Author Question: Nursing 1940’s


Anonymous Asks
:

First and foremost, I have to say that I am in love with Medical Edge. I’ve been spending a lot of time on it lately because I enjoy studying medicine and also because I am starting to do research for my novel. It’s set in 1939 through to 1943. I have three questions for you.

One of my main characters is a nurse in Sioux Falls, South Dakota. I want to be able to write her doing her job correctly. I was wondering what kind of equipment they used, how they used it, and for what illnesses (No need to be extremely specific here, I think). Also, what would her responsibilities be within the hospital? Would she rotate through all the wards or do/did nurses have particular specialties like physicians?

Jordyn Says:


Thanks for your compliments on my blog! Glad you find it helpful.

Nursing in your time frame of 1939-1943 would have looked a lot different than it does today. They definitely wore uniforms and caps. Doctors would have been formally called “Dr. Smith” versus using first names like we do now (although not in front of patients).

Nursing work was viewed as inferior to the physician meaning—you do what the physician says. Now, a nurse’s input is more respected. Doctors and nurses realize they can’t work separate from one another.

Nurses likely didn’t specialize then like we do now and there was likely not a lot of physician specialties either as there weren’t any intensive care units or emergency departments until the 1970s. Equipment would have been non-existent like the heart monitors and stuff we now use. Read through this info to get a general feel of how the floors or “wards” would have been split up.

This link is from Britain but would probably have some cross-over to the US. Here is a linkto some personalized stories from people who nursed during your time frame. I would read through these for the 1930’s and 1940’s to get a feel for what their jobs were like.

Thisis also from the UK but should provide some insight. 

Question
:

Another one of my main characters goes off to fight in the war. How severe would an injury have to be for him to be discharged? Presently, I have a situation designed where he is aiding a family out of a bomb shelter; there is an unexploded shell nearby, and a child accidentally kicks rubble at it and sets it off. Big boom, main character loses part of his leg and half of his body is burnt. I’m also thinking that he loses his hearing. Would this be plausible?


Jordyn Says:

I would search military discharge related to a medical condition two ways. One—what medical conditions are prohibitive for military service and those conditions that would lead to discharge.

 I found this list, but you could probably find more and if it’s the 1939-1942 time frame it may be different than those that cause discharge in these times.

The injuries you list related to the bomb blast are realistic and I think would be enough to cause his discharge from the military as well.

I contacted a cousin of mine who serves in the medical corp of the military and he said to look at AR 40-501 which is the standard of medical fitness. Basically, if you couldn’t do what’s listed than you could be discharged from service. He did say that there are personnel who are still serving who have amputated limbs.

Question:

Lastly, my nurse has a patient, a woman in her 40s or 50s, who she loves with all her heart. I want this patient to die. What would be a good way to kill this woman off? I need her to have been in the hospital for around four years. I also want to have her weak but able to speak with my other characters. What’s a good malady for this situation?

Jordyn Says:

This kind of criteria would mean the character would need a chronic illness that’s debilitating. You could look into multiple sclerosis, Lou Gehrig’s Disease, Huntington’s Chorea or some of the autoimmune disease like Lupus or Sarcoidosis.

These diseases fall on a spectrum (more MS and the autoimmune diseases) but Lou Gehrig’s Disease and Huntington’s Chorea lead to neuromuscular wasting, etc that does lead to death and there is currently no cure.

In that time frame you’re looking at you’d have to determine if they were able to diagnose these diseases. To do that you could Google search “When was Lou Gehrig’s Disease discovered?” That should get you in the ballpark to know if the medical community knew about whatever disease you chose for your time frame.

Keep in mind—it would be highly unusual for someone to be hospitalized for four years straight.

Author Question: Wet Nursing

Kristin asks:


I have a question for a novel I’m writing. In it, there is a woman who lost her nursing baby in a space ship crash and finds herself in a place where the have-nots are so malnourished that nursing infants are skinny. So if this newcomer takes on nursing these babies, how many could she sustain? I was thinking six (for the story) to keep them alive, although not well nourished, but better off than before. 

