Medical Question: Illness early 1980's.

AJ Luck asks:

I just found your website and I have to say….I am hooked! What a great concept!!

I am a fiction writer currently working on a spiritual thriller project.

I have a character that is in her late 70’s in the early 1980’s. Ideally I would like her to suffer about a year before passing away. I need to find a way to have her pass away-possibly in her sleep. I need to find something semi complex for that era that would allow her to hide the (fatal) disease, at least for a considerable amount of time.

I would love your thoughts!!

Thanks so much!

Jordyn says:

Here are a few ideas for your illness.

Cancer: There are a couple of cancers that when discovered, even with treatment, death might occur in about a year. A few to consider would be brain, liver, pancreas or kidney.

Neurological Disease: Here you could do a rapidly progressing ALS which is also known as Lou Gehrig's Disease.

Cardiac: In general, she could have congestive heart failure. There are a number of causes. This could have her feeling generally unwell for a long time and then you could have sudden death really at any point in your story line. Here's a blog post I did along those lines.

 http://www.jordynredwood.com/2010/11/historical-medical-question.html.

Hope this helps AJ and good luck with your novel!

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AJ is a Christ follower trying to encourage others by being transparent in her trials and triumphs. You can find her a http://randomnessofluck.com/.

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A Humor Break: Physician, know thyself.

I got this diagram e-mailed to me from a nurse friend of mine. It gave me a good laugh. Those that work in medicine can appreciate this as there seems to be these diagram boxes for everything. This one goes over how a medical student might find their specialty. Now, I don't know who to credit it to. So, if anyone knows, please e-mail me. And, if you find one for nursing, I'd be happy to post it.

I think the diagram does lend to the fact that certain medical specialties attract certain personalities. Nursing is no different. For instance, I happen to believe a lot of labor and delivery nurses have been cheerleaders in the past. Wouldn't you have to love to do that to get all those women through labor? What do you think the personality type is for a neurosurgeon, a podiatrist, or a family practice doctor? What about for an ER nurse, a neonatal nurse or a medical/surgical nurse?

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Medical Myth: Head Injured Patients Need to Stay Awake

I love the series Dexter. If you're unfamiliar with it and you're a writer, I think it's a great exercise in intricate plotting techniques. However, it is violent, so proceed with caution. The general premise is that Dexter works for Miami Police as a blood splatter specialist. In his free time, he's a serial killer, but only kills those that the justice system doesn't put away. This show is also good study for the sympathetic villain.

In one episode, poor Dexter has been in a motor vehicle collision. He is dazed and is taken to the ER. The doctor says something to the effect of, "You have a head injury. You'll need to stay awake for the next several hours." Great.

Sleepiness post head injury is a classic set-up for pediatrics. Every day in the ER is a story like this. It's close to bed time. The children are running amok. Some child falls down, falls into, or falls off of something and hits their head. They cry their little heart out. After all, hitting your head hurts, a lot. After a good crying bout, they're sleepy. Parents first thought is, he must have a terrible head injury. Off to the ER.

Now, one, I want to make it clear. Getting your child checked in the ER for head injury is good and reasonable. However, we aren't all that concerned with sleepiness. What we are concerned with is how arousable they are from sleep. This is what we'll be monitoring every fifteen minutes to an hour if the child sleeps during his ED visit.

Level of consciousness is assessed as an indicator of an injury going on inside of the head. How arousable you are is the most sensitive indicator of level of consciousness. If the child falls asleep, and we are concerned about head injury, we'll try to wake them up every so often to assess their level of arousability. If we cannot wake them up, then we are concerned. It has to be more than a gentle nudge. You are really working to wake the patient and they won't respond. This is concerning.

Remember, things that are injured need rest. This is why we put you on crutches if you break an ankle. The brain rests by sleeping. It helps it to heal. If you're a subscriber to this myth, how long should we keep the patient awake? An hour? Two hours? A day? If you want a skewed neuro exam, try doing one on a sleep deprived patient.

For additional resources regarding this myth, check out the following:

1. http://firstaid.about.com/od/headneckinjuries/f/09_Waking_Heads.htm

2. http://familydoctor.org/online/famdocen/home/common/brain/head/084.html

Did you believe this myth?

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Stitch Me Up!!

Often times in fiction, regardless of genre, our characters need to suffer a little mayhem to increase the conflict, like a physical injury. Today, I thought I'd give some routine guidelines for care of a laceration that would require stitches as background information for these scenes.

Cuts are preferably closed within 6-8 hours after injury. Long outside shot is 24 hours and only if the physician feels the wound is not highly contaminated.

First, the wound is generally cleaned with copious amounts of sterile saline. This is to wash out any debris/germs that are in the wound to prevent infection. Prior to this, the wound is generally "numbed" up. In kids, we use a topical gel called LET which is a combination of three substances (lidocaine, tetracaine, and epinephrine). This substance can be used on most cuts except the ends of certain areas (fingers, toes, nose.)Yes, I know that rhymes. It helps us remember! LET sits in place for approximately 30 minutes and then we irrigate the wound.

blistik/PhotoBucket

If the laceration is in an area where LET cannot be used, then the physician may use a digital block, which is an injection of anesthetic near a nerve site, to numb up a whole area, like a finger/toe.

