Author Question: Law Enforcement Shooting with Vest in Place

Carol Asks:

I have a cop who is involved in a shooting. She’s wearing a vest and is hit outside the vest’s protective area. I need her hospitalized long enough that the shooter (who she killed— they shot simultaneously, more or less) to have been claimed post autopsy. I can’t have her debilitated for months— just a week or two. Where would I shoot her? Hip? Leg seems hard to hit and shoulder does too. I don’t want her disabled, nor do I want a months long rehab.

Jordyn Says:

What I would recommend is a shot coming through the side, under the armpit, causing the lung to collapse. I would pick the right side over the left— there’s just a lot more vasculature on the left that could prove deadly/problematic. If her right arm was raised and she was say . . . turning into the shot . . .  it could leave her vulnerable.

She would have difficulty breathing. How difficult would depend on how quickly the pneumothorax (air moving into the chest and deflating the lung) expanded. She would be transported to the ER via ambulance and receive an IV, oxygen, and vital sign monitoring.

A chest tube would be placed, likely after a quick chest film, unless she is in significant distress to re-expand the lung. If in significant respiratory distress or cardiovascular compromise then she would get a rapid needle decompression to buy some time or some facilities will go straight to chest tube placement. For a “simple” pneumothorax she would be admitted into the hospital (regular floor— not ICU) and observed.

Generally, depending on the size of the pneumothroax, it’s a few days to get the lung to re-expand, a day or two with the tube to “water seal” to make sure it stays up without suction, and then the tube would be removed. Maybe one or two more days after that to make sure all was well.

If she’s young and healthy she should recuperate pretty quickly, but would still be winded, perhaps easily fatigued for another week or two.

Hope this fits your time frame.

Dear Medical Thriller Author: Please, Ask a Nurse

I just got done reading a recently released medical thriller by a well known author. The novel, overall, was really enjoyable. Truly a captivating story line. However, there is one medical scene that continues to bug me because of the medical inaccuracies that could easily be solved by having a nurse with expertise in the area read over the scene.

In the last three medical thrillers I’ve read, the author always notes the doctors that helped with the novel, but I honestly don’t think I’ve ever heard a nurse mentioned. Trust me, they needed a nurse. Our expertise is in delivering the medical care as ordered by the physician so we know what makes sense and what doesn’t.

In the scene, the patient is suspected of ingesting the poisonous mushroom Amanita Phalloides also known as the Death Cap. The patient has potential political fallout so our hero, a family practice physician, is designated as team leader for this code over two ER physicians. I’ll discuss some of the things I find problematic with the scene.

The hero admits he’s not an expert on mushroom toxicity, but doesn’t phone a friend. One of the first things that should be done in addition to providing for the patient’s medical needs is consulting a toxicology expert (a poison control center is a great place to start). In toxic ingestions of any kind, the medical team needs to know how to counteract the poison. This targeted therapy may be the only thing that will save the patients life. Even if the patient is provided stellar medical interventions, if they’re not given the antidote, it will all be in vain and the patient can proceed to death. That being said, not every poison has an antidote, which then means supportive care.

Let’s discuss these two statements from the novel:

“BP is sixty over palp,” said a nurse, taking the measurement by palpating with her fingertips.
“Pulse one forty-eight by monitor. I can’t even feel a carotid pulse.”

First of all, taking a palpated blood pressure is not usual in the hospital setting. This is typically done by EMS as a quick and dirty measure for obtaining a BP because it is really hard to hear through a stethoscope with sirens blaring above you. Next thing is, one of these two people are wrong. A carotid pulse is considered a central pulse so if it can’t be palpated then the patient is pulseless, has no BP (because you need a palpable pulse to have a BP), and therefore requires CPR no matter what is seen on the monitor. This rhythm is called pulseless electrical activity (PEA) and is treated medically like the patient is asystolic or flatlined. Treatment is high-quality CPR and IV epinephrine, but our hero calls for a central line.

Then there’s this statement:

“Right now, D-five normal saline at two hundred an hour. Wide open.”

D-five normal saline is an IV solution. This is typically not given in a code situation which I won’t highlight here. In reading about this mushroom’s toxicity, I get why the author chose this IV solution, but the reader doesn’t know and so it should be spelled out what the doctor is worried about clinically for this ingestion and how he’s going to treat it.