Jordyn says:

Wow. This is a pretty interesting question. I ran it by a few doctors/nurse practitioners I work with and the consensus was about three. If you think of just how much an infant eats and how much the woman would have to drink and eat to sustain even three infants– it would be a lot.

Also, you have to consider what type of environment she’s now living in. The past nutrition she had, if good, would need to be sustained. If she’s now living in an environment where she herself would also have trouble obtaining food– then she’s going to be in the same boat as these other women. 


Lisa’s Story: Part 2/2

Today concludes Lisa’s story– a story that likely happens every day– nurses advocating on behalf of their patients to save their lives.

You can  read Part I here.

Welcome back, Lisa!

I instantly had a suspicion of what I might be dealing with and finally called the pulmonologist. Lucky for me, it was a doctor I was quite familiar with and someone I trusted. He could sense the urgency in my voice, as I relayed the information to him. And he started dictating a number of tests that he wanted done. I had to get firm with him, and finally told him to stop.

“She just returned from India 2 weeks ago, she’s been in and out of 3 hospitals and 4 urgent cares in the last 2 weeks.”
 He stopped dead in his tracks, and said, “Lisa, what do you think this is we are dealing with?”
I was shocked he asked, but I had a gut feeling. “I think she might have malaria.”
His reply was a barrage of orders and ended with a “Holy . . .”
 
“Wait,” I replied.
He stopped and asked what was wrong. I then relayed that she had taken her 2 year old daughter with her.
Here’s the thing. I had heard about malaria and we had touched on it in nursing school, but I had never seen a case of it, so I had truly no idea if that was right. His mind was racing too. This was South Carolina! We don’t see cases of malaria here. He said I needed to call the hospitalist back and make sure he told the husband to take the little girl to the children’s hospital.
I called the hospitalist back and had to argue with him on the phone. I remember as clear as day telling him that if he didn’t let the man know to get his 2 year old daughter to the hospital, her death would be on his hands not mine. I remember arguing and even cussing at him, I was so angry and he seemed to care about was that I was interrupting his 3 am sleep.
Fast forward . . .
The lady ended up being transferred to the other hospital where in fact the 2 year old had been admitted for also having a case of Malaria. The husband had not traveled with them so luckily he had not contracted it. My patient was transferred to the other hospital on her 30thbirthday. What a way to spend your birthday!

In the end, both she and her daughter were treated and were fine. But that story still warms my heart, because of my stubbornness and persistence I truly believe that I was responsible for saving not one but two precious lives.

The following day I was leaving the floor and heading home. For some reason I decided to go through the ICU to take the stairs instead of the elevator.
As I walked past the nursing station, I heard a man’s voice saying, “Are you Lisa?” I stopped to see the face of an unfamiliar doctor. “Yes, I’m Lisa.”
“The same Lisa who called me last night and chewed me a new orifice, and demanded I call Mrs.X’s husband?”
I sheepishly replied, “Uh, yeah, that was me, guilty as charged.” I said holding up my right hand in admission of being the woman who had made his night a living hell.
He bowed and said, “You may have just saved not only 2 lives, but my career.”
He reached over and kissed my hand in a bowed position with one knee on the floor. I was to say the least shocked and embarrassed. The entire ICU staff started smiling at me. I left with the biggest smile on my face and my heart filled with joy.
Those are the moments that make nursing truly worthwhile.
Shortly after this happened, have you traveled outside of the country was added to the admission forms.
Here is a link to Malaria and its signs and symptoms: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646/
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Lisa was born Lise Amanda Forest on November 19, 1966 in Ontario. She has 2 children, and 1 grandchild. She currently, lives in SC. Lisa speaks French and English. She graduated from College and worked as a flight attendant for a Montreal based airline. Lisa is a world traveler, having been to South America, Caribbean, and all over Europe; Lisa has been employed as an RN for the last 18 years. Lisa has moonlighted as a realtor and interior designer. Now she’s a writer and her debut novel Oracle is in editing. You can visit Lisa at her blog www.lisaforest.blogspot.com.

