Medical Personnel Torture: The High Fidelity Code Simulation Lab

Off the top of my head, I'm trying to think of professions that have simulators and airplanes and NASA shuttles are the only ones I can think of. Plenty of professions run simulated experiences-- like police, firefighters and the like.

Code Simulation

In medicine, we too run simulations. Often these are called mock codes. Sadly, it's really hard to practice real code events in a non-threatening situation because people don't voluntarily offer to be put into cardiac arrest for us to practice bringing them back.

It is important to practice because all sorts of team dynamics can be analyzed and discussed and no one has died in the process. The issue with medicine is that mannequins are static-- they don't give you information. Usually, there is a code facilitator who feeds information to the group. Not only does a mannequin not give information but you often can't do real procedures on them-- like start IV's or intubate.

Over the last several years this has changed. Mannequins have evolved and become more life like to allow for a more realistic code experience. They draw breath. They can have procedures done to them.

Recently, I participated in a high-fidelity code simulation. The purpose was to do it with fellow nurses that I work with on my unit. This made it more interesting because there are already team dynamics in place. We were all emergency nurses with many years of experience. We know each others quirks and weaknesses.

The photo is fairly close to how our room was set up. The situation is presented in as real an environment as possible. Another nurse comes and gets you and presents the scenario and then generally leaves.

Our team was comprised of three nurses, one nurse practitioner, a physician and a respiratory therapist.

The first scenario went off without a hitch and we were feeling pretty good about ourselves . . . until scenario #2.

I can't give much away because I did sign a confidentiality agreement to not divulge specifics about the scenario. Let's just say the scenario was difficult as it presented us with a lot more torture than any of us imagined would be involved in a mock situation.

Team dynamics are a very interesting thing. Not only was there a lot of stress in our scenario, but tension, frustration and hopelessness at one point. It's amazing to feel all of that even when intellectually you know that no one's life is at risk.

I think these type of code simulations are invaluable and I hope that more and more hospitals invest in this type of training for their staff. It has been show to increase staff competency.

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Author Question: Gunshot Wounds

I’m happy to have award-winning author Jocelyn Green return to Redwood’s with a couple of questions about gunshot wounds.

Welcome back, Jocelyn!

Jocelyn asks:

I decided not to do a gunshot to my character’s shoulder because of all the bones and major things it could have hit. Too complicated for my story. Instead, I am writing that she was shot through her bicep, missing the bone, though. A year later, she raises a gun for the first time since her injury, to do target practice.

Is it possible that due to nerve injury, her aim is off, or she can’t raise the gun properly? It would be great if something doesn’t look right to her “instructor.” So, can we limit her range of motion or something, due to her injury? The year is 1863, by the way, and according to my medical textbooks from that time, the treatment of a gunshot wound was to clear out the debris and just put water dressings over it.

Jordyn says: 

Yes, this is possible. A gunshot wound through the bicep could injure the musculocutaneous nerve that is responsible for part of the upper arm like the flexor muscles. Flexor muscles decrease angles at joints like the elbow. So, if her arm would need to be slightly bent to shoot the weapon, she would be unable to do that. That being said—if it were needed that the opposite be true (for instance her arm would need to be straight to shoot the weapon) you could injure a nerve that supplies the extensor muscle—which decreases the angle at joints like the elbow. You can view the two links below for detailed information about flexor and extensor muscles. 

http://www.britannica.com/EBchecked/topic/210143/flexor-muscle

http://www.britannica.com/EBchecked/topic/198909/extensor-muscle

Remember, though, she would exhibit these deficiencies all the time—not just when she’s learning to shoot the weapon with her instructor so that would need to be written into the story as well.

Jocelyn asks:

I also have another character who broke his arms and legs in an accident on a ship under construction. How long would he be in slings for his arms and casts for his legs? How long would he use a wheelchair or cane?

Jordyn says:

Wow! You are really torturing your poor characters in this novel! Those are very significant injuries. Bones can take anywhere from four weeks (on the short end) to eight weeks (on the long end) to heal. In the time era your novel is set in—I’m doubtful they would have done plating, screws, etc for stabilizing fractures but likely did externally set them. 

I think he’s going to be wheelchair bound for a long time. A person quickly loses muscle mass and strength in a few short weeks of being immobile so even when he’s out of his casts (in say six to eight weeks) he would not be able to tolerate a lot of physical activity for likely several months.

These days a person who suffered these injuries might be in a rehab center for several weeks building their strength and mobility back up.  

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

 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

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Up and Coming

Hello Redwood's Fans!

How has your week been?

