The Big Idea: Karen Osborne

Sometimes, good things can emerge from bad circumstances. Author Karen Osborne’s newest book, Architects of Memory, is a prime example of that. What started as a medical emergency spiraled into a novel about facing one’s fragility. Read on as the author shares her emotional journey from pain to novel.


An orthopedist once saved my life with a phone call. 

Two weeks before, he’d slapped a walking boot on my broken foot and told me I’d be on crutches for a while. The break had been painful, but the pain I felt that day was worse—a ravening agony, like someone had shoved a knitting needle made of molten lava up my femoral artery. 

He took one look at my swollen calf, frowned behind his Claus-congruent beard, and told me to drive to a specific hospital where the radiologists had special training in vascular issues. He called ahead—I skipped triage and was delivered almost immediately to an ultrasound room in the vascular department, where a technician tried her very hardest to keep an adequate poker face as she stared at the massive time bomb in my leg.

The orthopedist had not been my first stop. I’d appeared in his office without an appointment, literally crying in pain. I’d previously been to two urgent care doctors and my GP, who all told me that I’d probably just pulled a muscle or was experiencing referred pain, that I was too young for a blood clot. I believed them—they were doctors, and I was not—but I couldn’t shake the crawling sense of doom that was making a slow apocalypse of my composure. That day in the ER was the very first time I really understood that you could know down to your bones that something was wrong with your body and the world. I did have a blood clot, and it would have killed me if left to its own devices. 

They also found that I had a clotting disorder known as Factor V Leiden. FVL is a funny little genetic twitch that tells the platelets in my blood to keep right on singing “Come On Eileen” like they’re bartending at Coyote Ugly when they should be staggering on home after the last rendition of “Closing Time.” People with FVL have to worry about blood clots forming all the time: after surgery, after broken bones, or when they’re minding their own business walking down the street.

Recovery was $600/day of blood-thinning tablets, injections, and near-daily lab visits. It was also a major hit to my mental health: since I’d almost been gaslighted out of going to see the orthopedist, every minor pain in my leg for the next decade sent me into an anxiety spree (which the support groups actually said was completely normal). 

Pre-clot, I’d wanted to be a freelancer, but post-clot, that was completely out of the question. See, this was 2006 in the United States of America, and FVL was a pre-existing condition that put you on the no-fly list if you didn’t have employer insurance. The diagnosis stapled me to a job until I died. Want to live, Karen? Pay for it. Your worth is in your wallet.

If you’ve never had issues with American healthcare, say a prayer to whatever level of divine pasta monster you believe in that you never will. I can’t imagine what would have happened if I’d been freelancing for my paper instead of on staff. It’s a story told over and over again around here: she didn’t think she could afford the bill, my friends would have said. So she didn’t go.

A lot of us with pre-existing conditions ugly-cried when the Affordable Care Act became law. And we just haven’t been all right since the election of 2016, when the “businessman” holding the nation’s highest office started farting off about tearing it down whenever possible. 

I had just started Architects of Memory. I was angry. I imagined my protagonist Ash uninsured and staring down a healthcare system that wouldn’t give her the time of day. I gave her a quintessentially American problem: I put a time bomb in her blood and sent her off to a world where she couldn’t get treatment because she had a pre-existing condition, just to see what would happen. She’d recognize the steaming humanitarian crater that is the healthcare system of the most developed country in the world.

At least Aurora pays for your hospital bills if you get hurt on the job, she’d say. At least the CEO believes in science.

Science fiction is the literature of ideas. But ideas live in minds, and minds are meat like the bodies they run. They are linked together with an unassailable bond. When we love, we feel butterflies. When we lose, our heart aches. Ideas are married to the bodies in which they are born. Creativity is not some heavenly state divorced of care; it is a chronology of pain and nausea and viscera and breathing and moving and being. And so is science fiction. 

But Ash doesn’t have the luxury of money or time or health—the secrets of Tribulation are coming for her, whether or not she wants them. Life doesn’t wait. Everyone’s a terminal case. It’s only a matter of time. Until then, it’s a matter of if you want to be like the doctor who dismisses your crying patient, saying “it’s just anxiety”—or the one who listens and makes a call. 

Writing Architects helped me get through a time in my life when I felt like I was collecting chronic diagnoses like extremely crappy Pokemon, but at least I was allowed to actually go places. Since COVID was revealed as a disease that causes serious, fatal clotting, I’ve basically walled myself up as much as I can with a partner that plays church services for a living. The walls of my house are pretty much my world. Going for a walk feels like going EVA.

That’s the funny thing. I gave Ash her world and her problems. She gave it all right back to me. We’re all Ash now, facing down our squishy, delicate bodies, going no no no no, not symptoms, it’s too early for symptoms. Every twinge says: is this the day? Is it now? Is this it? Can I afford to go to the ER? I’ll be fired if I go, so should I go to the office instead? It’s care for those who can pay and everyone else can have prayer and oleandrin.

One of my first readers said they didn’t understand why an organization like Aurora doesn’t have more resources to deal with the problems at Tribulation. Look at how many ships they have, he said. They shouldn’t need to pick the bones of old wrecks to function. 

They shouldn’t, I agreed, but they do. Kinda like us.

And organizations like that never forget that you, too, have bones.


Architects of Memory: Amazon|Barnes & Noble|Indiebound|Powell’s

Read an excerpt. Visit the author’s blog. Follow her on Twitter.

5 Comments on “The Big Idea: Karen Osborne”

  1. And this is the kind of book that gets people like Canadians – including me – thinking about the gaps we still have in our own health care system and how we need to fill those in properly. And how we need to remain vigilant about the people amongst our own citizenry who’ve never forgiven the progress we’ve made and want the societal clock rolled backward on health care so that they can profiteer the way their pre-medicare forebears used to.

  2. See, this is what I love about the NHS. It’s not just that the health care bit of my taxes is so very much cheaper than an American policy; it’s that I know I’m covered. Even if I get cancer I KNOW they won’t find an excuse to cancel my coverage just before my op and I KNOW I won’t have to battle piles of paperwork in the middle of chemotherapy. Because dealing with the cancer would probably be enough to cope with. I still hope I don’t get to find out.

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