Lisa’s Story: Part 1/2

I wanted to share this story of a fellow comrade in arms– a nurse working in the trenches that likely, only through her efforts, did a patient not succumb to death.

There is so much of nursing that goes unnoticed. What nurses do every day. The battles we fight on behalf of patients and their families that likely are never known by those we care for.

I also like first person accounts because they allow writers to “live in someone else’s shoes” for a moment and might make writing from that person’s position much more authentic.

Part I will be today and Part II will conclude on Wednesday.

Welcome, Lisa!


I am so happy to share this story, as this is one of my favorite moments as a nurse.

I typically worked the Baylor shift of 7pm to 7am at one of the local hospitals. Even though the story I am telling you happened about 7 years ago some of the details are still so very fresh in my mind. I have always believed there are no such things as coincidences. And this story truly emphasizes that.
I had arrived to the floor, received my change of shift report and was settling in for the night.
Shortly, thereafter we got a call that a young 29 year old woman was being admitted to the floor. I had no empty beds and my co-worker was a male nurse. This young woman was brought up to the floor with an admitting diagnosis of urinary tract infection and possible respiratory alkalosis.
Immediately, the diagnosis just seemed off to me. When the woman arrived I also noticed she was from India, she felt very uncomfortable with the male nurse so I asked him to switch off with me and I would take the admission. I really didn’t understand why she was being admitted to my floor. We were the IICU, intermediate intensive care unit. We essentially took the overflow from the ICU, with the only exception that we didn’t taker arterial lines. We did everything else, from vents, to trach’s, to PICC lines, and countless drips, and we rarely got anyone under the age of 50.
At first glance the woman really didn’t seem that ill. I was rather confused by her admission to my unit. After a few questions, I returned to enter her information into the computer system. I had barely sat down and the bell was ringing. I got up and headed towards the room. I had never seen anything like it. She was ashen, diaphoretic, and trying to make her way to the bathroom due to nausea. As I reached over to help her up she felt like she was on fire. I told her to sit still. I had just checked her temperature not 15 minutes prior and it had been slightly elevated around 99.8. But this time when I checked it, it was over 103. I was shocked and terrified for this poor woman.
I helped her up to the bathroom and helped her get changed and settled her back into bed. I took a look at all the new orders, returned with some Tylenol for her and began looking at the history. Something in my gut was telling me we were missing something. I read and reread her admission paperwork trying to find a clue. I called the hospitalist on call and related my story. He essentially blew me off and said I needed to contact the pulmonologist. Before I had a chance to call, she was ringing the bell again, and this time she looked even worse. Her body was writhing all over the bed, almost convulsing and she had no control over it. I looked at her and asked a simple question.

“Have you traveled outside of the country in the last few months?”

Her reply was “yes”, she and her daughter had just returned from India 2 weeks prior.
 I looked at her, and asked, “How old is your daughter?”
The reply, “She is only 2 years old.” 
Hope you’ll join us for Part II on Wednesday to see what this patients mysterious illness is. What might your guess be?
**************************************************************************

Lisa was born Lise Amanda Forest on November 19, 1966 in Ontario. She has 2 children, and 1 grandchild. She currently, lives in SC. Lisa speaks French and English. She graduated from College and worked as a flight attendant for a Montreal based airline. Lisa is a world traveler, having been to South America, Caribbean, and all over Europe; Lisa has been employed as an RN for the last 18 years. Lisa has moonlighted as a realtor and interior designer. Now she’s a writer and her debut novel Oracle is in editing. You can visit Lisa at her blog www.lisaforest.blogspot.com.

