I got a couple of bad reviews for Too Much blood this week. I won’t say I’m not upset, because I am. Nobody likes being told that her magnum opus is just so much dreck. I know, I know, everybody doesn’t like the same things, and I can’t please everybody, but I can’t help feeling bad. I know perfectly well that everybody doesn’t hate Too Much Blood, because I’ve got 4 and 5 star reviews too, and I’m glad they got to me first.

I’m not going to post either of these reviews in their entirety, but I feel that certain aspects deserve comment.

First item: HIPAA.

“I found it odd that Toni is able to get information that a typical pathologist probably wouldn’t be able to get her hands (on).”

“Toni looks up confidential medical information on several people who are definitely not in her care (she’s a pathologist for crying out loud, she doesn’t take care of live patients) in
order to “solve the case.” Again, HIPAA laws anyone? That is completely inappropriate and really puts doctors in a bad light, because it suggests that we think this is okay. It’s NOT. People get fired for doing things like that all the time.”

These reviewers are absolutely right; HIPAA is a big deal, and people do get fired for violating it. However, there is such a thing as need to know. Doctors have much more leeway than other medical personnel because they have a need to know about patients, whether they’re taking care of those patients or just providing consultation. Pathologists are consultants.

Pathologists do deal with live people, 99% of the time. They aren’t the primary caregivers, but what they do impinges directly on their care. Every specimen they get should come with adequate medical history, supporting lab data, radiological reports, and any particular concerns the submitting doc might have. But they don’t.  Specimens come to us with no history, or history that isn’t pertinent to that particular specimen. So we have to be able to look that up, or we can’t do our job properly and might not be able to provide the specific information the primary doc needs to know. We might fail to fail to handle the specimen properly for their needs if we don’t know what their needs are, and surgeons aren’t always available by phone. Having access to the electronic medical record is essential for pathologists. When I’m signing out cases, about 25% of my time is taken up by looking things up in the medical record because I don’t have enough information.

Next item: phones.
“In the very first chapter of this book, Toni’s home phone rings in the middle of the night and her husband picks it up. First, what about a pager? A pager on vibrate? A cell
phone? How has this never occurred to her through medical school, residency,
and now her job? If I were her husband, I would have lost it much sooner.”

“How can a medical professional not know about pagers or putting one’s phone on vibrate mode? How can a spouse of a doctor not be used to having the phone ring in the middle of the night occasionally? It would seem to me to be par for the course in marrying a
pathologist who needs to be on-call regularly.”

Pagers make noise. Cell phones on vibrate make noise. A cell phone that vibrates loud enough to wake me up would also wake up my husband, even if it’s under my pillow. Even if it didn’t, my getting out of bed to go out of the room to talk on it would. I know this, I used to have a husband. Even if it didn’t, I would still have trouble getting back to sleep, and for nothing because I wouldn’t be going to do an autopsy in the middle of the night. This seems blown out of proportion as something to condemn an entire novel for.

Third item: Toni’s arrogant and unlikeable.

“Toni Day is extremely nosy and a really unlikeable character. If a character is going to carry a whole set of books named after her, she’d better be someone people want to read about. I
was hoping she would grow and develop over the book, but she was the main reason I couldn’t finish it. She is pushy, arrogant and says the most inappropriate things like she is on the autistic spectrum. I personally would want to divorce her too.”

“Toni uses the excuse that since she did the autopsy on the dead man that this gives her the right to ask all sorts of invasive questions to people she barely knows. In what universe is this okay?”

That hurts. I can’t help taking that one personally, even though I shouldn’t. Toni’s a fictional character. I’m really quite mild-mannered, and not nearly as arrogant as some doctors are. It puts me in mind of a CAP inspection I once did, where the pathology department had seventeen Phase Two deficiencies, which they had 30 days to fix or the entire lab would lose accreditation. At the summation conference, chaos ensued. The techs were bewildered; the pathologists livid. Nothing had changed in ten years, they protested, and they’d been through five other inspections in that time, and nobody else gave them any Phase Two deficiencies. I can’t help it, I told them, I have to call it as I see it, and you are welcome to appeal it. I told them how to do that. I was the epitome of reasonableness. I never raised my voice.

To my utter astonishment, I got slammed for being arrogant and condescending. The regional inspector called me to discuss it. I told him exactly what happened. He allowed as how I did exactly right, and that lab was just going to have to suck it up and fix those deficiencies.

But it didn’t make me feel any better. I still dread doing CAP inspections. Maybe so close to retirement I won’t have to do any more.

But I digress.

Last item: excessive and oddly placed swearing. One reviewer had an issue with swearing in both books.

Guilty as charged. I swear a lot. Nobody cares. Most people laugh. I write the way I talk. In the future, I shall warn reviewers that if they don’t like strong language, perhaps they shouldn’t review the book.

So how did I handle these two reviews? What did I do to make myself feel better? I looked up Lisa Scottoline, who is a best-selling author whose novels feature kick-ass lady lawyers whose language is as strong as mine. She has many many 4 and 5 star reviews, but she also has some 1 and 2 star reviews, and some of them put a lot of emphasis on all the swearing these lady lawyers do.

If Lisa Scottoline gets a few bad reviews, who am I to complain about a couple? It’s life, for a writer, to take the bad with the good and deal.

In other words, suck it up, princess.