Adults are given local injections of an anesthetic, typically Lidocaine, then the wound is irrigated.

If the cut is on the scalp, staples are used for closure. If the cut is in an area where the laceration will stay closed with movement (like under the chin), then the physician may choose to use Derma-Bond, which is a medical grade glue. However, if the cut is under "tension" it will need sutures. If the cut is near a joint, then the area will likely be splinted to ensure the stitches don't rip.

Here are guidelines for how long stitches need to stay in place.
Face: 3-4 days
Neck: 5 days
Scalp: 6 days
Chest/Abdomen/Arms/Back of Hand: 7 days
Leg/Tops of Feet/Back: 10 days
Palms of Hands/Soles of Feet: 14 days

The sutured area should stay undisturbed for 24 hours. No soaking in the bathtub or swimming until the stitches are removed. After the first 24 hours, the wound can be gently washed twice a day and covered with an antibiotic ointment to help prevent infection (unless glue or dissolveable sutures are placed-- then no ointment and most often no washing).

A tetanus shot will be given if the patient hasn't had one in the last five years.

Question for you: Why do stitches further away from the heart need to stay in longer?

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Medical Question: 1940's C-Section

Nike asks the following question:

Can you tell me anything about Cesarean section in 1946 in a tiny village hospital. It's in Long Island, NY, only two hours from NYC, so they're not isolated and totally backward.

The woman is a minor character who appears in only one scene, but I want to get it right. It's after a brutal snow storm, a maternity nurse stops by just to check in. Everyone knows everyone in the village and the doctor, a woman doctor, mentions she's been thinking about this patient. The nurse is going home, and says she's been thinking about her too and will probably stop in on her.

I figure the patient was in the hospital about a week and she'll need bed rest for about two weeks. Is that right? I'm thinking the patient might have her mother either living with her or staying w/her for the duration and the mother would be doing all the daily chores and taking care of the infant.



Justawomen/Photobucket

Jordyn says: I've been researching your question and am not quite finding the specifics you're looking for. Right now, a woman who has a C-section would be in the hospital for anywhere from 2-5 days with 2 weeks of light chores at home and no driving so your parameters of a week in the hospital and a couple weeks bedrest--- I think you could have some latitude. I tried to get some first-hand accounts and found one... number three below. That might lend to getting a feel for the culture at the time.

I've included several references/resources for you to look through.

1. General overview of the history of C-section:

http://www.nlm.nih.gov/exhibition/cesarean/part3.html

2. Here's some of the procedures a woman might experience:

"By the 1940's, the standard was set, with hospital birth being thought to be the ideal. The idea was that at the hospital the doctor had all the "tools of the trade" handily available. Unfortunately, this was and continues to be a major downfall of hospital birth, as well. Included in those tools were medications, forceps, surgical instruments, confinement to bed, enemas, pubic shaving, arm and leg restraints, and hospital nurseries with rigid schedules. Birth was seen as an illness that required medical attention."

Here's the reference that was taken from: http://www.naturalchildbirth.org/natural/resources/history/history01.htm

 3. I found a patient experience from the 1940's-- though not a C-section. What she says and the pictures that they include I think will help give you a lot about the culture at the time. Plus, the couple is absolutely adorable!

 http://news.bbc.co.uk/2/hi/uk_news/6159909.stm

4. Some more about the culture of the 1940's. "During the 1940s most women gave birth in an unconscious state, courtesy of drugs such as scopolamine. Women of that time seemed very happy to be numb, and end the "suffering" their mothers experienced in childbirth. They looked at birth without drugs as uncivilized."

http://www.ivillage.com/power-giving-birth-interview-nancy-wainer-cohen/6-a-144604#ixzz18fjYonLe

5. Historical Overview

http://www.mesacc.edu/dept/d46/psy/dev/Spring02/prenatal/history.html  

I found this little snippet that mentioned the length of hospital stay but couldn't pull the reference.  Period 1940-1950, the length of stay in hospital was reduced from 20.5 to 9.8 days per patient.

Any other suggestions for Nike?

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Nike is a wife, mother, and animal lover. She loves living in coastal metro NYC, a short distance from the Atlantic Ocean. Like so many other writers, Nike started writing at a very young age. She still has the Crayola, fully illustrated book she penned as a little girl about her then off-the-chart love of horses. Today, you might call her a crime fictionista. Her passion is crime fiction. She likes her bad guys really bad and her good guys smarter and better.

Nike was a 2010 Inspy Awards judge and writes book reviews for The Christian Pulse on-line magazine. She’s the founding board member of the Grace Awards, a reader driven inspirational fiction award and current  member of the American Christian Fiction Writiers (ACFW), where she serves as a small critique group leader. Also, she’s a member of Edgy Christian Fiction Lovers on Ning, where she coordinates a group summer blog tour and has taught a workshop on proposal writing. You can find Nike at Crime Fictionista: http://www.crimefictionandfaith.blogspot.com/.

 

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