Author Question: Jack and Jill

/ Jordyn Redwood / Leave a comment

Maisie asks:

My 16 year old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I’ve never broken anything to know how it feels. I want the medical scene that follows to be realistic, her Mom will meet her at the hospital, it’s late at night.

What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don’t want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they’ll look for, and how this is going to encumber her in her regular life





Jordyn says:

The thing to know about ankles is that they rarely fracture. 95% of the time, they are sprained. For a sprained ankle, an air splint (crutches if the patient can’t bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful– they should follow-up with their regular doctor or orthopedic doctor at that time.
It’s more likely, with your scenario of falling down a hill, for a simple break to the lower forearm.

Treatment in the ER will be x-ray to evaluate for fracture, pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast.

Pt will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn’t be any permanent damage.

Lacerations: Generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn’t had one in the last five years.

Author Question: What is a Good Condition for my Character?

/ Jordyn Redwood / Leave a comment





Teena asks:

I want my main character to have a medical condition his girlfriend is unaware of. It needs to incapacitate him and put him in a bit more jeopardy when he doesn’t get his meds. I also want him to have a concussion so he black outs once or twice while he’s with the bad guy. But he also needs to escape.

A little earlier in the book I want him to exhibit some symptoms to his girlfriend but without revealing his condition…maybe watching what he eats, and in another scene exhibiting dizziness and weakness to a friend but claiming he’s just out of shape. Then, a little later, while he is by himself working on his novel, maybe some shaking where he takes pills and readers don’t know why. They may just think he’s an addict.

He is not obese and is in his early thirties. Which is counter to the profile for most type 2 diabetics I think.

Any suggestions?

Jordyn Says:

Thanks for sending me your question.

I don’t think Type II diabetes is a good option considering his age and good health status.

Here are a few posts I did specifically on diabetes:

1. http://jordynredwood.blogspot.com/2011/07/diabetes-part-12.html
2. http://jordynredwood.blogspot.com/2011/07/diabetes-part-22.html

Off the top of my head– I might consider some type of cardiomyopathy. Where he needed digoxin and lasix as maintenance meds. If he came off those– he could definitely be symptomatic. A lot of the criteria you want would fit this type of condition.

1. What is cardiomyopathy: http://www.nhlbi.nih.gov/health/health-topics/topics/cm/

2. Cardiomyopathy: http://www.nlm.nih.gov/medlineplus/ency/article/001105.htm

3. Cardiomyopathy: Treatment and Drugs (and lots of other info): http://www.mayoclinic.com/health/cardiomyopathy/DS00519/DSECTION=treatments-and-drugs

Read through these resources and see if they strike a chord.

Teena Says:

Thanks so much for the suggestions. I think maybe the hypertrophic
cardiomyopathy is the way to go!

*****************************************************************************

Teena Stewart is a published author, artist, and ministry leader. She is currently working on a sequel to her first completed romantic suspense novel. Recent published books include Mothers andDaughters: Mending a Strained Relationship and The Treasure Seeker: Finding Love and Value in the Arms of Your Loving Heavenly Father. For more info visit www.teenastewart.com and
http://nearly-brilliant.blogspot.com/

EMTALA and the Writer

/ Jordyn Redwood / Leave a comment

What is EMTALA and why should I, as an author (and maybe a healthcare consumer), care about it? EMTALA, like HIPAA, sounds like a foreign language but has large ramifications for healthcare providers. Here’s a series I did on HIPAA and how it is often dealt with poorly in fiction writing.

1. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-13.html
2. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-23.html
3. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-33.html

EMTALA stands for the Emergency Medical Treatment and Active Labor Act. It was passed in 1986 as part of the Omnibus legislation and is sometimes referred to as COBRA. COBRA is the legislation that dictates how you’re covered by medical insurance when you change jobs.

The reason behind EMTALA was to prevent patients (those covered by Medicare, Medicaid, or without insurance) from being “dumped” to other institutions because of poor reimbursement or no reimbursement on part of the patient.

When refusing care (problem #1), the patients condition can deteriorate while they’re trying to get to another hospital. This is overall, of course, bad.

This only applies to those hospitals that receive Medicare and/or Medicaid funding which is virtually all US hospitals. If a hospital is found to have an EMTALA violation– heavy fines can be imposed and hospitals can lose their government funding. If that were to happen, the hospital would likely have to close its doors.

