My New Job

I have a new job! It requires me to be sophisticated but accessible, assertive but diplomatic, literary but not highfalutin. Unfortunately, it comes with no office, no salary, and no chance for promotion.

No, after nearly 30 years at UCSF, I haven’t quit my day job. But I have taken on a moonlighting gig. I’m the Self-Appointed Regional Marketing Director for my wife Katie Hafner’s soon-to-be-published memoir, Mother Daughter Me. In this blog, I’ll share a few observations about my new role and the way the world of bookselling has changed. My hope is that you find this world as interesting as I do… and (since I do have a job to do) that you end up buying the book. (Here!!!)

This is Katie’s sixth book, but the first one that is remotely personal; her others were non-fiction, covering the history of the Internet, computer hackers, the reunification of Germany, and the eccentric piano virtuoso Glenn Gould. I’ve written several books myself, including textbooks on hospital medicine and patient safety, and books aimed at lay audiences (Internal Bleeding, The Fragile Coalition). Both Katie and I have learned a few things about the book business, and we’ve both been astounded by its transformation in the last few years.

Before I get into that, a few words about Mother Daughter Me. Katie, who is an accomplished journalist (she’s written for The New York Times for nearly twenty years, mostly covering technology but more recently healthcare), survived a traumatic childhood. Her mother, Helen (not her real name), a brilliant woman who was an alcoholic, got a quickie divorce when Katie was five, whisking Katie and her older sister away from their father and their home in Rochester, New York to live in Florida, then, 18 months later, San Diego. But not long after arriving in San Diego, Katie and her sister found their mother comatose following a binge of pills and alcohol. The kids were removed from her care and sent back East to live with their father. While Katie stayed in touch with her mother throughout her teenage years and adult life, it was from a distance.

Fast-forward 41 years, to 2009. Katie, now a 51-year-old single mother with a teenage daughter (she and I met four years ago and married last year), faced a difficult decision. Helen, still living in San Diego, was in a life crisis, one familiar to millions of people with aging parents. Helen’s partner of several decades was showing signs of dementia and had entered a nursing home. A combination of severe osteoarthritis and carpal tunnel syndrome rendered Helen in need of help. In a blink, Katie confronted the classic Sandwich Generation dilemma, but with a twist: What are our obligations to our aging parents as they enter a stage of dependency… if they were far-from-perfect parents to us when we were kids?

Katie chose to have her mother move in with her and her teenage daughter, Zoë. Hope was high. Zoë was excited about bonding with her grandmother, and vice versa. Katie looked forward to deepening the relationship with her mother, a woman she loved but in retrospect did not know very well. In fact, the two older women began to refer to their upcoming experiment in tri-generational living as “Our Year in Provence.”

But the “Year in Provence” rapidly spiraled into a Half-Year in Hell. Here’s one brief scene from the book that will give you a sense of how sideways things went. A few months after her mother’s arrival in San Francisco, Katie and her mother leave the office of the family therapist they’ve been seeing. The therapist, Lia, has been trying to broker a truce between the two of them, but things aren’t going well. Katie and her mother stop at a store on the way home.

We’re on our way to a nearby Trader Joe ’s, and I savor the silence, wondering if my mother is going over her mental grocery list: Lactaid, frozen vegetables, and salmon, which she’ll fret about the entire time it’s in the cart as it gathers warm-air “contamination.” When we get there, she suggests we take a single cart to avoid redundancies but divide our groceries—my items on one side, hers on the other. Then she says, “We’ll make it work.” At first I think she’s referring to the divided grocery cart, but then I realize she means something else, and I’m not so sure I agree with her. If she’s not going to give therapy an honest try—and she seems to distrust Lia already—that’s surely going to make things harder. In no mood to be agreeable, I watch her struggle with her good hand to retrieve a half-gallon of Lactaid from a high shelf. Pretending I haven’t noticed, I turn my back and, cruelly, offer no help.

When we get home, my mother pulls from her bag a receipt for something I had asked her to buy for me a few days earlier.

“You owe me ten dollars,” she says.

You owe me a childhood.

And with that I realize that perhaps I should have sought help before creating this situation. For years, whenever I told people about my childhood but assured them that my mother and I were now close, that I held no anger, they would ask, “How can you be so forgiving?” I always responded with this: You can spend your life carrying hurt and anger toward a parent, or you can get over it and move on. All that time I had thought I resided safely in the latter category, but now I’m seeing that I’m still in the former.

I’m not over it. Not one little bit.

A few months after her mother moved in, Katie lay in bed one night and told herself, “I’m either going to write about this or it’s going to kill me.” Over the next few days, she produced a book proposal, then signed a contract with Random House. Three years and a half-dozen drafts later, it was done. Mother Daughter Me will be published one month from today.

