Author Question: Post-Mortem Injuries

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.

 

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Getting Sued: A Doctor's Experience

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@ 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.

 

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Sweating Bullets: A Story of Ann Boleyn 3/4

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 20^thcentury.  Still more advanced 21^stcentury 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”.

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Up and Coming

Hello Redwood's Fans!

How was your Thanksgiving celebration? Hopefully good.

What's your favorite Thanksgiving food?

Mine is my mother's homemade stuffing with turkey gravy. As I'm writing this, I haven't had it yet and am looking forward to it . . . on Saturday as this is where I'll be on Thanksgiving Day:

I know, jealous, right?

For you this week:

Monday: JoAnn Spears continues her series on Ann Boleyn and the mysterious sweating sickness. Fascinating posts!

Wednesday: What's it like for a doctor to get sued? Dr. Kate O'Reilly shares a very personal experience of her legal drama. I think sometimes when doctors get sued, it's the public's perception that something negligent did happen. I'll be the first to say I've known of cases where the bad outcome for the patient wasn't the result of any medical negligence and the family still sued. What do you think about that?

Friday: Author question . . . you know I LOVE these. This one deals with post-mortem injuries.

Have a great week. Did anyone venture out for Black Friday shopping?

Jordyn

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The Death of Dr. Mark Sloan

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?

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I'm Thankful . . . For You!

Happy Thanksgiving!

Just a quick note to all my readers...

Thank you.

For reading this blog.

For leaving comments.

For participating in discussion.

You make it worth every minute.

Enjoy your day.

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Top Three Medically Inaccurate Shows: IMHO

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?

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Sweating Bullets: A Story of Ann Boleyn 2/4

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”.

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Up and Coming

Happy Thanksgiving!

Hope you all enjoy joyful time with friends and family.

This year, I'll be working the ER so think of me when you toast and say a prayer that there are NO kiddos needing our services.

What are you thankful for?

I thought I'd take a moment to list my top five. What would yours be?

1. My faith.
2. My family.
3. My home.
4. A good paying job.
5. Getting to see something I wrote be published and enjoyed by others.

Now that that's over... what are some things I'm REALLY thankful about.

1.Getting to see something I wrote be published and enjoyed by others . . . and I get to do it more than once!
2. Electric blankets. I hope these don't cause cancer (I've checked... so far most say no.)
3. Chocolate. What I survive by.
4. Flavored Coffee Creamers. I use them in tea and multiple varieties must be on hand.
5. Books. You should see my bookshelves. Truly, my drug of choice.

For you this week!

Monday: JoAnn Spears returns to discuss Ann Boleyn and the mysterious sweating sickness.

Wednesday: The top three most medically inaccurate TV shows in my honest opinion.

Friday: The death of Grey's Anatomy's Dr. Mark Sloan.

Hope you all have a fantastic week!

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HIPAA and Law Enforcement

I had a phone consultation with an author who wanted to discuss HIPPA.

As you know, HIPAA is a set of laws designed to protect patient privacy.

Here're links to a previous series I did on HIPAA: Part I, Part II, and Part III.

His question centered around whether or not law enforcement was privy to medical info.

In the pediatric ER-- we will readily discuss medical issues with law enforcement because it usually deals with us reporting child abuse.

However, I didn't know much about how my adult ER compatriots generally approached the issue. HIPAA is difficult to understand in its entirety and most healthcare professionals are apt to err on the side of providing no information rather than get in trouble for giving out information that they shouldn't.


Keep in mind that the main crux of this law was also to give you the power to always view your medical information. A hospital or medical provider cannot keep your records from you. Even if you are in the hospital-- you should be able to ask to see documents. What the hospital may do is have a representative sit with you to "watch" you so 1. you don't tamper with the record and 2. they can explain the medical lingo.

Unfortunately, some places make it challenging for patients to get their information. You should absolutely have to sign a medical release form. But after that, I've know of hospitals to state it can be up to two weeks or more for records and that they may charge you for the copying of each page. That can be frustrating experiences for families.

