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.