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.

Medical Air Evacuation in World War II—Part 3

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood’s this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood’s Sunday, September 30th.

Welcome back, Sarah!

The broad grin on the private’s face didn’t reveal how serious his condition was. “Hiya, nursey.”

“Lieutenant,” Mellie said, but she smiled back. “How are you feeling?”

“Depends. How many girls you got at that hospital in Algiers?”


“Oh, not one of them is good enough for you.”


“She wears a skirt, she’s good enough.”


Mellie clucked her tongue. “Too bad. All the women wear trousers.”


In my novel With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


On September 24th I discussed general principles of air evacuation, on September 26th we followed one patient in his flight experience, and today we’ll meet the flight nurse.


Training

The profession of flight nursing began in World War II. The US Army Air Force started the first training program at Bowman Field in Louisville, Kentucky in the fall of 1942. Training was haphazard at this point, and the first two squadrons (the 801st and 802nd) were sent overseas before training was complete. The formal program ran six to nine weeks, changing throughout the war. The first class of flight nurses graduated in February 1943.

The program was named the School of Air Evacuation in June 1943 and moved from Bowman Field to Randolph Field, Texas in October 1944. The US Navy started a flight nursing program in December 1944 in Alameda, California.


In training, the nurses studied academic subjects such as aeromedical physiology. They also learned field survival, map-reading, camouflage, ditching and crash procedures, and the use of the parachute. The program included calisthenics, physical conditioning, and a bivouac in the field with simulated enemy attack.


Organization


Each Medical Air Evacuation Transport Squadron (MAETS) was headed by a flight surgeon and chief nurse. The MAETS was divided into four flights, each led by a flight surgeon and composed of six teams of flight nurses and surgical technicians. A Headquarters section included clerks, cooks, and drivers.


Uniform

The typical Army Nurse Corps uniform of white dress or a skirted suit uniform did not work in flight. Although some resisted—including in ANC leadership—the women were allowed to wear trousers. The first few squadrons improvised uniforms, often cutting down the dark blue ANC service jacket and purchasing trousers. Eventually an official flight nurse uniform was authorized—a waist-length gray-blue jacket and matching trousers and skirt, with a light blue or white blouse. Depending on the climate, nurses also wore the combat airman’s heavy flight gear.


The official insignia of the flight nurse was a pair of golden wings with a maroon N superimposed. These wings were changed to silver later in the war.


Duties


The role of the flight nurse was revolutionary. No physician accompanied her on the flight, and she outranked the male surgical technician, who worked under her authority. She was trained to start IVs and oxygen, tasks reserved for physicians at the time. In addition, she was trained to deal with medical emergencies including shock, hemorrhage, and sedation. One flight nurse even performed an emergency tracheotomy using improvised equipment.


Dangers

The primary responsibility for the lives of the patients rested on the shoulders of the flight nurses. Their emergency training was put into use in many cases throughout the war. Flight nurses and technicians successfully evacuated patients into life rafts after a ditching in the Pacific, unloaded patients from a burning plane after crash landing in North Africa, and loaded patients under enemy fire in the jungles of Burma.

One flight nurse was taken prisoner briefly by the Germans after crashing behind enemy lines, and another parachuted to safety in the mountains of China. In one dramatic incident, a plane carrying a dozen nurses from Sicily to Italy was blown off course and crash landed in Nazi-occupied Albania. With the help of their survival training and Albanian partisans, the crew and nurses all evaded capture and crossed snowy mountains to be rescued at the coast—a two-month ordeal.


Seventeen flight nurses lost their lives during the war. Lt. Ruth Gardiner, 805thMAETS (pictured), was the first flight nurse killed, in a plane crash in Alaska.


Through professionalism and courage, the five hundred women who served as flight nurses in World War II saved many hundreds of lives and comforted over a million sick and wounded servicemen.