Pertaining to this author's question-- come to find out through a little research for said author, that HIPAA does allow for discussions with law enforcement personnel.

Here is the particular section that pertained directly to the authors question from this link:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.³⁴

Just goes to show you what you can learn whilst doing some research!

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Are ER Nurses Superstitious?

Sometimes as an author, you need to get the flavor of a certain profession. What are some of the things they believe or don't believe? These don't necessarily have to be based in scientific fact, but are held beliefs none the less.

So-- what are some held beliefs among ER nurses that may or may not be true.

1. Full moons (the celestial bodies-- not a patient's backside exposed) do cause people to come to the ER. If the unit is falling apart, there have been moments where all of us have looked at one another and asked, "Is it a full moon tonight? Is it coming in the next few days?" I don't know what it is but it feels like ER volumes go up and mental health patients increase too.




2. Strange medical diagnosis happen to medical people. Personally, I feel if you work in medicine, you should get a free pass illness wise (yes, Lord, I am talking to you!) You hear stories of Hem/Onc nurses getting cancer. Doctors going into preterm labor-- this may be proven as I think I looked it up once on a slow shift that doctors are more apt to go into preterm labor because of the odd sleeping hours and time spent on their feet. But, if you've never heard of an illness, a medical person probably has come down with it. You could say-- well, perhaps it's because they're all hypochondriacs. Maybe a little truth there (as she slowly creeps hand up.)

3. If you mention a particular patient-- they will check in. It's like a batman signal. Sadly, not all patients are warm and fuzzy to deal with. That's just a fact of life. So, you really don't want to say the name of a patient you had a tussle with.

4. We NEVER say the following phrases-- and if someone does, they will be scorned.

"Wow, it's really quiet."
"It is soooo slow!"
"Is it time to run someone over so we can take care of a patient?"
"Come on! Isn't it flu season?"
"Nothing is going on."
"We'll be with you in ONE minute."

You have just invited hoards of people to check into the ER in the next 30 seconds. It's worse than saying a patient's name you may not want to see. It's one million bat signals sent into the universe. These phrases are strictly forbidden to be uttered. Period.

5. Yes, some providers do have black clouds over them-- like Pig Pen's dust trail. Not in the weather sense but in the Angel of Death/Sickness sense. When some people work, it just hits the fan. Patients are sicker and there will likely be a code. It's probably akin to the cat who would visit the nursing home patients and sit with them when they died. The Grim Cat.

Did you know about these ER superstitions?

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Sweating Bullets: A Story of Anne Boleyn 1/4

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!

Welcome back, JoAnn!

Part I:  Working up a sweat, bugs indeterminate, and a man named Butts.

The courtship of Anne Boleyn and Henry VIII is the stuff of legend.  Tudor history buffs and Anne Boleyn fans alike will already know that Anne Boleyn was the first and foremost proponent of ‘if you like it… put a ring around it’.  By 1528, after about two years of courtship, Henry had yet to do so.  Anne parried with a retreat from Henry’s court to her family’s country home at Hever.  Romantically enough, she was suffering from, or at risk of contracting, a catching ailment.  There was a real chance she could die from it.  More romantically still, she hastened away to protect Henry from the contagion. 

Dr. William Butts

On a less romantic note, Henry himself did not follow Anne to Hever.  His devotion only stretched to his sending, in his stead, his second-best physician.  Less romantically still, that physician was called Butts, and the disease he was to treat Anne Boleyn for was known as ‘The Sweat’.

Life-threatening plagues and infectious diseases were a feature of life in Europe during the Middle Ages and the Renaissance.  Some of these illnesses are fairly well understood retrospectively.  For example, a good deal is known today about the causation, mode of transmission, treatment, and natural course of Yersinia pestis, or Plague.  The Sweat, however, remains, like its star sufferer, something of an enigma.

The Sweat debuted in England around the same time that the Tudor dynasty did, in 1485.  It recurred in 1508, 1517, 1528 and 1551; as far as we know, it did not recur thereafter. Each of these outbreaks began in England, and four of them had little or no spread outside of the British Isles.  The fourth, the outbreak of 1528, made its way across much of northern and eastern Europe. 

