Although uncertainty is an unavoidable part of life, 21st century medicine has advanced to the point that we can learn whether we are predisposed to certain cancers, heart conditions, autoimmune disorders, and neurological illnesses. While many view this information as a gift, others don’t want to carry the burden of a negative result. This dilemma – to know or not to know – is at the center of Carol Efron’s debut novel, A Hidden Fate.
Efron follows newlyweds Julia and Matt as they learn that Julia’s father has lied about her mother’s illness and death. When Julia’s mother died, Julia was a child, and her father claimed that the cause of death was multiple sclerosis. Now in her twenties and planning on children of her own, Julia learns that the true cause of death was Huntington’s disease – a genetic condition that has a 50% chance of being passed down. Julia’s unexpected pregnancy further complicates matters, and her marriage begins to crack as Matt’s ideas about what they should do conflict with her own.
Efron tells a wrenching story of a family thrown into turmoil as they face the possibility of a life-threatening diagnosis and grapple with how to navigate uncertainty and accept their fate.
She chatted with us about the inspiration for the story and her pivot from doctor to writer.
Baltimore Fishbowl: When did you know you wanted to write a novel, and how did you decide to focus on Huntington’s disease?
Carol Efron: In the mid-1980s, I was the clinical director of the Huntington’s disease clinic at Johns Hopkins, just as presymptomatic testing for this fatal illness first became available (only at Johns Hopkins and a Harvard teaching hospital). I witnessed people struggling with whether they wanted to know their future.
Later, in my private practice as a psychiatrist, I treated people who sank into major depression after using 23andMe to learn whether they carried a gene that doubles the risk for Alzheimer’s disease. Add to that a lifetime of voracious reading, and fifteen years of running a book club, and the ground was fertile.
BFB: Uncertainty is a significant part of the story. How did your work as a doctor inform your exploration of this theme?
CE: Some patients wanted detailed prognoses—if they had cancer, for instance, what did the statistics indicate about their chances to survive for five years? Other patients wanted answers that were truthful but vaguer, such as only whether they were likely to live longer on medicine X or medicine Y. Those patients were choosing to live with more uncertainty, and that was their right. I tried to be sensitive to what each person was asking and not bombard them with information they hadn’t requested—unless there was a crucial reason they needed to know more.
BFB: Many of the characters keep secrets to protect their loved ones, most notably Julia’s father, who hides the truth about her mother’s illness. The narrative remains nonjudgmental, but I’m curious about what you would do if you were faced with the same dilemma?
CE: I am sympathetic about Julia’s father’s agony as it would be awful to deliver such terrible news to one’s child at any age. I think it would have been reasonable for him to wait until Julia was 21 to tell her about her serious medical risk (unless she married earlier)—so as not to cause her extreme anxiety in her childhood. But I am convinced that it was wrong to continue to lie to Julia when she became an adult, and very poor judgment not to tell her before she married. Julia’s husband had a right to know her risk, and the risk to their potential children, and Julia should have had the information so that she could have that difficult conversation with her fiancé. In short, were I in the father’s shoes, I would have told Julia the truth when she was an adult, despite my aching heart, and done everything to help her with the terrible angst, fear and grief bound to follow.
BFB: Is there any reason (besides the proximity to Hopkins) that made Baltimore an ideal setting for A Hidden Fate?
CE: I had never been to Baltimore before interviewing at Johns Hopkins for medical school, but I fell in love with the city and still treasure its unique mix—diverse neighborhoods, a rich historical and cultural background, a lively local culture, and, of course, the crabs.
I also needed to set my story in 1986, when genetic testing for the Huntington’s gene had to involve whole families, making my novel much richer. That left Boston or Baltimore, and since I knew Baltimore and Johns Hopkins well, the choice was obvious.
An extra treat: Julia is a history grad student, so I picked an interesting figure with Baltimore ties for her to research—and then did the same for her new best friend, which is how I came across the flamboyant Baltimore socialite and the first self-made female millionaire in America, Betsy Bonaparte.
BFB: Why did you choose history as Julia’s field? And why physics for Matt?
CE: There’s a piece of writing advice that authors should beg, borrow, and steal from their own lives, especially in a debut novel. I was a history major and I love history. Making this Julia’s passion let me add rich background material about Baltimore and about the history of mental institutions in the nineteenth-century U.S.—which relates to Julia’s experience with her mother becoming psychotic due to a neurological illness and dying in a state hospital. My husband was a physics grad student at the University of Maryland, so I knew that world well, along with many physicists and their different psychologies. Luckily, my husband didn’t mind my borrowing from his life—though he does NOT have a lot of the characteristics of Julia’s husband, Matt.
BFB: Could you talk about the process of publishing the novel?
CE: When I thought I was done, I submitted to two good literary agents I had access to through friends, and to a few others. The feedback was positive, but I didn’t get an agent. I understand; it’s a tough market, and agents, like writers, are trying to survive current trends. I then applied to small presses and was accepted by one, with another giving me serious consideration.
Meanwhile, She Writes Press sent comments. They wanted some changes, and though I’d thought I was done, I agreed with their criticisms and wanted to address them.
Also, the small press that accepted me wanted my novel’s foreign rights indefinitely, with no indication they could do much with them. I also needed time to make the changes I had learned would improve my novel. So I walked away from that offer, while still waiting to hear whether She Writes Press would accept my book. I wondered if I was being absurd and reckless, as a debut author, to abandon a firm offer, but I took my chances.
It all worked out! I couldn’t be happier to be published by She Writes Press.
BFB: What are you working on now?
CE: I am writing a historical novel built around the amazing stories surrounding the dramatic 1940 collapse of the Tacoma Narrows Bridge, featuring many imagined characters. My theme is how things fall apart—projects, bridges, relationships—and what it takes to mend them. I also want to explore our tendency to ignore inconvenient truths, and the courage it takes for those who see what is coming to stand up and speak out despite serious consequences to their careers and personal relationships.
Learn more at Carol’s website, or order from bookshop.org.
