Well: Martin Cruz Smith Reveals a Twist in His Tale

It is probably no accident that the pivotal object in Martin Cruz Smith's newest detective thriller, "Tatiana," is a notebook nobody can read.

Early on, Mr. Smith worried that his novel, being published Tuesday by Simon & Schuster, would be unreadable too — or wouldn't be written at all.

Author of the 1981 blockbuster "Gorky Park" and many acclaimed books since, Mr. Smith writes about people who uncover and keep secrets. But for 18 years, he has had a secret of his own.

In 1995, he received a diagnosis of Parkinson's disease. But he kept it hidden, not only from the public, but from his publisher and editors.

He concealed it, although for years, tremors and stiffness have kept him from taking detailed notes and sketching people, places and objects for his research — and even as he became unable to type the words he needed to finish his 2010 best seller "Three Stations."

"I didn't want to be judged by that," Mr. Smith, 71, explained recently in his light-filled Victorian home north of San Francisco. "Either I'm a good writer or I'm not. 'He's our pre-eminent Parkinson's writer.' Who needs that?"

In talking about his Parkinson's odyssey, including a relatively new but promising treatment, Mr. Smith is opening a window on the still incurable disorder affecting four million people worldwide, a disease that is becoming increasingly prevalent as baby boomers age.

His experience reflects a common desire to conceal often-stigmatizing symptoms, like shaking, slowness, and rigidity. (He mostly didn't mind his Parkinsonian hallucinations: a black cat in his lap, whirlwinds spiraling from computer keys, a butler, a British military officer in full regalia. "Having hallucinations for a fiction writer is redundant," he said.)

A Flow of Words

Ingenuity, gumption, and others' generosity have allowed him to keep working. "Tatiana," whose title character is a journalist who writes despite life-threatening dangers, was produced in an especially unusual way, which he also hid from his publisher and editor. In a room with a blue floor and a window glazed with prehistoric creatures, Mr. Smith perched on a wooden stool and spun out words while his wife, Emily, known as Em, typed them into the computer, gave feedback, and made his on-the-spot changes.

Neither was sure they'd succeed. Writers often "think" through their fingertips, not knowing exactly what they'll create until their hands are at the keyboard. Could Mr. Smith, whose novels braid history, suspense, deadpan humor and subtly surprising characters, write a book one step removed?

"I had a great many doubts," he confessed. "It's like playing football, except you've got two quarterbacks. It promises confusion, complication, and loss of immediate contact. You want to keep that ball moving, keep that idea within your grasp."

After finishing the book, Mr. Smith tried another gambit. His medication faltering, he got deep brain stimulation, with electrodes implanted in his brain and electrical pulses from a pacemaker trying to tame disruptive movements.

Doctors at the University of California, San Francisco, customized the procedure for their literary patient to curb "effects on verbal fluency," said the neurosurgeon, Dr. Philip Starr. "That's something, obviously, in a writer, that you want to minimize."

'Your World Collapses'

Before his diagnosis, Mr. Smith would lose his balance or bungle opening a can, but he'd dismissed it as "little things that pop up like gremlins, go away, and may not come back again for a year."

Then, at Thanksgiving in 1995, he recalled, a doctor friend asked, "Why are you holding your arm that way? You're just letting it hang." Asking Mr. Smith to raise his arm, he noticed jerky movements, and said, "I'm afraid you've got Parkinson's."

Mr. Smith said he happened to be seated that Thanksgiving next to a man with Parkinson's "so bad he had to be fed, this poor man locked within himself, a good man with a good brain." It was, he said, "a day when your world collapses."

After all, Mr. Smith, who is known as Bill, is no armchair writer. For his books, notably those featuring the sardonic Russian detective Arkady Renko, he does detailed research about nuclear weapons, Russian mafia, and political scandals, traveling to Chernobyl, Cuba, and elsewhere.

But like the bullet lodged in Renko's brain, which could shift anytime, turning deadly, Parkinson's seemed destined to outmatch Mr. Smith. "It's not like Hillary conquering Everest," he said. "It's like Mallory never coming down."

To avoid being defined by disease, Mr. Smith began what he called "hiding out within yourself, finding other ways to do things. Shaving is suddenly an adventure. Changing a light bulb in this house; Victorians never had Parkinson's."

