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A Toxic Thriller, Full of Twists

Posted on Sep 26, 2022

Developmental pediatrician Joel Shulkin, M.D.
Developmental pediatrician and novelist Joel Shulkin, M.D.

When developmental pediatrician Joel Shulkin, M.D., published his first medical thriller in November 2020, the world was in the middle of a different type of medical thriller as the delta variant of COVID was winding down and vaccines were not yet available.  

His first book (Adverse Effects) followed Boston-based neuropsychiatrist Cristina Silva, M.D., in a dangerous struggle with a small pharmaceutical firm called ReMind. She has enrolled some patients in a clinical trial of ReCognate, a drug designed to restore memories in people with trauma-related amnesia. In a journey from Boston and Washington, D.C., to Rio de Janeiro and back, Silva encounters police, the FBI, international assassins and other nefarious figures – and begins to decode her dual identity and past. 

In his latest book, Toxic Effects, which is now available in bookstores and online, Silva starts a new job at a prestigious memory center in Boston, and then learns from the FBI that she may be in grave danger once again due to her role with ReMind. Uncovering her buried memories may be key to saving her life — and many others. 

We caught up with Shulkin to learn more about his own dual identity as a pediatric specialist and writer. 

When did you become interested in science and writing? Which came along first? 

Both were strong interests early on. I grew up in New Hampshire and thought I wanted to be a space veterinarian. I also loved to read and write. In elementary school, we were asked to draw a picture and write a story to go with it. I came up with a space-traveling veterinarian who wrote stories about and painted pictures of pets. 

Those interests stayed with me. While a pre-med, pre-vet major at University of New Hampshire, I also took creative writing classes. I reworked a short story that I’d written in high school and it was published in an anthology. Eventually, I decided that I’d prefer people as my patients, and the next step was medical school. 

Tell us about your journey to pediatrics and behavioral/developmental medicine. 

I knew pretty early in medical school that I wanted to take care of children. I completed my pediatric internship and residency with the U.S. Army in San Antonio, Texas. When it was time for me to serve, I spent three years at a base in Germany and was assigned to a developmental pediatrics clinic. That work solidified my focus. 

When I returned to the states, I spent a year doing short-term pediatric assignments and applied for a developmental pediatrics fellowship, and was accepted at Boston Children’s/Harvard, Johns Hopkins and other programs. 

You started to focus more on writing in the year before your fellowship. 

At a Massachusetts Medical Society meeting, I heard Michael Palmer, M.D., talk about what a medical thriller should be like. He’d published many thrillers, including Extreme Measures, which was adapted into a movie starring Hugh Grant and Gene Hackman. I started reading and devouring many of these books, and he became a mentor to me.  

What got you started on writing your own first thriller? 

One day I was the only rider on a bus in Boston when a man boarded and, for some unknown reason, chose to sit directly behind me. I wondered why he would make that choice and the question stayed with me. It became an early scene in Cristina’s story. 

Were there other events that influenced the story? 

During my fellowship I also earned a master’s in public health at Harvard. In a course on global human rights, one of the topics was pharmaceutical research being done in other countries with limited institutional review board oversight, which got me thinking about the potential for abuse, which led me to Adverse Effects and now to Toxic Effects

How is writing a mystery like working with kids with developmental issues? 

It can be a bit of a puzzle to fit the pieces together. There are times when in the first 10 minutes of a new patient appointment I might have one opinion, but it may change by the end of the visit. Sometimes there’s still information to tease out from teachers and other specialists. In medicine they teach you “when you hear hoofbeats think horses, not zebras.” But often I’m the one looking for zebras because everybody else has already chased away the horses. 

You and your wife have 6-year-old twin daughters. How do you carve out time to write along with your other responsibilities? 

I set my alarm for 5 a.m. and first take care of morning chores. Then I sit down for an hour. I usually try to write 500 words a day, or at least do something writing-related during that time. 

Who are some of the medical thriller and mystery authors you admire?  

For medical thrillers, Tess Gerritsen — whose stories are also set in Boston — and Gary Birken. For mysteries, I especially enjoy Jennifer Hillier and Clare Mackintosh. 

Toxic Effects is the second book of a planned trilogy called “The Memory Thieves.” How do they connect? 

Dr. Silva is the heroine of both books, and there are other characters who have a role in both stories. Toxic Effects stands on its own, too. I provide some backstory so there’s no need to have read the first book. Some characters will appear in the third and later books, too. 

Since it’s September and you grew up near Boston, one last question: Rays or Red Sox?  

I’m not a huge baseball fan in general, but I was in town to celebrate when the Red Sox finally broke their endless losing streak and managed to catch their parade through town, so … yeah. 


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