This combination of clinical expertise and writing experience led Dr. Hwang to explore fiction that examines the psychological and ethical complexities that arise when medical care meets human suffering. The idea for The Regression Strain came to him shortly before the pandemic reached US shores — then got shelved entirely when COVID arrived. He was swamped with work, and convinced nobody would want to read about a medical crisis on a cruise ship during an actual pandemic. Eventually he talked himself back into it. From start to finish, it took seven years, including editing, rewriting, and long stretches when medicine took priority. The grueling years of residency shaped protagonist Dr. Peter Palma's backstory more than he'd like to admit.
Living close to Galveston, he has always been fascinated by cruise ships as floating cities. Medical emergencies become exponentially more complex when you're days from the nearest hospital — the perfect pressure cooker for a thriller. He studied real cruise ship medical protocols and drew on conditions that genuinely affect brain function and behavior. The Regression Strain, his debut novel, was released in 2025 and has garnered multiple awards and honors.