Two Tudor physicians, Thomas Forestier and John Caius, are the sources of much of the extant medical information about The Sweat.  The accounts these two physicians give of the condition are like bookends to its history.  Forestier speaks from the perspective of the first outbreak of The Sweat, in 1485.  He isolates The Sweat from other pestilences and poxes of the time by identifying the primary way in which it was unlike them; the absence of rash, pustule, buboe, or other manifestation on the skin.   “The exterior is calm in this fever”, Forestier explained, “and the interior excited.” 

John Caius authored “A boke or counseill against the disease commonly called the sweate or sweatyng sicknesse” in 1552, after the last outbreak of The Sweat.  He felt confident enough in his experience and findings to subtitle the work “uery (very) necessary for everye personne and much requisite to be had in the hands of al (all) sortes, for their better instruction, preparation and defence, against the soubdein (sudden) comyng, and fearful assaultyng of the same disease”.

Prominent as Forestier and Caius were as practitioners, they do not have the same Tudor cache as the man who was on the job when Anne Boleyn commenced The Sweat:  Dr. William Butts.  Other than his Sweating-Sickness association with Boleyn, little is known about the man.  Just what would the second-best Butts encounter when he arrived at Hever to tend his King’s lady love?  It’s difficult to tell the exact point in Anne Boleyn’s Sweat trajectory at which Butts came into the picture.

************************************************************************
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”.

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Up and Coming

Hello Redwood's Fans!

How has your week been?

Mine... one word. EDITING! Ugghhh.

What one word would describe your week?

For you coming up:

Monday: JoAnn Spears returns!! I love, love, love her posts where she takes a current medical eye to long lost monarchs and their illnesses. This Monday starts a four part series on Ann Boleyn (our favorite Tudor bad girl) and the mysterious Sweating Sickness.

Wednesday: Are ER nurses superstitious? What might some of those beliefs be?

Friday: HIPAA and law enforcement. Can medical professionals disclose patient information to the police?

Hope you guys are doing well. Anyone Christmas shopping yet?

Jordyn

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Author Question: Treatment of Minor Injuries

Maisie Asks:

I'm writing today with a medical question, I really appreciated the flow of your medical expertise in Proof, with it being a part of the story, and not a distraction from the story. I want to accomplish that same steady flow with my current work in progress.

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:

Thanks so much for sending me your question.

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 would be x-ray to evaluate for fracture, and 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. Patient 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.
 

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Author Question: Major vs. Minor Organs

When I first got this author question, I thought, okay-- this should be really simple. A major versus minor organ-- easy right?

Until I started to think about it.

What I would consider the major organs would be the brain, heart and lungs. Then I began to think about some of the minor organs (liver, stomach, etc...) that become very problematic if they aren't functioning correctly causing major problems for the patient.

 

Then I thought-- this isn't really a distinction I make in medicine. For instance, it's not a term used on a daily basis. So, then I wondered if someone did use that type of terminology.

 

On with Dee's question.

Dee Asks:

I'm wondering if/hoping you could answer a quick question for me...

Is a spleen considered a major organ? Or not so much because it's not vital to the body?

Jordyn Says:

Not sure how I would answer. Why is it important to make the distinction?

This isn't a distinction we make in medicine.

Maybe this explains my difficulty: http://www.anatomy.org/content/how-many-organs-no-matter-how-minor-it-does-human-being-have-and-what-are-they


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Dee J. Adams is the author of the Adrenaline Highs series published by Carina Press. Her first book, Dangerous Race, was a finalist in the 2012 Golden Quill Contest. Adams also has the distinction of being hired by Audible.com to narrate Danger Zone and Dangerously Close. Living Dangerously will be a May 2013 release. New York Times bestselling author Suzanne Brockmann says: “Dee J. Adams delivers it all in Danger Zone: romance, intrigue, and a cast of characters to fall in love with, authentically set in the gritty and entertaining world of movie-making. This one’s on my keeper shelf!” You can connect with Dee J. via her website: http://www.deejadams.com/

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Author Interview: Eddie Jones

As a nurse, I do think it's important to consider the spiritual aspects of patient's lives and all that entails. What is their spiritual belief and does it have elements that are becoming more mainstream? When a patient is in crisis-- we need to consider these aspects.