However, what’s really wrong with this statement is that it is a contradiction in terms for the nurse. Either the rate is 200 ml/hr or the rate is wide open which means the IV bag is let to run into the vein via gravity as fast as it will go. In an adult patient, the IV bag could be delivered in as little as five minutes depending on the size of the IV catheter that’s been placed.

Lastly, this gem:

“Compressions at ten per minute.”

There is a lot wrong with this medical scene (too much to blog about here), but this is by far the most egregious. I read this to my accountant husband and even he knew this was not medically correct. In fact, I googled, “How fast should you do CPR?” and it gives the correct answer without having to click into a web site which is 100-120/minute. This can’t even be a typo because one hundred and ten— can you really mistype that?  Flat out, this is an easily researched aspect and there is prolific information out there on doing CPR.

Dear Medical Thriller Author: Please, Ask a Nurse Click to Tweet
What’s Wrong with this Medical Scene? Click to Tweet

Just as I ask doctors about the medical accuracy of my scenes, so should nurses be asked. Particularly those who are actively practicing in the area.

C-section Primer for Writers

Today, Heidi Creston gives some nursing insight into the world of obstetrical nursing.

Welcome, Heidi!

STAT Sections, TOLAC, VBAC, Let’s think about all that . . .

STAT C-sections definitely give your story drama, critical hysteria in some cases, just what you need to keep your readers turning pages except . . .

The patient who has had only one prior cesarean section for an indication that no longer presents itself in her next pregnancy may ask the physician for a trial of labor termed trial of labor after cesarean section or TOLAC. For example, if her first baby was breech but the second baby is not. These patients that deliver vaginally are then referred to as successful VBAC (vaginal birth after cesarean section). The patient, however, will undergo a TOLAC for each succeeding pregnancy thereafter.

Midwives, physicians assistants, and nurse practitioners cannot manage the care of these patients alone. There must be a physician present during the labor process. It is important to note that the physician has to agree to the TOLAC. If the doctor does not agree to it then it is the patient’s responsibility to find another physician who will. Some physicians do not carry the insurance for TOLAC or VBAC. There are some states and countries that do not offer TOLAC or VBAC option regardless. Some hospitals do not carry TOLAC or VBAC insurance due to the maternal risks and expenses associated with these procedures. If you’re writing a novel set in a real life state, city, and or hospital with this type of scenario then it would be important to check out these specifics for those locations.

The first thing writers should keep in mind is that cesarean sections are major abdominal surgeries. There is nothing lackadaisical about it. Given that information, any time a muscle in our bodies is cut, torn, or otherwise altered, that muscle is weakened permanently. During a cesarean section the abdominal muscles are both cut and then torn. The uterus is also a muscle. The physician cuts into the uterus in order to remove the baby.

There are two commonly used incisions: Lower Transverse (aka the bikini cut) and the Classical Incision (aka the T-cut). Lower Transverse is the preferred, most common and least damaging of the incisions.

The uterus can develop a uterine window, a fragile site on the uterus that can lead to medical emergencies for the mother and baby. Partial and full abruption of the placenta and ruptured uterus are the most lethal and common complications associated with TOLAC and VBAC procedures.

An abruption is when the placenta dislodges from the uterine wall prior to delivery. In this case, without emergency intervention (imminent birth or emergency cesarean section), the baby will die.

A ruptured uterus is a breakdown of the uterine wall, in which case both mother and baby are at risk for sudden death. Cesarean sections leave the uterus in a compromised state. The more c-sections a patient has, the more compromised the uterus is, which leaves the patient more at risk for abruption and or rupture.

In my experience, patients having had two or more cesarean sections, regardless of the indication, a TOLAC or VBAC are not an option. At this point the risks outweigh the benefits. This risk is so prevalent neither the hospital nor the physicians are willing to accept that responsibility. The physician and hospital will go to great lengths to explain the risk associated with a TOLAC to the patient.

Ultimately the decision is up to the patient. The patient can go against medical advice. Proper paperwork must be filled out indicating that the patient is cognitively aware of their decision and understands the risks involved. The physician and hospital can also file a legal petition to a judge concerning the patient’s decision.

What plot scenario can you think of using these guidelines that will still have a lot of conflict?

C-section Primer for Authors. Click to Tweet.

*Originally published 4/25/2011.*

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Heidi Creston is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

The Lyme Wars: Part 2/2

Today, I’m concluding my interview with author Brandilyn Collins. You can find Part 1 here. Today, we focus on healing and what medical professionals can do to improve the care for those affected by chronic illness.

