A Woman’s Guide to Living With Heart Disease: my blog-turned-book project!

by Carolyn Thomas   ♥   @HeartSisters

The Pitch. . .

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”  Have you considered writing a book based on your excellent Heart Sisters blog? I would love to explore the possibility with you.”

The date was September 9, 2015, and that’s how the message began that was about to change the next two years of my life. It came from Jacqueline Wehmueller, then Executive Editor at the prestigious Johns Hopkins University Press (JHUP), the oldest academic publisher in North America.

These thrilling words led to many e-mail and phone conversations with Jackie, followed by submitting a project backgrounder, a draft 10-chapter table of contents, and a sample chapter to JHUP before we could sign the book contract.

I also completed the JHUP multi-page standard proposal document (essentially questions like “Why this book? Why now? And why are YOU the person to write this book?” – to which I’d previously answered with my inside voice: “Ahem. You called ME, remember?”) 

I wrote and rewrote this document, with additional creative input from artist/wordsmith Judith Westerfield!  (Thank you, Judy-Judith!) 

As you might expect from a prestigious academic publisher like Johns Hopkins University Press, there are a number of careful steps potential authors must go through before a publishing contract gets signed.  The first steps for my book project were to have the entire package successfully reviewed by:

• an anonymous Johns Hopkins University cardiologist (it passed!)
  
• the Editorial Advisory Committee (passed!)
• the Faculty Board (passed again!)

Which brings us to the official signing of the publishing contracts at my living room coffee table one evening after a family dinner. My deadline to submit a 70,000-word draft manuscript was November 1, 2016, with the final book delivery tentatively planned for about a year later. I signed both copies of the contract and assorted paperwork to return to JHUP, but only after first consulting with my accountant friend Terry Parkes who was able to translate the vagaries of the U.S.-Canada Tax Treaty for me. (Thank you, Terry!)

 The late author Susan Sontag once advised other writers:

“There is a great deal that either has to be given up or be taken away from you if you are going to succeed in writing a body of work.”

That sums up nicely another important factor that I’d also been struggling with ever since that first approach from JHUP.

As a heart patient living with the ongoing and debilitating symptoms of coronary microvascular disease, I’ve learned how to carefully pace each day, each event, each outing so as to minimize symptoms, buffered by naps or rest or nitro spray both before and after every one. Mostly, this pacing works pretty well. But throw in a busier day, a bigger event, a longer-than-expected outing, or getting stuck in traffic, and I’m often reduced to an exhausted wreck.

How on earth did I think I’d be able to write an entire book on top of everything else?  How could I add anything this BIG while still safeguarding my health?

I had raised these concerns during my initial discussions with Jackie Wehmueller at JHUP.  She reminded me that, with over 700 published articles on my WordPress-hosted Heart Sisters blog so far, I’ve essentially already written the book. All I needed to do now was to organize each chapter’s theme to include some excerpts from this post, more from that post, still more from others, and then write simple transitions between each excerpt. Easy peasey.  (Thank you, Jackie!)

Writing the book. . .

In anticipation of this writing project, I bought myself a new laptop to replace my ancient MacBook Pro (which I loved dearly, despite its one fatal flaw: the “o” no longer worked on the keyboard).

You would not believe how many words have the letter “o” in them. . .

The new laptop is another MacBook Pro, but this one had weirdly perverse issues from Day One that weekly put me on a first-name basis with the Apple Support folks on the phone. How could I possibly write an entire book while struggling with a screen that liked to freeze up for no reason, or page numbers and citation endnotes that refused to be inserted properly? I learned a lot of do-it-yourself tech tips from the Apple folks, and practiced a few new swear words.

Then I started populating my draft Table of Contents with actual words and paragraphs, better known as “writing the book”. Like many of my blog articles, each chapter started with a theme introduced with a specific personal narrative which then expanded to a broader discussion of closely related themes, including what research suggests about each chapter’s unique focus. As you already know if you’re a regular Heart Sisters reader, I like evidence! This was especially important when discussing potentially controversial subjects – like the known rates of misdiagnosis of women’s heart disease. As I reminded my editor: “Jackie, I’m not making this stuff up!” – while pointing out the corroborative weight of published scientific research. Still, when the anonymous JHU cardiologist had reviewed my draft Table of Contents, the reaction to Chapter 3 (titled: “Finally. A Correct Diagnosis”) was simply “sounds like doctor-bashing to me” – and that defensive response was to just a little bullet list of sub-headings!

I knew I’d need a visual outline of my 10-chapter draft Table of Contents to constantly refer to. A big foamcore poster fit the bill, propped up on my dining room table, covered with large Post-its, piled and rearranged endlessly, as pictured below. It made a nice decor accent and a conversation piece for visitors.

