Author Beware: Taking out Perfectly Good IVs

If you’re a frequent reader of this blog then you know I have kind of a love/hate relationship with James Patterson. Love his books (most of them), but I frequently take him to task for medial inaccuracies. I rarely call out an author in person or name their book because I like to mostly teach on medical topics, but I think James could use a medical consultant and I also think he has enough money to afford one– though I think these posts are not increasing my chances of working for him.

Anyway . . .

In one of his recent titles, Woman of God, the first part of the book highlights the main character serving as a physician in a war torn region.

Early in the novel, a young boy comes to their primitive hospital suffering from a bullet wound to the chest. During the surgery, which involved opening up the side of his chest, it is noted that the patient stops breathing and so the surgeon, a mentor of the main character, just gives up.

First of all, a patient receiving major surgery like this should be intubated and anesthetized. They do offer surgery, so must provide this to most of their patients. Earlier in the chapter, it is noted that the patient is being bagged and anesthetized patients can’t breathe on their own anyway— so why is a decision made to let him die when he stops breathing when, if properly cared for, he shouldn’t be breathing anyway?

However, this situation does not deter the main character and she continues his operation.

“The heart wasn’t beating, but I wasn’t letting that stop me. I sutured the tear in the lung, opened the pericardium, and began direct cardiac massage. And then, I felt it— the flutter of Nuru’s heart as it started to catch. Oh, God, thank you.

But what can a pump do when there’s no fuel in the tank? 

I had an idea, a desperate one. 

The IV drip was still in Nuru’s arm. I took the needle and inserted it directly into his ventricle. Blood was now filling his empty heart, priming the pump.”

Where to start, where to start.

First, it’s never noted that this patient is receiving blood. I think this is an add on by the author for effect. Secondly, remember IVs are not needles, but very small plastic catheters, that would not be able to puncture through the tough muscle of the heart.

Thirdly, and by far the most egregious, the physician takes out a perfectly good IV for a nonsensical reason! It is hard, really hard, to get IVs into sick kids— particularly those suffering from hemorrhagic shock like this boy is from a gunshot wound to the chest. That one, lonely IV you took out to puncture his heart (not a good idea either), you’re going to need back because this kid will still be sick. You’ll close his chest and then have to find more IV access. Giving fluids via a vein can rapidly fill the heart and it is insanity to take out a good IV to do what the text suggests.

Call me, James. Really. I’m not as expensive as you might think.

Medical Review of The Shack

There’s nothing like a Christian movie to create a firestorm of controversy. I am a Christian and saw the film and I thought the biggest failure of the film was actually medical in nature.

That’s right . . . medical.

There have been plenty of articles written on The Shack’s theology, but I doubt anyone has touched on the medical inaccuracies which I’ll do here. If you haven’t seen the movie and don’t want any spoiler alerts then stop reading . . . like right now.

The story revolves around a man named Mack who early in the film narrowly misses a major collision with a semi. At the end of the movie, it’s revealed that he’s been in a coma (he’s been unresponsive) for approximately 2-3 days. Our first glimpses of Mack post accident are in a regular patient room. He has an IV, IV fluids and is on a monitor.

Problem One: If you’re broadsided by a semi, you should actually look injured. Mack is relatively uninjured as a result of this accident. He has but a few scrapes (not even stitches) on his face and none of his bones are broken.

Problem Two: The IV pump is not running. If you watch the film, the IV pump is off. If it were on, you’d see numbers lit up on the screen.

Problem Three: If a patient is unresponsive, you have to provide a way for things to come out. Think about it, do you ever go three days without peeing? Neither does a comatose patient. Plus, we need to ensure kidneys are functioning properly which means we need to monitor urine output. This is the type of patient where the phrase “a tube in every orifice” means exactly what it means. Also, there is a significant amount of literature that patients should be nourished with tube feedings much earlier. In real life, Mack would likely be in the ICU, perhaps even on a ventilator, until he woke up. His only medical support would not just be IV fluids.

Next time Shack, call me.

Can You Commit Suicide With an AED?

Recently, my husband and I have been binge watching through all five seasons of breaking-bad-s5-400x600-compressedv1Breaking Bad. In the last season, a gentleman decided to kill himself using an AED.

AED stands for Automatic External Defibrillator. It is a quick rescue device used mostly by non-medical people for cardiac arrest. It is designed to recognize lethal heart arrhythmias and deliver a shock (electricity) if the patient is in one. The AED will not always fire. In fact, there are really only two arrhythmias it is designed to treat.