For a while, he said, "I was getting away with it. Being a writer, you can hide out more easily. You only have to present an amended version of yourself once or twice a day."

He told his agent, Andrew Nurnberg, who accompanied him on research trips, and whose reaction, Mr. Smith recalled, was, "Oh, thank god. I thought it was me. I thought you were upset with me for some reason because you had a fixed gaze, a flatness of expression."

Tipping Point

About a dozen years and five books ago, "things started to fall apart," Mr. Smith said, when he couldn't write intricate notes or sketch images like he'd always done: coralroot orchid for "Stallion Gate," herring fishermen for "Polar Star." "My research started really being affected."

He started taking his wife along. "I would ask questions and she would write down the answers." He took photographs, but felt "when you can't draw things, to some degree it makes you blind."

He became less agile, once tripping in Red Square. To steady tremors, he'd affix his hand to his face like a Rodin statue. "You can only stuff your hands in your pockets so much. People would say, 'you're flapping inside your pants.' "

While typing "Three Stations," he repeatedly made typos, and correcting them and wrangling ideas into sentences exhausted his body and imagination. "It was like trying to catch a fish with your hands," he said, an image he includes in "Tatiana."

Then, Ms. Smith, 70, offered to be her husband's fingers. "I actually didn't know if Bill could do it," she said. 'How could you say things aloud to someone else?' "

Mr. Smith imagined reactions: "When I go to the dentist, I want just the dentist. I don't want the dentist and his wife."

But in the room lined with books about seemingly everything except Parkinson's, the Smiths found a rhythm.

While he thought, she entertained herself reading back copies of The New Yorker. She declared: "I'll do this if there are no children and no dogs that are killed," things that occurred in the last book.

He spilled out remarkably fluent sentences, then yanked back words and swapped them. Ms. Smith loved entering his fictional world. She'd note if dialogue rang false or scenes seemed thin. She suggested that he write the first draft of a love scene without her in the room.

"There's probably an amendment or change or suggestion of hers on every page," he said. The process had "a calamitous nature to it, an are-you-swimming-or-are-you-drowning kind of aspect. Then it's like, no I'm just treading water."

Now, Mr. Smith calls his wife "my interpreter." In "Tatiana," loosely based on the 2006 killing of the Russian journalist Anna Politkovskaya, the cryptically important notebook belonged to an interpreter.

Mr. Smith did not tell his editor, Jofie Ferrari-Adler, until he learned he loved the manuscript.

"You could have knocked me over with a feather," Mr. Ferrari-Adler said. "You would never ever, ever, think it was written that way." Mr. Smith told him he hadn't disclosed his Parkinson's because "he didn't want me to pull my punches."

Mr. Smith also reported he'd just had brain surgery, after years of different types and doses of medication.

"He was kind of between a rock and hard place," said his neurologist, Dr. Jill Ostrem. "Lower the medications too much, then you have tremor. But if he took more medication, he developed nausea, low blood pressure, and hallucinations."

Treating the Tremors

He was a good candidate for deep brain stimulation, or D.B.S., which was approved for Parkinson's in 2002. But D.B.S. can have cognitive effects, and Dr. Starr said Parkinson's had already slightly affected Mr. Smith's short-term and verbal memory. On tests of "naming objects rapidly, he scored in the moderate level," Dr. Starr said. "In language testing, his score was good, but one would have been expected him to be kind of excellent."

So Dr. Starr, highly experienced with D.B.S., implanted electrodes in a brain area, the globus pallidus, believed to cause fewer cognitive issues than a more commonly-implanted area.

And doctors implanted only the left brain, to treat his most-affected side, the right, because "if you implant both sides your risk of cognitive decline is probably a bit higher," Dr. Ostrem said.

Now the "daily torture of the tremor" on the right has largely disappeared, Mr. Smith said. He is well enough for a cross-country book tour and traveled to Italy for his next book, which Ms. Smith is typing, since that ability hasn't returned.

He has fewer hallucinations, although "yesterday I saw a woman by the stairs who wasn't there, and a black dog often appears in places where there isn't one," he said.

"I'm not who I was since Parkinson's," he said. And sometimes, "I don't find the first word I'm after. But I'll take the second word, the third word. I'll take it because I like new ways of expressing things. It makes the work alive."

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