Author Beware: Know Your Equipment!

I have a confession to make– I am LOVING the new series Hannibal on NBC and I hope it sticks around for a while.

It’s a great study in the uber-maniacal villain. The actor who play the psychiatrist/serial killer, Mads Mikkelsen, is amazing and I think he’s performing Lector better than Anthony Hopkins– which is saying a lot. And I know– what a name for the actor to have!

This is definitely an adult show– not for kids under 17 (I would say) but I tend to be very conservative with what my children watch on TV.

That being said– I have a little medical error to point out.

For some reason, television types LOVE putting medical sounds to add suspense and drama into a scene. This generally happens with putting the sound of a ventilator in the background when the patient is not even on oxygen or is on something simple (nasal cannula or oxygen mask.)

Lately, I’ve noticed a couple of instances where the show/movie puts the noise of an MRI scanner in the background of a patient getting a CT scan.

CT Scanner

A CT scan is very quiet. An MRI– that’s another story. Those scans are very noisy– the persistent knocking and cave feel can send patients over the edge.

MRI Scanner

Well, dear Jordyn, how do you know it was JUST a CT scanner and not an MRI scanner?

For one– the machines LOOK completely different and it’s easy to tell the difference. I’ve posted pictures for you here. The easiest way to tell the difference is that a CT scanner is donut shaped and an MRI scanner is tunnel shaped or thicker. The fronts may look similar. Plus, when you get an MRI of your brain, you get to wear the nifty Hannibal Lector jail mask.

So, Hannibal, I hope you stick around but please– no unnecessary noise.

Principles of Radiation Exposure

Even as nurses, we’re exposed to radiation– particularly in critical care areas. X-rays can be taken by a portable machine in the ER and ICU for patients that are too sick to move. Taking critically ill patients to radiology for CT scans who need to be monitored closely during transport and during their procedure. Patients getting reductions of fractures and dislocations in the ER where they bring a different type of x-ray machine that can take successive pictures and the picture can stay on for several seconds. We call it a C-arm but I’m sure it has another technical name.

Let me just say one of the most challenging places to code a patient is in radiology. Particularly if you have to pull them out of scanner which I have had to do on occasion.

But I digress.

I-stock Photo

As nurses, we have to think about protecting ourselves and our patients from extra exposure to radiation. We can benefit our patients in a number of way by advocating for:

1. X-rays NOT to be done portably. Portable x-ray machines tend to expose the patient to a higher amount of radiation than taking them to the radiology department.

2. Advocating for lower level films or for no films. There are a couple of situations in pediatrics that are very specific to this. Let’s look at abdominal pain. The single biggest cause of abdominal pain in pediatrics is constipation– yes, I said it– poop. You can actually tell how constipated a patient is by doing a basic abdominal x-ray which is one of the lowest radiation exposures. I like it because it rules out something simple and likely first. If the patient is constipated– alleviate that and see if their pain improves. If not– further testing may be indicated. Versus sending them straight to the CT scanner for abdominal/pelvis films looking for appendicitis which is lower diagnostically on the list. Abdominal/pelvic CT’s also have one of the highest radiation exposures.

Another example of not using CT scans is in the case of minor head trauma and/or concussion. Lots of parents bring their children to the ER over concern for concussion expecting a CT to be done. A CT is not necessary to diagnose concussion– we can do that based on signs and symptoms.

A CT in this example is really used to diagnose a bleed that might require surgery. So we look for more specific clinical signs that might indicate a bleed. Persistent vomiting (three or more episodes), diminished level of consciousness, or a focal neuro deficit (like the patient can’t use their arm). Then CT scanning is more indicated.

We are becoming more concerned in pediatrics about lifetime radiation exposure. A baby/child who has multiple CT scans has a much longer life to live to worry about developing later cancer versus an adult who has the same amount of scanning.

3. Provide protection. In our department, this might be using lead aprons to cover reproductive organs while a pediatric patient is getting an arm fracture reduced. Screening for pregnancy if a girl is menstruating.

