Two years ago, my friend Christi asked for my help framing a book about her breast cancer journey. Although she had previously written and published a memoir and self-help books, she was struggling to arrange these painful new experiences into a clear narrative.
The storytelling techniques I’d learned from studying fiction helped us uncover the dramatic structure already present in Christi’s story. By combining those techniques with her vision, her clinical knowledge as a psychologist, and her hard-won wisdom as a cancer survivor, we shaped her experiences into an inspiring memoir and guide to emotional healing.
As Christi related her memories, I realized interviewing her was like researching to write historical fiction. When plotting my novels, I mine old books and archives, scanning the text for interesting details and events to form the bones of the story. I found I could apply the same methods to narrative nonfiction.
This October, Christi and I published Reluctant Warrior on Amazon, just in time for Breast Cancer Awareness Month.
Here are eight lessons I learned about using fiction techniques in narrative nonfiction:
1. Establish Character and Perspective
Christi, of course, is the main character; her family, friends, and doctors serve as supporting characters. Just like in a close first-person point of view, the reader experiences events through Christi’s perspective and senses. I asked many questions to drill down into that experience . . .
- “What did you notice?”
- “What scared you?”
- “What did you see as you walked into the hospital room?”
- “Did you notice any smells or noises?”
She wrote, “I tried not to flinch as the thick, long needle penetrated my right breast. It went ‘click, click, click’ as the doctor removed three samples.”
When Christi describes her biopsy, the reader feels as if they are watching the scene unfold.
2. Set the Scene to Ground the Narrative
Whether Christi is hooked up to an IV in the hospital, resting in her bedroom, or traveling to the Mayo Clinic, her surroundings reflect her mood, beliefs, and actions.
In this passage, she describes her return to a hospital where she’d earlier undergone treatments:
The physical therapist had offices in the hospital where I’d had several of my surgeries. I’d pull up outside the west campus of Flagstaff Medical Center and already feel my body tense. Walking in was triggering, or looking up at the window of the room where I’d spent a week marinating in heavy-duty antibiotics. The same halls. The same smells. The same furniture in the lobby.
Here, the setting carries emotional weight. Common sights and smells link her current experience to the stress of earlier hospital stays.
3. Find Each Chapter’s Theme
Themes emerged as we discussed the central insights Christi wanted to convey in each chapter. She made a list of things she wished someone had told her during treatment: that recovery can continue long after treatment ends, that completing chemotherapy can feel unexpectedly lonely, that losing friendships during illness can add another layer of grief . . . We focused our conversations on these themes to explore how they influenced Christi’s beliefs about herself and her recovery.
4. Identify Conflicts
To find the main conflict in each chapter, I would ask her, “What happened that changed things for you?” Her answers included difficulties such as a loss of identity, the death of a dear friend from cancer, and the emotional effect her cancer diagnosis had on her loved ones.
In both fiction and real life, external challenges create internal struggles and shape thought processes. Christi’s surgical complications, familial strain, and judgments from online and real-life friends become emotionally meaningful as they challenge her beliefs about herself, her relationships, and her recovery.
For example, Christi received online messages such as, “Stop milking a diagnosis you no longer have,” and “Quit whining. It happened. So what?”
These messages prompted her to ask herself, Am I whining? Am I making a bigger deal out of this than it is? Do I just need to try harder?
5. Structure the Plot
Using plot beats as prompts helped us find the story structure inside Christi’s memories. We talked about where to start, what obstacles arose, how Christi responded, and what changed inside her. Because most of the problems she faced didn’t have clear endings, most chapters ended with a new insight instead of a final resolution.
I recorded our conversations with Microsoft Word’s Transcribe feature. Then we went through the transcripts, looking for parts that:
- moved the story forward,
- conveyed the emotions that accompanied Christi’s experiences, and
- supported each chapter’s main theme.
To find the inciting incident—the event that interrupts the main character’s normal life and starts the story—I asked, “What happened that changed things or made it impossible to continue as you had before?”
Christi’s cancer diagnosis is the inciting incident for the book as a whole. In each chapter, we also looked for an event that pushed the story forward and generated tension: a situation, a disruption, and a response.
In one chapter, we presented the situation in which Christi attended her final appointment with her plastic surgeon, still feeling far from healthy and whole. The disruption came when he told her she was “done.” Her response was confusion and disbelief:
A cold hollowness opened up in my chest. I said out loud: ‘I’m done? What does that even mean?’ His verdict didn’t inspire relief or an ending. Instead, it felt more like dismissal—or like the medical system was saying, ‘We’re done with you. Good luck.’
To explore how challenges developed, I asked Christi: “What did you try?”; “What obstacles did you encounter?”; and “How did you respond?”
In a later chapter, a series of emotionally taxing, embarrassing tests at Mayo Clinic let readers follow her through the uncertainty and strain of her search for answers. We also explored moments when she felt she had reached rock bottom. One such moment occurred when a doctor blamed her surgical complications on her attendance at her brother’s wedding.
Finally, we looked at the results of these experiences by asking, “What did you feel then? What happened afterward? Did the experience change what you believed or did next?” Her answers helped us link outside events to their emotional effects and see how her beliefs changed.
6. Revise Wisely
Carving out the story required a lot of editing, but we didn’t want to remove anything important. We decided which sections to cut by asking, “What does this moment add that we haven’t already established?” We aimed to set the relevant moments apart while retaining enough background to help readers understand what was happening and in what order.
Balancing meaning and emotion while trusting readers to make their own connections was a bit tricky. We cut explanations that were too obvious, parts that distracted from the main theme, and repeated ideas.
On the other hand, some parts moved too fast or didn’t give enough detail. Sometimes, we described an event without explaining why it mattered. In those places, I asked Christi, “What made this event difficult, and how did it affect what you did or felt afterward?” We added her answer to the story.
This is where a great editor—shout-out to Hailey Webb!—helped us determine what parts to cut and what needed more development.
7. Establish a Consistent Voice
We wanted to include Christi’s experience as a clinical psychologist and apply her reflections to her lived experience, making the book part memoir and part self-help. As such, Christi is both the person living through the events and the expert helping readers understand their emotional impact.
To show both viewpoints, we focused on making the voices sound natural. Her insights came from real experience. We even wrote a scene where the wise “Dr. Christina Hibbert” (name changed) talks to the scared, hurting Christi.
8. Create Tonal Contrast
We paced the story so readers wouldn’t feel overwhelmed by constant conflict. We added lighter memories and humor to give readers a break between tough topics like death and illness. This contrast also shows Christi’s fun side and lets her voice guide readers sensitively through subjects that might otherwise be triggering.
Helping Christi write this memoir pushed me out of my comfort zone, but I’m thankful for the chance to try a new genre and grow as a writer. I’ve always believed that studying the craft of storytelling helps us understand life, and I feel lucky to have helped Christi share her story. I know that other cancer warriors who read it will find hope and encouragement in her experiences.
Kami Pehrson
Author, Editor
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