Jordyn: You’ve been open about God healing you during your first Lyme infection. Did your feelings/attitude toward God change when you were reinfected? Are some of these attitudes reflected in Janessa’s attitude toward God as displayed in the novel?

Brandilyn: When I was reinfected with Lyme in 2009, I couldn’t believe it! I gave God a hard talking-to. What are you doing? We’ve been here, done this. And aren’t you worried about your reputation—so many people know you cured me once? What if they doubt you now?

Well first, God informed me that He’d been dealing with the reputation thing since He brought the Israelites out of Egypt, so thank you very much, but He had that under control. Second, I can see now in hindsight that if I hadn’t experienced round number two of Lyme, I wouldn’t have written Over the Edge. As it turned out, six months of antibiotics cured me of that round.

Regarding Janessa, her spiritual journey is similar to mine. When I had Lyme the first time, I learned how to pray the psalms, both as petition and in praise—whether I felt like praising God or not. Most of the time I didn’t. It was a wonderful lesson that has changed me to this day.

Jordyn: Any words of wisdom for doctors/nurses in dealing with patients who have chronic pain/illness?

Brandilyn: Please, please don’t tell them it’s “all in their head” or some form thereof. Just because you can’t diagnose an illness—that doesn’t mean the patient simply wants attention or is a hypochondriac. It’s bad enough facing chronic illness. Worse still to be invalidated by the medical community. And please—educate yourself about Lyme. Admittedly, this is hard to do, because typical education would be in the form of reading published articles in esteemed medical journals. Unfortunately, these articles are based on the old, wrong assumptions about Lyme (or the authors simply ignore other research altogether). Google “lyme wars” to start online research. And—I have to get in that plug—read Over the Edge. It will alert you to the symptoms and issues involved in the Lyme wars—and how those wars came about.

Secondly, I want to talk to you doctors/nurses who do know about Lyme but are afraid to diagnose it. I understand your dilemma. I understand you don’t want to get into a battle between treating a patient long-term as he or she needs and your medical board. The political climate for you regarding Lyme is very bad. But please don’t send that patient away, saying, “I don’t know what’s wrong with you.” At least admit to the patient that he may have Lyme and refer him to an organization that can help find a Lyme doctor. (Googling “find a Lyme literate doctor” is easy.)

Leaving a possible Lyme patient completely in the dark opens him up to extended, further debilitating disease—if he does indeed have Lyme. I’ve seen this happen. I’ve seen Lyme patients lose all quality of life and become bedridden because their doctors didn’t want to admit Lyme, even when those doctors recognized the signs. I’ve even seen doctors refuse to test for Lyme when the patient requested it.

Jordyn: Any final thoughts?

Brandilyn: Good health and blessings to all. ~ Brandilyn

Thank you so much, Brandilyn, for your time. Blessings to you in your writing and to the continued success of Over the Edge.

Even in writing fiction, it’s a must to be factual for the story to ring true. Brandilyn also started a web-site for Lyme patients to discuss their experiences as well as some additional education regarding Lyme disease. These are great resources for research.

Blog Note: This interview with Brandilyn was originally published in May, 2011. Still, there appears to be confusion on how to deal with these patients as evidenced by just one recently published news piece called Defining Lyme: Medical community struggles with treatment.

Do you know anyone who suffers from chronic Lyme disease? Have you ever incorporated a disease into a story line?

Help spread the word about Brandilyn’s interview and Lyme Disease!

Brandilyn Collins’ insight into Lyme Disease: Part 1/2. Click to Tweet.
Brandilyn Collins’ insight into Lyme Disease: Part 2/2. Click to Tweet.

 

The Lyme Wars: Part 1/2

Since May was Lyme Disease Awareness month and we’re getting into tick season with everyone enjoying the outdoors, I thought it would be great to repost Brandilyn Collins’ thoughts on the topic. You can check out all of Brandilyn’s amazing books by vising her website. Part two of her interview can be round by following this link.

What do you do if your a novelist, infected with a potentially life-threatening illness (twice) and there are two camps of medical thought as to the diagnosis, seriousness and treatment of that illness?

How about . . . write a suspense novel.