When we think of radiation exposure– four factors must be considered.

1. Time: The length of the exposure.
2. Dose: What was the level of radiation at the time?
3. Distance: How close was the patient to the exposure?
4. Shielding: Was the patient protected in any way?

Check this link for further information on the basics of radiation exposure.

Also a GREAT article: Everything You Ever Wanted to Know About Radiation and Cancer. 

What do you think about radiation exposure? Have you ever used it in a story line?

Up and Coming!

Hello Redwood’s Fans!

How has your week been? Mine– busy but fantastic. I think I met my first UBER fan– Babs. And although I’m thankful for all those who are loving my stories she was a true treat and I think may have nearly had a heart attack when she held my phone. We met for dinner (along with a couple of other FABULOUS ladies) through one of those cosmic turns of events. Her sister posted that I was lucky she got in the right car for the ride home but I think I need a little Babs in my pocket for those hard author days when the words are hard to type– just for a serious ego boost. I’ve pictured her below. I’m the one in shades.

Uber-Super Fan Babs V.

How are things going for you?

This week we’re going RADIOACTIVE!!

Monday: Principles of radiation exposure. Plus, some great advice on kids and x-rays.

Wednesday: Author Beware!! I haven’t done one of these posts in a while but they are important in getting details right. This is where I take a real life example of published material or TV/movie and expose the medical error. This week– the new NBC series Hannibal.

Friday: Author Question: Radiation Leaks.

Hope your week is glowy and fantastic but without radiation sickness.

Jordyn

Thin Wire: Heroin Addiction

I’m pleased to host author Christine Lewry as she shares from her book that deals with her daughter’s struggle with heroin.
Abridged extract from Thin Wire: A mother’s journey through her daughter’s heroin addiction.

Amber’s story: Heroin Withdrawal

Living with Dave, I’ve always had an easy supply of heroin. The thought of what a long, enforced withdrawal might be like flits across my mind. I dismiss it – I’ll be okay and we’ll soon be home. ‘Sleep as much as you can, it’ll help slow the cluck. The more you move around, the more it’ll hurt,’ he says.
The journey to the station doesn’t take long. The police van pulls up into an under-cover, concrete courtyard. A policewoman unlocks the barred door of the van and swings it open. We step down, straight into a frigid, stark cage.
‘Out you come,’ the custody sergeant says as he opens the door from inside the station. He points at me. ‘You first.’ I follow him to his desk. He has a two-page questionnaire to fill in about me. When he reaches the end he says, ‘Do you need to see the doctor?’
I lift my chin. My eyes settle on his face. ‘No. I’m not a drug addict.’
‘Okay,’ he marks it on the paperwork. ‘If you say so.’
In my cell there is no mattress or pillow, only a scratchy old blanket. I pick it up and shake out the dust. It smells of old men and greasy hair, like it’s never been washed. I lay the blanket on the wooden bench and use my coat to cover me.
The mental itch for heroin creeps over me. I close my eyes and try to sleep, turning on my left side and then my right. The fake-fur collar of my coat makes my nose itch so I push it away. I take off my shoes then decide my feet are cold, so I put them back on.
It’s been ages. I ring the bell on the wall of my cell. The empty echo of the policeman walking down the corridor gets closer. He pulls back the slat in the door.
‘What is it?’
‘Can I have a cup of tea?’
‘Only after you’ve been here an hour. I’ve got too much to do.’
‘Well, I’ve been here an hour.’
‘Fifteen minutes actually.’ The slat slams shut.
Fifteen minutes! He’s having a laugh! Panic rises up inside me. I must get a grip of myself, stop the uncontrollable shaking. The itch is getting stronger and I have no idea how long the police can keep me here.
Pacing up and down the small room, I notice the heavy door is scuffed excessively on the inside, as though most of the previous inmates have leant their weight against it and kicked it continuously. One of the walls is painted yellow, the colour of sick, and the other three are brick. The floor is cold concrete and there’s a stainless steel toilet in the corner that smells of bleach. I lie down, telling myself to relax and stay still.
A heavy key turns in the door and someone opens it. A cup of tea is placed inside. My hand shakes as I take a small sip from the white plastic cup. It squashes in and I think it’ll spill over the top. The tea is tepid, not hot, and tastes of metal like it’s come out of a machine, weak with no sugar.
I’ve been walking up and down the limited space in my cell for most of the day. The windowsill has hundreds of messages, names and poems scored into the wood. I read them all, running my fingers over the surface as if it’s Braille. Do I know any of the people who have been here before me? Are they addicts? Dave’s punters?
The pain in my arms and legs is excruciating; I can’t stand it any longer. I’m starving hungry yet sick to my stomach. Freezing cold and shivering, but when I touch my skin it’s burning and wet with sweat. I’d do anything now, anything to stop the unscratchable itch for heroin.
I ring the bell again. ‘I’d like to see the doctor.’
The policeman looks at his watch. ‘Sorry love, too late for the doctor to come out tonight. You’ll have to wait until the morning.’
‘But I can’t wait till then. Please.’ My mind is frantic, searching for some reason I could give him to make the doctor come out.
‘Did the custody sergeant offer you the doctor when he signed you in?’
‘Yes, but you don’t understand …’
‘Then you should have said “yes” when he asked you.’ He shut the slat.
I sit on the cold floor and rest my head between my knees, waiting to see whether I’ll puke. The blood in my ears is roaring. The ache of withdrawal has taken over. I’m exhausted, but my speeding brain prevents me from sleeping. The pain comes like a hard punch, as if I’m a boxer in the ring being beaten, but even a boxer gets a thirty-second break between rounds. I clench my fists and knead them hard into my guts as a wave of agony flows over me. The worst part is knowing that if I just had a little heroin all this pain would go away.