This coming week is very exciting for me. I'll be heading out of town for the annual ACFW conference. ACFW is the largest group of Christian Fiction authors and includes all different types of fiction genres.

My debut novel, Proof, was nominated for the Carol Award in the debut novel category. This week, well Sunday, Sept 15th-- I get to find out if I actually won at the award's banquet.

More than that, the conference is a chance to catch up with my author friends who are scattered across the country and learn a lot about the writing craft-- which never ends.

So, you'll have to wait until Monday, Sept 16 to find out what really happened while I was there. But if you happen to be there in Indie-- be sure to come up and say "hi".

Also, I am launching my newsletter October 1 with a great prize give away worth over $75.00 but you have to subscribe (and live in the USA) to be eligible. Don't miss out. There will be stuff in there not found anywhere else.





For you this week:

Tuesday: Fabulous award-winning author Jocelyn Green stops by with some questions about gunshot wounds.

Thursday: What exactly are high-fidelity code simulations and how did I feel about going through one?

Have a great week!!

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Losing a License

Sometimes you need a medical character to go through the wringer-- I mean really go through the wringer. One possible way to do this would be to have them lose their license.

But what could cause a medical person to lose a license?

Remember, each state has a governing board that manages all kinds of licenses-- not just those covering medical persons. There are licenses granted to plumbers, cosmetologists, and massage therapists so this could be a drastic turn of events for other types of professionals, too.

Doctors usually are managed by a separate entity than say nurses and other licensed persons-- usually it's called something like the Board of Healing Arts.

Here is a list of reasons a medical person could lose their license.

1. They operated outside their scope of practice. Scope of practice deals with what a licensed person can and can't do. It does differ from state to state. For instance, some nurses may be able to start an IV without a protocol in place. It means a dermatologist shouldn't be doing C-sections. It doesn't mean they can't do something like this in your novel but your character should face some consequences if they do-- which of course can add to the overall tension.

2. Drug or alcohol abuse. This would have to be long and protracted and the person would probably have to be non-compliant with drug treatment. It would not be an automatic loss.

3. Abusing patients. A nurse intentionally causing pain and suffering.

4. Stealing Drugs/Diversion of Drugs: Giving someone you know prescription drugs-- even if they are your own. This is more likely to be a problem if the drugs are narcotics than say naproxen sodium but it is highly frowned upon for a nurse to give their prescription drugs to anyone but themselves. Another thing under this would be adjusting a family member's medication without the consent of their physician. Like increasing pain medication or adjusting insulin dosages. Selling drugs is even worse as it could carry criminal prosecution as well.

5. Patient Abandonment: Leaving the hospital without proper notification. Not giving report on a patient.

6. Negligence: For a nurse, this could be something like a nurse not reporting a change in a patient's condition to the physician and the patient not getting the attention they needed and suffering a turn for the worse.

7. Providing a False Copy of License: This might be a case where a nurse has received a reprimand-- which could be printed on the license and she provides a copy that is restriction free (such as an older copy.) Even if the suspension is over-- this is a big no no.

8. Falsifying Patient Records. Something like recording a set of vital signs that you made up.

9. Unprofessional Conduct: This could be using foul language at work to hosting a pornographic website.

10. Violating Probation. If you're in trouble with the State Board of Nursing-- you better do everything they say otherwise it could end up in total revocation of your license.

To read further on these points-- check out this article. 

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News Stories for Authors: Police Sue Woman

Honestly, sometimes you just don't have to go very far to get plot ideas. They are in the news every day.

This news story totally shocked me-- and honestly it takes a lot to do that for me these days.

Evidently, a woman called 911 yet "failed to report how serious a situation was" though evidently did say a man was on bath salts and acting belligerently. The situation became volatile and the man was shot and killed but one deputy was injured in the scuffle. He's the one that's suing. Here's a link to the news story.

Very early in my nursing career, a man was transported to us via ambulance. He had passed out and cut his head open on a rock mowing the lawn in the Midwestern heat and humidity. I mean, who wouldn't, right?

Now, if you know head lacerations-- you know they bleed pretty severely. Even small wounds can bleed impressively and this man had a significant laceration and blood was everywhere. He wasn't all that coherent when we tried to ask questions and get a history so we bypassed that and began his medical treatment. The physician and I were gloved up and raking through his hair when his sister arrived and we began asking her his history.

"Does he have any medical problems?"

"Yes, he's HIV positive."

I mean-- we both just froze and I remember thinking I wish I'd been in the habit of triple gloving. The physician and I were fine because, as healthcare providers, we assume EVERYONE is infected all the time and we should be using precautions based on that assumption. Always assume the worst case scenario.