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Very early on, I enlisted the help of my favourite daughter-in-law, Paula Dunn.

Not only is she a tech whiz who rarely feels the urge to throw the laptop over the balcony railing as I do, but she is the most detail-oriented proofreader and grammar expert I know. Paula was also kind enough to memorize the entire Chicago Manual of Style (that’s the writing guide required of all JHUP authors) so that when she was proofreading my early drafts, we’d know if I were appropriately following all writing style guidelines. While on vacation in Harrison Hot Springs with her hubby/my son Ben, Paula chose to be indoors in the hotel proofreading my draft manuscript to help me meet a deadline while Ben played in the hot springs pool. (Thank you, thank you, thank you, Paula!)

I had to keep to a regular writing schedule which, because of ongoing cardiac issues, I was not good at doing.

Unlike my blog articles, which have neither deadlines nor any need for third-party edits, suddenly I now had big deadlines marked with a red Sharpie on my calendar, and countdown pressure to produce something quite fabulous by those deadlines.

Not since my long-ago days working in public relations had I been writing for anybody else, but suddenly I had to not only send the finished product to one JHUP editor, but the draft would need another final round of feedback from their internal reviewers (the cardiologist, the Editorial Advisory Committee, and the Faculty Board).

I needed somebody to write the book’s foreword for me – but it couldn’t be just anybody. I knew that, in a perfect world, it should be written by somebody who is highly respected in the field of cardiology, somebody with expertise in women’s heart health specifically, and somebody I admired who was also familiar with my work. I gathered up my courage and asked Dr. Martha Gulati (a born-and-raised Canadian like me, and a cardiologist I’ve described here as one of the true “rock stars of cardiology”). I was over the moon when she immediately said YES! Her beautiful four-page foreword made me cry when I first read it.  (Thank you, Dr. Martha!)

Most days, I spent a couple of pre-breakfast hours (when my brain seems to function best) working on the book.

The smartest decision I made was to keep participating in as many daily social outings as possible (e.g. my weekly walking groups, coffee with friends, taking my darling grandbaby Everly Rose to daycare in her stroller four mornings a week). But much of my post-writing hours later in the day were spent crashed on my big red chair in an exhausted heap trying to recuperate enough to write more the following day.

I was also well over my maximum word count. My book included a unique chapter called Carolyn’s Patient-Friendly, Jargon-Free Glossary of Confusing Cardiology Terms at the back of the book. I’m really proud of it – but it’s over 8,000 words long. I wondered: How strictly does JHUP count words, really?

I’m sure now, in the deadline-free luxury of hindsight, that relentless exhaustion was what led to a few dark periods of feeling utterly stuck during the summer of 2016.

I’d seesaw between paragraphs that fell effortlessly into place, followed by feeling like I was writing and rewriting the same awful paragraph for days with no hope of ever improving it.

The lowest point: I vehemently disagreed with JHUP marketing staff over the title (and I still wish I hadn’t caved!) Our working title for two years had been “Heart Sisters: A Survivor’s Take on Living With Heart Disease”. The (now former!) Marketing Manager had not actually read my manuscript (or anything on my blog) but somehow, he still knew everything about the subject. He told me he’d never heard the phrase “heart sisters” (which is commonly used in cardiac support circles  – it’s what women often call other women with heart disease). But the Marketing Dictator decreed that our working title would be “too confusing” for women readers, explaining it to me like this, very slowly as if I were simple-minded:

“They might think this book is a romance novel. Or a book about Valentine’s Day.”

I spent an entire weekend struggling under his deadline to change to the title he suggested – or else. I wasn’t sure what the “or else” meant –  but I suspected that if your publicity staff feel hostile to an author, they’re not going to do their best to help market the book. So in a state of utter exhaustion and despair, I caved in, and that’s why the book lives with its title as published (even though it is definitely not a “guide” to anything).

Then, very close to the absolute drop-dead deadline – and as if I weren’t distressed enough by then -I lost entire chunks of the  manuscript. Thousands of words had somehow disappeared from my new Mac and had to be rewritten at the last minute.

Finishing the book. . .

I did make that deadline for the completed first draft manuscript on time, and then I waited for a response.

And waited. And waited. What was taking so long to hear back from Johns Hopkins University Press?

My question was answered a few days later with a return email from Jackie that basically said: “I LOVE IT!”  Even the introductory preface I’d written for the front of the book was described as “a masterpiece”. Whew. . .  🙂

The next step: the entire draft needed to be reviewed by a cardiologist for his/her assessment. This makes sense. A publisher of JHUP’s status and reputation would of course expect that the content of a heart book bearing their name is credible and medically accurate. But tracking down a busy Johns Hopkins University cardiologist who has the time to spend weeks casting a critical eye over 70,000+ words of a new heart book would be a challenge.

