Medical Scene Diagnosis: Part 2/2

Today, I’m continuing my analysis of this medical scene. You can read the Part I here. Last post we learned this patient has been in a terrible car accident. We’ll resume with the physician entering the room to give the patient the low down. My comments will be in parentheses in red. I’m just focusing on the medical aspects, not grammar.

doctor-840127_1920-1The door opened, and an older gentleman in a lab coat walked briskly into the room. He checked the clipboard hanging from the end of the bed, noted the numbers on the monitors beside the bed that were tracking Tony’s vitals, and nodded, apparently pleased with what he saw. (Patient information is not kept in plain view. Clipboards hung on the end of the pateint’s bed with medical information is a HIPAA violation. HIPAA is the law that protects patient information.)

“I’m Dr McGregor, your attending physician. Arnold says you remember the accident?”

“Just parts of it.”

“Do you know what day it is?”

Tony squinted his eyes as he concentrated. “Well, I was driving home from San Jose late Saturday night or early Sunday morning. Other than that, I couldn’t say for sure.”

The doctor made some notes on the chart. (Many hospitals have gone to computer charting.)

Tony forced a grin. “Is that a good nod or a bad nod?”

Dr McGregor smiled at him, peering over the frames of his bifocals that perched on the end of his nose. “That’s good. It’s Sunday, actually. You haven’t lost much time. Considering the shape you were in when they brought you in here, that’s a miracle.”

Tony nodded gently. “Yes, sir.  God is in the business of miracles.”

The doctor peered intently at Tony, then smiled. “Apparently so. You should have died.”

Tony tried to shift, then winced at the waves of pain and nausea that threatened to engulf him.

The doctor moved closer to him and laid a restraining hand on his shoulder. “Take it easy. If you want to move, ask your nurse for help.”

“I’d like to have my head up.”

“I think we can arrange that.”

Dr. McGregor beckoned to Arnold, who came around to the head of the bed. Using his forearm, he propped Tony in the bed, adjusted the pillows, and nodded to the doctor, who stood at the end of the bed. Dr. McGregor pushed a button that raised the head of the bed. Arnold eased Tony back to the pillows and adjusted the sheet covering the lower half of his body. (I like that it’s a male nurse because it’s unusual. However, the doctor is coming across as very stereotypical. He’s older, long lab coat, bifocals on the end of his nose. What are some ways to vary this character to make him more unique?)

Tony gripped the handrails as another wave of nausea passed over him.

Dr McGregor patted his shoulder. “It’s normal to have some dizziness after a head injury, and you got a pretty nasty bang on the head.”

Tony held up one bandaged hand. “What else is wrong with me, Doc?”

Dr McGregor cleared his throat before proceeding. “Well, some lacerations on your hands from broken glass.” He flipped another page on the chart. “Same on your legs and back. A couple of broken ribs. The most serious injury is to your liver.” (Remember in the first part of this scene, the writer noted his legs and feet were unscathed. Maintain consistency with the patient’s injuries.)

“My liver?”

“Yes. You sustained a fairly serious tear in the accident. We were able to stop the internal bleeding, but right now your liver is not working well. In fact, the most recent blood panel we did shows it is deteriorating quickly.  I’m sorry, Tony.”

Instinctively Tony’s hand moved to his right side. He felt the edge of a bulky bandage that covered his flank, the incision still tender.

“A person can’t live without a liver, can they, doctor?”

“Your only option at this point is a liver transplant.” (I liked this a lot because I learned something new. As a confessed medical nerd, the first thing I thought was really? Went and looked and transplant can be used in cases of severe traumatic injury to the liver. Check it out here if interested.)

“A transplant?” Tony felt sweat running down the back of his neck and realized his face was wet, too. He ran a hand across his forehead.

“Yes. We’ll enter your name and statistics on the national database for liver transplants. To be honest, although your need is critical, your physical condition at this point in time would place you near the bottom of the list. In the meantime, you will have to stay in hospital so we can monitor your liver function.”

“Come on, Doc. Don’t beat around the bush with me. Not everyone who needs a liver transplant gets one, do they?”

“That’s true.”

“So, what other alternatives do we have?”

