Anna Caltabiano was born in British colonial Hong Kong and educated in Mandarin Chinese schools before moving to Palo Alto, California. Now a student in Brown University’s eight-year medical programme, she continues to pursue her interests in healing through the science of medicine and the power of narrative.

1. You self-published your first book All That is Red when you were only 14 years old, having sent the manuscript to a long list of literary agents first. In an article you wrote for the Guardian, you impart a uniquely refreshing attitude to this disheartening process, saying ‘As the rejections poured in, “No” started to sound like “Not this way”‘. To what extent do you feel self-publishing has opened doors for a wider selection of quality writing?

When querying literary agents with my first novel, a common response I received was that they didn’t know what to do with it. It read like YA, but it dealt with the dark subject of non-suicidal self-injury in a way that seemed better suited for an adult audience. They enjoyed reading the manuscript, but there didn’t seem to be a perfect, ready-made market for the book. Self-publishing helps books, like my first novel, that seem to resonate with people, but can’t be neatly categorised into a particular genre or audience demographic. As a reader, self-publishing allows for more types of books that fit untraditional niches — whether it’s a specific hobby or a topic, there’s now a series of books on it!

2. How did you learn what was necessary to self-publish your first book? Was there an immediate response or did you have to work to get it seen?

I look at self-publishing a book as a two-part process. First, there’s the writing. You have to really love the story you’re telling to not only stick with it and see it to completion, but also to go back to it numerous times to revise. Second, there’s the business of publishing. In self-publishing, you are the business; you are the one who singles out a target audience and figures out how to engage with them. This way of building a brand is much like what an author does when traditionally publishing. I was fortunate to be able to use interest in the topic of my book and my background to secure interviews and opportunities to write articles. This turned into more opportunities, such as speaking on television and radio. Social media also helped in giving me a way to interact directly with readers.

3. How did your traditional publishing deal with Gollancz come about?

After I had self-published my first novel, I was contacted by a literary agent who had read my book and seen the buzz around it. She believed in the stories I wanted to tell and even the stories I had yet to write. By the time I signed with her, I had already written a complete draft of my second novel, The Seventh Miss Hatfield. She read the draft that I had and wanted to send it to an editor to receive feedback on what to focus on in the next round of edits. The editor ended up loving the book and wanted to buy it. He became my editor at Gollancz and we worked on the trilogy together.

4. You wrote your first book by drawing scenes in a sort of visual outline, which you then strung together with words. Do you still use this method to write? How has your approach to writing changed as you’ve grown older and more experienced?

Since my first novel was thematically driven, I thought a visual outline would be a great way to jog my memory of the scenes I wanted to include in my novel without plotting out every detail ahead of time. For The Seventh Miss Hatfield and the rest of that trilogy, a regular written outline worked better, since those books were more plot-driven. I’ve found that I like to outline only a few chapters ahead and write the manuscript beginning to end, just as my reader would experience it when reading it for the first time. For the character-driven manuscript on which I am currently working, I find that this approach, coupled with detailed character outlines, is most helpful.

5. What do you have planned for the future? Would you ever return to self-publishing?

I’m currently a student in an eight-year medical programme at Brown University, so the near future involves lots of studying! I see medicine as a unique perspective from which to explore and participate in the most elemental and important human issues. I believe this experience will make me a better writer. I am currently busy working on my next book. It’s too early for me to decide if I will self-publish my next novel. For now, I am focused on my studies and writing as much as possible in order to keep some balance in my life and stay sane.

6. What is the best book you’ve read lately?

I recently read When Breath Becomes Air by Paul Kalanithi at many friends’ suggestions. Dr Kalanithi studied literature as well as medicine. While he was able to explain his own terminal illness in medical terms, when he reached the limits of what science can teach us about being human, he grasped at his literary background to explain and describe questions that science cannot answer. I can’t recommend this book enough!