Month: December 2012

Wishing…

/ Jordyn Redwood / Leave a comment

Over the next few days, I’m participating in the WordServe Water Cooler Christmas Blog Parade! The Water Cooler post will go live Dec 14th.

If you’re not coming from the Water Cooler, I hope you’ll stop by and take a look at all the posts and prizes being offered. There are LOTS!!

If this is your first time wandering to Redwood’s Medical Edge– it’s a blog designed to help authors write medically accurate fiction. Generally, how to maim, injure and kill your FICTIONAL characters. I field writing related medical questions and blog on medical topics.

I am giving away a chance to win one of three personalized copies of Proof to three people drawn at random (must live in the USA) who leaves a comment on this post that ***includes your e-mail address*** by midnight Christmas Eve. Winner announced here Christmas Day.

Hmm… my writer’s wish list.

Just one simple wish really…
 
Lunch with Dean Koontz– to say thank you.

Last June, when Proof released, fellow medical author Candace Calvert posed me this question and I have been thinking about it ever since. If you were in Southern California and were lunching with Dean Koontz, what three questions would you ask him.

I nearly passed out just thinking about that scenario.

But more than that, I would like to thank him for writing such great stories. I can’t confess to reading his entire body of works. I also don’t claim to LOVE every one of his books but he is, by far, an author I have learned a lot from. An author I would like to write like. An author I love to learn from. When I’m stuck in my own writing I’ll often crack open one of his books to get me going again.

Okay– I’m going to amend my wish. Dean, please write another book on writing! Please, for me. Just. For. Me.

Then I thought, why stop at Dean? What writers/authors would you say “thank you” to and for what? Let me know in the comments section– when you leave your e-mail (hint…hint).

Here’s a short list from me. If I could have a Castle like poker game with all these folks . . . well . . . heaven!!

1. Dean Koontz: for being a master story teller.
2. James Scott Bell/ Donald Maass: for writing such great craft books. Really, check them out.
3. Julie Cantrell: for being the most down to earth NYT bestselling author I’ve ever met that I get to call friend. Oohhh, I did lunch with her!
4. Candace Calvert: for being a mentor to me.
5. Lynette Eason: for being the first person to ever endorse one of my books.
6. Robin Cook/Michael Palmer/Harry Kraus: for writing great medical thrillers.
7. Harlen Coban/Linwood Barclay/Karin Slaughter: for writing great suspense.
8. God: for writing the best book there ever was.

What would your list look like?

To all my readers– and hopefully some new ones– Merry Christmas!!

Jordyn Redwood

Author Question: Car Accident

/ Jordyn Redwood / Leave a comment
Amy D. Asks:

I am putting one of my characters in a pretty major car accident — a rollover in which she lands on a broken window and ends up with a lacerated back full of broken glass, in addition to a broken leg, fractured ribs, etc. I need a scene to take place in the hospital where she is recovering. With those kinds of injuries, what treatments would she be under? More importantly, how exactly would she be laying in the bed? Obviously not on her back. But would she be on her side or stomach? Perhaps that depends on the other injuries she sustains… but the lacerated back is the biggest one I want her to have.

Jordyn Says:
The biggest issue here is that she will likely have to lie on her back for a while. Considering her mechanism of injury (MOI)—the big rollover accident. The EMS crew is going to be very concerned that she may have injured her neck or back and she will be put onto a spine board and C-collar. To alleviate the pressure on her back, they may then tilt the whole board to side but it’s going to cause some pain to lay on that flat board until her x-rays are complete.
Care for lacerations: One, she’ll need x-rays of her chest to look for the glass. She’d likely have this anyway for her MOI which could then reveal the rib fractures. If the lacerations are severe and extensive– she may end up going to the OR so they can be cleaned and stitched up under general but they’d have to be REALLY bad. Otherwise, we irrigate them out with sterile saline. Stitch them up. Antibiotic ointment over top. Make sure she’s up to date on tetanus. She would get a shot if she hadn’t had any in five years. It’s 10 years without injury.
Rib fractures are generally problematic because you don’t want to take a deep breath because of the pain which can lead to pulmonary problems. Lung contusions can actually put you on a ventilator if they are extensive enough. If several ribs are broken in succession– this is actually referred to as a flailed chest which can inhibit the patient’s ability to breathe. So, I’d keep it simple with one or two rib fracture so the character mostly has to deal with the pain issue and not the lung issues.
Broken leg– which bone is broken and how bad? This would determine treatment.

Author Question: Jack and Jill

/ Jordyn Redwood / Leave a comment

Maisie asks:

My 16 year old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I’ve never broken anything to know how it feels. I want the medical scene that follows to be realistic, her Mom will meet her at the hospital, it’s late at night.

