Killing my Arteries: Truth or Die by James Patterson

If you’re a frequent reader of the blog, you know I have a love/hate relationship with author James Patterson. LOVE his books but he needs a medical consultant– STAT.

Recently, I read Truth or Die by James Patterson and Howard Roughan. Here is my Goodreads review of the novel if you’re interested.

What I’d like to discuss here is an interesting medical aspect that was part of the book.

SPOILER ALERT. If you haven’t read the book and don’t want any part of the novel divulged then stop reading right now.

In the novel, a journalist is murdered when she goes to see one of her sources. The question is why? What comes to light is that there has been a new drug invented to be used as a torture device to illicit confessions. In short, the drug will kill you if you don’t tell the truth.

The concept itself is intriguing from a fictional point of view and I do give the authors credit for brainstorming this medical scenario and the ethical implications that surround it.

My issue is the way they deliver the drug– always through an injection into the carotid artery.

I’m sure this is done for dramatic effect but giving drugs via arteries is generally not done. The question is why.

Let’s first think of the main difference between veins and arteries. Arteries are vessels that are leaving your heart. The blood has just been oxygenated. These vessels operate under pressure– we measure your blood pressure at arterial points. Arteries flow into smaller vessel beds.

Veins lead back to your heart. Smaller veins lead to bigger vessels. The oxygen has been off loaded and the red blood cells are on the return trip for more. You have far more veins than arteries.

Many drugs can be “caustic” to veins. This means the drug itself could cause irritation at the least– loss of the blood vessel at the worst.

Considering how many veins you have– possibly losing the function of one vein probably won’t be a huge deal. However, say I give a drug via your radial artery and completely destroy it. That radial artery feeds a lot of tissue in your hand– which would die off if the artery were destroyed. That’s generally what we consider poor patient care.

The other thing about arteries is that they are usually deeper and harder to access in comparison to veins. As I stated above, they also operate under high pressure. You know you’ve hit an artery when blood backs up into your syringe– and pulsates.

Lastly, arteries carry oxygen rich blood to cells. If that blood flow is displaced for a period of time with liquid from an infusion that dilutes the bloodstream– those tissues could become oxygen starved to the point of dying. Again, generally a bad idea for patient care.

There is an alternative the authors could have used and still had dramatic effect for the book and that would have been IO or intraosseous access. This is where we drill a large needle into your bone marrow. It is considered central access and all drugs could be given this route. Also very dramatic.

Remember, James, I’m available for medical consultation.

Ahhh– James Patterson and Medical Fictionism

First, let me be clear. I am a fan of James Patterson. I love his novels– mostly I’m sticking to the Alex Cross novels these days.

However, I also have a love/hate relationship with Mr. Patterson. LOVE the Alex Cross novels– hate the medical info.

I don’t think Mr. Patterson is hurting for money which is why I’ve requested several times on this blog for him to hire me as his medical consultant– because though he’s a great story teller– he does need help in this area. 

In Hope to Die (Alex Cross #22) James sets up a very implausible medical scenario that I’m going to discuss here. There are spoilers in this post— you have been duly warned to read no further if you haven’t read the novel. 
In this book, Alex’s entire family is kidnapped. That includes his ailing, elderly grandmother (who is at least in her late 80s or early 90s from what I can tell), his middle-aged wife and a couple of teen-aged kids.

They are drugged, placed on life support and housed in a cargo container for about a week, On top of that, the cargo container is being moved (placed on a boat, etc) so it is not stationary.

AND– there is not a medical attendant 24/7. Just a group of people, drugged, on life support for a week. Oh, they are checked ONE time during the week.

Okay– sure.

Let’s talk about the medical aspects and how this scenario would never work.

1. The tubes. When someone is on life support– there’s going to be a tube in every orifice as they say. The tube that keeps them breathing. A tube into their stomach to drain secretions. A tube into their bladder to drain their urine. And they will still poop– I’m just being real people. So if no one is there to drain these items and ensure that they stay in the proper place it will cause life threatening issues for the patient.

2. The drugs/fluids. It’s not so much that I have a problem with the drugs that were used– more the fact that no one is there to change them out. Keep in mind, someone on life support cannot eat or drink for themselves. This has to be provided for them. If your goal is to just keep them hydrated then an adult needs, let’s just say, 100ml/hr to maintain hydration. That means a one liter bag is going to last 10 hours. Then the sedation drugs themselves need to be changed out as well– they are not going to last forever.

3. The oxygen. It is very rare that a ventilator doesn’t use oxygen. Ventilators generally don’t run off O2 tanks. They need a special source with adapter. So, how are all four of these vents running? Even if we could leap to oxygen tanks– again– who is changing them?