Good news is Christine’s daughter beat her heroin addiction and has been clean for almost a decade.

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Christine Lewry lives in Hampshire, UK with her husband and two youngest children. She worked in the defence industry as a finance director for twenty years before leaving to write full-time. Thin Wire is her first book. For more info: http://www.christinelewry.com/

Concierge Medicine

Personally, I didn’t have a lot of strong feelings about concierge medicine until my personal physician decided to convert his practice to it.

I do have VERY strong feelings about Obama Care speaking as a pediatric ER nurse. I tend not to get political here but, regardless of how you feel about the law, healthcare is changing in the US and physicians moving to concierge medicine is just one of them.

In the current state, physicians are worried about the feasibility of making a profit and keeping their practice doors open. Reimbursement is low– particularly from insurance companies– Medicare and Medicaid are prime examples. A doctor can only care for so many patients. So when money is cut they are required to see more patients to earn the same amount of money.

After a while, it becomes impossible to make the bottom line and provide quality care.

Concierge medicine is where the patient pays the doctor a fee for access or increased access. In my case, this was in addition to what we would pay for our regular medical insurance. What was the physician going to charge in our case? $1,800 per person. Just to see him. That didn’t cover other diagnostics like lab and x-ray and likely an office visit fee.

In a letter he sent out, he was decreasing his practice from 2800 people to 400. Where will those other 2400 people go?

Realistically, the average American family is not going to be able to pay this type of money on top of their insurance premiums. What I see developing is a two-tiered medical system. A completely privatized, fee for service side and the government side– unless changes are made to the current law.

What do you think of concierge medicine? Would you pay extra to see your current physician?

Researching a Doctor’s Training

Sometimes the challenge of writing a medical scene is knowing how young or old to make your physician based on their medical training. Some specialties require many years of training and others not so much (as far as specialized fellowships, etc.)

In my current novel, I needed to figure out what type of training my physician needed to go through. He’s a pediatric transplant surgeon.

Here were the basics.

College: Four years
Medical School: Four Years
Surgical Residency: Four-Six Years
Cardiothoracic Sugery Fellowship: Two Years
Pediatric Cardiothoracic Fellowhsip: One-Two Years

Why the varied length? One interesting thing I read was that surgeons were required to have a certain number of particular procedures before graduating which makes perfect sense. We can’t guarantee when certain types of patients will come in but we’d definitely want a doctor to have a certain number of cases under his belt before hanging a sign on his door.

