How a Novelist’s Method Wrote My 23-Page Medical Protocol

Low working memory makes every interruption costly. Randy Ingermanson’s Snowflake Method gave me the granularity to recover.

Photo by Hugo Rocha on Unsplash

The protocol came due in a week, and I wrote it at the kitchen table.

There was a reason for the table. The document governed the crash cart in the operating block where I work, twenty-three pages specifying how a resuscitation unit is checked, sealed, opened, restocked, and logged. The operating block offers no quiet hour in which to write about it. So the writing happened at home, laptop open beside a cooling cup of coffee, in the one space where I could give it consecutive attention.

At home, there are two daughters, fourteen and eighteen. A week of writing at the kitchen table is a week of interruptions: a question that cannot wait, a door, a phone held out so I will look at the screen, a negotiation over plans for the evening, the small constant traffic of a household that does not pause because a parent has a clinical deadline. Each interruption lasts a minute. For the kind of mind I have, each one costs far more than the minute it takes.

The Minute That Costs an Hour

I have low working memory. The phrase reads as mild, a line on a neuropsychological report, and the report that named it reached me at forty-eight, decades after the trait had already shaped every page I had ever tried to write. The diagnosis was autism, with ADHD alongside it. Low working memory sits underneath both.

What it means at the kitchen table is precise and ruinous. When something pulls me out of a thought, the thought does not wait politely in the corner. The thread I was holding, the exact place in the reasoning where I had stopped, dissolves. It does not blur at the edges and stays legible. It goes. I return to the document, the last sentence is still on the screen, and the argument that was about to follow it has left no address.

For most of my life, this turned complex writing into a siege. The work was never the problem. Holding the work in place while the world reached in and tapped my shoulder, that was the problem, and for years I had only one defence against it.

The Bottleneck Underneath Both

It helps to be exact about what low working memory is, because the phrase invites the wrong picture, something like a faulty archive. The archive is the part that works. My long-term memory is dense and associative; I can retrieve a sentence from a book I read fifteen years ago and set it beside a conversation from last week. The deficit sits in a different system: the volatile workspace where information is held live for a handful of seconds while I do something with it. The mental desk. Mine has almost no surface.

That small desk sits at the meeting point of two profiles, and each one presses on it from a different direction. The ADHD side governs the regulation of attention. Whatever is most salient in the present instant claims the workspace, and an incoming stimulus, a voice, a notification, a thirsty child, does not queue behind the current contents. It overwrites them.

The autistic side runs on monotropism, a single deep channel of attention that pours almost all available resource into one stream. Inside that stream I am precise and tireless. The cost arrives at the boundary: leaving the stream and re-entering it later demands that I rebuild a context the workspace never had room to store. One profile clears the desk by accident. The other makes the cleared desk expensive to reassemble. Together they produce a writing mind that is formidable along a single uninterrupted track and helpless across the seams between tracks.

My thinking runs in branches rather than lines. A single idea throws off associations in several directions at once, and the live workspace is where I hold the branch point while I follow one limb down. Lose the workspace and I lose the branch point, and the other limbs, the ones I had not yet followed, go with it. An interrupted argument does not simply pause for me. It loses its unwritten futures.

The deficits this produces are specific and they recur. Multi-step instructions held only in the head collapse before the third step. Time inside a task carries no felt length, so a block of work swells without any sensation of duration to flag the overrun. A plan made in the morning evaporates by afternoon unless it lives somewhere outside me.

And the lost line, the thought that vanishes the instant attention breaks, which for someone whose work is the construction of long arguments ranks as the costliest of them all. Every one of these points to the same correction: move the holding out of the head and into a structure that does not forget. I had built versions of that correction for years, in calendars and note systems, before I understood the trait I was correcting for. The report at forty-eight named it. The compensations had been running, unnamed, for two decades.

Naming it changed nothing about the trait and a great deal about the strategy. A deficit without a name gets fought as a character flaw: you try harder, you blame your discipline, you close the door tighter. A deficit with a name gets engineered around. The instruction the name issued was plain. Stop defending the workspace, which cannot be enlarged, and start building one outside the skull. The most exact tool I ever found for building one came from an unlikely source.

What Ingermanson Built for Novelists

Randy Ingermanson designed the Snowflake Method for people writing fiction. A novelist with four hundred pages ahead of them needs a way to grow a novel outward from a single sentence, expanding it stage by stage without losing the shape of the whole. Ingermanson named the method for the snowflake fractal, a figure that keeps its structure at every level of magnification, from the entire form down to its smallest edge.

