Seasoned readers, within a few paragraphs, can tell if they’ve entered the presence of a strong writer. Pyrotechnical prose can get you so far, but then you need a strong plot and engaging characters. The Patient, a thriller from first-time novelist Jasper DeWitt, checks all these boxes and delivers a fast, intriguing story with an ending you can see coming, until it changes course completely and surprises you again.
What started as “The Patient Who Nearly Drove Me Out of Medicine,” a series of diary-like chapters, documenting fictional encounters between a bright young doctor named Parker and a mysterious patient, was first posted on a Reddit forum for aficionados of the horror genre. It caught the attention of readers, Hollywood, a literary agent and a major publisher. Three years later, The Patient, from Houghton Mifflin Harcourt came out to strong reviews, a Best Debut Novel nod from Library Journal, and an option picked up by actor Ryan Reynolds for a film.
The story shifts between medical diagnoses, scientific discussions and evil spirits choking with rage. The narrator, a top-of-his-class, fresh in the field, open-minded psychiatrist who’s eager to help, slips into paranoid unreliability, or perhaps it’s the perfect clarity needed when dealing with a demon. It’s hard to tell, and that’s part of the intrigue. In a nod to the book’s own progression, the story is presented as blog posts, increasingly fraught as the tension builds.
DeWitt is now in the editing stage of his second novel which he describes as “psychology colliding with the possibly paranormal.” He writes anonymously, under a penname, in the manner of Elena Ferrante, so we can’t include a photo, but he discussed the book and his journey with Woman Around Town in an interview edited for length and clarity.
Maybe you could start by giving readers a sense of what The Patient is about.
The Patient is the story of Dr. Parker H—–, a Yale School of Medicine graduate who goes to work at a poorly funded, out of the way hospital in Connecticut against the wishes of his professors, looking to assuage his guilt over not being able to save his schizophrenic mother from dying. He discovers that, at this hospital, there is a patient who people are afraid to even talk about, and who no one has been able to diagnose or treat in the 30 years he’s been there. Convinced he’s the smartest person in the hospital and more than equal to this problem that decades of doctors have failed to solve, he finagles his way into working with “The Patient.” It goes both better and worse than he could possibly have expected.
Fiction can be a form of extensive metaphor, telling something that didn’t happen as a way to talk about something that does. But it can also just be a good, page-turner of a story. Which did you set out to write?
When it comes to metaphor in my fiction, I usually do the equivalent of shooting arrows and then setting up targets so it looks like I hit bull’s-eyes. That said, The Patient did literally start with a metaphor: in this case, for how self-loathing can become a self-fulfilling prophecy. That said, that metaphor would’ve been useless if I didn’t construct a banger of a plot around it, like an architecturally gorgeous roof built on a shack. The story was always going to be the foundation that justified the metaphor, and so that’s what I most consciously set out to work on.
A writer’s path to publication and their artistic practice and journey aren’t usually in lock step, but in The Patient they were intertwined. Could you talk a bit about the Reddit posts and how the novel evolved?
So when I posted the first chapter of The Patient on Reddit, I had written three chapters of it, covering the parts in the novel now that lead up to when Parker (the doctor) meets Joe (the titular patient). But I was totally stuck on where to take the story from there: anything that happened between Joe and Parker felt like an anticlimax. However, when I put the story on Reddit and it went viral, I realized that what people loved about the story was the mystery element, and so (spoiler alert) leaning into the anticlimax element was actually the best thing I could’ve done with the story. From there, the rest of the plot fell into place in a revelatory flash. It also, totally by accident, got its one title that stuck. Before Reddit, it had gone through several titles, such as “Incurable Joe,” “The Internalizer,” and “The Incurable.” But thanks to having to format the title to meet Reddit’s standard, it got the much sexier title “The patient that nearly drove me out of medicine,” which of course just became The Patient.
Were those early readers and their reactions part of the writing process?
Yes, actually, mostly because they would try to guess the outcome, and that would give me an idea of which ideas were too obvious. I was playing with several ideas of just what was wrong with “Joe,” concerned that my first idea had been too obvious. As it turned out, it was the only thing they didn’t guess! So that was helpful.
You use a first person narrator, Parker, so the reader hears only his thoughts. Why did you choose that? What did it facilitate, and what did it complicate?
I had to do that because everything on Reddit’s NoSleep board is told in first person. But the story was always intended to be in first person, even before I thought of putting it on Reddit, because ultimately, it’s someone warning the world about what they’ve experienced. A lot of great horror takes the form of apocalyptic logs like that: most of Lovecraft, M.R. James, E.F. Benson, Dracula, etc. It also felt very important that this story have a narrator who could be seen as unreliable because so much of this novel is bound up with the subjectivity of mental health. To be honest, I can’t imagine this story with a third person omniscient narrator. I could maybe have shown what the other doctors in the hospital were thinking, but ultimately, the claustrophobia of being in one person’s head with one person’s thoughts throughout was absolutely essential for the story to work.
Yet, Parker’s voice changes in significant ways throughout, and that change becomes part of the story. How did you make those changes come through to the reader?
I think the key balancing act there is that Parker is telling this story from a position of knowledge, and yet we still have to feel we’re there with him. So when I needed to show his thinking changing, or his voice evolving, I would let his narrative style converge a little bit more with what we read early in the chapter, to show the increased maturity, cynicism, and humility that came from the experience. I also wanted to very clearly emphasize his emotional reactions to the many, many jarring events that take place in the novel, because those emotional reactions can set the tone for different approaches to the world. Trauma, obviously, changes a person.
What do you hope surprises readers about The Patient?
The ending, and in a good way! I know it’s been divisive among some audiences: some have accused me of writing a cop-out, for example. I assure them that the ending I wrote is exactly the one I wanted to write, and the only one that fit with the story I wanted to tell, and the metaphor I wanted to use. I didn’t write myself into a corner and then take an easy way out: this was the intended end and the intended theme all along. I hope people can allow themselves to enjoy that surprise.
What do you hope stays with people, after they’ve closed the final page?
What Parker says at the end of the book: don’t denigrate anything by treating it as “just your imagination.” You never know what might happen. Originally the 1931 version of Dracula ended with a speech by Edward van Sloan as Van Helsing, saying: “When you get home tonight and the lights have been turned out and you are afraid to look behind the curtains—and you dread to see a face appear at the window—why, just pull yourself together and remember that after all, there are such things…” I can’t put it better than that.
Top photo: Bigstock
Cover image courtesy Houghton Mifflin Harcourt