How to Kill Your Darlings (With Fictional Drugs)
How can a writer make up a drug that advances the plot and also sounds believable?
So a character enters a room and grabs her teacup — like she usually did across the story. Now, however, a villain added a deadly poison to the ginger tea. Before long, this poor woman will feel…
… what will she feel?
What symptoms is she about to experience?
How do drugs work in fiction?
It is a challenging question for authors who have no background in health sciences. For writers like Agatha Christie, however, who worked as a pharmacy assistant at University College London years before she published her first novel The Mysterious Affair at Styles, it is significantly easier to describe the actual effects of medicines.
It is no wonder that Christie killed off over 30 characters using poisons that do exist. And she invented the murders with such an admirable accuracy that even the New England Journal of Medicine analyzed her fiction works.
But what if you aren’t Agatha Christie (and the odds are that you aren’t)?
What if you don’t possess the medical knowledge to poison a character?
How do you come up with a drug that exists only in your book — and remains believable?
It seems like a lot, doesn’t it?
Let’s look at authors who created imaginary drugs that look so real that many readers believe they exist.
This is Stephen King’s case in the novel Misery, which features the medication Novril, the painkiller writer Paul Sheldon becomes addicted to during his nightmarish stay in Annie Wilkers’ home.
Also, a more recent example of a fictitious drug being used in a horror novel is the drug Thiolax, seen in Raphael Montes’ Perfect Days.
Perfect Days bears a strong resemblance to Misery. The authors of both novels, for example, come up with an imaginary drug to enable the gruesome plot events. Also, both novels revolve around a sadistic character keeping a writer as a hostage. And they keep these hostages (aspiring writer Clarice Manhães in Perfect Days and best-selling writer Paul Sheldon in Misery) sedated for long periods.
Now, while Stephen King’s imaginary drug Novril was based on opioids like codeine, Raphael Montes’ Thiolax plays the role of a fictitious sedative.
And it is the drug Thiolax we will discuss now — its literary and pharmacological properties.
Just relax. This won’t hurt.
The pharmacology of a fictional drug
First, let’s analyze what Thiolax does.
Early in the story, medical student Téo Avelar steals the medication from a laboratory, commenting it is used to sedate mice in experiments. This corresponds to the many sedatives in real-world tests.
Then, Téo injects his girlfriend-hostage (what a complicated relationship, right?) Clarice Manhães with the substance, and we understand that Thiolax has an intravenous administration. In anesthesia, some of the most commonly applied intravenous sedatives include propofol, thiopental, and etomidate. It is reasonable to assume that Montes must have read about the drugs and played with their real-world effects to conceive Thiolax.
When injected intravenously, Thiolax has a rapid onset of action of a few seconds. Thus, when Téo injects Clarice with a single dose, she is rendered unconscious almost immediately.
And how realistic is this onset of action (how long does it take for a medication to kick in)?
Well, it is pretty much realistic.
Three of the most widely used sedatives in general anesthesia — propofol, etomidate, and thiopental — make people unconscious after a few seconds.
But there is a catch — a difference between the fictitious Thiolax and real-world anesthetics.
After you inject someone with enough sedatives to make them unconscious, they may stop breathing by themselves.
Although this might sound uncanny, this is the bread and butter of anesthesia. Every anesthesiologist is prepared to ventilate a patient throughout a surgery — with machine-assisted ventilation through tubes or masks.
However, Téo does not have to insert a tube through Clarice’s mouth or to bring up an anesthesia machine to their deranged road trip. This is because Thiolax allows people to breathe spontaneously even under deep sedation.
Montes acknowledges the issue of a sedative inducing respiratory arrest by not using an actual drug — like the mentioned propofol, thiopental, and etomidate. It would be impossible to enact the events in Perfect Days with these drugs.
The author, then, created a drug that allows deep sedation for many hours after a single shot, and that does not provoke respiratory arrest.
This is impossible with actual sedatives.
How would the fictional Thiolax look like in real life?
In modern-day anesthesiology, doctors calculate how much sedative you need (mainly based on your weight) and also how much medication you need over time. So, in clinical settings, sedation is extremely precise.
But Téo Avelar would have a lot of trouble in real life.
None of the existing sedatives can maintain deep sedation for many hours after a single injection. This is due to their plasma levels — the concentration of a substance in the blood. After you inject a drug into someone’s circulation, the drug concentration reaches a peak and then starts to wear off. This “elimination” can occur, for example, through the liver or the kidneys.
Look at the example below:
After an anesthetist injects propofol into someone’s circulation, the sedation only lasts for a few minutes. This is because the concentration shrinks over time as the body eliminates the drug. So, to maintain someone sleeping under a sedative, anesthetists must either:
- Inject it again and again.
- Inject it over time through an infusion pump.
Infusion pumps are devices frequently seen in current medical practice. They allow doctors and nurses to define the rate through which a medication enters your body.
Téo, however, does not inject Clarice repeatedly with Thiolax, nor does he carry an infusion pump with him.
We assume that Thiolax must have an incredibly (and impossibly) long action. This would be a dream scenario in anesthesia (pun intended), but this simply does not occur with actual drugs.
Also, we assume that Clarice undergoes deep sedation throughout many scenes because she does not react to external stimuli. In reality, to achieve such a level of sedation, the danger of a respiratory arrest is too great.
Odds are that if Téo injected Clarice with a large dose of an actual sedative and then hid her inside a Samsonite travel bag, he would find her dead a few minutes later.
A quick guide on how to create your drug
All right. You acknowledged Raphael Montes’ Thiolax, but you still need to create a fictional drug for your novel.
What should you do?
Let’s look at these steps. I based them on my reverse engineering of Thiolax:
Creating your drug 101
- Identify what your drug needs to accomplish. Should it be primarily a painkiller (like in Misery) or a sedative (like in Perfect Days)? Should it have side effects? How long should it act?
- Research. Based on your drug effects, read about actual medicines that do this. Stephen King’s Novril is closely related to opioids, while Raphael Montes’ Thiolax has many similarities to sedatives. You can look up the many properties of actual drugs here (try to search for “Thiopental” and compare it with what you just read about Thiolax).
- Acknowledge the differences. What does your drug do that real-world ones don’t? Thiolax, for instance, acts for hours after a single dose, which is pretty much impossible with actual medications.
- Talk to a health professional. A doctor, a pharmacist, a nurse. Talk to someone who is used to the different medications and their effects. Ask if you got something wrong, or if something sounds unrealistic. If you want your drug to look believable without having a medical background yourself, this is a must.
- Name your poison. Branding a fictional drug can be troublesome. To achieve this, you need to look up the names of the actual medications of that drug class. Thiolax, for example, has a name that resembles thiopental, one of the first widely used medications in general anesthesia.
Pharmacology in a jar
I find Perfect Days one of the most brilliant horror novels in contemporary Brazilian literature. Raphael Montes leads a new wave of writers who aim to portray Brazil as it is — instead of inserting characters into a generic Los Angeles and calling it Rio. The novel, too, has a fast pace throughout the book, and partly thanks to Thiolax.
I mean, Raphael Montes made a good call by coming up with Thiolax. It would be a bummer if Téo had to inject Clarice over and over again with propofol, or if Montes had to describe the intricacies of an infusion pump.
So, let’s celebrate the imaginary drugs.
I hope you give Perfect Days a try — and I hope, too, that you learned a bit of pharmacology here.
And I’m looking forward to seeing you murdering your characters.
