The History of Vaccines

Typically, historical novels are set before the 19th century and into the early 20th century. Historical medical questions can be some of the more difficult ones to answer because it’s challenging to find source material from the time.

However, when it comes to medicine, historical might be considered a time frame of more than ten to twenty years ago because of the rapidly evolving nature of the practice of medicine. One example of this would be CPR guidelines. Did you know CPR guidelines generally change every five years? To put it simply, the way we are doing CPR now is not the way it looked even ten years ago. Often times, what a writer might consider a contemporary medical question is truly a historical one.

I came across this resource called The History of Vaccines  which reviews what vaccines were available when.

For instance, diptheria vaccines began in 1926, tetanus in 1938, pertussis in the 1940’s, and polio vaccine was widely available around 1955. 

If you’re curious whether or not a character could have had the potential to be vaccinated against a certain disease, this source would be great to check out.

Author Question: How Do You Develop a Vaccine From Blood?

Ruby Asks:

I’m currently writing a sci-fi story where a pharmaceutical company has created something that could possibly cure any disease and behaves similar to a virus. Unfortunately, it falls into the wrong hands and is used to harm people. It is decided that a vaccine could help if developed from someone’s blood who carries antibodies to this substance.

Can a vaccine or antidote be made using a blood sample? Also, what would be the proper term for this? Is it a vaccine, antidote, or a serum?

Jordyn Says:

Hi Ruby! Thanks so much for sending me your question. This was pretty fun to research as I learned quite a few new things.

First, let’s define these three terms: vaccine, antidote, and serum.

A vaccine is a “preparation used as a preventive inoculation to confer immunity against a specific disease, usually employing an innocuous form of the disease agent, as killed or weakened bacteria or viruses, to stimulate antibody production”.

An antidote is a “medicine or remedy for counteracting the effects of a poison, disease, etc.”

Blood serum is the substance that remains after the blood forms a clot. Serum is the liquid that “blood cells move through”. It is used for the creation of antiserum. “Because blood serum contains antibodies as well, doctors can also use serum samples to develop what is called antiserum: essentially, blood serum containing resistances to specific illnesses and ailments. When transferred into a non-resistant patient’s bloodstream, antiserum allows that patient to gain resistance to illnesses they may have otherwise been vulnerable to.

A vaccine is usually considered to be a preventative– the person has never had the disease and they get inoculated to keep them from getting it. This would be diseases like measles and mumps.

An antidote usually reverses the effects of a medication or poison and not a biological agent. For instance, Narcan, given to reverse the effect of an opioid overdose could be considered an antidote. Medical people refer to these medications sometimes as reversal agents.

An “antiserum” would be the best term for you to use, as this is giving someone antibodies who is currently infected with the disease. For instance, Dr. Kent Brantly, who contracted Ebola while providing medical aid in Liberia, was treated with antiserum.

So, ultimately, you would need to research how an antiserum is developed. Generally laboratory animals are used and then exsanguinated to be able to collect large quantities of antiserum. So– if you want this character to live– this may not be a good choice for your story. Though, you as the author could also use the death of this character to create conflict in your story, too.

For further articles on developing antiserum you can look here and here.

Best of luck!

Author Question: Bullet Graze Wound Near the Ribs

Ella Asks:

I’m writing a pseudo-novel, and in order to inflict the most possible pain on my character without leaving him entirely incapacitated or even dead, I have a couple questions.

1. Would one be required to go to the hospital for a bullet graze?
2. If one is grazed on the side in roughly the 6th-8th rib area, how much would they bleed?
3. If you were grazed in the 6th-8th rib space, would it be possible that the bullet would fracture a rib?
4. If so, how severely?
5. How would a fractured rib and graze impact basic motor functions?

Jordyn Says:

Hi Ella!

Thanks for sending me your questions.

I think first it’s important to understand what a graze wound is medically— which would be a skin injury without serious underlying injury. The bullet nicked the person and that’s about it. Is it required that the person goes to the hospital? No, I think going to the hospital would be determined by if they could get the bleeding to stop and how extensive the injury is. The smaller the graze the less likely the need for the hospital.

