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.

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.