Which is why I can't reason this officer's actions for the following reasons.

1. Every responding officer should assume they are going into a volatile situation until proven otherwise. I don't think it's routine to put on Kevlar after you get on scene.

2. People aren't good at disclosing details that may be pertinent to your job when they are having an emergency. They are thinking of only a few things. "I need help." "Come as quickly as you can." "Did I say fix this now?" It's up to us as emergency responders to ask for the information that we need yet realize even then-- the answers may not be accurate.

3. This is a workman's comp issue. If you're injured in the performance of your duties-- this becomes a workman's comp claim and I have no idea why a police officer thinks suing her for money will engage the public trust.

I am a HUGE supporter of the police. My brother is a police officer. But, we don't want civillians worried about getting sued when they truly need help. I hope the courts throw this case out.

Please.

What are your thoughts?

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Up and Coming

This Labor Day weekend was my birthday! Yea, me, right?

I don't know if birthdays are as sweet as they once were. You get to a point where you don't want to see your age increasing. What I will say is that I do feel better this birthday than I have for many of my past ones because of some physical challenges I put myself through over the last several months. Things like running a 5K, a 10K and a mud obstacles course.



And some thought I hadn't truly run the course because I wasn't muddy enough in the pictures I posted so I have included a few more as "proof" of my endeavor.

What do you do, regardless of age, to keep your life interesting? I had just seen a man over 60 attempt American Ninja Warrior. He didn't get very far but he trained and tried.

What dream do you have that you need to take that first step toward. I think this man proves age does not have to be a limitation.

For you this week:

Tuesday: Evaluation of a police scenario.

Thursday: How would a medical person lose their license?

Hope you guys have a fabulous week and hope you enjoyed our Labor Day Weekend!

Jordyn

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Being a Male Nurse

If you've seen the movie, Meet the Parents, you very early on painfully realize the torture than Ben Stiller goes through as his character Greg Focker is a male nurse. Of course, there is parody and good ribbing from Robert De Niro but what's it really like to be a male nurse.

No, this is not my co-worker.

Evidently, being a male nurse is becoming a little less rare. Male nurses have tripled in the work force since the 1970s and 1 in 10 nurses are male. You can read more about male nursing statistics here. 

I wouldn't know personally but I do work with one-- yes, just one right now. He really is a great nurse and pretty quirky so I thought I'd ask him-- "What's it really like to be a male in this profession?"

And his first response was, "It's f***ing hell. If I would have known working with this many women would have caused me this much anxiety I would have chosen another profession. Oddly enough, it only took me three years to start menstruating."

As you can tell-- he's somewhat of a jokester. And no, he doesn't use that kind of language around his pediatric patients. They love him . . . seriously-- tattoos and all.

So what is unique about being a male nurse? What does he face that the rest of us estrogen laced cohorts don't?

Here's his list.

1. I'm either a brother or a therapist. I now have two-hundred sisters.

2. I'm asked more often to deal with difficult people-- those that are under the influence or intoxicated. Difficult family situations.

3. I don't know who can handle my antics and who can't.

4. It's the first time I was a minority as a white male. I got tons of money for grad school.

5. If it wasn't for my tattoos it would probably be assumed more often that I was a doctor.

6. I'm not disrespected by doctors like my female co-workers are.


What's it like working with women all the time?

1. Taxing. Because I have to watch what I say. For instance, I got pinched in the butt by a horny old lady in front of supervisors from five different units one time in the elevator. Exactly what do you say?

2. I've got to be careful what I share and I can't be on Facebook. All Facebook did was cause me problems because co-workers would look at my pictures and ask me who I was in relationship with.

3. I want a lot of alone time after I work three twelve hour sifts in a row because I also live with two women. I need to hang out with guys or just have alone time.

4. I receive a lot of unwanted and unwarranted advice.

Any other male nurses out there? What's your experience like?

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Seven Medical Must-Do's For Fall

If you are like me-- you sent kids back to school this past week and celebrated cried as they walked their book-filled laden backpacks through the school doors.

The start of school generally increases the pace of the pediatric ER. Kids are in closer contact and therefore-- sharing all those wonderful germs with one another.

There's usually an increase in illnesses when school starts-- strep throat and meningitis are a couple. And, if your child starts daycare-- you can expect quite a few illnesses as they adjust to their new germ-filled environment.

I like to do a few things to get ready for the coming viral onslaught that fall and winter bring and I thought I'd do a little public service by sharing these things with you. It's better to do these things now than have to fight weather to go get them when you really need them.

