The Evolution of Fatal Intent

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Tammy Euliano, author of Evolution Of Fatal Intent, on The Table Read

Written by Tammy Euliano

After 20 years as a physician, researcher, and educator, something was missing. I’d achieved the goals I’d set for myself and realized the next logical step, moving up the administrative ladder did not play to my strengths (understatement – I stink at managing people). Also, my eldest was a senior in high school and the others weren’t far behind.

Meanwhile, after completing an introductory textbook of anesthesia, my 80-year-old mentor and I decided to continue our collaboration with a work of fiction featuring the full-scale human patient simulator he and I had worked on since its invention. Sadly he fell ill before we made much progress on the novel, but the seeds for my encore career were set. While hiking in Sedona with my husband on our twentieth anniversary, I had an epiphany—I can reinvent myself. (What better place for epiphanies, really, than amongst all the crystals and vortex…es(?) and general kookiness.)

Finding Writing Time

We returned from our trip and I resigned my position as Residency Program Director (shepherding 88 Millennials through their anesthesiology residency – ugh) and other administrative posts, closed out my research, and dropped to part-time at the hospital. I intended to spend the new-found hours writing, except I almost immediately learned that I didn’t know how. That years of writing academic articles, and a love of fiction did not translate to writing fiction. Who knew? Probably everyone but me…

So, being the academic I was, I began a quest to learn to write. Turns out, I was a writers dream reader, so engaged in the story I never analyzed the craft. Very quickly I learned terms like point-of-view and head-hopping and passive voice and wow, the world of writing is no less dense than medicine. I went to trusty Amazon to find a book to teach me to write a book, which seemed kind of meta, and discovered there were pages and pages of great-sounding titles, and whole books on setting and character and theme…oh my.


I started with K.M. Weiland’s “Outlining Your Novel” and learned a ton. With that guidance I came up with an outline for the book that had been in the back (and often front) of my mind for several years, a book about a mercy-killer for hire and the surrounding implications.

The issue of managing the end-of-life has fascinated me since childhood, oddly enough. My 5th grade class debated the fate of Karen Ann Quinlan, a young woman in a persistent vegetative state whose parents wanted her ventilator disconnected, while the State of New Jersey disagreed. The fact that technology can keep the body alive called into question the meaning of life. Kind of a big concept for a ten-year-old.

In medical school and residency, the question resurfaced repeatedly, while watching families’ extended mourning in the ICU, and anesthetizing patients for innumerable procedures despite little to no hope of a meaningful recovery. Meanwhile, the absurd cost of medical care in the US frequently made the news, especially expenditures in the last few months of life and final hospitalization. 

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Creating My Characters

And so, Dr. Kate Downey, the protagonist in my debut novel, came to life. She is quite a lot like me. Shocking for a debut author, I know. Though a few years my junior, we share careers as anesthesiologists who specialize in obstetric anesthesia and teach medical students and residents, sometimes using a simulated operating room environment. Our personalities overlap a bit, or did when I was her age, but there the similarities end.

Instead of my tragedy-free life to date (knock wood), she suffered the loss of her parents and now the traumatic brain injury of her husband. Boy, are we authors cruel, or what? I have to keep reminding my husband that Kate is not me, and he is not her comatose husband, Greg. As for her dog, I’m afraid mine is just as energetic, spoiled, and completely untrained…times two.

Tammy Euliano Book

One thing I found interesting was the evolution of my characters over the course of writing. They began fairly two-dimensional but eventually took root as fully formed people distinct from anyone I knew, with their own ideas about things. Weird, I know. When a scene doesn’t feel right, I have them write me a letter. Just free-form writing, stream-of-consciousness without editing, and they say the most interesting things!

I’d read about that happening to authors and thought they were a little kookie…maybe spent too much time in the red rocks of Sedona. But it really happens, and when I let the characters do what they “want” and respond in the way that’s true to them and not what I thought they should do, it flows along seamlessly. Well, not seamlessly, but far better than the square-peg/round-hole version.

The Road To Publication

After innumerable revisions and query rejections and pitch-fest requests followed by rejections, I volunteered to moderate a panel of medical fiction authors at Bouchercon, a huge annual mystery writer/reader convention.

One of the panelists, Pat Gussin, is a retired family practitioner who wrote a wonderful series of medical mysteries and now owns a medium-size publishing house called Oceanview with her husband, a former executive at Johnson & Johnson. After the panel, she asked about my writing and invited me to submit my work to Oceanview. I sent my two completed novels and received an email a few months later that they loved what was then called, “Do No Harm.”

We signed a contract in January of 2020. You remember 2020, the year that wasn’t. From there, everything went smoothly. A title change (“Do No Harm” is too common), a few edits, a great cover, and then the blurb requests. I HATE asking people for things. Part of why I wasn’t a good administrator. But I did it.

Having been to Thrillerfest several years in a row, the thriller-writers version of Bouchercon, I’d met many of the most popular authors at least in passing. With Covid raging, I think they were (1) less busy with travel and (2) prone to kindness for a physician in the trenches. Fatal Intent launched on March 2, 2021 (the other year that wasn’t) and I had a great time with blog-based and podcast interviews arranged by a (very expensive) publicist. With no book signings or public appearances surrounding the launch, it was fairly low key, but still thrilling for a debut author.

Without the unwavering support of my husband and kids (and dogs), and the invaluable cheer-leading of my writing buddies, Fatal Intent would not have come to be. I hope Kate’s story will stimulate discussion about meaningful life and compassionate death.

Find more from Tammy Euliano:



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