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I knew that writing fiction would be different. After years of writing scientific papers, editorials, essays and reports, it was the very challenge of trying something new that attracted me. That, and the thought that maybe my lifelong interest in enhancing public understanding of health care might best be tackled through story-telling.

Released from the constraints of non-fiction – rigorous adherence to accuracy, avoidance of personal opinion straying into scientific discourse, keeping to long-established structure and order – it took time to break free from those familiar and comforting shackles. But when I did, the sense of liberation, the scope to imagine, to create new realities, to shape the narrative was exhilarating. To take the historical, documented facts and have licence to conjure up plausible explanations to link disparate events was wonderful.

In some ways, there were still parallels with non-fiction. After all, scientific research papers require you to offer explanations, based on explicit theory, of how what you’ve observed may have come about. And just as non-fiction requires a lot of preparatory research, so did fiction – background reading on the age of reform, trawling through medical journals and newspapers, examining hospital archives, searching college and society registers, scrutinising maps and visiting sites. It didn’t end there. Having assembled a mountain of evidence, a narrative had to be constructed that could bring order and clarity, a task that hardly differed from the simple guidelines I had spent years teaching junior faculty and doctoral students about how to write up their research.

But from there, the similarities ended. Tentatively tip-toeing into the first draft, I became aware that the characters I was fumbling with, trying to make coherent, consistent and believable were starting to take on a life of their own. I was discovering something most novelists know. I could start to sit back and let my characters speak for themselves. They were helping me work out what they’d do or say. All I had to do was to put them in situations and then watch and listen. The writing was still challenging, at times tough going, but it felt as though I was now sharing the task. I was on a journey with them, a journey in which only I knew the destination.

I wasn’t surprised by the way my characters were taking on an almost independent existence. The limited amount I’d read about fiction writing had prepared me for this, though until it happened I had remained somewhat sceptical and doubted it would happen for me. What I hadn’t been prepared for was my emotional involvement with them. I felt protective towards them. I found myself sharing their joy and their despair as if they were close friends, real people. I shouldn’t have been surprised given the intensity of our relationship. Not just measured in terms of the hours spent writing but the days, weeks, months spent living with them. They were ever present as I walked by the sea, stood in the shower, chopped vegetables, pruned roses. As if by magic, solutions to dilemmas I had been grappling with would offer themselves, resolving obstacles that had concerned me for weeks.

At times, I wondered if I had become too involved with the main characters. Maybe greater detachment would enhance my writing. But that didn’t seem to be an option, even if I wanted it. Sometimes my involvement was overwhelming. Without giving anything away about the plot, there were scenes that reduced to me tears as I wrote them. Even now, months later, I have to brace myself to read those sections. So, yes, fiction and non-fiction share much in common but there are striking differences as well. Forty years of non-fiction writing never made me cry.