The snow senses when you're not stocked up and will dump three feet of frosty flakes on your house just to prove it.

1. Make sure you have a back-up for your child's medications. Things like rescue inhalers, epi-pens and insulin.

2. Have fever reducers/pain medication that are appropriate for your child. Make sure what you have on hand is not expired. Tylenol for infants under six months. Ibuprofen and Tylenol for infants/children six months and over. No aspirin for any kids unless prescribed by a physician.

3. Stock up on replacement fluids. This would be Pedialyte (or equivalent) for kids two and under Gatorade/Powerade for kids two and up to adult. Don't forget yourself. Usually if one person comes down with something in the household-- everyone else is bound to get it.

4. Kleenex and hand gel. Good hand washing is always the best prevention for illness.

5. Hats and mittens. Snow Pants for those that live in cold climates. Buy a few pairs. It never fails that you won't be able to find any mittens for your six-year-old when the first blizzard hits. I buy a few cheap pairs as extra.

6. Don't forget-- kids playing in the snow should be wearing sunglasses-- particularly at higher altitudes (like when skiing.) 

7. Get your flu shot!

What else do you do to prepare for fall/winter?

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Up and Coming

Hello Redwood's Fans!

Are you like me and maybe celebrating a little too joyously the children going back to school?!? I do love my children but it is nice to have some quiet in the days as well to get back to writing.

I DO love fall and am excited for all things pumpkin to come out over the next several weeks. Autumn is really my favorite time of year. Plus, it's the beginning of the holiday CANDY season-- yep, trainer dude is going to be ecstatic about that, too.

This week is also birthday week-- me and my oldest daughter will celebrate. I think we'll focus more on hers than mine. 

For you this week:

Tuesday: I thought I'd do a little public service and help get you all ready for the fall/winter viral season. This post will be seven things I do to make sure I'm ready.

Thursday: What's it like being a male nurse? My one and only male nursing colleague steps onto the edge to let me know his deepest darkest thoughts-- and it is pretty hilarious, too.

Hope you all have a great week.

Jordyn

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How People Die

Are you curious to know what people die of where you live?

There are tons and tons of websites that can help you get a feel for the leading causes of death in a particular area, a particular age group, a particular race and gender.

I have to give a shout out to my agent's wife, Becky Johnson, for posting this to her Facebook page and I thought it would be an excellent resource for all you medical nerds to bookmark in your research folder.

It's a website called World Life Expectancy. I know-- right? I just got chills.

I've linked you to one particular page that looks at the top 15 causes of death in the US and ranks each state and where they fall.

The state leading in death by heart disease: Mississippi.

How about cancer? That would be Kentucky.

How about something more mundane like accidents? You get the gold West Virginia.

It's like Becky said-- "If you want to live a long, disease free life-- Hawaii seems to be your best bet."

There is literally a plethora of information on this website. Life expectancy-- down to your particular county. It also has lots of data for the WORLD. 

How does your state fair? Does it give you any plot ideas? I think cancer clusters always serve for interesting medical plots.

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Ideas From the ICU Waiting Room

Omni

I have probably seen the inside of a hospital more than I've cared to these past couple of weeks. I have a relative who had surgery-- then a major surgical complication-- for which he had to be admitted back to the surgical ICU.

He is on the mend but continued prayers appreciated.

What was interesting while sitting in the waiting room? I can't help but look at and examine my environment and develop story ideas.

Many of you are probably aware that most medical units use machines to dispense drugs. These go by a few names. Pyxis machines or Omni cells.

When I first started nursing, these machines were mostly used for drug dispensing so nurses on units didn't have to wait for the pharmacy to fill a med order and then deliver it. It's very helpful in situations where the patient is in a lot of pain or say . . . seizing.

These machines have evolved to dispense quite a few things. In our unit, they dispense not only drugs but about 90% of the supplies we use for patient care. Things like suture kits, nasal cannulas, wound packing, etc.

I discovered a Pyxis machine that dispensed scrubs.  How awesome is that!

Now, you may ask yourself . . . "Just why did Jordyn find that soooo fascinating?"

Simple-- how could a bad guy use it to get where he wanted to be in the hospital setting. Or, how could someone use it to disguise themselves to get out.

Awww--- now you see how my devious mind works.

What the machine required was an ID and password because they probably know what devious minds think. Yes, I did punch a few buttons to see exactly how it worked. Research, people.

What ideas have you come up with in waiting rooms?

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Up and Coming

How has your week been?