We’ve now entered the uneasy interlude between the completion of the book and its publication, the AV node of the publishing process. The goal during this stage is to drum up interest and get prepared for the launch. In the old days, a big publishing company like Random House would decide on whether the book was any good and whether it had a realistic chance of selling reasonably well. They would list the book in their catalog, offer it to bookstores, and wait for reviews. About a month after the launch, the verdict would be in: either the book was catching fire, or it would be allowed to die a quiet death. The latter was precisely my experience with my first book, The Fragile Coalition, about the politics of HIV/AIDS as seen through my role as program director of the Sixth International Conference on AIDS. It was published by a reputable house (St. Martin’s Press) and it got great reviews. But I was an unknown and it sold a few thousand copies, mostly to friends and family. While not a huge surprise, it was disheartening.

But when publishers were committed to a book (as determined by some combination of big name author, hot topic, and great writing), they did more: pushed to get you on national TV and radio shows; sprang for a national tour; ran some ads in The New Yorker or the Times. And the leash was longer: they might wait a couple of months to watch for embers of sales momentum that they could fan before making a book a DNR. I had a positive experience with Internal Bleeding, which was promoted well by a small publishing house and briefly landed on a few national bestseller lists.

In either case, the publisher unambiguously drove the marketing bus; it was considered unseemly for an author to be too aggressive or independent. Sure, authors talked up books with their friends, and tried to capitalize on any media or bookstore opportunities. But the idea that the author would run a parallel marketing campaign… well, that would have been seen as bad form.

It’s no secret that the book biz has been transformed by the Internet. In all but the biggest cities, bookstores are struggling, leaving far fewer opportunities for book readings. While appearing on Terry Gross and getting a glowing Times review or an Oprah atta-girl remain crucial ingredients for success, so too are a boffo website, a lively Facebook page, and a large Twitter following. And a buzz on Amazon or Goodreads? Priceless.

The economics frame the decision making. If a book has a list price of $26, the author receives 15 percent, minus 15 percent of that for her agent, for a grand total of $3.30 per sale. Although the publisher’s total cost per book is a closely guarded secret, one can assume that the company has more skin in the game than the author. Yet the author has only this one book to worry about. Random House, the world’s largest publisher, has hundreds of books on its plate.

This means that the author – and her Self-Appointed Regional Marketing Director – need to be squarely in the PR business, including deciding whether to invest their own money into promoting the book. For those who want to do so and can afford it, the sky is the limit: there are private book publicists (up to $50,000 for a full-court press), webpage developers ($1000 and up), even niche players who specialize in, say, getting clients interviews on local NPR stations in secondary markets like Hartford and Nashville. Moreover, unless the publisher is willing to spring for a tour, one has to decide whether the time and money spent traipsing around the country to speak in bookstores and to book clubs is worth it. (I can’t remember being as dispirited as I was during a few of my own bookstore appearances, speaking to a handful of people, some of them homeless, others who had come in looking for gardening books and felt sorry enough for me to sit down.)

At this stage, we’ve been pleased with Random House’s commitment. They designed a spectacular cover (when we first saw the rip and the Scotch tape, Katie and I wondered whether it had torn en route, and then we said, “Oh, now we get it!”), staged a 50-book giveaway on Goodreads that drew nearly 1500 entrants, and gathered “blurbs” from prominent authors. At the same time, we are doing our own thing, including setting up book parties in key cities and launching the book’s website.

In the end, it’s a crapshoot. For Anna Quindlen or Salman Rushdie (two other Random House authors), a bestseller is a guarantee. For an obscure author, it’s a moon shot. For a well-respected New York Times journalist who has written beautifully about a compelling topic, the odds are long (after all, there are about 42 million books on, including 638,279 biographies and memoirs), but success isn’t out of the question.

The early reviews are mostly positive. Last week, Parade Magazine, which goes to 33 million people in nearly 500 Sunday newspapers, named MDM one of its five recommended nonfiction summer reads. The early customer reviews on Goodreads are fabulous, as have been the first reviews in trade journals Kirkus, LibraryJournal, and Booklist. But there are also speed bumps: a tough review in Publisher’s Weekly, and the publication three months ago of a memoir by poet Maya Angelou (her sixth!) with nearly the same name. Through it all, I’ve been doing my thing by tweeting about the book and chatting it up; my colleagues were even taking bets on whether I’d hawk it during my keynote last month at the annual Society of Hospital Medicine conference (I didn’t).

Why am I spending so much time on this, my second job? I love my wife, I love this book, and having a bestseller would be great fun. And I love a good suspense tale: at this point, I have no idea how this particular story ends.