What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don’t want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they’ll look for, and how this is going to encumber her in her regular life





Jordyn says:

The thing to know about ankles is that they rarely fracture. 95% of the time, they are sprained. For a sprained ankle, an air splint (crutches if the patient can’t bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful– they should follow-up with their regular doctor or orthopedic doctor at that time.
It’s more likely, with your scenario of falling down a hill, for a simple break to the lower forearm.

Treatment in the ER will be x-ray to evaluate for fracture, pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast.

Pt will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn’t be any permanent damage.

Lacerations: Generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn’t had one in the last five years.

Author Question: What is a Good Condition for my Character?

/ Jordyn Redwood / Leave a comment





Teena asks:

I want my main character to have a medical condition his girlfriend is unaware of. It needs to incapacitate him and put him in a bit more jeopardy when he doesn’t get his meds. I also want him to have a concussion so he black outs once or twice while he’s with the bad guy. But he also needs to escape.

A little earlier in the book I want him to exhibit some symptoms to his girlfriend but without revealing his condition…maybe watching what he eats, and in another scene exhibiting dizziness and weakness to a friend but claiming he’s just out of shape. Then, a little later, while he is by himself working on his novel, maybe some shaking where he takes pills and readers don’t know why. They may just think he’s an addict.

He is not obese and is in his early thirties. Which is counter to the profile for most type 2 diabetics I think.

Any suggestions?

Jordyn Says:

Thanks for sending me your question.

I don’t think Type II diabetes is a good option considering his age and good health status.

Here are a few posts I did specifically on diabetes:

1. http://jordynredwood.blogspot.com/2011/07/diabetes-part-12.html
2. http://jordynredwood.blogspot.com/2011/07/diabetes-part-22.html

Off the top of my head– I might consider some type of cardiomyopathy. Where he needed digoxin and lasix as maintenance meds. If he came off those– he could definitely be symptomatic. A lot of the criteria you want would fit this type of condition.

1. What is cardiomyopathy: http://www.nhlbi.nih.gov/health/health-topics/topics/cm/

2. Cardiomyopathy: http://www.nlm.nih.gov/medlineplus/ency/article/001105.htm

3. Cardiomyopathy: Treatment and Drugs (and lots of other info): http://www.mayoclinic.com/health/cardiomyopathy/DS00519/DSECTION=treatments-and-drugs

Read through these resources and see if they strike a chord.

Teena Says:

Thanks so much for the suggestions. I think maybe the hypertrophic
cardiomyopathy is the way to go!

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Teena Stewart is a published author, artist, and ministry leader. She is currently working on a sequel to her first completed romantic suspense novel. Recent published books include Mothers andDaughters: Mending a Strained Relationship and The Treasure Seeker: Finding Love and Value in the Arms of Your Loving Heavenly Father. For more info visit www.teenastewart.com and
http://nearly-brilliant.blogspot.com/

EMTALA and the Writer

/ Jordyn Redwood / Leave a comment

What is EMTALA and why should I, as an author (and maybe a healthcare consumer), care about it? EMTALA, like HIPAA, sounds like a foreign language but has large ramifications for healthcare providers. Here’s a series I did on HIPAA and how it is often dealt with poorly in fiction writing.

1. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-13.html
2. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-23.html
3. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-33.html

EMTALA stands for the Emergency Medical Treatment and Active Labor Act. It was passed in 1986 as part of the Omnibus legislation and is sometimes referred to as COBRA. COBRA is the legislation that dictates how you’re covered by medical insurance when you change jobs.

The reason behind EMTALA was to prevent patients (those covered by Medicare, Medicaid, or without insurance) from being “dumped” to other institutions because of poor reimbursement or no reimbursement on part of the patient.

When refusing care (problem #1), the patients condition can deteriorate while they’re trying to get to another hospital. This is overall, of course, bad.

This only applies to those hospitals that receive Medicare and/or Medicaid funding which is virtually all US hospitals. If a hospital is found to have an EMTALA violation– heavy fines can be imposed and hospitals can lose their government funding. If that were to happen, the hospital would likely have to close its doors.

Dr. Tanya Goodwin covered how this relates to a patient in active labor in this post.

I thought I’d talk a little about how it relates to the emergency department.

Any patient that presents to the ER must be given a “medical screening exam”. This will vary from state to state on who can provide these exams. Some may require a physician while others may be okay having an RN complete it. This is dictated by that state’s scope of practice. Here are a few previous posts that deal with scope of practice issues:

1. http://jordynredwood.blogspot.com/2011/09/perinatal-providers-scopes-of-practice.html
2. http://jordynredwood.blogspot.com/2011/08/author-beware-wrong-medical-procedure.html

If the patient does not have an emergency, the hospital can “screen” that patient out to another facility, urgent care, or their doctor’s office to be seen later.

Let’s look at a real life example. I work in a pediatric ER. We generally treat patients up to age 21. After that– they need to transition to adult care.