Treatment would be:

1. Apply direct pressure to stop the bleeding.
2. Clean the wound thoroughly– sometimes vigorous flushing with relatively clean water and a touch of something like dish washing soap can be enough if the character is choosing not to go to the hospital. This can reactivate bleeding because the clots are getting washed out as well. After cleaning, apply direct pressure with the cleanest item available (preferably sterile gauze) or a really clean cloth.
3. If the wound edges can come together consider using butterfly closures to close the wound. This might also indicate that the person requires stitches. Sometimes you can apply antibiotic ointment over the butterfly closures to help control infection (something like over-the-counter antibiotic ointment), but keep in mind the oily nature of these ointments will tend to loosen anything with adhesive (like the closures as well).
4. Cover with a bandage.
5. Consider a tetanus shot if it’s been over five years since the last one.

Reasons to consider visiting the ER would be a large wound, unable to control the bleeding, and/or the wound is nicely approximated (and might benefit from stitches to control bleeding and reduce scarring), and to update the character’s tetanus shot. If the character is exhibiting any difficulty breathing this would be another reason for an ER visit.

How much bleeding would occur if the graze was near the 6th to 8th rib? Again, considering a graze wound is mostly a skin injury then applying pressure should be enough to stop the bleeding. Think of this type of wound as a cut or abrasion.

Could a graze wound fracture a rib? Yes, this is possible. How severely? This could be up to you as the author. The fracture could range from a simple fracture (a line is seen through the bone but the bone is stable and the parts stay together) to a type of fracture where the bone breaks apart into small pieces. The more extensive the rib injury, the more extensive the skin injury will likely be (and also increase the chances for internal injury) and could border past a simple graze wound.

A fractured rib and graze wound will have some effect on motor functions— mostly to the upper body. The person should still be able to walk and run but the motions of the arms (while running) will be painful. Fractured ribs are very painful so a person will naturally inhibit motion of the upper body to keep the pain from flaring up so raising the arm on that side while holding a weapon will hurt, but won’t be impossible. Taking deep breaths will be painful so anything that increases a person’s respiratory rate (like running) will hurt. Pain can be treated with over-the-counter pain medication like acetaminophen or ibuprofen particularly if just a simple fracture. Every day the pain should improve and be pretty tolerable in seven to fourteen days. The actual fracture (depending on how complicated) will take four to six weeks to heal.

Hope this answers your questions and best of luck with this story!

Author Question: Does Blood Loss Effect Fever?

Fraidy Asks:

I was wondering how blood loss would effect a fever? The character is ill with strep throat (or a stomach bug) and a fever that makes her want to cover up under layers of warmth. This is before an accident involving shattered glass and deep cuts and moderately serious blood loss. Would her fever be brought down due to the blood loss or would it complicate things more?

Jordyn Says:

Hi Fraidy! Thanks so much for sending me your question.

In your question, you don’t specify whether or not the patient/character has received treatment for the cause of her fever. In the case of strep throat, they should have been prescribed an antibiotic, and should be feeling markedly better in 24-72 hours. There can still be fever, but it should not be as high as the days go on if the antibiotic is working against the bacteria that is growing.

If this accident occurred say after three days, I would imagine she should be fever free by that time.

However, let’s say the character was just diagnosed and still has increased fever related to the illness.

I would theorize that a high fever, 102 degrees and higher, could cause your character to have some exacerbated symptoms related to additional blood loss. A high fever will naturally increase a patient’s heart rate— and so does blood loss. There could also be a concern that an untreated infection could cause the patient to go into septic shock, of which one complication of sepsis is lowered blood pressure. Low blood pressure is also a symptom of blood loss— if the patient bleeds out enough.

The combination of these two things, low blood pressure and increased heart rate, in light of a patient with a high fever and blood loss can paint a complicated picture for the medical team. They may not know which (blood loss or infection) is making their patient so sick so they would take a dual approach to their treatment which could entail the following.