22 Responses to “My New Job”

  1. Chris Johnson June 2, 2013 at 2:20 pm #

    Good luck, Bob. I know your new job quite intimately. My fourth book comes out in October and . . . . who knows how it will do. Like your first book, my last one had starred reviews in Publishers Weekly, won an award, made a top 10 list, etc. Yet sales were so-so. Still, although mediocre sales are the kiss of death for many author’s next book, my agent managed to sell the next one to a publisher. So we’ll see.

    Like many folks in my position, I’m watching the ebook sales piece closely. Now I sell as many ebooks as dead tree ones. Interestingly, my publicist is heavily slanted this go-around toward internet marketing.

    Interesting times for authors. But I’ll buy the book. So that’s one anyway.

  2. anne vinsel June 2, 2013 at 3:18 pm #

    Don’t apologize! I follow a blog on social media where the author routinely posts his high school kids’ sports triumphs. Your new job is actually pretty relevant to a lot of people here. I’m working on a novel with a strong medical connection (about a concentration camp survivor who just found out she has AZ, and starts telling stories to her dogs so they don’t get lost forever), and it is interesting to see what happens to other people who are farther along than I am.

    Also, your spouse is interesting. Not sure why a reviewer called her “plucky”, that sounds very condescending, but her backlist is exactly the kind of stuff I’d be interested in if I were a real nonfiction writer. I’ve ordered everything. I noticed that one of her books is high on the ebook sales list, so something is working!

    Finally, my boss is away right now helping settle his in-laws half way across the country, and almost everybody i know is either in the same boat or has been or is looking at being in it soon. If you have a lucky reader who hasn’t got this issue in their lives, their patients certainly have.

  3. Jerod Loeb June 2, 2013 at 4:58 pm #

    Well Bob, you sold a copy to one of your Chicago fans (my wife). It has been preordered on Amazon as an e book! You are a marketing genius and have found a second career, not that you ever needed one.

  4. Alain Ades June 2, 2013 at 5:40 pm #


    As a little reminder, I was Chief GI Fellow when you were Chief Resident. Lots of Chiefs, but in those days that was a good thing.

    I am going back to school this year to start my PhD in American History. I find myself bored with medicine, and truly frustrated about the transliteration of your tenets in the community hospital and the associated sociopathy of overpaid hospital CEO’s. Time to eliminate the impossible dream, fighting an unbeatable foe.

    Hopefully I will leave behind a book or two. One of my dreams is to write about the Hepatitis C epidemic at Exeter Hospital. The concentration of the press and the US Attorney has been the “serial infector” , but not the environment that really allowed it to happen. Unfortunately, the hospital has been settling all the cases with huge pre-deposition payments with gag clauses. I am concerned that money will hide criminality, and since this is a small community, the press has been beyond woefully inadequate.

    Wish me luck, Bob. The hospital has already threatened defamation lawsuits, etc. But once gathering the necessary knowledge, an agent, and another set of letters after my name, I will ask you your techniques for getting the book sold.

    I very much admire what you are doing!

    • anne vinsel June 2, 2013 at 6:49 pm #

      I would read that! Don’t forget that truth is a defense to libel, I assume the same logic applies to defamation as well. Have you thought about “fiction”? I suspect that, more than threats from the hospital, it will be lack of cooperation from people who have taken the money that would hamper your ability to do it journalistically. With “fiction” you wouldn’t have the same constraints. I bet you know what went on and could turn that into part of a novel, or maybe even a murder mystery? Or maybe Gray’s Anatomy would like it if you could get it to them.

      I also work in a hospital, in a position where people are continually telling me I should write a book. It’s the no-income hiatus between getting fired and being able to live off my royalties that stops me 😉 I have no idea what your Hep C situation involved, but my all purpose medical title is Speed and Greed. It’s yours if you send me a free ebook 😉

      • Alain Ades June 2, 2013 at 9:03 pm #


        You got a deal. A former editor for a major publishing house suggested I do the same thing- write historical fiction. I could even use names, etc. The unfortunate issue is that truth is the ultimate defense, but I do not want to blow huge sums on lawyers, and when in the hands of a judge and jury, the decision is very often totally separate from the facts. My best friend the lawyer told me never trust 12 people with an important decision.

  5. Debi Wong June 2, 2013 at 7:16 pm #

    Hi Bob:

    I usually attend regiional SHM updates, perhaps at the next national convention, you should have Katie speak. She seems to tell a compelling story, certainly one I can relate to. I’d love to meet the both of you! Good luck and where can I find a hard copy of her book?