I take the granularity and leave the fiction where it stands. The plots, the character arcs, the scene lists, none of that touches a clinical protocol. What carries over is the architecture of resolution: the way the method moves a document through escalating degrees of detail.

It begins with one sentence stating the whole. The sentence opens into a paragraph that lays out the structure. Each part of that paragraph widens into its own summary, and each summary into its own section, until the document exists as a hierarchy of small pieces. Every piece is bounded. Every piece carries a label naming its function and its place in the structure above it.

The Address of the Lost Line

This is what wrote the protocol through a week of interruptions.

When a daughter appeared at the table, I was never working on “the protocol.” I was working on a named, bounded piece: the daily defibrillator check, the post-emergency resupply sequence, the expiry-management rules. The piece had an edge and a function, both written down before I started filling it. The interruption could still take the sentence in progress. It could take the next three sentences I had lined up behind it. What it could not take was the structure that told me where the piece sat.

I would come back to the table, read the label of the piece I had been inside, register where that piece sat in the structure above it, and the granularity handed me the line back. The label returned the position, and often enough, the words rebuilt themselves from there.

A flat draft holds no such structure. A long document written as one continuous flow gives an interruption the whole surface to erase, and a mind with low working memory cannot triangulate its lost place from a wall of undifferentiated text. The method replaces that wall with a grid of labeled rooms. Lose your place in a room and you have lost a room, recoverable in seconds. The grid is the prosthesis. It holds the location my working memory will not.

The standard advice for a scattered writer is to remove the distractions. Close the tabs, silence the phone, find a clean hour. The advice assumes the distractions are the disease. For me they are the climate. I cannot subtract two children from a week, and the years I spent trying taught me only that the climate wins. The method works on the other variable. It leaves the interruptions in place and changes what an interruption is able to destroy.

The Door I Stopped Closing

The real beginning of this lies further back than the protocol, years before the diagnosis, before I had any name for the working memory or for the profile it belongs to. I had always written. Writing was never the difficulty. The difficulty was the condition writing demanded of me: complete isolation. Door closed. Phone switched off. The fragile hope that nothing would interpose itself between me and the page before the page was finished. A single knock at the wrong moment could empty an entire day of work.

The method retired the closed door. Once a document lives as a labeled grid rather than a single fragile thread, the knock stops being a catastrophe. The granularity left the preference for quiet intact and removed the penalty for losing it. The work survives the knock now, so the door can stay open, and the household can stay a household while a parent writes a clinical protocol six feet away.

Free in a Way People Miss

People tell me, with a faint note of pity, that a person cannot build a life out of protocols.

They have the geometry inverted. I have built a life out of protocols, deliberately, one for nearly every recurring demand it makes on me. A protocol for travel. A protocol for an evening with friends. A protocol for the holidays, for the unforeseen turn on a shift, for romantic relationships. To each trigger, a response already worked out before the trigger arrives.

The person who pities this hears confinement, a life narrowed to a script. What it produces for an autistic mind runs the opposite way. When the algorithm is already written, the situation stops draining the workspace I do not have. I walk into the evening, the trip, the difficult conversation, with the cognitive load already discharged onto a structure built in advance, and what is left over is attention, presence, the freedom to be inside the moment rather than frantically computing it in real time.

The clinical protocol on the kitchen table is one instance of the same architecture. The granular method that let me write it through a week of interruption is the same method that lets me pre-build the protocols I live by. Both move the holding out of the head and into a structure that does not forget. Most people are handed that capacity by a working memory that does the holding for free. I had to construct mine, piece by labeled piece, and the construction is what set me free, not what caged me.

Back at the kitchen table, the protocol finished on time. Twenty-three pages, written in minute-long fragments across a week, each fragment returning to its labeled place after every interruption. Several cups of coffee went cold across those days. The document held.

The protocols are the architecture that keeps my life open, and the granularity is what keeps them within reach.

If this piece carried something you want to keep.

Wrong Planet / Right Mind is the memoir-essay this piece grew out of. It traces the late autism diagnosis from undiagnosed masking through burnout to the shape of life on the other side. Second revised edition, available on Amazon.

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The Substack is where the material before the article lives. Reading notes that fed the pieces you read here, the thinking before it hardens into a thesis, the conversations the Medium format does not accommodate. One email a week. Full archive for paid subscribers.

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This piece draws from my experience as an autistic adult diagnosed in adulthood.