1. Drawing labs that look at blood counts, blood chemistries, but also those that would address sepsis concerns like blood cultures. Also type and cross for blood. Initially, for symptoms of low blood pressure and tachycardia, the patient will usually receive fluid boluses of normal saline IV.

If the patient is really hypotensive (low blood pressure) and tachycardic (increased heart rate) and is not improved from the IV fluid, the medical team might choose to give O negative blood instead of waiting for a formal type and cross to come back. If the patient is actively bleeding and the bleeding is hard to control, they could opt to start giving blood right away.

2. Consider antibiotics early in the course of treatment once any body fluids are cultured the provider thinks necessary to determine the source of infection. It is helpful if a family member could offer insight into what infection the patient might have or the symptoms they were experiencing before the accident.

3. If the blood pressure remains low despite fluid boluses IV and perhaps blood, then patients are generally placed on a vasopressor which is a class of medications given as a continuous infusion IV to help raise blood pressure.

4. Treat the fever with a fever reducing medicine like acetaminophen or ibuprofen. If the patient is headed to surgery to treat wounds from the car accident, then acetaminophen (or Tylenol) might be preferred.

Hope this helps and best of luck with your story!

Five Things This Is Us Got Right About Medical Care

Usually, when I write these blog post, it’s a scathing review of something a television show or movie got wrong. However, in a recent episode of This Is Us entitled The Waiting Room, there were several things that the show got startlingly right for a change. Chrissy Metz’s character, Kate, was in preterm labor leaving the family to dwell in the waiting room. Here’s what the episode got right.

1.  People use Google all the time to question medical professionals. In the episode, one of the family members pulls up the drug Kate is on to quell her contractions and begins to question its side effects. Listen, I’m all for informed family members, but as many medical professionals know, the information on Google can be less than accurate.

It does become frustrating as a medical person to take Google’s word for a medical treatment over a trained medical professional. I’m also all for questioning a provider in a respectful way. A better way to approach this question with your provider is to ask, “What side effects are common with this medication?” and “Do you feel like those side effects are worth the benefits of the treatment?” Any provider worth their salt should easily be able to answer these questions. If not, then you may have a problem on your hands. This will tell you more than Google will be able to tell you.

2. Often times, people think that waiting equates to poor medical care. In one part of the episode, Kevin begins to question the delay in hearing any news, and openly questions if his sister should be moved to another facility, insinuating that she’s not getting proper care. The truth is, few things are fast in medicine. I think the culture and patient expectations haven’t benefited from these one hour television shows.

Nowadays, everyone wants to be seen within an hour and discharged home shortly after. In reality, especially in units where you don’t have an appointment, triage happens all the time based on how life threatening a patient’s condition is. Also, sometimes patients need to be watched for lengthy periods to see if their condition will resolve to a point where they could go home, or see if they’re appropriate for admission. If needing to be admitted, where to? Does that unit have capacity and staff to take care of the patient? Just because you’re waiting doesn’t mean anything necessarily bad is going on or that your loved one is getting bad medical care. A lot is probably happening behind the scenes that you’re not aware of.

3. Threats to staff happen a lot more than you might think. Maybe a better term for this would be microaggressions. Threatening to leave. Threatening to transfer. Threatening to call the patient care representative to file a complaint. Threatening to sue.  Using profanity directed at the medical staff and not just expressing frustration at the situation. Unfortunately, medical professionals hear variations of these every day and often without merit. They are designed, generally, to force medical care to happen more quickly. Using threats or aggression to speed up medical care is not necessarily wise for a variety of reasons. The largest reason is that stressed out healthcare workers tend to make more mistakes— the one thing you don’t want to have happen.

4. Waiting rooms are pressure cookers. It’s not unusual for arguments and fights to happen in waiting rooms. The waiting room becomes a voluntary prison and all people can do is watch the clock ticking. The more time that goes by— the more frustration builds. We are all more likely to take out frustration on our loved ones most— probably after the staff. That frustration will bleed over into other people and families.

