The Fredericksburg Writers Group recently asked me to speak on publishing my book, Carrying The Black Bag, and to provide thoughts for new writers trying to become authors. I was pleased to do so and thought I might share these same thoughts to my readers.
My book took me five years to write (on and off) and confronted many difficulties and rejections. Some suggestions on dealing with this process are as follows:
1. BE passionate about your story. In my case, my stories demanded to be told. I felt my patients entrusted me with their stories, and I was brimming to share my patients’ humanity and courage.
2. LEARN to write for a popular audience. This may seem simplistic but it is not. I found it challenging to break away from scientific and medical writing. Texas Tech University in Fredericksburg offered popular writing courses that proved very helpful. I developed the courage to begin using similes, metaphors, alliteration etc., something as rare in medical writings as finding the Lochness monster.
3. REWRITE, Rewrite, and Rewrite some more. I had at least a dozen edits that I thought were wonderful, until I reread them. Your finished product (or at least what you think is your finished product!) must be your best to stand a chance of being published.
This young reader gave me a great morale boost when I saw this picture of her reading my book between surgical cases
4. JOIN a critique group. Critiquing others and having them critique your work are extremely helpful for improving your writing. It may seem a little threatening, but you’ll get over it. Once trust has been established you will end up sharing what you may never have shared with your spouse or even with your dog.
5. IDENTIFY beta readers for your best version. These are a few folks well versed in literature and grammar and can provide a good editorial review.
6. FIND an agent. The best way to do this, in my opinion, is by going to Literary Conferences. Many conferences have agents and publishers present and interested in the subject material of the conference. It’s a great way to practice your pitch, gain feedback, and make helpful contacts.
In my case I landed two prospective agents at a medical writer’s conference. I selected Don Fehr at Trident Literary Group in New York City. It is the largest such group in the U.S.A. and has substantial expertise and reach.
7. From my agent I learned that for nonfiction, publishers did not buy books, they bought book proposals! This was news to me.
Many books exist on how to write a book proposal. My agent stressed the proposal be at least 65 pages long and be extremely well written. This was quite a task.
8. The agent then sends the proposal (in the case of a nonfiction work) or the entire fiction manuscript to a number of potential publishers. Then you wait, wait, and wait some more for the reviewers to respond. Ugh!
9. Once a publisher says it is interested, the publishing house (in my case Texas Tech University Press) will assign an editor. I can only hope you find someone as good as Joanna Conrad at TTUP. She was delightful and made the book better.
Following the review process by your press (mine being an academic institution, the manuscript had to be approved by, of course, various committees!) The next step is copy editing. I had a contract copy editor who proved extremely helpful. It’s humbling to learn that errors still exist in your much pored over manuscript.
Expect your publishing house to change your title. It’s inevitable. Also it will assign an artist to develop the cover, but hopefully it should ask you for your opinion. Also you will be asked to supply the “information about the author” and various blurbs for your book.
The whole process of publishing may take one to three years before your book reaches the bookshelves. This considerable delay is a frequent surprise for most new authors.
10. HIRE a publicist. Unfortunately even the largest publishing houses these days have limited marketing budgets. While this seems strange given that marketing sells books, but it is a truism. Authors are being asked to do more and more to market their books. As an aside, my barber even keeps a supply of my books in her shop. Customers ask about them and she has sold a number of my books. Be Creative!
Actually I have enjoyed marketing my book. It has been a heck of a lot easier than writing it. 
I began by forming a “street team” of people that liked my writing. These wonderful folks became “Tom’s Wranglers” and were invaluable in spreading the word, writing initial reviews, identifying book events where I might present, and providing much needed encouragement.
Two of my Wranglers- Betty and Cecil Selness
Madeline Douglas and La Nelle Etheridge, two more of my wonderful Wranglers
Now back to publicists– these are invaluable. A cost is involved but you really didn’t think you were going to get rich on your book, did you? The publicist can arrange for reviews of the book and may put your book up for awards.
11. Speaking of awards, nothing builds the confidence of a struggling writer as much as public recognition. In my case I won a third prize early on in a writing contest. Woo Hoo! This provided a surprising amount of confidence.
I next won The Creative Expression Award from the American Academy of Neurology. Now this award, given by my peers, made me feel like a real author. You likely too have some outlet through your vocation to provide an outlet for your work and an possible award. It is worth a try.
In my case the agent and I went through some thirty publishers before finding one that wished to take on the task of putting my book into print without having to do a major rewrite. Authors best have thick skins as this process can be painful. There is simply no way to sugarcoat this– rejection hurts.
12. Once published my book won an award for best debut author and became a finalist for the Montaigne medal. 
These awards proved reassuring for me as a writer. How much they contribute to sales is highly questionable, but undeniably recognition provides a stimulus for the author to keep writing. Again, these awards were the result of the knowledge and expertise of my publicist, Maryglenn McCombs.
So there you have it. Becoming an author is arduous. It is nine tenths perseverance. One author I heard speak recently said success publishing depended on three things: 1) talent, 2) determination, and 3) luck. I agree that a degree of talent, a lot of perseverance, and finally a little luck are all needed to move from being a writer to becoming a published author. I wish all of you good luck in this process.
Views From Medicine Spirit Ranch 