of Wainwright Erectors. 1) I don’t really know what Erectors means but assumed it has something to do with construction (or legos 8-); 2) If he’s not from around here, how could the ambulance be responding to what sounds like a construction site ‘accident’ with this person? Unless he was just visiting another one of his company’s sites. In any case the “not from around here” didn’t add anything to the page. 3) To offset the old style feel about Santa Barbara given through the elderly couple, a good opposite to that would be if there is a very short, telling detail about Wainright’s clothes or manicure that reflect the up & coming side of Santa Barbara. 4) Last but not least, while I agree that the EMT probably wouldn’t have time for idle pondering about how much more money this injured guy makes than David, I was thrown off by the “Man, something really big fell on this dude.” I would assume the ambulance responded to the location where the injury occurred, so I find it hard to believe that there would be no report of exactly what happened to the guy as they are treating the patient on scene. Seems like there are always by-standers waiting to spill their guts about what happened.
Yes. Good points. There are many ways to look at this intro, given any of our life’s experiences. This short piece will no doubt generate more discussion.
As far as David bouncing dialogue off someone in back of ambulance, it can be the ER doc he’s got on headset. Standard practice. That’s why I was suggesting more lines between them to establish med jargon, sense of urgency, & maybe hint at mystery of the patient’s accident.
Thanks, BK
If I can bounce in here again… 🙂
The conversation with the ER doc could provide some of the backstory to Wainwright and the on-scene specifics – “I’ve got a male, mid-40’s, crush injuries to the lower abdomen, blah, blah, blah…” being careful to not over-jargon the conversation and lose the average Joe (or Josephine)…
Absolutely. I had intended to find a good example of a fast paced medical scene but ran out of time. You can pack in a lot of info in rapid-fire lines. A collapsed lung is something for David to do with his hands to stabilize the guy. I’ve written scenes like this (during a jungle firefight) using advice from an EMT advisor. His input to my scene was tremendous. Thanks, George. Good instincts.
I like the potential of this opening. But I’d start it here:
Desperate to keep the man alive, EMT David Ortega kept his eye on the heart-rate monitor for any changes to Bobby Wainwright’s vital signs.
I liked the specific reference to Narcan IC and the needle in the heart.
As per Jordan’s suggestion, you could put in a bit more medical detail where they “prepared” Bobby. You don’t have to lard them on (again, as Jordan points out). That can often overtake the action and feel like you’re trying too hard (I just read a thriller where in the first chapter the details of the cop operations, weapons, ammo, etc. were so overdone it felt like the author was “showing off” and didn’t want to waste a single bit of all the research. Ugh). But a few apt details sprinkled in throughout the action are enough to establish verisimilitude and not slow things down.
And I’m afraid the old couple will have to be retired UNLESS they are there for a reason to be revealed later. In that case, a brief look at something more startling than “scared to death.” And cutting the internal thought will keep the scene moving.
Again, great potential for an opening page.
Great input, Jim. Completely agree The author’s instinct to start with this scene is a good one and the points brought up in this post discussion can easily improve the opener.
My thoughts are not to be critical at all, but I think another constructive approach to critiquing this first page is to change the entire scene to start at the accident site rather than inside the ambulance. The story seems to be about Bobby Wainwright, the injured. So, if you’re introducing all of these characters in the beginning before even getting to the main character (at least it’s my perception of the main character), it’s a huge waste, because I’m confused on who the story is about. My justification is that if Bobby isn’t the main character, why the need for the detailed notes about him? I think it was a way for the author to introduce him but putting some action on the page in order to do so.
None of the other characters were introduced in this fashion: age, occupation, not an insider, social status, etc.
David read the notes Tom had taken at the accident site.
Bobby Wainwright. Just a few years older than me. Huh? Owner of Wainwright Erectors. Not from around here. Bet he makes a ton more than me. Accident on the job…Man, something really big fell on this dude. Goose bumps jumped out on his arms. No matter how much he makes, I sure don’t want to be him right now.
If this much information was gathered at the accident site, then why not start the story at the accident site?
Hi Diane. A different take is always welcomed.
I can see a brief intro that features the accident, if Bobby is an important character. Hard to know in such a short snippet. For most authors, me included, the start of any story is a challenge. This story has potential for an exciting opener in a few directions. Thanks for your different perspective.
(25 years as Emergency physician in level one trauma hospitals.)
No aspect of the medical content or EMT’s actions/purported tasks are realistic/credible. (e.g. Narcan treats narcotic overdose. No possible indication in trauma. Intracardiac injection incomprehensible) Multiple other medical content issues.
Basic and extensive research needed.
Did like starting with action and energy. If protag is the EMT the author should check out author Michael Morse. Brilliant and real window into paramedic/EMT/EMS world.
Good luck!
Good advice, especially with your experience, Tom. The tip on an author to read is VERY helpful. Thank you.
Thanks – hope i didn’t sound harsh. Medical, legal and technical are always difficult in fiction as you aim for ‘credible’ and can’t be comprehensive as it stops the flow (esoterica and “look what I know” details bore readers imo).
BUT the fundamentals have to be solid or huge numbers of readers are immediately put off. Trauma patients go to the ER – they don’t go directly to the OR. EMTs do not ‘prepare’ patients for surgery, etc. Millions of knowledgeable readers know these things.