The question becomes, can you use an AED to commit suicide? An AED has two large, white patches connected to the device. In the show, the gentleman places one patch on his chest, pulls off the other patch and places the exposed wires in his mouth. After this, he turns on the device and discharges it, thereby killing himself.

aedThis scenario is highly improbable and here’s why:

1. Both patches must be in place for the defibrillator to analyze the patient’s rhythm. If they’re not, the machine will not progress any further.

2. Let’s say the AED would read the rhythm (one patch on the chest and exposed wire in the mouth)— it won’t deliver electricity for a normal rhythm (which this gentleman likely has because he’s alert and conscious.)

3. Let’s say the AED did fire for his normal heart rhythm— would he die? There is a slight chance that he might die, but only if the AED fired during a very sensitive time in the electrical cycle of his heart which has a very low probability.

All in all, I don’t find this method of suicide possible. Sorry, Breaking Bad, though I did love the series.

Author Beware: Don’t Make Medical People Look Like Uncaring Idiots 3/3

Today is the last post on my displeasure with a particular, bestselling novel. Click on the links to find Part 1 and Part 2.

In short, a fourteen-year-old girl has come to Planned Parenthood for the Morning-after Pill.

What follows in italics is an excerpt from the book where the nurse giving the patient her discharge instructions. I’m keeping the identity of the author and the name of the book anonymous.

 girl-1149933_1920Several more minutes ticked by before the nurse, her peppiness especially noticeable in the wake of her cool, serene, superior returned.  A brown paper lunch bag full of brightly colored condoms bunched underneath her arm, a prescription bottle in one hand, and a glass of water in the other.

“Take six right now.” She shook six pills into my clammy palm and watched me chase them down with water. “And six twelve hours from now.” She looked at her watch. “So set your alarm  for four am.” She shook the paper bag at me teasingly. “And being careful can be fun. Some of these even glow in the dark! ”

Wow! Just yikes. Trust me, nurses are usually not so peppy. How does the patient know the “brown paper bag” is full of “brightly colored condoms”? Can she see through brown paper? I digress.

Problem: What’s really wrong with this passage is the patient instructions. The author makes it clear in the novel that the patient is taking the Morning-after pill. There are two such pills. One by the same name and the other is Ella. Neither pill has such a dosing regime. Both are one pill only. That’s it.

I honestly don’t get the point of writing something so ridiculous that is so easily researched.

More seriously, this nurse’s teaching is cringe worthy. I don’t know a nurse on the earth who would talk about condoms glowing in the dark. How about having a serious talk about contraception? How about having a serious talk with a fourteen-year-old girl who is having sex and how she feels about that?

So much more should have been done for this girl in this book by these medical professionals that it was truly disheartening to read. Why? Because this is not the impression I want any woman of any age to expect when they interact with a medical professional about something as important as this.

Writers and authors everywhere— please, do better. Your words educate those we interact with as patients and this is not the impression we want them to have. I’m only asking for one, redeemable, medical person. Make all the rest awful— you have my permission.

Author Beware: Don’t Make Medical People Look Like Uncaring Idiots 2/3

Today, I’m continuing my discussion of an uber popular book that didn’t paint medical people in a good light— like at all.

You can find the first post here. I’m not mentioning the author or the novel here to protect the author from angry medical people everywhere (okay, perhaps it’s just me.)

What follows is the same encounter, different section. As a quick reminder, this fourteen-year-old girl believes she’s been raped and is looking for guidance from a female physician.

What follows in italics is an exert from the book.

doctor-563428_1920-1There had been a question burning in my throat for the last ten minutes, but it was her reaching for the handle of the door that forced me to say it. “Is it rape if you can’t remember what happened?”

 The doctor opened her mouth as if she were about to gasp ‘oh no’. Instead, she said so quietly I almost didn’t hear it, “I’m not qualified to answer that question.” She slipped out of the room soundlessly.

 Problem: There are so many problems with this response from this doctor to her patient that I am flabbergasted as to even know where to start. First, how about starting with a doctor who cares enough to simply ask a few follow-up questions?

Such as, “Please, tell me what happened.”

What is shocking is just the amount of information that has been disseminated to the population about getting mutual consent before a sexual encounter. In fact, in just the last couple of years was the infamous “Tea Consent” video which you can view below.

In fact, the video states, “And if they’re unconscious, then don’t make them tea. Unconscious people don’t want tea and can’t answer the question, ‘Do you want tea?’ because they’re unconscious.” So it seems the issue of whether or not this was consensual would be fairly easy to determine.

No consent, then a crime has occurred.

The first signal to this physician is her patient’s memory problems. This is very concerning for her getting slipped a drug so that she could be raped. If the physician feels this is something she can’t explore, especially considering the patient’s age, then she should seek outside guidance. This could rise to the level of needing to be reported to the police.