Dr. Tanya Goodwin covered how this relates to a patient in active labor in this post.

I thought I’d talk a little about how it relates to the emergency department.

Any patient that presents to the ER must be given a “medical screening exam”. This will vary from state to state on who can provide these exams. Some may require a physician while others may be okay having an RN complete it. This is dictated by that state’s scope of practice. Here are a few previous posts that deal with scope of practice issues:

1. http://jordynredwood.blogspot.com/2011/09/perinatal-providers-scopes-of-practice.html
2. http://jordynredwood.blogspot.com/2011/08/author-beware-wrong-medical-procedure.html

If the patient does not have an emergency, the hospital can “screen” that patient out to another facility, urgent care, or their doctor’s office to be seen later.

Let’s look at a real life example. I work in a pediatric ER. We generally treat patients up to age 21. After that– they need to transition to adult care.

So, let’s say I’m in triage and a 65 y/o male presents to the ER for treatment of an uninfected ingrown toe nail. Based on our treatment guidelines– being a pediatric facility– the on-duty physician can either treat or “medically screen” the patient out because though an ingrown toe nail may be painful– it is not a medical emergency.

Now, can you do this in your manuscript? A physician is fed up with a patient and kicks him out of the ER. Is that an EMTALA violation? Did he provide an exam? Was the patient having an emergency?

As a result of this law– generally a patient who collapses (maybe a patient suffering a gun shot wound is “dropped off” at the hospital) on hospital property needs to be given care. There have been instances of this on the news where someone collapsed and based on their position in relation to hospital property– care was or was not provided. EMTALA dictates the hospital’s response in these circumstances.

For more on EMTALA– you can read here.
http://www.emtala.com/faq.htm

Have you ever dealt with an EMTALA issue in your manuscript?

Sweating Bullets: A Story of Ann Boleyn 4/4

/ Jordyn Redwood / Leave a comment

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate! Here are Part I,  Part II and Part III.

Welcome back, JoAnn!

Part IV:  The cold hard facts.
 

Influenza has been around since at least Hippocrates’ time.  It is thought of today mostly as a nuisance that can be sanitized or vaccinated away.  This testifies to a short collective memory when the story of the Spanish Flu pandemic of 1918 is considered. 

Within 25 weeks of the beginning of the Spanish Flu pandemic, an estimated 25 million people died worldwide.  When the pandemic finally ended in 1920, as many as 50 million people had died.  In an era when supportive care for influenza symptoms such as fever was better understood than it was in Tudor times, the mortality rate for Spanish Flu was still around 10%.



Ann Boleyn

It doesn’t take much math to figure out that as many as 500 million people developed Spanish Flu between 1918 and 1920.  It was an era when people knew a lot more about disease transmission than they did when Anne Boleyn retreated to Hever.  As a result, many a large public gathering was cancelled for preventive purposes during the Spanish Flu pandemic, and people around the world wore surgical-type face masks when in public.  These efforts were unavailing against the spread of the infection; Spanish Flu was as mysterious and maddening as Anne Boleyn herself.

Many believe nowadays that Spanish Flu was an avian virus, akin to the modern H1N1 or bird flu virus which is originates in, and is spread by, infected poultry.

Anne Boleyn is unlikely to have personally prepared poultry for consumption.  She did, however, feast in the Tudor court where feathered fare ranging from swallows to game birds to swans were prepared by the help and consumed by ‘the quality’ with gusto.  The Tudor court was also a home to falcons which were used by both men and women for hunting for sport.  Anne Boleyn’s family crest actually features a falcon.  Parrots and parakeets, novelty birds from the New World, were also present at the Tudor court as pets.  Henry VIII himself was said to have an African Grey Parrot which could mimic calls to boatsmen on the Thames, leading more than one of them on a fool’s errand.  Another tale says that when the parrot fell into the Thames on one occasion, it was recognized and rescued only because it started to scream ‘boat!’ as it fell into the river.

The Sweat and the Spanish Flu do not have only a surprising causation in common.   Both claimed, for the most part, a surprising set of victims.  

The Sweat did not prey on vulnerable folk such as the weak, the very young, and the very old.  According to Caius, “They which had this sweat sore with peril of death were either men of wealth, ease or welfare, or of the poorer sort, such as were idle persons, good ale drinkers and taverne haunters.”  Contemporary sources also tell us that men were disproportionately affected; “mortalitie fell chieflie or rather upon men, and those of the best age as between thirtie and fortie years. Few women, nor children, nor old men died thereof”.

