Jason Joyner

There was that time when the editor saved the medical professional.

As a physician assistant, I enjoy having medical aspects in my story. But even medical folks can slip up and have errors in our fiction.

I have a scene where my heroine gets head trauma and wakes up later in the clutches of the villain. The freelance editor, Ben Wolf, wondered about that. He had read that if there was significant time of loss of consciousness (LOC), then it suggested a serious injury that would be hard for the victim to bounce right back from to be active.

One of my pet peeves is when characters are injured and recover too fast, so I had to look into this again.

Basically, my heroine suffered a concussion, also known as a Traumatic Brain Injury (TBI). Symptoms of a concussion can include headache, confusion, dizziness, visual changes, a blunted affect, and may or may not include LOC. (People always flash lights in pupils to check for concussion. If the pupils are affected, it is a serious sign and they won’t be up and active soon.)

LOC usually is only for a few minutes, and as my editor noted, will mean a much more severe injury if it lasts for hours.

Blast. Foiled by the editor.

Except, you can use the amnesia angle.

A concussion with LOC may have retrograde (before the incident) or antegrade (after the incident) amnesia. According to one research article, the antegrade amnesia can last for a few hours after the incident. I can attest – I had a concussion in 5th grade and couldn’t remember a couple hours afterwards.

So if you need your protagonist to be out of it for a while, keep the actual LOC on the short side and use the amnesia angle to get you where you need to be. The victim may be incoherent, unsteady, with a blank expression during this time. Use these symptoms to add drama to the situation.

When your protagonist comes to, it is actually the end of antegrade amnesia. I remember with my concussion it was like I “woke up” after lunch during our quiet reading time at school. I was confused, unsure of what happened. I could remember part of the morning, but about two hours was blank. I even found a goose egg on my head later, but I didn’t know how it got there.

So that was my work around. My heroine didn’t have LOC the whole time. But there was enough injury to cause confusion and amnesia, keeping her from attempting escape. There you go Ben. A few minor tweaks, and all is well. Except for my heroine, who’s tied up and threatened. But that’s another story.

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Jason loves good stories and wants to use words to make a difference. When he’s not writing, playing soccer, or losing in fantasy football, he works as a physician assistant in southeast Idaho. He also tries to keep up with his awesome wife, three high-energy boys, and his little princess. He writes suspense and YA supernatural, and likes to use his medical experience to punch up the stories. You can find him on Twitter @JasonCJoyner or his blog at www.jasoncjoyner.com/blog.

Today, I’m pleased to host guest blogger Jason Joyner. Have you ever been confused by certain letters behind health care provider’s names? Jason is here to clear that up.

Welcome, Jason!

When I interviewed for the physician assistant program at my university, the program director offered this scenario to me.

“You are working as a PA, and you need to consult with your supervising physician on a patient. You go to the exam room he’s in, knock softly, and when you don’t hear an answer, you crack the door to see if he’s really in there. You find him making love to a patient. You shut the door quietly, apparently escaping detection. What do you do?”

Recently there was a guest post by Amitha Knight on How To Write A Hospital Scene that described the different levels of medical training from med students to interns, residents, and attending physicians. There are other levels of health care providers that can be in a hospital or clinic setting, with potential for deeper conflict and development in a story.

A relatively new concept is the “mid-level provider,” a clinician that is under a doctor but can still see and treat patients. There are three main types of mid-levels: nurse practitioner, nurse midwife, and physician assistant. They function in similar ways and are often indistinguishable to a patient, but there are training, legal, and practice differences.

A nurse practitioner has to be a graduate from an RN (registered nurse) program first, with a bachelor’s level degree. Most of the time they will have practiced as a nurse before going back to school. They are trained in the nursing model, with an emphasis on patient care and learning diagnosis and treatment algorithms to treat patients. They often can practice independently – an NP could hang out a shingle and see their own patients, but they are usually working with other physicians. This may vary by state. NP’s are often trained in a specific field, such as pediatrics, ob/gyn, or internal medicine.

A nurse midwife is similar in that they are RN’s first, but then do advanced training that focuses on ob/gyn. They are an option for uncomplicated deliveries, but have to be able to have back-up in case of complications.

A physician assistant is trained in the medical model like a regular physician, but with a shortened time frame. The average program is two years, and it is mostly a master’s level degree anymore. A PA is required to work under the supervision of a physician, but it does not mean that the doc has to see every patient the PA does. It means that the doc has to review a certain amount of the PA’s charts and be available for consult. The PA could be hundreds of miles away from their supervising physician in a rural area, if the doc is available by phone. PA’s are trained in primary care, not usually specializing at first. They can be trained by their supervising physician for specialties such as orthopedics, cardiology, or urology.

Oh, and my pet peeve? It is physician assistant. No “apostrophe ‘s'”. We’re not someone’s possession.

Mid-level providers have received a lot of acceptance in the medical field by both patients and professionals alike, but there are still barriers. I get asked when I’m going to finish medical school by patients. Cardiologists in hospitals fight against giving privileges to an NP, because they don’t want to be asked to consult by a “lowly” mid-level. PA’s and NP’s have a friendly rivalry, but there can be sniping between the two groups. Nurses and mid-levels can be partners together against a tyrannical MD, but may have turf battles or issues on their own.

Many patients now prefer to see mid-levels, feeling the PA or NP listens to their concerns better. Doctors are so busy that they may rush through patient visits more (of course this is stereotypical – there are very caring physicians and mid-levels that have the bedside manner of moldy bread). Mid-levels are working more and more in hospitals to help alleviate shortages of physicians, so it is realistic to have one involved in a medical scene.

As my opening hook suggested, there can be a lot of drama created by utilizing a PA, NP, or nurse midwife in a story. What if a doctor orders the wrong medicine for a patient, but the NP sees it in the chart? What if a PA makes a mistake and has to tell their supervising physician?

A good novel has many layers of depth and sub-plots going on that help drive the plot or challenge the characters. I would encourage a writer to use mid-levels in their books to give them a better prognosis.

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Jason works as a physician assistant in southeast Idaho, while trying to keep up with three crazy boys and a little princess. He is working on a medical suspense with international flair. Follow him on Twitter @JasonCJoyner or his blog at http://spoiledfortheordinary.blogspot.com/