Author Question: Burn and Crush Injuries

Amitha Knight returns to give her medical insight in this reader question.

Welcome back, Amitha!

Q:

I am writing a novel and understand that you give medical information online which I would be really grateful for.  The two main characters in my current book are hurled out of a burning bus which has smashed into a building after going out of control.  They land on concrete.  One of those characters has been in the smoke-filled bus about 15 minutes.

I would appreciate it if you could tell me the following;
1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents. What equipment would they use? 
2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.
3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he’s
unconscious …. what machinery would he be attached to.
  
Thank you in advance for your help!!!
M.G.
Amitha says:
I will help you the best that I can. My specialty was pediatrics and not intensive care or emergency medicine, so keep that in mind.
1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents.  What equipment would they use. 
The types of injuries sustained could range from anything from a few bruises to severe cranial fractures and multiple broken bones. When medics show up, they will place a neck collar in case there are spinal injuries and basically follow the “ABC” rules for emergency medicine. (some links to read more about this: http://en.wikipedia.org/wiki/ABC_(medicine)) This means if the patient isn’t breathing, they’ll make sure there is no obstruction, then they will intubate the patient as necessary. They will also start IV fluids and take them immediately to the hospital. What they would do *exactly* would depend on the extent and severity of the injuries. For fiction purposes, I would think hard before going into too much medical detail.
2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.
This depends on the type an extent of the injuries. if there was a perforation to the lung, they may have a chest tube. They probably can’t get up and thus would need a foley catheter for urine. they would definitely have some kind of IV fluids attached. This website has some good information about smoke inhalation injuries: http://www.emedicinehealth.com/smoke_inhalation/article_em.htm
3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he’s
unconscious …. what machinery would  he be attached to.
This person who is unconscious might be intubated for at least some of that time, which means they would have a ventilator machine in the room in addition to everything I said in #2. As far as amnesia, there is a blog post on Jordyn Redwood’s blog that may help with this: http://jordynredwood.blogspot.com/2011/08/remember-me-use-of-amnesia-in-fiction.html 
Her website is a great place in general for information like this!
I hope this helps.

*************************************************************************

 Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/. 

Medical Question: Orderly Conduct

CT asks:

I’m working on a short story that takes place in a hospital. The patient is in the room with his family when an orderly shows up. What does this orderly say?  Does he introduce himself in a friendly way or is the relationship strictly analytical and dry?
How can I avoid clichés when describing this scene? Is a clipboard mandatory? Would they wear scrubs and a stethoscope? Also, what should I avoid in the “doctor-talking” between patients and doctors/nurses/orderlies? Any information or advice you have is appreciated. And thank you for your help and your time.

Amitha says:

My first reaction when reading this was–what the heck is an orderly? I vaguely remembered an old Jerry Lewis movie called The Disorderly Orderly. I knew this wasn’t a made up job description, and ended up using Wikipedia to find out the answer. You can find that here: http://en.wikipedia.org/wiki/Orderly

For those who don’t know, an orderly is a type of medical assistant no longer used in the US health care system, but still exists in other countries. Thus, if your story relies on the existence of an orderly it will be very clear that your story does not take place in the US.

Asking whether the orderly is friendly or not is kind of like asking whether a lawyer is friendly or mean, or if a shoe-salesman comes to greet you in a store or not. It depends entirely on the person. This answer is a little bit of a cop-out so I’ll try my best to give you some hints.

How a person talks to a patient also depends slightly on the type of information they need. Naturally, if he is someone like a hospital administrator who just needs basic facts to fill out forms–name, birthdate, social security number, etc.–his demeanor will be less engaging, and more fact-based so they can efficiently move on to the next patient.

If he is a doctor or a nurse who needs the answer to broader questions–about the history of the patient’s illness, the patient’s medical history, etc.–he will try to be more sympathetic, friendly, and engaging to get more information. It is difficult to get answers from people if they don’t like you.

In general, the professional thing to do when working at a hospital is to be kind and courteous. Doctors and nurses try not to talk down to patients or use too much jargon. Remember that these are real people, so the way they interact with others also depends on their personality, how tired they are, etc. I can say that in general, it is unprofessional to talk about a patient in a way they can’t understand in front of the patient. But this doesn’t mean that people don’t do it from time to time.

What a person wears depends on where they work and what their role is. For example, doctors usually don’t wear scrubs, but rather professional attire (pants, blouses, button-down shirts, ties). If they are on call or are surgeons, they may wear scrubs and even then it is considered more professional/cleaner to only wear scrubs in the OR.

Nurses often wear scrubs no matter where they are in the hospital as do medical assistants because they do handle more bodily fluids than doctors tend to. But if you were to have a doctor wearing scrubs or a nurse wearing regular pants, this wouldn’t really be “incorrect” either.

Clipboards–if someone needs to fill out forms a lot, they may carry a clipboard, or they might just use the table that’s in every hospital room. It depends again on the person. I used to carry a clipboard as a med student and as a starting out intern, but as I got busier, I quickly realized the clipboard was just something that didn’t fit in my white coat pocket, and thus could potentially be left somewhere on accident. But if you have more of a desk job or something more patient-intake oriented, it would make sense to keep one around.

To make a long story short–you are the one writing your story, not me, so it’s up to decide how people will interact with each other. Likewise, I can’t help you choose which details tell the most about a person. I can only tell you whether things are realistic or not. Deciding what is or isn’t cliché, unfortunately, is up to you.