The Spanish Flu likewise claimed the least likely as its victims, with many heretofore healthy young adults succumbing.  The Spanish Flu pandemic started, in fact, in an army base in Kansas, claiming the lives of robust young World War I soldiers while their physicians looked on, helpless. It is thought today that this was due to a phenomenon known as cytokine storm, a scenario in which a healthy immune system is actually a liability. 

If a virus such as bird flu enters the body through inhalation, the infection will center in the lungs.  It is normal for the body to fight infection in the lungs with inflammatory responses that are familiar:   increased circulation to the area, mucus production, coughing, fever to ‘burn out’ the infection, etc. In a cytokine storm, too much of all of these symptoms creates as much of a problem, if not more of a problem, than the infectious agent itself.  Soldiers with Spanish Flu were drowned by copious blood and fluids produced by their own lungs, possibly as a result of this phenomenon.  Perhaps a similar phenomenon caused the profuse, and often deadly, heat and perspiration of Tudor-era Sweat sufferers.

The Sweat, and the Spanish Flu, were both maddening, mysterious forces, capable of bringing about a strong man’s downfall, and yet as elusive and as hard to contain as a bird in flight.  The association with Henry VIII and Anne Boleyn, surely, is fitting.
***********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

 

Author Question: Post-Mortem Injuries

/ Jordyn Redwood / Leave a comment

Giacomo asks: I’m writing a scene where the killer cuts off the victims’ lips while they are alive. how would the M.E. know if the vic was alive or not by looking at the corpse?
Jordyn says:
Sometimes, the best thing for me to do is offer an author several resources to delve through to find the answer they’re looking for. Here’s the list of resources I sent to Giacomo:
1. What Crime Scene Insects Reveal About the Victim’s Wounds: http://insects.about.com/od/forensicentomology/p/csiwounds.htm
2. Antemortem vs. Postmortem Injuries. Which means injuries before and after death.  http://shs.westport.k12.ct.us/forensics/07-injuries/antemortem_&_postmortem_injuries.htm
3. Twenty-seven differences between antemortem and postmortem wounds: http://ourforensicmedicine.blogspot.com/2010/02/27-differences-between-antemortem-and.html
4. Medico-legal significance of a bruise: http://www.legalserviceindia.com/medicolegal/bruise.htm
5. Post-mortem changes: http://emedicine.medscape.com/article/1680032-overview

Does anyone else have any resources that might help with Giacomo’s question?***********************************************************************Giacomo grew up in a large Italian family in the Northeast. No one had money, so for entertainment he and his family played board games and told stories. He loved the city—the noise, the people—but it was the storytelling most of all that stuck with him. Now Giacomo and his wife live in Texas, where they run an animal sanctuary with 41 loving “friends.” Sometimes he misses the early days, but not much. Now he enjoys the solitude and the noise of the animals.

 

Getting Sued: A Doctor’s Experience

/ Jordyn Redwood / Leave a comment

It was a cold winter day in 2009 when my life changed forever; however, it would be months before I figured that out.  On that fateful day, a drug-addicted surgical scrub tech assigned to my operating room allegedly stole syringes of fentanyl, a potent intravenous narcotic, from my anesthesia cart.  According to news reports, investigative summaries, and the scrub tech’s confession, once she took the syringes, she used them on herself.

It’s hard to fathom, but that’s not even the really sick and twisted part to this tale.  The scrub tech had hepatitis C, a blood-borne virus that attacks and, sometimes, destroys the liver.  Based on her own testimony, she knew she was positive for the virus.

Yet, after supposedly injecting herself with a drug intended for a vulnerable and innocent patient, she then allegedly chose to refill the syringe with saline.  Theoretically, the syringe was contaminated with her infected blood.

She then allegedly replaced the syringe in my cart.  If these allegations are true, and there is no way of knowing, there was no way I could have known that she had tampered with my drugs.  The syringes purportedly would have been in the same place where I left them, and both fentanyl and saline look identical.  So, on that unfortunate day, it is alleged that I injected a mixture of saline and hepatitis C into my patient’s bloodstream, instead of a painkiller. 