Happily, the same cardiologist who had approved my original sample chapter and draft Table of Contents almost a year earlier was interested in now reviewing the completed manuscript! (Thank you, anonymous cardiologist! )

But wasn’t this the same person who thought that even saying the word “misdiagnosis” equaled doctor-bashing? Should I be worried? My target readership, after all, is NOT cardiologists, but their female patients.

The month of November passed agonizingly slowly while I waited for the cardiologist’s final review.  When the review comments finally arrived, I opened the file to find that the reviewer had called my book “an important new contribution to the literature”. (Thank you again, Dr. Reviewer!)

But what knocked me right out of my chair was this little assessment, almost a throwaway line on the second page of the review: “Chapter 7 was irrelevant to female heart patients, and should be deleted.”

I was so shocked that I had to go back and open the file containing my draft manuscript and look up Chapter 7, because I honestly couldn’t remember what it was in this chapter that rendered it so objectionable that it deserved to be trashed.

Then I had to have a wee lie-down just to pull myself together.

Let’s just say that in follow-up communication with Jackie to discuss the reviewer’s comments, I argued that, in my opinion, Chapter 7 was the most patient-centric chapter in the entire book (and did I really have to mention the irony of a cardiologist telling a female heart patient what is or is not relevant to female heart patients?!?) 

Happily for female heart patients, Chapter 7 would end up staying in, as is. I’ll leave it to you readers to determine whether the reviewer was correct when you read the book. Excerpts from Chapter 7 can be found here,

or here,

or here.

The next steps were a blur while we waited for the copy editing stage to finish.  Meanwhile, I heard from the JHUP graphic design team who were working on my cover, the sales team who would be selling my book to bookstores, the marketing team who would be publicizing my book to media and book reviewers, as well as the catalogue team who were describing my book for the 2017 fall/winter catalogue of new JHUP books.

The catalogue was followed shortly by an unexpected gift in the mail: a box of business cards with my book cover on one side, and pre-ordering discount information on the other from JHUP publicists. (Thank you, Kathryn Marguy!)

But the best news amid those two years of excitement was landing my wonderful new copy editor, Deborah J. Bors!

Her official title: Senior Production Editor, a longtime staffer at Johns Hopkins University Press. Debby would become my go-to person from the moment she requested the assignment. Her first email to me after she had edited the entire first draft was so encouraging, adding that she felt “truly privileged to have the opportunity to work on an important and life-saving book.”  Our working relationship evolved over months and was one of the highlights of my entire book experience. I learned that I could confidently trust Debby’s wisdom and experience, and that any changes she suggested inevitably made for a better book – well, maybe except for those Tim Hortons maple dips! (Thank you, my dear Debby!)

But we still had lots of editing left to do. I had to carefully go through the book page by page now, incorporating Debby’s editing suggestions, adding another deadline on the calendar to get everything sent back to her. Several weeks later, the page proofs arrived (they’re the unbound finished pages just as the book will actually look, including page numbers) and that meant another page by page proofreading process to see if any overlooked errors remained in the page proofs. Once again, I met the page proof correction deadline on July 21st, and a week later I met the index deadline, too. It was All Book, All The Time around here, 24/7.

I loved creating the index! This meant going through the whole book looking for key words or phrases or people’s names, grouping them appropriately, and adding page numbers to help readers looking for a quick way to find a specific topic. Paula and I had several meetings to discuss this index – in person, by phone, via email, but our favourite indexing meetings were over lemon French toast at Sunday brunch.

On August 2, with the index returned and rechecked for accuracy, I could follow Debby’s advice:

“Rest now and do not worry about anything. Just enjoy anticipating your wonderful book coming out!”

About three restful months later, the Fed Ex man delivered a cardboard box of advance review copies to my door (below).

The reality didn’t quite sink in: my two-year adventure was coming to an end, and another one was about to start when the books are shipped out to bookstores and start generating book reviews and media interviews.

Already, I’ve had experiences with different cardiologists who have seen one of the advance copies, saying something polite like “Oh, very nice. . .” but then doing a double-take when they saw the publisher’s name, stopped in mid-sentence and said some version of “Wow! Johns Hopkins University Press!??!” (Thank you, JHUP!)

See also:

The book reviews are coming in! Read them here!

A few different ways to order your own copy

Read Chapter 1 here.

Excerpts from this blog article were also re-posted on the Johns Hopkins University Press blog in three weekly parts:

Part 1,

Part 2

Part 3

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Author photo for book cover: Robin Duncan

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Q:  What’s your best advice for balancing a big project with the demands of real life?