DETECTIVE FICTION

Before Stieg Larsson and Keigo Higashino, it was Raymond Chandler who transformed detective fiction

‘Neither of the two people in the room paid any attention to the way I came in, although only one of them was dead.’

The Big Sleep cemented Raymond Chandler’s place in the literary hall of fame and it did so with a smart-aleck, rarely sober shamus and a plot as important as a torch in daylight. Here’s remembering the quick-witted writer’s debut novel on his 58th death anniversary.

This isn’t a piece about how good Raymond Chandler’s debut novel, The Big Sleep, is. We know that already. Neither is it a systematic pegging down of Chandler’s treatment of women characters: “...you have to hold your teeth clamped around Hollywood to keep from chewing on stray blondes.”

No, the plan is to simply dive into the story and its impact on one of the most immortal genres of writing. Nearly six decades after his death, Chandler’s novel remains exactly what the man intended it to be: hardboiled detective fiction that doesn’t just walk tenderly across the tightrope between literariness and pulp. It hops and summersaults with wild abandon to the other side.

Non-literary stories use ordinary language in a precise and accurate manner. Their job is to temporarily inform, educate and entertain. Whereas literary works of fiction make aesthetic use of artistic devices to further the plot, leaving an indelible mark on the reader. With The Big Sleep, Chandler throws this theory out of an eighteenth floor window. The characters, their dialogue, the meandering plot exist for one purpose only – to entertain and expose with finesse.

Meet the detective

The Big Sleep introduces us to Philip Marlowe, the lone-wolf, self-loathing private detective who is the central protagonist in all of Chandler’s seven novels. Marlowe’s a straight-shooter who upholds his own sense of moral justice, enjoys the attention of women but rarely ever succumbs to their mine-ridden charms, and drinks like it’s going out of fashion.

Then we have the Sternwood sisters – Carmen and Vivian. Their wheelchair-ridden millionaire father, General Sternwood, sums them up perfectly: “Vivian is spoiled, exacting, smart and quite ruthless. Carmen is a child who likes to pull wings off flies. Neither of them have any more moral sense than a cat...I presume they both had, and still have, all the usual vices.” Marlowe’s been hired to get to the bottom of a blackmail involving Carmen and what seems like a straightforward job quickly unfolds with multiple murders, an erotica-lending library and deadly secrets. All the characters have something to hide.

Murder, he wrote

Before you put this down as a classic whodunit you should know Chandler didn’t care too much about the movement of plot. Like the olive in a martini, he would say. As you near the end of the novel you begin to realise the murders were almost incidental, existing mainly for Chandler to create characters and situations that astonish and delight the reader. And boy, does he go to town with physical descriptions of places, events and people involved!

When Marlowe visits the Sternwood mansion in the second paragraph of the opening chapter, he describes the first thing he sees, “Over the entrance doors, which would have let in a troop of Indian elephants, there was a broad stained-glass panel showing a knight in dark armor rescuing a lady who was tied to a tree and didn’t have any clothes on but some very long and convenient hair. The knight had pushed the vizor of his helmet back to be sociable, and he was fiddling with the knots on the ropes that tied the lady to the tree and not getting anywhere. I stood there and thought that if I lived in the house, I would sooner or later have to climb up there and help him. He didn’t seem to be really trying.”

Here’s Marlowe’s description on seeing Carmen for the first time.

“She was twenty or so, small and delicately put together, but she looked durable...She walked as if she were floating...She came over near me and smiled with her mouth and she had little sharp predatory teeth, as white as fresh orange pith and as shiny as porcelain...I could see, even on that short acquaintance, that thinking was always going to be a bother to her.”

After inspecting a suspected murder made to look like a road accident at the pier, Marlowe is riding back with a copper friend and describes the scene out his window: “We went back along the pier and got into Ohls’ sedan again...drove back towards town along a three-lane highway washed clean by the rain, past low rolling hills of yellow-white sand terraced with pink moss. Seaward a few gulls wheeled and swooped over something in the surf and far out a white yacht looked as if it was hanging in the sky.”

Wordy wise

The only writers left who have anything to say are those who write about practically nothing and monkey around with odd ways of doing it. Chandler’s metaphors and use of adjectives create vivid images in the mind of the reader and help you understand a little more about the characters and places being described.

The Big Sleep is peppered with descriptions that are brought to life with comparisons (“dead men are heavier than broken hearts”), sardonic retorts (“I don’t mind if you don’t like my manners. They’re pretty bad. I grieve over them during the long winter evenings”), and Brylcreemed summing-ups (“He sounded like a man who had slept well and didn’t owe too much money”, or, “Neither of the two people in the room paid any attention to the way I came in, although only one of them was dead.”)

One of the main reasons why this novel stands out among other detective fiction popular at the time is because of its realist approach to crime. Arthur Conan Doyle’s Sherlock Holmes or Agatha Christie’s Hercule Poirot are geniuses whose approach to solving a murder (usually a high-profile one) is more akin to solving the Sunday crossword. Philip Marlowe dives headfirst into the seedy underbelly, dirties his hands to get to the truth, and his sense of justice doesn’t usually end on a happy note.

As The Big Sleep comes to an end, certain characters have got a raw deal or made to face a bitter truth. The novel’s title alludes to death – which has already taken place for some, is round the corner for others, and is metaphorically significant for most of the characters, including Marlowe. “I was part of the nastiness now.”

While the Sternwoods continue living the life of privileged millionaires, Marlowe gets by on $25 a day plus fuel while he’s on the case. But at the end we’re made to realise the great leveller isn’t partial. What did it matter where you lay once you were dead? In a dirty sump or in a marble tower on top of a hill? You were dead, you were sleeping “the big sleep”.

The continuous use of symbolism and metaphors in the novel is what elevates Chandler’s fiction. WH Auden was right when he said Chandler’s thrillers were not escape literature but works of art. The Big Sleep is a cocktail of crime. Its ether-sniffing, slightly deranged femmes fatales are a handful. Not a page goes by without a direct allusion to sex, drugs, booze and violence. Yet it’d be foolish to brand it pulp fiction.

Unknowingly, you will embrace Chandler’s prose from the very beginning. It’s all edge-of-the-seat without trying too hard. The Big Sleep took detective fiction out of the country house and flung it into the street, letting it gather grime, and in doing so, managed to raise it artfully. Raymond Chandler is to detective fiction what Chuck Berry is to rock and roll.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.