The following summer, the story made local and national headlines.  At least 5,000 patients were at risk for having been exposed to the virus.  Every anesthesiologist in my group secretly prayed that they weren’t involved.  The hospital went into extreme damage-control mode.  Tight restrictions and policies regarding the handling and securing of narcotics were strictly enforced.  Panicked patients were tested en masse for the potentially lethal virus.

A few months later, I received notice that I was being sued, along with the hospital.  Receiving the summons and the two-year ordeal that followed was, by far, the most painful, mortifying, demoralizing, and caustic event of my life.  Of course I grieved for the patient, but I had to do so in silence because any discussion of the event was forbidden, on the advice of my attorneys.  Never before would I have imagined the depths of shame, guilt, and self-doubt that I was capable of inflicting upon myself.

As the lawsuit evolved, the lawyers and the patient grew nastier and greedier.  My initial feelings of compassion and empathy dissolved into rage and betrayal.  I suffered through an eight-hour deposition with hostile attorneys where I was belittled, ridiculed, verbally abused, and intimidated.   Months later, I was emotionally beaten down, and I made the painful decision to settle.

At that point, it was no longer about right vs. wrong.

I just wanted the nightmare to end.  It was at that time, in the middle of settlement negotiations, that I was featured on the local television news station, only to be followed a week later by a front-page headline in the local paper.  Statements I made during my deposition were taken out of context.  The public commenters on the stories cried for my crucifixion.  I will never know this for certain, but the timing of the stories and their prejudicial slant reeked of a couple of reporters on the take.  I was made to look like a cold, heartless, reckless villain, whose patient was the innocent victim of my blatant negligence. 

I never got my day in court or the opportunity to explain that I’m not a monster.  I wish I could have explained that, before this happened I was a caring, compassionate, skilled, and highly qualified physician.  The manner in which I secured and stored my narcotics was identical to the manner in which most of my colleagues handled theirs.  We were all taught during residency that the operating room was a secure environment.  Furthermore, we were taught to have our drugs drawn up in advance of our cases, so as to be able to handle emergent and unforeseen events more expeditiously.

Now I am a shadow of my former self.  I’m bitter, defensive, cynical, and wounded.  I want to stress that in no way is this article intended to take away from the fact that a patient was hurt.  I was as much of a victim of the scrub tech’s crime as was my patient.  We just endured different kinds of injuries.  Mine were of the heart and soul and will never heal.

Note: I would greatly appreciate any feedback.  Also, if you have any questions or would like to schedule an interview regarding this or any other facet of life in the operating room, please contact me by email @ kateoreilley@gmail.com or visit my website@ http://www.kateoreilley.com.

 

*****************************************************************************

Kate O’Reilley, M.D. is a practicing anesthesiologist in the Rocky Mountain region. In addition to being a physician, she has also written two books, both of which are medical thrillers. She plans on releasing her first book, “It’s Nothing Personal” in the near future. When not writing, blogging or passing gas, Kate spends her time with her daughter and husband. Together, they enjoy their trips to Hawaii and staying active. Please visit her at her website, http://www.kateoreilley.com/ , and her blog www.katevsworld.com.

 

Sweating Bullets: A Story of Ann Boleyn 3/4

/ Jordyn Redwood / Leave a comment

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate! Here are Part I and Part II.

Welcome back, JoAnn!

Part III:  The cold hard facts.

In the Latin that united the cosmopolitan Renaissance medical world, the Sweating Sickness was called ‘sudor anglicus’, or The English Sweat.  Some Brits thought it an imported commodity, courtesy of the mercenaries from continental Europe who helped Henry VII, the first Tudor king, to win his throne.  In the sickness’ last rampage, it spread eastward through northern Europe as far as Russia, but largely spared Scotland, Ireland, and the more southern portions of Europe.

Much of Europe thought England in Tudor times a bit behind when it came to cleanliness and hygiene practices.  Erasmus described floors “covered with rushes, occasionally renewed, but so imperfectly that the bottom layer is left undisturbed, sometimes for twenty years, harbouring expectoration, vomiting, the leakage of dogs and men, ale droppings, scraps of fish, and other abominations not fit to be mentioned. Whenever the weather changes a vapour is exhaled, which I consider very detrimental to health.” The grasses and straw which comprised rushes, and which were also used to fill mattresses and cushions, were often infested with critters such as lice and bedbugs.  This perception played a large part in two of modern sciences’ earliest hypotheses about causes of The Sweat:  potties and pests.
 
