Whether in terms of genre or even the layout of words on the page, Luna Rey Hall strives to explode traditional structures with their writing. Their most recent book, The Patient Routine, blends experimental, surrealist poetry with the grotesque intimacy of body horror to create an engrossing narrative that explores oppressive systems, particularly the American health care system.

“I think that’s where my writing likes to go,” says Hall, who identifies as queer, trans, and nonbinary. “Breaking out of defined structures, breaking out of defined systems.”

Born in Lakeville, Minnesota, Hall now lives in Minneapolis, where they’ve spent more than a decade immersed in the state’s thriving literary scene. “We have a very robust community here,” they say. “I like to be involved in that as much as I can.”

But before 2013, Hall was far from interested in pursuing writing. “Even in middle school and high school, I could not figure out the whole poetry thing,” they recall. They earned an AFA at a Minnesota community college, where, being a devoted film buff, they signed up for a screenwriting class to fulfill elective requirements. To their surprise, it was the first time that the act of writing started to make sense. “That’s where it started to click for me that writing doesn’t have to be the ‘Great American Novel,’” Hall explains.

Through screenwriting, Hall realized how precise and to the point they could be by focusing on brevity and dialogue—something that has held true with The Patient Routine, which uses succinct phrasing to cinematic effect. “Even when I’m writing prose, I try to focus on just what needs to be said,” they explain.

Hall followed the spark that ignited in that screenwriting class by taking a subsequent course in poetry, where they discovered numerous local Midwestern poets—writers who spoke to Hall on multiple levels. That then led Hall to graduate with a BFA from Hamline University in St. Paul in 2015, a program they cite as being one of the best in the state, offering important support along their journey to becoming a writer. Hall also earned an MFA in creative writing with a focus on poetry from Pacific University in 2017.

Since then, they have published three books, each defying categorization. “They tend to be whatever I want them to be,” Hall says. “I try to get away from the linear.” With The Patient Routine, Hall has pushed particularly on the most basic of boundaries, while still telling a gripping story. Hall interweaves shards of prose and poetry and plays with the visual appearance of words—stretching spacing and breaking lines until the landscape of the page itself feels as unstable as its narrator.

Kirkus Reviews describes The Patient Routine as “simultaneously revolting and intriguing, and continually compels one to ask, ‘Is this real?’” At its center is Ashton, a nonbinary narrator who spirals into panic after discovering a small bump on their skin. Convinced it may be a death sentence, Ashton seeks comfort in an ER, only to be caught in a sudden “routine lockdown.” Ashton’s fears flicker across the page like intrusive thoughts, shifting between blocks of prose, passages that resemble transitional verse, and words that Ashton can’t get out of their head: “are we okay?” “s a f e ?” “are you sure?” “are we okay?”

After a kind doctor who initially offers reassurance is called away, Ashton is left alone with a dismissive physician who berates them for their pronouns, mixing the very real, disorienting terror of being misgendered with grotesque and imaginative imagery worthy of a David Cronenberg film:

from my skin burst a leg, a tarry black & bristled appendage, then another. the searing edge of a blade peeling flesh. they writhed for a moment before a sudden gasp of pain leapt over me as four more legs ruptured the skin. how undulated they stretched from the flappy hole.

For Hall, horror felt like the only genre expansive enough to simultaneously address traumas stemming from identity and health care. They came out as trans and nonbinary in 2019 and have wrestled with the medical system firsthand ever since—both for themself and while supporting their mother through a serious illness and the myriad nightmares of insurance bureaucracy. “I was struggling with getting the health care system to understand and help me through the process,” they say. “This horror setting felt right because it was such an oppressive feeling to me…It is my attempt to get people to understand.”

Behind the novel’s best scares lies not only grotesque imagery but also the terror of being stripped of one’s identity, which often comes from losing control of one’s body. Ashton’s greatest fear emerges with the doctor’s refusal to recognize them, and the use of intentional misgendering as a weapon. “Being stripped of identity is the big overarching fear,” Hall says of the ways health care can feel particularly oppressive to trans and nonbinary individuals. “That couldn’t have happened with a cis person who has never thought about what it means to be misrepresented.”

Influences for The Patient Routine range widely, but Hall drew particularly from horror writers like Hailey Piper, Nick Cutter, and even Stephen King. More surprising is that Hall cites YA coming-of-age stories as having had an impact on The Patient Routine. “A lot of people understand identity crisis when it’s put in that frame,” Hall says, explaining that they believe queer stories often end up mapped onto coming-of-age tales so that they become more digestible for a wider public. “I think maybe part of me wanted to write that kind of story, but wrapped in with all these other things,” they say.

Hall acknowledges that their boundary-breaking style isn’t for everyone. “There are people who, from the start, are just turned off,” they admit. But those readers who stay with The Patient Routine are rewarded with an understanding of Ashton’s struggle and perhaps a reflection of their own frustrations with large, oppressive systems, such as health care. “Breaking free from identity systems or your perceived notions of gender is similar,” Hall says. “Gender norms or expectations are very oppressive on people until they understand themselves and can finally break free from that.”

The Patient Routine marked a new turn for Hall toward fiction, but it remains very rooted in poetic language. “I start everything as poetry and then it shifts,” they explain. “So there were moments where it was in prose, and it didn’t make sense to me to be in that format. And then I realized there was a character, and then I realized there was a story.”

Hall is continuing that instinct to let form evolve naturally as they explore more work in fiction with multiple future projects, including a horror novel that delves into YouTube true-crime culture, a spooky premise involving the disappearance of a young girl, and a third work exploring how to say goodbye to past selves.

But as Hall expands into new stories, they still start from a commitment to having all aspects of their writing working in concert to push boundaries. “I want everything to be meshing together, including the form and structure and the space on the page,” they say. “I want everything to be unified. That’s where real, true, good poetry comes from—or good writing in general.”

Rhett Morgan is a writer and translator based in Paris, France.