Miracle or Experience?

I can’t tell you how many times a day I run into parents at the hospital who don’t believe what I tell them in triage. Now, as a nurse I can’t diagnose an illness but when I try to relay their fears– I often get the quizzical one eyebrow raise.

This happens a lot with abdominal pain. Abdominal pain in kids is most often constipation and it fits a pretty consistent pattern. Most parents who present with their children to the ER for abdominal pain think their child has appendicitis. That also fits a fairly consistent pain pattern. This is not to say you can put ALL kids into one of these two camps (because sometimes kids actually have both or one presenting like the other) but you can reassure parents who feel like the next step for their child is the OR by saying something like:

“This could be appendicitis but based on my experience, your child’s symptoms fit more into a constipation issue. You’ll get a doctor’s exam and they’ll diagnose you but you will not be going to the OR in say . . . the next ten minutes.”

And then I get that knowing eye roll that says . . . “Well, why believe her. She’s just the nurse.”

And nine times out of ten do you know what the discharge diagnosis is? Constipation.

It’s not rocket science. I don’t have a crystal ball. But what I have is nearly twenty-two years in nursing . . . almost twenty years in pediatric ER and critical care. What that says is I’ve seen, literally, thousands of kids present with abdominal pain. I know the classic signs of constipation. I also know the classic signs of appendicitis. They do present differently. I can educate (this is a nurse’s job) on the signs and symptoms of these two illnesses and what the doctor will likely choose to do– to prepare the family for what they face.

After an ER shift, I got home and the first thing my husband says is, “Harley let out the weirdest yelp when he was just lying down. We have no idea what it was about.”

Harley is our dog. Harley has pretty bad hip dysplasia so it’s not unusual for him to tweak a hip if he’s been moving but in this instance he hadn’t which raised my husband’s suspicion.

I call Harley over and immediately notice blood in his fur near his neck. Now, it wasn’t a lot of blood and my husband hadn’t noticed it. Why did I? Because I see blood every day and am in tune to noticing even the smallest amounts of it.

I comb through his coat with my fingers and there isn’t a cut underneath. How else would a dog get blood on his coat in that area? We’re used to asking ourselves this with kids– because kids may not always be developmentally able or willing to tell us.

Which led me to think that he’d scratched himself and the blood came from a paw. Then I see droplets of blood on the floor– like when we accidentally cut his toenail too close. Yes, I had done this myself.

I see one of his toes looks bloody.

“Where was he laying?”

My husband points to the spot and I see a full-length toe nail on the carpet. He’d been scratching himself and caught the nail in his chain collar which ripped it fully off.

Mystery solved in under five minutes. My husband was somewhat baffled.

Not me. It’s not a miracle. It’s my experience in injury mechanism that I practice every day.

This is how it can be for your medical characters. Have them use their experience in other situations to make them come to life in your novels. They don’t just have to stay in the hospital.

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





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/

Are ER Nurses Superstitious?

Sometimes as an author, you need to get the flavor of a certain profession. What are some of the things they believe or don’t believe? These don’t necessarily have to be based in scientific fact, but are held beliefs none the less.

So– what are some held beliefs among ER nurses that may or may not be true.

1. Full moons (the celestial bodies– not a patient’s backside exposed) do cause people to come to the ER. If the unit is falling apart, there have been moments where all of us have looked at one another and asked, “Is it a full moon tonight? Is it coming in the next few days?” I don’t know what it is but it feels like ER volumes go up and mental health patients increase too.

2. Strange medical diagnosis happen to medical people. Personally, I feel if you work in medicine, you should get a free pass illness wise (yes, Lord, I am talking to you!) You hear stories of Hem/Onc nurses getting cancer. Doctors going into preterm labor– this may be proven as I think I looked it up once on a slow shift that doctors are more apt to go into preterm labor because of the odd sleeping hours and time spent on their feet. But, if you’ve never heard of an illness, a medical person probably has come down with it. You could say– well, perhaps it’s because they’re all hypochondriacs. Maybe a little truth there (as she slowly creeps hand up.)

3. If you mention a particular patient– they will check in. It’s like a batman signal. Sadly, not all patients are warm and fuzzy to deal with. That’s just a fact of life. So, you really don’t want to say the name of a patient you had a tussle with.

4. We NEVER say the following phrases– and if someone does, they will be scorned.

“Wow, it’s really quiet.”
“It is soooo slow!”
“Is it time to run someone over so we can take care of a patient?”
“Come on! Isn’t it flu season?”
“Nothing is going on.”
“We’ll be with you in ONE minute.”

You have just invited hoards of people to check into the ER in the next 30 seconds. It’s worse than saying a patient’s name you may not want to see. It’s one million bat signals sent into the universe. These phrases are strictly forbidden to be uttered. Period.

5. Yes, some providers do have black clouds over them– like Pig Pen’s dust trail. Not in the weather sense but in the Angel of Death/Sickness sense. When some people work, it just hits the fan. Patients are sicker and there will likely be a code. It’s probably akin to the cat who would visit the nursing home patients and sit with them when they died. The Grim Cat.

Did you know about these ER superstitions?

Author Question: Car Accident Injuries 2/2

We’re continuing with Amy’s question. Dianna gave her thoughts here. I’m going to give my thoughts from an ER perspective.

Amy asked:

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 one 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 fractures so the character mostly has to deal with the pain issue and not the lung issues.

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Amy Drown has a History degree from the Universityof Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.