This is the situation that best-selling author Brandilyn Collins found herself in. Over the Edge is a novel based on her real life experience of battling the medical community in their current thought process concerning Lyme Disease. I have to confess, I learned a lot about Lyme while reading this engrossing suspense tale.

I’m honored to have had the chance to interview Brandilyn for her thoughts on Lyme Disease.

Welcome to Redwood’s Medical Edge, Brandilyn!

Jordyn: I was told once by an editor with a well-known publishing house that “issue-based novels don’t sell well.” Does this thinking concern you especially when writing this novel under a new publisher?
Brandilyn: First, thanks very much for our discussion today. I appreciate the opportunity.
As to your question—I never even considered it. A couple thoughts: One, it’s important that the novel first and foremost be about entertainment, not informing. If the author fails to keep readers turning pages, those readers will stop reading—and never “hear” the message. So when I sat down to write Over the Edge, topmost in my mind was meeting the four-point promise of my Seatbelt Suspense® brand: fast-paced, character-driven suspense with myriad twists and an interwoven thread of faith. Two, once I’ve met my brand promise in Over the Edge, I then have thousands of potential new readers—those in the Lyme community, who will feel validated by the story. So in that case, an issue-based novel only helps in marketing. Further, I’m passionate about the subject, which can only help as I interview in various venues.
Jordyn: Redwood’s Medical Edge focuses on dispelling medical myths that are commonly perpetuated in writing. What do you consider to be the three most popular myths among the lay public concerning Lyme disease? Among medical professionals?

Brandilyn: Great question!

Among medical professionals:

1.  That Lyme disease can always be cured by a two to four week round of antibiotics. In truth, chronic Lyme can take months, even years, to treat with antibiotics.

2. That a patient must display the bulls-eye rash to have Lyme. Many patients never have the rash. Others may have a rash, but it doesn’t look like a bulls-eye.

3. That a negative test result means a patient doesn’t have Lyme. The CDC (Centers for Disease Control) says on its web site that Lyme is a clinical diagnosis, meaning that the entire presentation of the patient is taken into account. In addition, tests for Lyme are notoriously unreliable, partly due to faulty criteria for certain tests, and partly due to the nature of the Borrelia (the bacteria that cause Lyme). Borrelia are a very formidable foe. They can hide from the body’s immune system by changing their outer protein coat, for instance. Since tests look for antibodies to the Borrelia, not the bacteria themselves, a true Lyme patient can test negative. Therefore symptoms of a patient can mean more to the Lyme-literate doctor than test results.

Myths among the lay public:

1. That doctors in general, or even specialists like Infectious Disease Specialists, know how to properly test and diagnose Lyme. Wrong—reference above.

2. That Lyme isn’t very widespread. In reality, the CDC has verified Lyme in all 50 states. What’s more, the cases of Lyme reported to and verified by the CDC is estimated to be only one-tenth of the actual number of cases.

3. That you’ll always know if you’ve been bitten by a tick. Nope. Many Lyme patients never knew they were bitten. The most likely stage for a Lyme-infested tick to transmit is during its nymph stage, in which it’s no bigger than the head of a pin. Very hard to spot on a body, especially after it’s half submerged under the skin.

Jordyn: You list several recommendations in the Author’s Note section to improve care for Lyme patients. If you could pick one for nationwide implementation, which do you think would have the most beneficial effect?
Brandilyn: The first step, even before redefining treatment, is to create better testing. Too many patients test negative for Lyme under the CDC criteria, then take years before they find a Lyme-literate doctor to administer more accurate tests, which show positive. Meanwhile, the Borrelia have had time to spread throughout the body systems and burrow deep into body tissue, where they’re hard to eradicate. Lyme patients, therefore, face a double whammy. They’re first told they don’t have Lyme—when, if they’d been allowed to catch the disease early, it in fact is treatable with two to four weeks of antibiotics. Then when they’re finally diagnosed months to years later—when the disease will now take long-term antibiotics—they’re denied the long-term treatment.
Jordyn: Are you a proponent of a Lyme vaccine?

Brandilyn: The first Lyme vaccine was a major disaster and was soon pulled off the market. Of course I’d be in favor of a vaccine that really worked. But the medical profession has such a hard time even defining Lyme. It was defined far too narrowly the first time around and is still being too narrowly defined. Hard to create an effective vaccine under those conditions. However, researchers continue to work on it.