*******************************************************************************

Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/.

Medical Question: Brain Surgery

Today, Amitha concludes her thoughts on surgery with some specifics about brain surgery.

–>>Note: If you’re squeamish stop reading here!<<–

As far as what would exactly happen during the brain surgery, it’s hard for me to say because I don’t really know what kind of surgery your fictional patient is having. But most basically, the surgeon first cuts into the patient’s scalp, exposing the skull. They drill open and remove a portion of the skull, then cut into the dura (a membrane surrounding the brain) to expose the brain. Then the surgery is performed (depends on the type of surgery). At the end of a craniotomy, the skull is reaffixed using screws or other techniques (though in a “craniectomy” it is not replaced).

This website: http://www.brain-surgery.us/12_open_surgery_postop.html goes into some specifics about what’s involved during different brain surgeries. Make sure to scroll down to the bottom for some nice images.

Search YouTube for craniotomy:

If you have an idea what specific kind of surgery your fictional surgeon is performing, there’s probably a video of it on YouTube.

But as far as things that would make your story believable, I think this video of an awake craniotomy is excellent. You get views of the room, the equipment they use, the patient, the doctors and others in the room, and the surgery itself.



This video isn’t quite as self-explanatory, but shows a surgery where the patient isn’t awake and where a special microscope is used during the surgery.



When writing, I’d try not to get too bogged down in research and details. You’ll bore yourself and your readers to tears. I’d focus on getting the overview of things right. What people are wearing. What people are doing—rather than specifics of the surgeries.

It’s the simple things that will make your reader question your credibility as an author. For example, knowing that your surgeon will already have her face mask and hair coverings on before she enters the OR and that she’d keep these on the entire time she’s in there is something that anyone who has seen a surgery would notice. Whereas, choosing the wrong type of scalpel, or the wrong kind of anesthesia, would be overlooked by most people.

******************************************************************************

Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/.

Medical Question: Surgical Timeline

I’m pleased to have Amitha Knight back who will be hosting a medical question today and tomorrow about surgeries. Today, she covers the general surgical timeline and what the patient’s process is through the OR. On Friday, she’ll cover more in depth about brain surgeries.

RB asks:

In the book my one lead character, a Brain surgeon, will be performing two major surgeries during the life of the book, one on (an animal), and the other she will be performing a radical operation on the male lead.

Could you, in as short as possible, give me an overview of what happens during such a surgery. The big picture and any suggestions you could give me that would make the scenes believable.

Even if you can point me at a website where I can read up about brain surgery – any videos would help as well, I am not squeamish about blood etc… so don’t worry about that side (more fascinated by the whole process).

Any help would seriously be appreciated.

Amitha says:

While I saw lots of surgeries during my 12-week surgery rotation in medical school, ranging from cholecystectomies (gall bladder removal) to liver transplants to cardiac surgeries to breast implants, I didn’t see any brain surgeries. I especially didn’t see any veterinary surgeries so I can’t comment on that part of your question.

The reason I didn’t see the brain surgeries was that the surgeons wanted you to be there for the entire surgery and brain surgeries can take a long time. For example, I heard of one brain tumor removal taking 6 hours. A quick search of the web reveals people who report their brain surgeries having taken more than 12 hours–not sure if they’re counting recovery time. Performing and assisting surgeries for long periods of time requires stamina, dedication, and patience. Alas, our hospital didn’t have a surgical theatre like on Grey’s Anatomy where people could eat lunch, gossip, and come and go as they please while watching surgeries.

While I haven’t seen a brain surgery, the very basic timeline of surgeries are generally the same:

  • The patient is wheeled into the sterile operating room (OR) and transferred to the operating table. Everyone in the room (besides the patient) is required to wear a face mask, a hair covering of some kind, scrubs, and shoe covers.

  • The anesthesiologist sedates the patient (sometimes this is started in the pre-op area). During some brain surgeries, the patient is kept awake for portions of the surgery (so they can monitor the patient’s brain functions by having the patient do different things during surgery) while in others, the patient is intubated and kept under general anesthesia the entire time.

  • The patient is positioned appropriately for the surgery. Parts of the body that aren’t being operated on are covered up. The patient’s head is shaved (or at the very least the part that they are operating on I should think).

  • Meanwhile the surgical team “scrubs in” (i.e. they go to a separate room attached to the OR to thoroughly clean their hands/arms up to the elbows and then return to the OR where they are helped by surgical technicians and nurses into sterile gowns and gloves, all the while making sure not to touch anything that isn’t sterile). Sterile coverings (which are usually all blue) are draped everywhere so that people who are “scrubbed in” don’t accidentally touch non-sterile things. People who aren’t “scrubbed in” aren’t allowed to touch anything in the sterile field. Keeping things sterile and clean is key.

  • The surgical area is “prepped” (i.e. cleaned).

  • Surgeons and surgical techs do a “time out” and double check the patient’s name and the procedure being done and the area being operated on.

  • The first incision is made.

  • The surgery is performed. Tools are all counted by the surgical tech. (During long surgeries, this may happen several times throughout.)

  • The surgical site is “closed” i.e. stitches are put in, the wound is dressed.

  • The patient is wheeled to the post-operative area (“post-op”).
Have you ever written a scene that involved the operating room?
******************************************************************************

Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/.