Never just stop and not say anything more. This young girl is clearly in crisis. A doctor is qualified to help this patient, particularly one in this setting, who should be clearly educated in circumstances just like this.

Who else can this girl turn to for answers if not a trusted physician?

Author Beware: Don’t Make Medical People Look Like Uncaring Idiots 1/3

I’m starting out my medical posts of the New Year truly fired up . . . and not in a good way. This title sounds harsh, doesn’t it? Sadly, it’s exactly how I feel.

If you’ve known me for any length of time, then you know I’m passionate (just slightly) about medical accuracy in novels. This is why this blog exists and a major reason was to clear up misconceptions about medical people and how they perform in their job.

teen-girl-2Let me first state, clearly, that you can have a bad medical person in a novel. They can even be doing bad things. Criminal things. That’s what drives fiction. Tension. Conflict. However, also should the author help the reader realize, in some fashion, that the author knows this fictional medical character is doing these things inappropriately and it is not a normal medical experience. To help with this, I encourage all authors everywhere to write a medical person performing ethically as a balance in the scene or book. This is beneficial so you don’t anger every medical person out there to want to hold gas and flame to your hard earned written prose.

Professionals like to be portrayed accurately in their profession. Anyone remember how Joy Behar angered thousands of nurses? Yes, this is what writers should avoid.

What follows is an exert from a highly popular mainstream novel. This novel hit both the New York Times AND USA Today Bestseller lists. I’m not naming the book or author here and if you know what either of these are, please do not leave it in the comments section. I’m only using the quotes as a teaching points.

For background, a fourteen-year-old female (from what I can tell from the book) believes she has been raped. She’s going to Planned Parenthood for the Morning-After Pill. The rape occurred on a Friday around midnight. The character is presenting for treatment Monday after school. What follows in italics is an exert from the book.

While she examined me, she explained what the Morning-after pill was. “Not an abortion,” she reminded me twice. “If the sperm has already implanted the egg, it won’t do anything.”

Problem: Medical professionals are careful to separate opinion from medical fact. A patient might view what an abortion is differently than their medical provider and ultimately a medical provider’s job is to disseminate medical information and not their personal opinion. If it is their personal opinion, it should clearly be identified as such.

Some people view abortion as terminating a pregnancy at any stage— including just after fertilization. You will find web sites that claim the Morning-after Pill is not an abortion pill. However, you also can find two, well respected medical sites (Web MD and The Mayo Clinic) that state one of the actions of the Morning-after Pill is “keeping a fertilized egg from implanting.”

Solution:  It would have been better for the medical provider in this passage to simply state the following. “The Morning-after pill works by delaying or preventing ovulation, blocking fertilization, or keeping a fertilized egg from implanting in the uterus. However, there is evidence out there that suggests that it also doesn’t keep a fertilized egg from implanting in the uterus. My personal opinion is that this is not an abortion pill.”

Given this information, a patient can then decide for themselves if this is ethically something they want to choose to do without the personal bias of the medical provider influencing their decision.

A patient should always be given opportunity to choose medically what works within their ethical framework. If the medical provider cannot support them in doing that (what is a reasonable decision) then they should refer them to a provider that can.

Next post, we’ll continue our discussion on the medical issues in this novel.

In full disclosure, I am pro-life.

What are your thoughts on this passage in how the medical provider relays the information to this fourteen-year-old girl?

Medical Errors in Manuscripts: Criminal Minds and Bodies Hidden in Cement

Happy Halloween Redwood’s Fans! What fun festivities do you have planned for today? What will your kids be dressing up as to celebrate?

criminalmindsToday, I thought a fitting Halloween post would be an evaluation of a recent episode of Criminal Minds. I’ve been a fan of the show for years and am always intrigued with the cases and devious/suspenseful minds of the screenwriters.

A few episodes back, uber chipperPenelope was presenting a case about a woman who had been buried in a barrel full of cement. She stated the woman’s body was discovered using ultrasound and then proceeded to show a picture of the body that looked like a plain x-ray.

This is a common mistake among writers— not knowing the proper technology to site or the right radiology equipment to use. First of all, ultrasound couldn’t penetrate cement to find the body and the scan images would not resemble anything that you’re used to seeing.

What probably would be used is something that utilizes Ground-Penetrating Radar (something that can actually look through cement) and I found an extensive article that discusses its indications and use which I’ll definitely be referencing later.

Writers— keep in mind that not all forms of radiology are interchangeable with one another. If you’re discussing the use of a particular radiological study in your manuscript— make sure it’s the right one.

Have a safe and happy Halloween!