So, let’s say I’m in triage and a 65 y/o male presents to the ER for treatment of an uninfected ingrown toe nail. Based on our treatment guidelines– being a pediatric facility– the on-duty physician can either treat or “medically screen” the patient out because though an ingrown toe nail may be painful– it is not a medical emergency.

Now, can you do this in your manuscript? A physician is fed up with a patient and kicks him out of the ER. Is that an EMTALA violation? Did he provide an exam? Was the patient having an emergency?

As a result of this law– generally a patient who collapses (maybe a patient suffering a gun shot wound is “dropped off” at the hospital) on hospital property needs to be given care. There have been instances of this on the news where someone collapsed and based on their position in relation to hospital property– care was or was not provided. EMTALA dictates the hospital’s response in these circumstances.

For more on EMTALA– you can read here.
http://www.emtala.com/faq.htm

Have you ever dealt with an EMTALA issue in your manuscript?

Sweating Bullets: A Story of Ann Boleyn 4/4

/ Jordyn Redwood / Leave a comment

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate! Here are Part I,  Part II and Part III.

Welcome back, JoAnn!

Part IV:  The cold hard facts.
 

Influenza has been around since at least Hippocrates’ time.  It is thought of today mostly as a nuisance that can be sanitized or vaccinated away.  This testifies to a short collective memory when the story of the Spanish Flu pandemic of 1918 is considered. 

Within 25 weeks of the beginning of the Spanish Flu pandemic, an estimated 25 million people died worldwide.  When the pandemic finally ended in 1920, as many as 50 million people had died.  In an era when supportive care for influenza symptoms such as fever was better understood than it was in Tudor times, the mortality rate for Spanish Flu was still around 10%.



Ann Boleyn

It doesn’t take much math to figure out that as many as 500 million people developed Spanish Flu between 1918 and 1920.  It was an era when people knew a lot more about disease transmission than they did when Anne Boleyn retreated to Hever.  As a result, many a large public gathering was cancelled for preventive purposes during the Spanish Flu pandemic, and people around the world wore surgical-type face masks when in public.  These efforts were unavailing against the spread of the infection; Spanish Flu was as mysterious and maddening as Anne Boleyn herself.

Many believe nowadays that Spanish Flu was an avian virus, akin to the modern H1N1 or bird flu virus which is originates in, and is spread by, infected poultry.

Anne Boleyn is unlikely to have personally prepared poultry for consumption.  She did, however, feast in the Tudor court where feathered fare ranging from swallows to game birds to swans were prepared by the help and consumed by ‘the quality’ with gusto.  The Tudor court was also a home to falcons which were used by both men and women for hunting for sport.  Anne Boleyn’s family crest actually features a falcon.  Parrots and parakeets, novelty birds from the New World, were also present at the Tudor court as pets.  Henry VIII himself was said to have an African Grey Parrot which could mimic calls to boatsmen on the Thames, leading more than one of them on a fool’s errand.  Another tale says that when the parrot fell into the Thames on one occasion, it was recognized and rescued only because it started to scream ‘boat!’ as it fell into the river.

The Sweat and the Spanish Flu do not have only a surprising causation in common.   Both claimed, for the most part, a surprising set of victims.  

The Sweat did not prey on vulnerable folk such as the weak, the very young, and the very old.  According to Caius, “They which had this sweat sore with peril of death were either men of wealth, ease or welfare, or of the poorer sort, such as were idle persons, good ale drinkers and taverne haunters.”  Contemporary sources also tell us that men were disproportionately affected; “mortalitie fell chieflie or rather upon men, and those of the best age as between thirtie and fortie years. Few women, nor children, nor old men died thereof”.

The Spanish Flu likewise claimed the least likely as its victims, with many heretofore healthy young adults succumbing.  The Spanish Flu pandemic started, in fact, in an army base in Kansas, claiming the lives of robust young World War I soldiers while their physicians looked on, helpless. It is thought today that this was due to a phenomenon known as cytokine storm, a scenario in which a healthy immune system is actually a liability. 

If a virus such as bird flu enters the body through inhalation, the infection will center in the lungs.  It is normal for the body to fight infection in the lungs with inflammatory responses that are familiar:   increased circulation to the area, mucus production, coughing, fever to ‘burn out’ the infection, etc. In a cytokine storm, too much of all of these symptoms creates as much of a problem, if not more of a problem, than the infectious agent itself.  Soldiers with Spanish Flu were drowned by copious blood and fluids produced by their own lungs, possibly as a result of this phenomenon.  Perhaps a similar phenomenon caused the profuse, and often deadly, heat and perspiration of Tudor-era Sweat sufferers.

The Sweat, and the Spanish Flu, were both maddening, mysterious forces, capable of bringing about a strong man’s downfall, and yet as elusive and as hard to contain as a bird in flight.  The association with Henry VIII and Anne Boleyn, surely, is fitting.
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.