Just as a general note for TKZers the special folks and action in prehospital and hospital emergency care are pretty unique. Content can be a great enhancement of scenes and developments in your books.
Again I liked the energy and “right into it” take-off by this author. Very positive.
If this author or others would be interested in suggestions for more writer-friendly resources please contact me (website/email)
Thanks and good luck!
Also try Kevin Hazard’s _A THOUSAND NAKED STRANGERS: A Paramedic’s Wild Ride to the Edge and Back_
What and who is the story about? Is it about the paramedic trying to save a life? Is he going to solve a mystery surrounding the injured man? That seems like a good story. But, I’m not sure about this story yet, since we are not given enough information and it moved around too much.
If the ambulance is screeching around the corner that means the ambulance is going pretty fast, so why does the driver need to drive even faster?
I don’t have anything to add about the medical details.
The old man tells the woman that the person in the ambulance is probably someone they know. That is not a reassuring thing to say. It makes her feels worse. Do they like hanging out in front of the hospital waiting for someone they know to come into the emergency room and getting scared enough to have a heart attack? There is a mystery going on in this story and I don’t know what the elderly couple has to do with anything so I am trying to imagine a connection. Maybe that will come up later or maybe they are a metaphor?
The paramedic seems sympathetic to the injured man but not sympathetic enough to the reader. He should be concentrating on his job and not on how much money anyone makes or where they come from at during the ambulance ride.
This start is very exciting! I would like to know right away that we are inside an ambulance and there is an emergency with a hint of a mystery or thriller.
Thanks for your comments, Augustina. One of your points resonated with me. If David will carry thru the story, or even if the author wants to deeoen his characterization, a few limes or thoughts could be hinted at, to endear him to the reader. Things like: he pushes to save the victim because he reminded the EMT of his father, or he had lost a patient and hadn’t gotten over it.
I’m also for retiring the old party, and believe this story starts in the ambulance. There are many online videos about ER treatments for various emergencies, from heart attacks to broken bones, that will help with the medical jargon. And you’re right, Jordan. Getting that correct is essential to a good novel. Good luck, author.
Great tip. There are tons of info on video. Vimeo can be a good resource. Most recently, I watched lots of videos on sniper and SEAL training, and on one of my young adult novels, I used Vimeo to research climbing Mt Denali in Alaska.
Thanks, Elaine. Good stuff.
First of all, thanks for sharing your work with everyone here at TKZ. Reading your work and the comments will help other authors. Here are some of my notes. I hope they help.
1. Who is your story about?
You’ve introduced lots of people in your opening including an elderly couple, David Ortega, Bobby Wainwright, Tom the ambulance driver, and Dr. Richard Kiersten. That’s six people. Whew!
First of all, I want to know who the protagonist is. The first line of dialogue is spoken by a nameless elderly man, but I suspect that the protagonist is David. If you’re going to tell the story from David’s point of view, he would not be able to hear what the elderly guy said to his wife. In fact, I doubt that he’d be paying attention to elderly couples or the outdoor scenery if he had an injured person in tow. So, assuming David is your protagonist, tell your story from his point of view. Get inside of David’s head and stay there for the whole scene. In a mystery/thriller you can use multiple viewpoints but only one per scene, please. If you’re inside of David’s head, you can show us everything he experiences through his senses. You don’t want to tell the reader about Tom pushing the accelerator. Only tell the reader what David can feel if you start the story in the ambulance.
2. What does your character want?
If David is the protagonist, it’s good to show him in action at his job, but I want to know more about him. I don’t need to know his height or what color pants he is wearing, but I do want to know a little about what he wants and what’s getting in his way. Give us some hints about how the first event ties into the main story and characters.
3. What kind of story are you writing?
Is it a mystery? A thriller? Mysteries tend to have an intellectual protagonist who solves a crime after it has been committed. Thrillers tend to be about preventing a crime before it has been committed. Let the reader know the genre as soon as possible.
4. Where does your story begin?
It’s usually not a good idea to start a story with your protagonist traveling from one place to another, but there are always exceptions. In this case, though, I don’t see any reason to doodle around. I’d begin with the ambulance arriving at the hospital. Limit the number of character introductions in your opening.
5. Read up on the correct way to use hyphens.
6. Research all of the medical details very carefully so that everything is believable.
7. “An older couple sitting on the bus-shelter bench at the corner was startled by the sounds of the vehicle, along with the knowledge of what that meant.”
Although I’d eliminate this older couple from the opening scene since there doesn’t seem to be a compelling reason for them to be there, I don’t like this sentence. Try something like:
The sounds of the vehicle startled the older couple sitting on the bench.
You can fill out the sentence with details however you like, but use the active voice. Learn more here: https://owl.english.purdue.edu/owl/owlprint/539/
Good job! Now have fun and enjoy the process as you revise your work.
Nice detail, GR. Well done.
Wow, Jordan. You gave such detailed feedback, I think you’ve covered it (along with the other comments here).
I loved the ideas & research tips in the comments, Sue. Love our little community.
Thanks, Jordan. I always enjoy reading your great posts and comments, too.