We’ll continue this two-part interview on Thursday. What’s your Lyme IQ? Also, for your education, here is a helpful slide slow regarding Lyme Disease. These were interesting to me after reading Brandilyn’s book as some of the myths she is trying to expose are perpetuated in these clips. Can you find what they are?

Brandilyn Collins’ insight into Lyme Disease: Part 1/2. Click to Tweet.

*Originally posted May, 2011.*

Can You Fake an Ultrasound in Real Time?

Gerard Asks:

I came across your blog as I was googling my question. This week, I was watching Grey’s Anatomy (Season 14, episode 18) in which an unscrupulous (or maybe it he was just a fraud?) doctor was giving false diagnoses for breast cancer through ultrasound—I think to sell treatment?

Knowing a little about computers, I wondered how that could be possible. Can an ultrasound store the millions of images or 3d imaging from another patient to be “played” on another patient? Of course, I wrecked the show for my wife by questioning the episode she was enjoying.

So, in case I’m all wet in my assumptions, is it possible to fake an ultrasound in real time?

Jordyn Says:

Hi Gerard! Thanks for submitting your question to me. The perfect person to answer your question is Redwood’s resident medical expert, Shannon Moore Redmon.

Shannon Says:

Today’s ultrasound technology does offer the ability to record video clips that an extremely unethical doctor could replay while pretending to scan a patient with a probe. Most patients would not know the difference between normal breast tissue compared to a malignant mass and the shape of the entire breast isn’t really a factor on the ultrasound screen, since we’re only scanning a small section at a time.

With that said, the hoax displayed in the Grey’s Anatomy episode – Hold Back The River, would be difficult to achieve in real medical life.

Gold Standard

First, ultrasound is not the Gold Standard for detecting breast cancer. That role belongs to mammography (x-rays of the breast). Highly trained technologists position and complete several different mammography views. Ultrasound simply supports suspicious lesions first detected on these images. Doctors use the scan to provide more information and ultrasound should never be used alone to detect malignancy. I hope most patients would not simply take a doctor’s word based on an ultrasound alone when determining whether they have breast cancer or not.

When a mass is identified on a mammogram and followed up with ultrasound, these images or video clips do not give a complete diagnosis of cancer. We can suspect cancer by the appearance of the mass we see, but the only way to know for sure if the mass is malignant, is through a biopsy. Stereotactic breast biopsies are often performed at imaging centers or hospitals. A large needle is used to take samples of the mass and then send them off for pathology testing. Those results tell if a mass is cancerous or not. If the patient is not a candidate for stereotactic breast biopsy, then the mass can be removed in surgery and sent to pathology for testing.

Appearance

When a sonographer finds a suspicious mass on ultrasound, we look for several factors in the appearance. Is it solid or fluid filled? Does is have smooth borders or finger-like spiculations extending into normal tissue? Does a shadow present posterior to the mass? The mass shown during the episode did not meet the specified criteria for malignancy. Let’s break the moment down:

The doctor shows the female character a mass on the screen. There was no shadowing posterior. The borders were smooth and looked like the normal tissue adjacent to it. The area the physician suggested was solid but had a Cooper’s ligament running through the tissue which is typical for a normal lobe of the breast. I’ve included an ultrasound image of a true malignant mass, so you can see for yourself what a true breast cancer might look like on ultrasound. I think you’ll find the video clip played in the scene looked nothing like the true cancer below.

 

 

 

Exam Inaccuracies

During the scene, a swishing heartbeat noise can be heard in the room. Grey’s Anatomy seems to think that when an ultrasound is being used, every machine creates this noise. Let me assure you, that’s unrealistic.

The noise heard in the background is created by a Doppler sample of a vascular structure, such as an unborn baby’s heartbeat or blood flowing through an artery. Neither of these were being scanned during our breast exam.

When no Doppler is activated on the screen, this sound cannot be heard. But yet, we have the heartbeat noise once again. I wish someone at Grey’s Anatomy would update their sound effects team.

After the blond female doctor goes back to Seattle Grace, she has her doctor friend scan her breast to make sure there is no cancer. The doctor who performs the scan and supposed to be knowledgeable enough to detect breast cancer, is holding the wrong probe. She should be holding a linear transducer used in high frequency imaging and provides a rectangular footprint on the screen. Instead, her probe is curved and used for abdominal and pelvic scanning because of the lower frequency range.