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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Medical Air Evacuation in World War II—Part 2

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood’s this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood’s Sunday, September 30th.

Welcome back, Sarah!

Mellie smiled at her patient. “Are you enjoying the flight?”

“Sure.” Corporal Fordyce stared at the fuselage curving over his head. Mud from the battlefield speckled his hair, and dark stubble covered his cheeks.


Mellie settled her hand on his blanketed arm. “How does your leg feel?”


“It’s gone,” he said through clenched teeth.


“I know,” she said softly. Now was no time for platitudes.


In my novel, With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


On September 24thI discussed general principles of air evacuation, today we’ll follow one patient in his flight experience, and on September 28th we’ll meet the flight nurse.


Pre-Flight

Let’s follow my fictional patient, Corporal John Fordyce. While retaking Sbeïtla, Tunisia from the Germans in March 1943, Fordyce steps on a landmine. Medics perform first aid and take him from the battlefield to the battalion aid station, where he’s stabilized. An ambulance carries him to a field or evacuation hospital, where his right leg is amputated below the knee. Since the corporal will receive a medical discharge, he will return stateside. An ambulance will take him to the airfield at Youks-les-Bains, Algeria. A C-47 will fly him to Algiers. Later he’ll fly to Casablanca in French Morocco, where he’ll take a hospital ship home for convalescence.

At Youks-les-Bains he arrives at a tent hospital at the airfield. The flight surgeon evaluates the patients to decide which are good candidates for air evacuation. Due to high altitude, the doctors prefer not to send patients with serious head injuries, sucking chest wounds, or severe anemia. Each combat theater has different policies on “neuropsychiatric” patients, but if they’re allowed, an extra technician will attend these patients.


At the airfield holding unit, the physician briefs flight nurse Lt. Mellie Blake on each patient. Mellie in turn orients the patients—most of whom have never flown—on what to expect. Corporal Fordyce wears an Emergency Medical Tag (EMT) which summarizes his condition and treatment. A large envelope with his medical records and X-rays rests beside him on the litter.


Loading the Plane


The surgical technician and medics from the holding unit carry the litter patients onto the plane. At the cargo door, Mellie checks the EMT against the list of patients on her flight manifest and directs the tech where to place each patient based on his medical needs.


The litters are clamped into aluminum racks along each side of the fuselage, stacked three litters high. Later versions of the C-47 will come equipped with lightweight web-strapping systems to hold litters. Fordyce is placed in the top tier with his bandaged stump facing the aisle for easier access. Lower tiers are reserved for patients with heavy casts or needing more intense care.


Flight

After the patients are secured, the C-47 glides down the runway. When the plane levels off, the flight nurse and technician see to the patients’ needs. They record Fordyce’s “TPR” (temperature, pulse, and respiration) on the flight manifest, and check for signs of bleeding and infection. Mellie is trained to treat shock, hemorrhage, pain, air sickness, and other medical emergencies, but Fordyce is stable and needs little care.

The flight team also provides water and food if needed. They converse with the patients, a voice of calm for the anxious and of encouragement for the depressed. If no patients are on oxygen, the men are allowed to smoke.


The interior of the C-47 is poorly ventilated and heated, and becomes stifling in hot weather and frigid in colder climates or higher altitudes. Smells can become overwhelming, especially when burn patients are aboard or someone becomes airsick. Surprisingly, air sickness occurs in less than 1 percent of flights. Corporal Fordyce is thankful his flight is in the 99 percent.


Unloading

After an uneventful two-hour flight, the C-47 lands at Maison Blanche Airfield in Algiers, Algeria. Mellie and the technician unload the plane with the help of men on the ground. A trained flight team can unload a full plane in 5-10 minutes, which is crucial in case of crash landing, ditching in water, or landing at a field under enemy fire.

An ambulance ferries Corporal Fordyce to a hospital in the Algiers area while he waits for the next step in his journey home.


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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.