Early epidemiologists associated The Sweat with Typhoid Fever.  Salmonella typhi spreads through contaminated food or water by what is known as the fecal-oral route and is strongly associated with poor sanitation and waste disposal.  This ailment probably killed such prominent Brits as Prince Albert, as well as several of the literary Brontes.  Typhoid fever has, however, a marked gastroenterological component.  Such symptoms are largely absent, or not emphasized, in contemporary descriptions of The Sweat.

Relapsing Fever, caused by louse-borne Borrelia recurrentis, is another Sweat contender.  It originated in the warmer parts of the world, including parts of Africa and South and Central America.  In the early Renaissance era, European exploration of these areas was just beginning. The plants, animals, and people that Europe’s explorers brought back home to the Old World could have been inadvertent Borrelia vectors.  Most of these early explorations, however, originated out of, and returned to, Southern European countries which were largely, unlike England, Sweat-spared.
Relapsing and Typhoid Fevers are caused by bacteria.

Bacteria were understood long before the discovery of viruses, which occurred around the turn of the 20thcentury.  Still more advanced 21stcentury knowledge about microbes provides a most convincing possibility for categorizing The Sweat:  influenza.

We’ll discuss the possibility of Sweating Sickness being viral in nature next post.
**********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

The Death of Dr. Mark Sloan

/ Jordyn Redwood / 19 Comments

Ahhh… Grey’s Anatomy Fans.

I need your help . . .

This may seem funny coming from a medical expert like myself but . . .

I. Have. No. Idea. What. Mark. Sloan. Died. Of?

Anyone know?

The tumultuous end of last season– the plane crash with almost every major character on the plane left us in doubt as to who survived and who didn’t.

At the beginning of the current season, it’s assumed Mark Sloan is dead. But then, he’s not. But then, he is.

From a medical standpoint, I do give Grey’s credit for showing some true aftermath of the crash. A renowned neurosurgeon who no longer has full function of his dominant hand and can no longer do surgery. Kudos. The post-traumatic stress aspects that had one character going through some fairly severe post-traumatic stress. Honestly, how Christina is still walking upright . . . you know after the whole gun situation too when she had to operate on Derick with a weapon to her head.

Really…

The confusing thing about Mark Sloan’s death was the ACTUAL cause of death was never mentioned. He had a major chest injury. We know that. He was coherent and talking after the crash. Good! But then, his happiness at Seattle Grace is noted to be “the surge”– which I guess is to equate with a real thing that can happen when a terminal patient has a period of lucidity in order to say good-bye.

But what would have been terminal for this doctor? His heart was too weakened by the crash he wouldn’t live? Hmm… how about a heart transplant? Vasoactive drips? An LVAD device?

To confuse matters more– he signs a 30-day DNR order where if he hasn’t fully recovered, they are to discontinue life support.

But, he still has the breathing tube in his mouth at the end of 30 days.

And here is my teaching point at the end of all my musings. Generally, a ventilator dependent patient (or one who isn’t recovering quickly) is typically taken to surgery and a trach is placed somewhere between 7-14 days (sometimes sooner.) A trach is easier to take of and a more secure airway. Having an endotracheal tube in the mouth and through the vocal cords for that long can cause damage.

So keep this time frame in mind fellow fiction authors.

And please . . . someone tell me . . . what did Mark Sloan die from?

Top Three Medically Inaccurate Shows: IMHO

/ Jordyn Redwood / Leave a comment

Let me say first, television shows are not a good resource for medical research. Scratch that– reality shows where they actually film a medical team in action are good for sights, sounds, etc.

However, those fictionalized series written by writers are likely not. Here are my top three offenders as far as medical inaccuracy goes. This is not to say that I don’t love watching these shows– how else would I know they were so horrible for medical inaccuracy?

#3  Dexter: The reason I include Dexter on this list is that it perpetuated one of the leading medical myths. . . that you must keep the head injured patient awake. This is not true and doesn’t prevent a serious medical outcome. You can read here about this medical myth.

 

#2  FlashPoint: From giving a patient (my favorite character) too much Morphine that would have likely killed him to my favorite sentence, “I can’t detect a heartbeat. His blood pressure is low.” For one, if you are listening to the patient’s chest and can’t hear a heartbeat, then your patient is dead and therefore has no blood pressure and should receive CPR post haste!