5. Healthcare workers respond to kind and courteous over anger a lot better. In the episode, Kevin and Randall both approach the nurses’ station asking for information. Randall does it with more kindness and respect and gets more of what he’s asking. We are normal humans and it’s true what they say about honey.

This Is Us used truth and reality to make a very effective episode. Well done.

VIP Patient Rooms: Are They Real?

When most think of hospitals, we envision sterile environments with mediocre food and beds that lack the comfort of home. However, while watching an episode of The Resident, the concept of VIP rooms emerged.

In the scene, the hospital admits a wealthy donor and hospital board member to their VIP room. The space is decorated with lavish furnishings and a duvet cover to compete with those in most hotels today. However, the scene pales in comparison to the real accommodations some multi-millionaires experience in the US.

How the rich endure their hospital stay never crossed my mind before, but apparently, they receive five-star rooms with services that the average American can’t afford.

Some hospitals cater to the those with vast amounts of money, the famous Hollywood crowd or politicians and diplomats who live in the US and abroad.

Luxury three-bedroom, two bath suites, beautiful living and dining areas with sweeping views of the city await them when admitted. Kate Hudson, Victoria Beckham and the Kardashian sisters have all experienced the posh treatment when delivering their babies.

Not only are the furnishings top-notch, but the affluent patients receive meal delivery from private hospital chefs, their own personal doula, hair and nail services along with free bath robes or anything else their heart desires.

As for the average Joe, our wallets can’t afford the four thousand dollar a night stay.  Our rooms are less ornate. We get one clean bedroom, one small bathroom, mediocre food from the cafeteria and bland furnishings. No personal doula for us although, breast feeding centers and coaches are available.

The maternity suites are not the only area where the wealthy thrive. Even when emergencies strike, affluent patients often skip past the ER department and straight to luxury accommodations. Where an average patient will spend hours waiting, the rich fast-track their medical care, bypassing the conflicts assigned to the rest of us.

My father always used to say, “Money doesn’t buy happiness,” and I agree. However, having some cash might make a difference when faced with a hospital stay.

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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.

Treatment for Partial Thickness Burns

Robin Asks:

I have a question regarding burn care. The main character in my novel is burned in a house fire and receives second degree burns to his back. How long would the wound be oozing? If it’s second degree burns, would he require skin grafts? What is the general treatment for second degree burns? What pain medications would be ordered?

Jordyn Says:

With burns to the back, it would really depend on what percentage of his back is burned. Burns are always calculated in percentages so it’s hard to know exactly what the treatment would be without knowing that number.

However, in general . . . second degree burns are now called partial thickness burns in medical terminology. Usually, to qualify as a partial thickness burn, the skin is reddened with blistered areas. These will probably ooze quite a bit for a few days.

Current treatment is to slather the burned area with triple antibiotic ointment, generally leaving blisters intact. After the ointment is in place, the burn is covered with something that won’t stick to the leaking fluid (called serous or serosanguinous fluid) like non-stick gauze pads and then roller gauze is applied around. This is why not knowing the burn size is problematic.

If the burn is large, covering most of the back, then the torso may need to wrapped to keep the non-adhesive barrier/dressing in place. The goal is to leave blisters intact. Blisters can be popped if they are problematic in size but the skin may be left over top because it provides a protective barrier. Exposed raw skin is the most painful. Blisters are also left intact because they provide a barrier against infection.

These dressings would likely be done until the skin heals which can take up to two weeks. As far as home pain medications, once the wound is covered it usually decreases the pain dramatically because the raw, exposed nerve endings aren’t coming in to contact with air anymore. These days, the patient might be sent home with a few doses of Lortab or Percocet (three days is becoming more common) with the patient instructed to take Ibuprofen on a schedule as well for pain control. I don’t think this is a situation where skin grafting would be required.

Hope this helped and best of luck with your novel!