4. Electricity. Everything connected to the patient runs on electricity. IV pumps can run on batteries for a certain length of time but probably not more than 12 hours. Ventilators require a power source– they must be plugged into something. There is nothing scarier for an ICU nurse than when the electricity goes out and you’re waiting for a back-up generator to kick in. Most often– this is seemless because vents are plugged into emergency outlets that are always fed electricity expcept under dire circumstances– like a hurricane or tornado takes out your back-up systems. If that happens, the patient must be manually bagged with an oxygen tank.

5. Turning. If bed-ridden patients aren’t repositioned every few hours they are going to develop pressure sores. This puts the patients at risk for skin breakdown and infection. Also, immobility increases the risk of developing blood clots as well.

6. Drug Metabolism. The author is also assuming patients metabolize drugs and use the same drug dose. This is not true. Drug dosages in pediatrics is calculated based on the patient’s weight. Adjustments are made in the elderly population as well.

So James– loved the story but the medical scenario . . . please.   

Medical Critique: James Patterson’s Kill Alex Cross 2/2

Last post and this post I’m doing a medical critique of James Patterson’s Kill Alex Cross. Usually, I don’t mention the book or the author’s name but I’m hoping James will spend a little of his cash on a medical consultant and am also probably losing out on a chance that he will endorse one of my novels.

Oh well, living on the edge . . . that’s me.

If you have not read the book this post may contain some spoilers you’d rather not know so you have been warned.

At one point in the book, a suspect is kidnapped and he is given “truth serum” in order to get him to divulge the location of the president’s kidnapped children.

The prisoner is given scopolamine.

Well, hmmm. This did cause me to scratch my head a little bit. Why? Well, come to find out this was a drug used once for this purpose in the early 20th century. Where did I discover that? Well from the CIA’s own website. Interesting what a little research will show.

Now– the CIA should know about good truth serum. Here’s what it says about scopolamine:

Because of a number of undesirable side effects, scopolamine was shortly disqualified as a “truth” drug. Among the most disabling of the side effects are hallucinations, disturbed perception, somnolence, and physiological phenomena such as headache, rapid heart, and blurred vision, which distract the subject from the central purpose of the interview. Furthermore, the physical action is long, far outlasting the psychological effects. 

And that was my thought– there are much better drug choices.

What scopolamine is used for most these days is as a patch for motion sickness. That’s really the only use I’m aware of.

What James Patterson did say in his book is correct: “Lying is a complex act.”

What “truth serum” drugs really do is loosen inhibitions and makes lying more difficult– not that it can’t be done.

Some better drug choices? Sodium thiopental or some of the benzodiazipines. I revealed something very personal under the influence of Versed given prior to surgery once that I normally would have never disclosed.

Yes, indeed, that was a fun time.

Let me just say– never have surgery at a hospital where you are employed.

Medical Critique: James Patterson’s Kill Alex Cross 1/2

I am a James Patterson fan. I’ve restricted myself lately to the Alex Cross and Michael Bennett novels.

I just finished Kill Alex Cross. You can read my Goodreads review of the novel here.

This post is to discuss the medical aspects of the novel and what I find suspect. Come on, James. Hire me as your medical consultant– I think– no I know you can probably afford me.

In this post we’ll deal with a male adult that is involved in a motor vehicle collision. The character was driving a van at a high rate of speed and took a header into a bus.

Initial treatment of the victim was good. Jaws of life. C-collar in place. Suspicion of drug use based on dilated pupils– specifically PCP which is an accurate bodily response.

All good until this line: “The van driver was out on a gurney now, hooked up to a nasogastric tube and IV.”

Anyone know what is wrong with this sentence?

Simply put, EMS is never going to put down a nasogastric tube.  Are paramedics trained to do the procedure? Yes. Have they ever in the field? Not that I’ve seen in twenty years of specialized nursing.

Now– a flight team on a long transport– maybe.

An nasogastric tube (or NG tube) runs from your nose to your mouth. It is used to drain/vent secretions and air from the stomach. If the stomach is retaining a lot of these things– it can impact on the patient’s ability to breath. A secondary use is as a feeding tube though there are many more comfortable styles (like a cor pak which is thin and flexible but doesn’t drain well.)

All this sounds very good for the patient, right? Why not put one in in the field?

One– patient priority is different in the field than in the hospital. It’s basically secure the airway, breathing and circulation and get on your way . . . fast. Placing an NG would simply slow down scene time and they can be difficult to place.

Impacted Nurse

There are also contraindications to an NG tube placement. One is a basilar skull fracture. We all have bones that line the base of our skull. If these are broken– there can be a direct conduit from your nose into your brain. Signs of basillar skull fracture are misshapen face, fluids (blood and serous drainage) leaking from the ears and nose. Mid face fractures.

That’s what we don’t want– an NG tube in the brain. Yes, it can happen as evidenced by the photo that comes from this article which discusses just such a case.

Really, James, call me.