  6. Carrie Brady June 3, 2013 at 12:08 am #

    Sold! It’s an important topic that is not often candidly discussed. I am looking forward to reading it.

  7. sharon kleefield June 3, 2013 at 3:23 pm #

    Bob, what a remarkable story you’ve shared with us. Professionally, I will miss reading your newsletters, articles and case studies, which I’ve used all over the world for teaching! I was just about to decide on my next book to read, and now you’ve solved that ‘problem’. What a wonderful family and wife you have. Your ‘new job’ is the job you’ve really had all along!

  8. Jon June 5, 2013 at 2:26 am #

    Guess I will go against the tide here and float the comment, utterly irrespective of the content and value of the book itself, which may well be superb, that Bob’s taking advantage of this forum provided to him by his position at the ABIM to shill his wife’s book is shameful.

  9. JustAPatient June 5, 2013 at 11:37 pm #

    Actually Jon, the reason no one else has made such an inane comment is that this blog predates Bob’s position with the ABIM (as anyone can see from this site, the first post was in 2007) and thus he is taking advantage of nothing other than the fact that it is HIS personal blog and he can write about whatever he wants.

    • Jon June 6, 2013 at 12:14 am #

      Well, yes and no. I first became aware of WW when the ABIM saw fit, for a time, to provide a link to WW, around the time he became Chair of the ABIM, and with a link to a particular part of his blog, the part that promoted MOC, a subject about which I have a great interest. I chose to follow that particular WW thread, and later on, a few other selected threads. However, I, like others, I am sure, who also first became aware of WW via that ABIM link, now receive unsolicted emails regarding all manner of topics that Bob chooses to post on his blog. So yes, I suppose under the strictest analysis of the situation, it is a private blog and he can post what he wants, but clearly, that original nudge from the ABIM helped him, inappropriately, in my opinion, expand his audience.

  10. Leah Binder June 8, 2013 at 2:49 pm #

    I can’t wait to get a copy! Katie Hafner is a brilliant writer and this sounds powerful.

  11. Jon Lloyd June 8, 2013 at 9:04 pm #

    Heartiest felicitations to Katie and you, Bob. Your promo is a monument to love and appreciation for excellent writing. I loved Katie’s Romance on Three Legs and look forward to this important next book.


    Jon C. Lloyd, MD, FACS

    Senior Associate

    Positive Deviance Initiative

    Tufts University

    Friedman School of Nutrition Science & Policy

    Cell Phone: 412-512-3974

  12. ARCpoint Labs of Salem June 11, 2013 at 2:30 pm #

    Congratulations on your new job supporting your wife. Hope for lots of success.

  13. ARCpoint Franchise Group June 13, 2013 at 2:25 pm #

    Hope it goes well, the book launch should be quite a wild ride. Wish you both the best.

  14. ARCpoint Labs of Altamonte Springs June 25, 2013 at 2:55 pm #

    Congratulations to you both on your new adventure! Sounds like it is going to be a great book, very heartfelt.

  15. SeniorCare Homes June 27, 2013 at 5:45 pm #

    How excited! Good luck to you and yours on this new venture!

  16. Barbara Nagler Wasylenki August 3, 2013 at 5:52 pm #

    Hi Bob,
    I am your second cousin (my grandfather, Bennett Steinhauer, and your grandfather, Julius Steinhauer, were brothers…I think). I live in Albuquerque.
    I loved Katie’s book.It is a “can’t- put- it- down human, and touching read.”
    You are a fortunate man, and she is too. She married into the nutty but lovable Steinhauer clan. I have heard from your parents how wonderful their children are and their daughter-in-law.
    Good luck with the book!

  17. Debi Wong, FNP August 18, 2013 at 4:03 pm #

    Well, instead of a hard copy, I did download Katie’s book from iTunes and have just finished the first chapter. Wonderful, totally relate, luckily I did consider having my mother move in with me, one of us would have likely done bad things to each other! She did unfortunately die on her own, alone, and when I received the call from the Walnut Creek police department, I knew it would not be good.

    On a happier note, I will be down this year to attend the UCSF Hospital Medicine course and look forward to your keynote and hopefully Katie will be there too! I plan to follow with a trip down memory lane to visit old neighbors scattered about the Bay Area and to visit my old home site where my one of my childhood buddies (or enemies), Steve Jobs grew up across the street from me.

  18. Managed care September 17, 2013 at 7:05 pm #

    Doctor, you’re doing a most commendable job in this new career you’re carving for yourself. You made a believer out of me. Purchasing a copy right now!


  1. "Mother Daughter Me" by Katie Hafner - July 2, 2013

    […] new husband, Bob Wachter, excerpts on his own website a key moment in her realization of “how sideways things went” a few months into their […]

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