Interview: Blake Charlton
Blake Charlton, author of "Endosymbiont," said that for him most stories have multiple origins that slowly combine over time.
"The first spark of ‘Endosymbiont’ came from an article in Science about Carsonella ruddii that revealed its amazingly short genome and examined its implications on horizontal gene transfer and the evolution of organelles," Charlton said. "In particular, I was fascinated by how in the serial endycytosis theory of prokaryotic evolution, the progenitors of mitochondria and chloroplasts would have had had to sacrifice their independence to become endosymbionts. I saw this as kind of the opposite of placental motherhood in which a mother has to sacrifice to give her child independence. Underneath it all was a question about whether there was a cellular basis to our conception of mother and daughter. I put on my sci-fi thinking cap and began to wonder if perhaps there might in the future evolve a new kind of creature, perhaps involving artificial intelligence, that would provide a new mode of motherhood."
But it wasn’t until Charlton’s first semester in medical school when he began to meet patients on the ward and in the classroom that the story matured. "My biochemistry professor, an oncologist, presented a fascinating case in which a middle aged patient, through doctor error, had been given a massive overdose of cisplatin–an exceedingly toxic chemotherapeutic agent that uses platinum ions to poison cells," Charlton said. "The result had put the patient into a coma, destroyed her kidneys and done massive damage to her liver. When she woke from the coma, the patient found herself in agony, blind, deaf, and without a sense of taste or smell. Through the Herculean efforts of the professor, the platinum was removed from the patient’s body. Slowly her vision returned, and her hearing recovered enough to be functional with hearing aids. She had to suffer through dialysis for three years before she received a kidney transplant."
But the truly, absolutely shocking thing about this seventy year old woman was her character. "When interviewed in front of the class, she alternated between joking with the doctors and scolding them for their ‘newfangled’ manners," Charlton said. "When the medical students got to ask questions she only called on the ‘handsome boys’ and reminded us all that she was single again. I’ve rarely laughed so hard and never laughed so hard in a biochemistry class. Here was a woman who had suffered more pain—and pain unlike anything I could even imagine—and yet was not in the least bit bitter. When I asked her how she avoided bitterness and how she could stand to be presented to a whole class of medical students when doctors had failed her so profoundly, she grew serious and said something like ‘It’s a struggle. There were some very long and agonizing and lonely nights. And when you face the dark times and think about what had been done to you…well, you have to choose to face it and then refuse it.’"
Somehow this patient’s irrepressible character and her struggle to avoid bitterness meshed with Charlton’s previous thinking about prokaryotic evolution and motherhood. "Of course I couldn’t use the patient’s voice," he said. "She was entirely too strong. The instant readers got to know her, they would know instantly that she would succeed in fighting off bitterness. So when I began to tell the story bouncing around in my head, I discovered I was doing so in the voice of a frightened, vulnerable, but equally irrepressible teenager. I was writing in the voice of many of my former students and those few teenage patients I had come to know. From there it was simply a matter of applying my butt to the chair and my fingers to the keyboard and the story seemed to write itself."
The protagonist’s snide and youthful voice comes very naturally to Charlton; she is an amalgamation of the learning disabled students and teenage cancer patients he has interacted with as a medical student. "An acute awareness of how unfair the universe has been to her heats her otherwise thoughtful words," he said. "When provoked she’s prone to sarcasm and snide remarks. Like most young people, she is phenomenally perceptive and constantly uncovering new emotional forces influencing her. She has more than a shade of scientist about her; her desire to understand why things are the way they are drives her curiosity. Most importantly, she seeks an explanation of and a reason for her cancer. But the answers she finds–as they are for so many of us facing adversity–only lead to more questions and more pain. It is in this context, that she struggles to understand the truth and define herself."
Stephanie’s struggle against embitterment is similar to the struggle Charlton has seen in many of his learning disabled students. "It is also a struggle I went through when I was dealing with my dyslexia," he said. "This background helped me to understand my character, but it also threatened to overwhelm her. I had to be very careful to be true to her voice, to constantly steer the story toward the feelings and issues of one struggling with a disease (not a learning disability) the themes of biology, technology, family, and motherhood that would be important to Stephanie."
Charlton’s father’s recent struggle with cancer also added to the inspiration and challenges of writing the story. "About four years ago my father was diagnosed with angiosarcoma, a very dangerous cancer of the blood vessels," Charlton said. "For several years in a row, everyone lived with the fear that dad only had a few months to live. It turns out that our family is one of the lucky ones and that dad has gone into full remission (knock on wood). But even so, it seems that we are all still recovering from the anxiety and shock that the surgeries and chemotherapies brought on. Writing this story provided me with an opportunity to reencounter the difficult family dynamics disease brings on. I knew also that the story might provide the chance to spread the word about research charities, and so in a way writing the story felt a bit like taking revenge on cancer."
Right away, the theme of Seeds of Change appealed to Charlton’s belief that fiction can be a mode of social change. "I firmly believe that it is only through imagining other ways of life and other experiences that we ever gain the ability to sympathize and so become more responsible citizens," Charlton said. "The most important revolutions begin quietly. The perception of injustice and suffering must precede any action against them."
In a moment of "gleeful linguistic frivolity," Charlton saw the anthology as a chance to plant his own–perhaps small–seed of change by bringing the strange world of cancer and the stranger world of neuroethics to readers. "It’s my hope that reading ‘Endosymbiont’ prompts understanding of what it’s like to struggle with disease and thought as to what exactly defines a human neurologically," he said. "The fields of neuroscience and neurology are advancing more quickly than most people realize. And as new imaginative and curative technologies enter the hospital and clinic, we as a society will be faced with new and strange ethical questions. In ‘Endosymbiont’ I speculate about a much larger step than we are likely to see in the new few years. But it is my hope that imagining these issues now will prime the pump as it were and prepare us for future ethical challenges."