Posted by Athena Scalzi
https://whatever.scalzi.com/2025/10/15/the-big-idea-caitlin-starling-5/
https://whatever.scalzi.com/?p=57772
Stick out your tongue and say “ahh!” for author Caitlin Starling’s newest gothic novel, The Graceview Patient. Follow along in her Big Idea as she recounts all of her real-life experiences in the wild world of hospitals that led to the inspiration and creation of this medically based horror story.
CAITLIN STARLING:
I feel like I’ve written a variation on this essay several times already, for various purposes and varied audiences. At first, I felt a little embarrassed–for my past works I’ve had a wide spread of topics to write about–but then I realized that this focusing effect really proves there is one Big Idea behind The Graceview Patient:
how stressful, complicated, and terrifying being a patient is.
My own hospitalization was almost routine. I had a kid. I very dramatically had a kid, but even without the drama, I would have been treated to at least a day or two inpatient, and that might have been enough to plant the seed that would become The Graceview Patient. It is a credit to my care team that the drama was manageable; I came out of a thirty-six hour induced labor (iv penicillin sucks, by the way), an urgent c-section with a surprise failed epidural, lots of meds being slammed into my veins very quickly, and some light hemorrhaging, and some strange blood pressure wonkiness feeling pretty okay with what had gone down.
This, I suspect, is not the norm.
And why should it be? Being reminded of the fallibility and idiosyncrasies of your body, being confronted with your mortality, having to cede control and even awareness, occasionally, of your physical self–it sucks. If anybody claims it doesn’t, I have questions. I do not like the missing time I still have between when the midazolam really hit me post-delivery and coming back to a very unreliably shaky body in the recovery room, even though I’m also very glad I was not aware of a lot of went down in the interim. It’s a funny story in hindsight, but it wasn’t great watching the IV tech try to get better access for a blood transfusion and fail because my veins decided to collapse every time she got near. Getting that blood transfusion (eventually) was great for experiential research, and the weird red phone we had to lift off the hook so that the door out of the NICU would slowly open is a fantastic sensory detail, but, on the whole, I wish we could’ve skipped both.
And that’s a lot of what being a patient is, right? Things we wish we could skip over. I was raised accompanying my mother to clinics and visiting her during hospital stays. She had AIDS, and it was the 90s, and she got to try a lot of experimental regimens. Some worked. Some didn’t. Some royally sucked the whole way through. Maybe having a front seat to all of that is part of why I’ve had this fascination with medicine my whole life, or why I feel oddly comforted being inside a hospital even when the specific experiences I have aren’t the best.
At any rate, I think we can safely say that I am drawn to writing about the body. About the medical. I’ve written Victorian surgeons (The Death of Jane Lawrence) and ill-advised enucleations (Last to Leave the Room) and logistically reasonable but capitalistically horrifying bowel surgeries (The Luminous Dead). Now, for The Graceview Patient, I decided to go all in.
It was time to write a hospital book. A gothic, in particular. The hospital as haunted house, as living setting, as mystery and threat and enticement.
And I immediately was hit by a problem. I did not want to make the doctors and nurses and techs and hospital staff evil. That’s often the way it goes: the sinister nurse, the sadistic doctor. Both bother me a great deal. We already have a lot of tension here in the US when it comes to medicine. It seems like, after a brief wave of treating healthcare workers like heroes (note: the definition and practice of that treatment deserves some discussion too, but perhaps not here), we overcorrected all the way towards disdain and distrust. I did not want to add to that.
I did add a potentially sinister pharmaceutical rep (my conscience allows that much), but even with Adam in play, I probably didn’t entirely succeed. I think, to write a hospital horror novel that avoided those tropes entirely, it would need to be from the perspective of the hospital staff themselves. Writing a book about a patient immediately creates an adversarial set up. Meg, our protagonist, has entrusted her care to people who come and go on shift, who have more insight into her body than she does at many points, that can administer medications that influence her perception of the world. And in a horror novel, the whole point is to delve into that adversity. To explicate on the terror and dread and risk of it all.
To reveal exactly how I solved this dilemma is, frustratingly, too far into spoiler territory for a release week essay. But I can say, at minimum: Meg’s care team are, first and foremost, trying to do their jobs. Meg will admit to you in the first chapter that she is unreliable. Oh, she’s trying her best. She is desperate to sort of fact from fiction, reality from hallucination. But she is, to put it bluntly, Going Through It. Even outside the realm of horror fiction, being a patient is extremely difficult. ICU delirium is a real thing. It’s easy to get disoriented, to grow frightened or angry or withdrawn. A good care team takes steps to ameliorate the problem, but there’s a limit. Hospitals are designed to help before they’re designed to be comfortable. The lights will stay on. The noise will continue. No, you can’t sleep through the night. Yes, it will eventually take its toll.
Something might be haunting Meg. Something might be haunting the entire hospital. There may be a grand conspiracy against her. Or…
Or maybe not. Maybe she’s just suffering. Maybe she’s confused. Maybe, in that confusion, she’s perpetrated horrible things herself. Care is difficult. Healing is not linear. And trust is fragile.
The Graceview Patient: Amazon|Barnes & Noble|Bookshop|Books-a-Million|Powell’s|Midslumber Media|Macmillan
Author socials: Website|Bluesky|Instagram
https://whatever.scalzi.com/2025/10/15/the-big-idea-caitlin-starling-5/
https://whatever.scalzi.com/?p=57772
![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
![[syndicated profile]](https://www.dreamwidth.org/img/silk/identity/feed.png){kind=small}