#1  Grey’s Anatomy: I’m not even a surgeon and I know that watching Grey’s likely causes surgeons across the country to go into lethal arrhythmias. Two of my favorite instances of medical inaccuracy. One was a patient who needed major neck surgery– twice. After the first neck surgery, he’s placed in a C-collar to prevent movement. But then, it becomes medically necessary to do plastic surgery on his ear (not life saving by any means). In that shot, the patient’s head was turned all the way to the side so they could reach it. Guess his neck was stable after a mere few hours. Then he goes back for a second neck surgery and after that, isn’t even in a C-collar. That is some rapid healing– let me say.

My next favorite Grey’s inaccuracy was the chief resident having control over the nurses’ schedule. People, let me tell, physicians do not have anything to do with staffing nurses. Never. Especially to put them closer to a physician they are pining over.

What medical shows would you add to my list?

Sweating Bullets: A Story of Ann Boleyn 2/4

/ Jordyn Redwood / Leave a comment

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate! You can find Part I here.

Welcome back, JoAnn!

Part 2:  Running hot and cold.

Anne Boleyn retreated to Hever when an unidentified lady-in-waiting of hers contracted The Sweat in June, 1528. Butts, however, is reported to have treated Anne herself for the ailment when he was dispatched to Hever.

Butts would have been under tremendous pressure, certainly, to pull his patient through, or suffer the ire of the infatuated Henry VIII.  The prospect of that must have loomed large for poor Dr. Butts.  Since Anne Boleyn was stricken during one of the midcourse outbreaks of the disease, it would likely have been established by then that mortality rates were high with this condition–as high as 70%–even in heretofore healthy individuals.

Pressure aside, Butts would have been faced with a patient who was enduring, had endured, or was about to endure a grueling progression of symptoms.  The acute trajectory of The Sweat was rapid.  From time of onset, death or a turning point toward survival typically occurred within 24 hours or, as Caius would have it, ‘one natural day’. 

Anne may have gone through the prodromal symptoms of violent chills and a feeling of doom before Butts got to her.  It’s possible that he arrived in time to see Anne through the second phase of the illness, characterized by severe cephalgia (aching and pain in the head and neck), diffuse myalgia (pain in the limbs), and prostration.  Even if he missed these prodromals, perhaps Butts was present for the eponymous symptoms that would have followed.

Caius relates that several hours after the initial vague symptoms of The Sweat set in, more telling symptoms followed.  He speaks of the “fight, trauaile (travail), and laboure of nature againste the infection receyued (received) in the spirites, whervpon (whereupon) by chaunce foloweth a Sweate’. 

As described by Caius, profuse and copious sweating and ‘heat’ were the manifestations of the fight of the patient’s constitution against the depredations of The Sweat. Caius, and poor Dr. Butts, practiced medicine in an era in which temperature, blood pressure, and electrolytes could not be accurately measured.  It seems likely though, that high fevers and autonomic instability were part and parcel of the acute phase of The Sweat.  This phase of symptoms would be followed by cardiopulmonary symptoms, according to Caius:  heart palpitations and chest pain, labored breathing, and an overall feeling of heaviness. Gastrointestinal symptoms such as nausea and ‘wind’ might also occur.  Eventually, exhaustion and a desire to sleep set in.

Anne Boleyn survived her experience with The Sweat and eventually went on to marry Henry VIII and give birth to his daughter, Elizabeth I.  Given Anne’s mercurial ways, it’s not surprising that there are some who say that she never had The Sweat at all.  Could it be that she merely used the circumstances that prevailed in the summer of 1528 to manipulate the besotted Henry VIII and advance her own agenda?  This scenario is certainly not outside of the realm of possibility. 

The Sweat was contemporaneous with the Tudor dynasty through the reign of Mary I, known as ‘Bloody Mary’.  The Sweat bowed off the Tudor stage in time to spare the subjects of the last of the Tudors–Anne Boleyn’s daughter, the glorious Elizabeth I– from its ravages.

(An interesting side-note to the story of Dr. Butts is the fact that his daughter, Anne, married Sir Nicholas Bacon.  Historical rumor and conspiracy theory have it that two scions of the Nicholas Bacon family, Anthony and the legendary genius Sir Francis Bacon, may actually have been the illegitimate children of Elizabeth I, and therefore the grandchildren of Anne Boleyn.)
***********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.