As a pediatric nurse, I want there to be a love of books among children. But, how do we capture a culture that is obsessed with instant gratification? I don't want to lose the next generation of readers, particularly boys, to movies and video games.

Eddie has some interesting thoughts on these aspects and he's released an inspirational novel geared toward boys that deals with spiritual issues. He even offers advice to aspiring authors at the end of the interview.

Welcome, Eddie!

Tell us about your upcoming release, Dead Man's Hand, with Zondervan.
First, it’s a fun, fast read aimed for middle school boys, but we’re also getting nice reviews on Goodreads from teachers and mothers. But my aim is to give boys a book they can enjoy, one taps into today’s fascination with the occult. This is the first book in the Caden Chronicles series and each story involves one element of the supernatural. Book one explores the concept of ghosts, spirits and what happens to our souls when we die.

Zonderkids is a Christian publisher, so the paranormal aspect is surprising.

I added the paranormal aspect because I want parents and youth to struggle with eternal questions. We’ve created such a culture of blood-letting through books and movies involving vampires, zombies and survival contests, that the reality of death doesn’t carry the sting it once did.

In high school my youngest son lost several friends to driving accidents. When another friend recently died, we asked how he felt and he replied, “I’m numb to it.” I fear that’s what we’re doing with our youth: desensitizing them to the horrors of death. In Dead Man’s Hand,Nick and his family discuss spirits and ghosts and the afterlife because I think it’s important for teens to wrestle with these questions before they’re tossed from a car and found dead on a slab of wet pavement.

You're passionate about getting boys interested in books. Why do you feel it's so important to get boys reading fiction at an early age?

I fear we’re on the verge of losing the male reader. I don’t mean men and boys won’t learn to read: they will. But the percentage male who read for leisure continues to shrink and this could be devastating for our country. We can’t lose half our population and expect America to compete on a global level. Reading forces the mind to create.

With video the scene and characters are received passively by the brain. There is very little interaction; it’s all virtual stimulation, which is different from creation. When you read, you add your furniture to the scene, dress the characters, add elements not mentioned by the author. This is why readers so often complain, “the movie was nothing like the book.” It’s not, because the book is your book. The author crafted the outline of the set but each reader brings their emotions and expectations to that book, changing it forever.

In general, boys would rather get their information and entertainment visually. This is one reason books have such a tough time competing for male readers. It can take weeks to read a book, even one as short as DeadMan’s Hand. Meantime, that same story can be shown as a movie in under two hours. So in one sense the allure of visual gratification is robbing future generations of our ability to solve problems.

I believe Americans only posses one true gift, creativity, and it’s a gift from God. Other nations build things cheaper and with fewer flaws. They work longer hours for less pay. But the thing that has always set America apart is our Yankee ingenuity. We have always been able to solve our way out of problems. That comes directly from our ability to create solutions to problems we didn’t anticipate. If we lose male readers and fail to develop creative connections necessary for the brain to conceive of alternatives, then we will lose our position as the world’s leader. 

What advice would you offer to parents to get their children interested in reading at a young age?

Watch for clues. If your child shows any interest in reading, reward the activity with trips to book fairs. I remember in grade school how excited I got when we were allowed to order books. All we had to do was check a box, (or so I thought), and wham! A few weeks later boxes of books showed up and the teacher began dealing them to the students. I didn’t learn until later my parents had mailed the school money for those books. I still have most of them.

But not all children like reading and you can create an anti-reading environment if you push too hard. An alternative for boys are comic books, graphic novels, or simply cartoon books. I read a lot of Charlie Brown cartoon books and still remember the plot: Lucy has the football. Charlie wants to kick the ball. Lucy promises she will hold the ball in place but at the last moment… We know this story because it’s repeated, not in a novel, but in a cartoon.

Do you have any advice for aspiring authors?