The doctor squinted. “I’m going to be honest. Your best bet at this point is to have a close family relative donate part of their liver. That will be the best match and can be accomplished a lot more quickly than a regular transplant.” (This is a place to be careful with your statements. After all, a stranger can come up as a perfect match. It may be better to say, “Your best hope for a new liver is to test a close biological relative like your mother, father and any siblings. If they prove to be a match, this process will be faster than waiting on the transplant list.”)

Tony’s heart sank. This didn’t sound good. “So what exactly are you saying?”

Dr. McGregor blinked at him myopically. “I don’t think you would survive the waiting. If you have any close relatives, you should call them.”

“My parents are dead and I’m an only child.”

“I’m so sorry, Tony. I wish I had better news. There’s not much more we can do at this point. Except pray.”

This writer deserves a lot of credit for setting up some nasty odds and conflict for this character. Strong work!! Do you have any other medical suggestions? 

Medical Scene Diagnosis: Part 1/2

This medical scene was submitted by a fellow writer who wanted some critique and agreed to allow me to post my suggestions leaving her name off the piece. The scene begins with a victim of a motor vehicle collision coming into the ER. His car rolled several times during the accident. What follows is her scene. My thoughts will be in parentheses at the end of the sentence in red. I’m only going to comment on the medical accuracy. Grammar editing is not the focus.

crash-1308575_1920Tony screamed out to God, and flung his hands over his face. Rough hands grabbed his hands as he tried to pry off whatever was smothering him. (This is good as patients often feel like an oxygen mask is smothering. Kids particularly aren’t fond of them.)

“Hey, take it easy. You’re all right. You need that oxygen.”

Tony opened his eyes, blinking rapidly in the bright lights. As his blurred vision came into focus, he tried to see who was holding his hands.

Blue scrubs. Dark face. The whitest of teeth. Name tag. Arnold.

Tony tried to speak, but his throat was dry. Arnold reached over, raised the mask on Tony’s face, and placed something cold and hard in his mouth. Making sure the mask was securely replaced, he sat back in his chair. (In the initial evaluation of a trauma patient in the ER, a patient is never given anything by mouth until it is ruled out whether or not they need surgery. The more the stomach is empty, the less likely the risk of aspiration during intubation. In this situation, aspiration would refer to inhaling vomit into your lungs while the endotracheal tube is placed. Aspiration can mean different things in the medical arena. And I also don’t know too many nurses who actually sit vigilant at a patient’s bedside.)

“It’s an ice chip. It’s all you can have right now.” (I know, we’re mean. But not even ice chips.)

Tony nodded his gratitude and slowly savored the small chip. It may have just been ice, but at that moment, it was like ambrosia to his parched throat.

Swallowing carefully past the pain in his throat, Tony lifted the mask and tried again. “Where am I?”

“You keep that mask in place. You can talk through it just fine.”

He waited until Tony complied before continuing. “You’re in the Regional Medical Center in San Jose.”


Arnold’s smile faded. “Yes. Doctor said you’re lucky to be alive.”

Tony nodded towards the container of ice. Arnold placed another chip in Tony’s mouth, replaced the mask, then set the cup where he could reach it on the bedside table.

“Where is the doctor?”

“I’ll go have him paged.” Arnold rose and left the room. (This is a situation where it is reasonable for a nurse to give the patient an update on his status and condition without needing to page the doctor. I may say something like, “Your leg is broken, but your other tests looks good. I’ll let the doctor know you’re awake and he’ll come in and talk things over with you in more detail.” Also, in the ER, doctors are generally present, and there may not be a need to have them paged. This can be very unit specific so you’d have some latitude as a writer.)

Tony surveyed his situation, beginning with his toes, and moving up to his hands. While he was achy all over, his feet and legs seemed to be unscathed. His chest and abdomen hurt, burning all the way through to his spine, and were heavily bandaged. (Saying his feet and legs are unscathed may be reaching a little. Remember, he rolled his car several times. At a minimum, there should be some bruising, cuts, or abrasions.)

His hands were bandaged but usable, and he took this opportunity to pop several chips into his mouth, crunching them to make them go down faster. Feeling with his hands, he knew his head was bandaged. Vaguely he remembered blood running into his eyes.

We’ll resume the analysis of this medical scene next post. Any other medical aspects you would change?