It was also interesting to learn that some hospitals are going to combined surgical residencies where the specialty they want to do is combined with their surgical residency. So, perhaps the training could be complete in six years versus the nine years above (for the cardiothoracic portion.) 

It’s probably easier now than ever before to ferret this out on the internet because doctors generally list their training, where they went and how long it took.

The easiest way to approach this is to Google search the type of physician your character is. For instance, in my case, I did “pediatric heart transplant surgeon”. Then looked up a couple of profiles to see what type of training they’d been through.

This could be done with any specialty.

What kind of doctors have you written about?

Up and Coming

Hello Redwood’s Fans!

How has your week been?

Mine? Crazy busy. I’m in the third round of editing the last book in the Bloodline Trilogy, Peril. Pretty soon my baby will be ready for the world– October 1st. It’s always a nerve racking time as other authors are reviewing the novel for possible endorsement and you always want to impress them.

I’m also doing a huge Facebook Party launching my new Facebook Author page. Hope you’ll stop by and check it out.

For you this week:

Monday: Researching a physician’s training.

Wednesday: Concierge Medicine– just what is it?

Friday: Christine Lewry returns to share a personal tale of her daughter’s heroin addiction.

Hope you guys have a GREAT week.

Jordyn

Author Question: Exsanguination

Heather S. asks:

I came across your website while browsing for some information for a project. I am currently a nursing student and am doing a project on arterial bleeding. I am trying to find specific exsanguination times for the major artieries in the body. I have had no luck after searching online and multiple medical books. I just need a simple answer, i.e carotid artery 2-20 minutes. I have a few times, however, I feel that they are inaccurate. Please see below:

I-stock Photo

Carotid – 2-20 min

Brachial – 5-60 min
Femoral – 5-60 min
Aorta – 1-2 min
Popliteal – 5-60 min

I would greatly appreciate your help as it seems you are extremely interested in medicine. This might go on to help your other readers as I came across the questions dated January 12, 2012 where you discuss exsanguination. Thank you!

Jordyn Says:
Your question is not an easy one.

Any major artery (and the ones listed are major) that is completely severed will likely lead to the patient’s death in less than five minutes. I saw a demonstration once where a physician simulated this happening.

He took a 2 Liter bottle (an empty pop bottle) and filled it with water. He drilled a hole into it (to simulate arterial severing) and then squeezed it at a regular rate to simulate the heart pumping. That bottle was empty in a matter of three minutes. Yes, we timed it.He said the diameter of the hole he drilled equated to the popliteal artery which is behind your knee.

However, the injury may not be a complete separation which is why you have the varying time lengths. Of course, if the person gets some type of medical treatment (like a pressure dressing that stems the bleeding) they may last a lot longer as well.

I know this answer isn’t a clear cut answer but in medicine . . . they usually aren’t.

Heather’s Follow-up Question:
Could I say the smallest time is the fastest time to bleed out without medical attention and the longest time is a small bleed from an artery?

Jordyn Says: Yes, this is reasonable. 

Injured Characters: Start From "The End"

I just returned from teaching at Colorado Christian Writers Conference up in Estes Park, CO. Not only is it a beautiful spot– being up in the mountains is stunning!– but it’s also a conference close to my heart. It was this conference in 2006 where I became firm in my decision to seek publication and so much has happened in the last seven years. If you haven’t considered this conference– do so! You get FOUR appointments. It’s the only conference I know that guarantees that.

I Stock Photo

While there, I taught my Medical Pitfalls lecture for authors where I teach you to maim, injure and kill your FICTIONAL characters the right way. Several people made appointments with me just to figure out the right way to do it.

It was awesome.