Write devotions, don’t focus on the praise, book sales and reviews. Forget about trying to find an agent and editor. Once you’re successful, they’ll find you. Explore the wounds in your life and minister to others through your writing. If God allowed you to be hurt, you can speak to that with authority. The rest of us, cannot. Ask yourself where your passions lie. I love surfing. If I could do anything, be anywhere, I’d be in a hut on a beach surfing a point break alone. I love playing and hate work. This is reflected in the types of books I write. I love pulling for the underdog, this comes out in the ministry God gave me. Only you can write the stories God dropped in your lap and if you do not, they will die.

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Eddie Jones is the author of eleven books and over 100 articles. He also serves as Acquisition Editor for Lighthouse Publishing of the Carolinas. He is a three-time winner of the Delaware Christian Writers' Conference, and his YA novel, The Curse of Captain LaFoote, won the 2012 Moonbeam Children's Book Award and 2011 Selah Award in Young Adult Fiction. He is also a writing instructor and cofounder of Christian Devotions Ministries. His He Said, She Said devotional column appears on ChristianDevotions.US. His humorous romantic suspense, Bahama Breeze, remains a "blessed seller." When he's not writing or teaching at writers' conferences, Eddie can be found surfing in Costa Rica or some other tropical locale. You can connect with Eddie at www.Eddiejones.org

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Up and Coming

Hey Redwood's Fans!

Did everyone enjoy Halloween? Hopefully, no one ended up six feet under nor did I see you in my ER. Just a ghoulishly good, enjoyable evening.

For you this week!

Monday: I'm happy to interview author Eddie Jones who has released Dead Man's Hand-- a YA novel for boys that addresses issues of the spiritual realm.

Wednesday: Author Question. Is there such a classification as major vs. minor organs?

Friday: Author Question. Treatment of minor injuries.

Who's getting geared up for Thanksgiving?!?

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Drug Screens

I think there is a general misconception in the public that all drugs can be detected by a basic blood or urine drug screen. This is not true.

First, when is a drug screen done?

There are several instances where we would likely run a drug screen. Here are a few.

1. You are having suicidal ideation. Suicidal ideation means you are having thoughts/feelings of hurting yourself and either you have presented or someone has brought you to the ED. This is fairly standard to see what might be in your system. What also will be added will be an acetaminophen (Tylenol) and salicylate (Aspirin) level. These are blood levels.

2. You are acting crazy. Meaning-- you're hearing and seeing things that aren't there. There are gait disturbances, a decreased level of consciousness. Perhaps even seizure activity. A common set-up for this scenario is a child or teen that begins to act funny at school. Here, there is a concern for ingestion and it will be best to sort out what we might be working with.

3. An actual ingestion in any age group. The history will be looked at very closely but if it is--- toddler got into grandma's medicine cabinet (this happens more often than you would think) and the youngster just flat out began to go through boxes/bottles swallowing everything in sight-- he will get a urine drug screen.

A urine drug screen can be an effective screening tool. But it definitely does not rule out all substances. That is the most important thing to know.

So-- the following drugs are on a basic drug screen. It may also be called a "drugs of abuse" of panel. Something along those lines.

1. Amphetamines-- interesting thing about this is some ADHD drugs contain amphetamines so kiddos on these will show positive. If they are on an ADHD med in this drug class-- it doesn't mean that they are not also abusing other types of amphetamines.

2. Barbiturates: The Truth Serum Drugs (Amytal Sodium, Phenobarbital and Luminal). But, do these drugs really act as truth serum? Interesting article here: http://www.damninteresting.com/the-truth-about-truth-serum/

3. Benzodiazepines: Drugs like Valium, Versed and Ativan are in this drug class.

4. THC: Tetrahydrocannabinol. Cannabis. The active ingredient in marijuana.

5. Cocaine

6. Opiates: Stuff of the opium poppy seed plant. Morphine, Fentanyl, Vicodin, Lortab, Codeine

7. PCP

Notice what is not on the basic drug screen? Alcohol... we would have to test separately for this.

Is this what you thought was on a drug screen?

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