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.

Author Question: Treating Injuries Related to Torture 1/2

Taylor Asks:

I have some character injury questions that I could use your help with, if you don’t mind! I contacted you last year with a bunch of questions about car crashes and injuries for another book that I was working on, and you were a tremendous help. I have some questions for this story, and thought I’d reach out to you again.
This story is a political thriller. One of my characters (Erin) is an American government agent who is ambushed and kidnapped by an Iraqi insurgent/terrorist leader while working in Iraq. He took her for two reasons. One is that he wants to use her as leverage/a bargaining chip to get what he wants. The other, more significant, reason is revenge. John (her current partner/coworker) had been a member of the US Army Special Forces. During a mission in the Middle East, he killed a fairly high-ranking terrorist who was responsible for the deaths of several US military members. That happened to be this man’s brother. Now this man has taken Erin, and plans to kill her – he wants John to know the pain of losing a loved one, and plans to make them both pay for John’s “crimes.”
One of her guards helps her escape after three or four days. He can’t deliver her back to the Americans, so he takes her to a local hospital and hands her over to the staff there for medical care. She is then rescued by the military a few days later. 
Iraqi insurgents are well known for their methods of torture and brutality to their captives. Fortunately for Erin, she was spared the worst of it; all things considered, they didn’t treat her TOO terribly.
Question #1: She’s hungry and dehydrated (they gave her very little food and water.) Other than IV fluids and adequate food and water after she is rescued, is there anything else that would need to be done?
Jordyn Says: In a time frame of four days, yes, she is likely dehydrated but she shouldn’t be terribly malnourished. A couple of liters of fluid (Normal Saline or NS) should get her feeling much better. Than some fluids that have some sugar and electrolytes in it at maintenance until she’s eating well and peeing well.  

We’ll continue with the remainder of Taylor’s questions tomorrow!

Use of Torture in Fiction

I’d like to welcome Tessa Stockton to Redwood’s Medical Edge. Today, she guest blogs about a controversial subject– use of torture in fiction. How much violence is too much violence?
Welcome, Tessa.
I have an odd fascination with torture and how to apply it in novels with believability. Since I’ve written a political intrigue series based in South America, touching on some of the endless conflicts between the politically left and the right, the subject of torture comes up in my research. A lot.
The interest started about 17 years ago while I worked with human rights groups. During a time where I had read so many testimonies from survivors of torture, I experienced a shift in my life’s direction and began applying what I learned toward what I wanted to convey through writing stories.
Reading testimonies is one thing. They can be incredibly stirring and influential. However, sometimes details need to be backed up by medical facts, such as the physical and psychological responses—not just the emotive. As an example, if a central character endures electric shock treatment, a writer needs to know how their body reacts—not just, “It hurt.” The swelling of a tongue and the immense thirst contribute to a likely residue. Also, if one drinks water too soon after “the session” he or she can suffer a heart attack. If a person’s nails are yanked, sometimes they can grow back in time, sometimes they can’t if the nail bed is too damaged.
This information is important, say, if you base a story around someone who is a political prisoner and who endured sessions in the “operating theater,” (my novel forthcoming), where spiritual healing coincides with physical healing.
While I don’t like my novels to get too graphic, I feel some description of this nature makes them more realistic. I try to strike a balance, inserting key depictions where most appropriate.
My debut novel, The Unforgivable, which released through Risen Books on April 1, 2011, is a love story entangled in the aftermath of Argentina’s Dirty War. In a nutshell, a Christian woman falls in love with a man who is despised by his nation, accused of war crimes, and who faces trial. There is a necessary chapter in my book entitled, “Private Testimony.” It’s necessary, because it causes the protagonist to shift in how she views this man with whom she has fallen in love. When she hears a survivor’s real life experience in undergoing an interrogation, suddenly a giant hurdle blocks the relationship with her love interest—especially with the claim that he was the one who quite possibly conducted and/or ordered the interrogation.
Details, details, details! They’re often gruesome but manageable. Here’s what I did in an excerpt, spoken from “Rosa,” the survivor:
“Electricity became intimate with me—forced its intimacy through pain I had never known—when it made contact with every part of my body, even my tongue which swelled, and under my nails.
 This man, my interrogator, focused especially on those areas that should have been hidden from him and all men, aside from my husband,” Paloma interpreted. “This man preferred applying shock to those parts the most. I did not recognize my own voice when I screamed. It made me feel like an animal. I defecated on myself. I begged for mercy. I remember thinking: this is what hell is. I had died and gone to hell.
“Soon after—but I really do not know how much time had lapsed—everything blurred and things like time became insignificant. Nothing mattered except for the need to survive.”
So, how much is too much?—because too little often doesn’t deliver the same weight—not if you’re a realist. Well, I’m a romantic realist—but that’s another story! While I like to insert a few “special descriptions” to give a scene that sense of horrible reality, I try not to go overboard. I might write a scene but use milder words when pointing out certain body parts for instance. Torture is by nature horrific but can be filtered for generality—if its inclusion is necessary for plot enhancement.

I can never read too little on the subject. Knowledge is useful. The more I learn the better I can write. Strange but true, fiction serves an array of purposes—even with its use of torture.

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A former contemporary dancer and missionary, Tessa Stockton, who has also been active in politics and human rights groups, now writes Christian novels. The Unforgivable, now available in Paperback, Kindle & Nook, is her first book in the political intrigue series, Wounds of South America. For more information, visit her at http://www.tessastockton.com/.