After doing this service for writers for almost three years, I’ve noticed a definite trend. People have an idea of how they want to injure the character but don’t necessarily like the end result. For instance, they’ll give me an injury and then want the character to be hospitalized for several days. However, often times the injury is not severe enough for the character to even be in the hospital. Sad part of today’s medical enviroment is you have to be pretty sick to gain admission.

Other issue is the opposite. The author has given the character a devastating injury but wants them to be semi-fuctional in the proceeding days. Well, maybe in a fantasy world where they can heal themselves would this work but otherwise . . . no.

My suggestion for all writers/authors is to think of your character’s end point by asking yourself a couple of questions.

1. Why am I injuring/killing this character?
2. Do I want them to be functioning in the next couple of scenes/days/weeks/months? If so, how well? Fully? Partially? With great incapacitation?
3. Do I want my character to be in the hospital? If so, for how long? Keep in mind the longer a person is in the hospital the more issues physically they will have– particularly with muscle atrophy, loss of strength, and potential for infection. The longer they are in the hospital the more likely they will need rehab.
4. Do I want this character’s injury to have surgery?

Let me give an example of how I as a medical consultant for writers can help knowing the end point first.

Example A:

Author: I want a pediatric patient to have what the parents think is a fracture that sends them to the ER but I don’t want it to be a big deal. I’m using the ER visit as a moment for them to come together as parents in concern for their child to maybe remember some of the reasons why they came together. However, I don’t want the child to really have injury. Be fine. Able to play and be normal by the end of the ER visit.

Impossible? Why, no, actually.

Injury: A nursemaid’s elbow. A nursemaid’s elbow is a dislocation at the elbow caused by pulling or tugging of a child’s arm– say to prevent them from darting into traffic. It is a VERY common injury among toddlers and parents feel very guilty when they bring them to the ER because they think they’ve broken their child’s arm. Not even an x-ray is required for diagnoses. A simple maneuver will pop the arm back into place and the child is happy and on their way with no restrictions. Back to normal life.

However, let’s take the other end.

Example B:

Author: I want a child to be injured in a fall. I want it to require surgery. Maybe a few days in the hospital.

Injury: Hmm… ideas? I have the perfect one. A supracondylar fracture. This fracture is just above the elbow. Any fall– generally onto the elbow can cause it. Other than a Type I– they generally require surgery to fix. Give a surgical complication– and your child character is in the hospital.

See how knowing the end point is helpful? So– consider this when you consult a medical expert for your writing. It will also open up possibilities you didn’t think of.

Author Question: Ankle Injury

Elaine Asks:

I have a medical question on my WIP that I was wondering if you can help me with. I have a 72-year-old woman who falls and hurts her ankle. It swells and throbs and her family brings her to the ER. From my research I gather that she can have a sprain as opposed to a break. I need her to be somewhat mobile because she needs to rush to a caving site where her son is trapped. Is it feasible to think that she can use crutches, can drive, pushing aside that she’ll pay a price afterwards? Any suggestions?

Jordyn Says:

Ankles are 95% of the time sprained and not broken. So yes, this is feasible. If you want her driving– I’d probably injure the left foot so there wouldn’t be major difficulties with driving. Crutches/air splint/or ace wrap for 7-10 days and then re-evaluate after that if her pain is not improved.
Here’s a link that pertains to your question: http://jordynredwood.blogspot.com/2011/07/welcome-dr-frank-edwards.html
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Elaine Stock is a former RWA member and has presented several writing workshops. Presently involved in ACFW, she was a 2011 semi-finalist in the prestigious Genesis Contest in the contemporary fiction division. She is also active on several social networking groups. Her first short story was published on Christian Fiction Online Magazine. New to the blogging world, Elaine started a blog this past April, Everyone’s Story. Since then, the blog has been graced by an awesome international viewership that totally pings her heart. Everyone’s Story features weekly interviews and reflections from published authors, unpublished writers…and just about anyone who wants to share a motivating story with others that may lift their spirit. She has also been the guest of several other blogs, helping to further grow her presence on-line.

She and her husband make their home in an 1851 Rutland Railroad Station they painfully but lovingly restored.