Another flaw in the episode is how all these doctors are experts at performing scans in every area of the body. In real life, trained, registered sonographers and technologist work in these modalities. They would be the ones to execute the imaging. Then a radiologist would read the exam and communicate with the surgeon or other physicians. But once again on TV, we see the Grey’s Anatomy doctors performing all the imaging exams. No sonographers or technologists around anywhere. So unrealistic and a little insulting.

I think it is time for the Grey’s Anatomy team to hold back more than the river— they need to hold back on performing any more ultrasounds until they consult a living breathing registered Sonographer.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Author Question: Treatment of Teen Suicide Victim (2/2)

Today, we’re continuing our discussion of the medical treatment of a fifteen-year-old male suicide victim who slit his wrists at school. You can find Part I of the discussion here. In this post, we’ll focus on more of the mental health aspects over the medical treatment.

Pink Asks:

Upon examining a patient, and if sexual abuse is suspected, what is the hospital protocol? How do the hospital staff work with police and the victim’s family?

Jordyn Says:

If outward physical exam of the skin shows injuries concerning for sexual abuse, this can be handled several ways. In order to answer this best, I’d need to know what kind of hospital your patient/character is at in order to give advice as to how that community would likely respond but I’ll give thoughts as to how my institution would handle it—which is a large, urban pediatric medical center. A rural hospital would likely handle it much differently.

One thing I want to say is that no sexual assault exam would be done without the patient’s consent (or parental consent—a court can order if needed)—so this would not be done on an unconscious person. What you can see from the outside would be the limit. For instance, in girls and women no internal vaginal exam.

There might be an extreme outlying caveat to an internal exam if the patient were near death, concern for loss of evidence, or other victims were at risk, but it would have to be VERY PRESSING circumstance and likely the courts/law enforcement would be involved in order to move forward.

Regarding the suicide attempt, the next thing to keep in mind is that the patient’s medical needs are always addressed first. In fact, the patient must be “medically cleared” by a physician before they can participate in a mental health evaluation.

If there is a concern for sexual abuse, we would first contact social work through our hospital to develop a game plan. If a sexual assault exam needs to be done, we have health care professionals that are very experienced in doing these with kids/teens and we want the most experienced professional to do the exam and collect any evidence. Social work will do a couple of things if they think the concerns are valid. One, report it to the state (Department of Children and Family Services—something along those lines depending on the state) and second, report it to the police if they believe a crime has occurred. The incident is reported to the police jurisdiction where the crime took place and not the location of the hospital where the patient is receiving care.

As an example, if a woman is raped in Anchorage, AK, flies to Seattle and seeks treatment there, the hospital in Seattle is going to have to call Anchorage, AK police to report the crime. Local police can help determine the appropriate jurisdiction if it’s not clear.

The timing of the sexual assault is important in collecting evidence. If a person was just raped, we’d be very anxious to encourage the person to have a sexual assault exam done ASAP. If they are reporting something that happened more than three days prior (it’s 72 hr for us)—it’s not as pressing that an exam should be done immediately but plans can be made with the patient and family for follow-up exam and care.

Larger police departments typically have victim advocates that can help families through processes like this, but it is up to them to call that person in. Contrast this with a more rural hospital that may “hotline” the concern for abuse to the state, call the police, and depend on state social workers to determine the course of action.

Pink:

Are patients who attempt suicide always sent to a mental health facility for treatment? I know patients speak with a crisis counselor, but what if the attempt wasn’t caused by being under the influence of drugs, or a mental illness, but due to a desperate situation (domestic violence)?

Jordyn:

The most important determination about whether or not someone will receive psychiatric care is whether or not they are a current danger to themselves (and/or others) and how likely are they to act on it. This is determined by a mental health professional and not the medical staff. The reason for the attempt doesn’t necessarily differentiate potential lethality—it’s what the patient is thinking about in their mind and how at risk they are to act on it.

I think you’re trying to make a distinction that a desperate situation caused by domestic violence leading to a person’s suicide attempt would be seen as less lethal and it wouldn’t. If a person is trying to kill themselves because their home situation is driving them to do that—that is very significant and taken as seriously as someone who swallows pills, or slits their writs, or is having a psychiatric break. Someone attempting suicide due to domestic violence will likely have other co-existing mental health issues like anxiety and depression.

This is a very serious topic and definitely worthy of fiction to help foster discussion of suicide. Good luck with this novel.