Mine? Well, you know, never a dull moment.

Yesterday, I participated in the Warrior Dash. It is a 5K with obstacles on the course. Things like climbing over a 10 foot wall. I think there were three of those. It was great fun minus a minor shoulder injury. Just why my shoulders like to gravitate out of their sockets mystifies me. I did finish and here is photo proof. I did clean up a bit.

This summer I've done a lot of physical things I've never done before and those who know me can attest to the fact that I am not a fitness guru. I still would pick chocolate over celery on any given day. Nachos over hummus. You get my drift.

But, I have been trying to get into shape. So, in my wake over the last several months are three 5K's, one 10K and I'm hoping to hike one 14teener (a mountain where the peak is at 14,000 feet.)

Sadly, I am still not a size four. Nor will I ever be but this summer of mostly fun physical activity got me thinking about writing goals. Just how do you try and achieve something where the finish might not be as glamorous as you imagined. A finish like you've published almost three books and still can't quit your day job.

Here are my thoughts:

1. Striving toward a goal gives you confidence. When you accomplish little things (like running a 5K)-- you believe you can do the bigger things (like running a 10K.) Words will add up to sentences. Sentences will add up to paragraphs. Paragraphs become chapters! Once you pile enough of those up you will have a novel.

2. Sometimes the step in front of you is all you can focus on. When I ran my first 10K-- I lasted about 5.5 miles. I had run six miles before but I was mentally having a bad day-- like my friend who was walking still had a faster pace than me jogging. At one point-- all I was doing was looking at the sidewalk and counting to four. Four steps was the distance between the cracks and meant that section of sidewalk was finished. I would count to four again. I must have done this for a mile just trying to take the next step. Focusing on the large picture can be overwhelming. What is your next step?

3. Finishing is fun! It is great to have that moment where you cross the finish line. You have a completed book. People like the book! Your words touch someone. Sometimes visualizing those moments can help you take those small steps.

What is a goal you're working on?

For you this week!

Tuesday: I've spent a lot of time in the hospital with a sick family member this month. Just what got my authorly wheels turning?

Thursday: A GREAT resource for writers with LOTS of information on death. I know-- but this is how suspense authors think.

Also-- I am getting ready to launch my newsletter! Subscribe and be eligible to win the WHOLE Bloodline Trilogy, $50.00 in gift cards and some nifty home-made items in time for Halloween!

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Medical Critique: James Patterson's Kill Alex Cross 2/2

Last post and this post I'm doing a medical critique of James Patterson's Kill Alex Cross. Usually, I don't mention the book or the author's name but I'm hoping James will spend a little of his cash on a medical consultant and am also probably losing out on a chance that he will endorse one of my novels.

Oh well, living on the edge . . . that's me.

If you have not read the book this post may contain some spoilers you'd rather not know so you have been warned.

At one point in the book, a suspect is kidnapped and he is given "truth serum" in order to get him to divulge the location of the president's kidnapped children.

The prisoner is given scopolamine.

Well, hmmm. This did cause me to scratch my head a little bit. Why? Well, come to find out this was a drug used once for this purpose in the early 20th century. Where did I discover that? Well from the CIA's own website. Interesting what a little research will show.

Now-- the CIA should know about good truth serum. Here's what it says about scopolamine:

Because of a number of undesirable side effects, scopolamine was shortly disqualified as a "truth" drug. Among the most disabling of the side effects are hallucinations, disturbed perception, somnolence, and physiological phenomena such as headache, rapid heart, and blurred vision, which distract the subject from the central purpose of the interview. Furthermore, the physical action is long, far outlasting the psychological effects. 

And that was my thought-- there are much better drug choices.

What scopolamine is used for most these days is as a patch for motion sickness. That's really the only use I'm aware of.

What James Patterson did say in his book is correct: "Lying is a complex act."

What "truth serum" drugs really do is loosen inhibitions and makes lying more difficult-- not that it can't be done.

Some better drug choices? Sodium thiopental or some of the benzodiazipines. I revealed something very personal under the influence of Versed given prior to surgery once that I normally would have never disclosed.

Yes, indeed, that was a fun time.

Let me just say-- never have surgery at a hospital where you are employed.

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Medical Critique: James Patterson's Kill Alex Cross 1/2

I am a James Patterson fan. I've restricted myself lately to the Alex Cross and Michael Bennett novels.

I just finished Kill Alex Cross. You can read my Goodreads review of the novel here.

This post is to discuss the medical aspects of the novel and what I find suspect. Come on, James. Hire me as your medical consultant-- I think-- no I know you can probably afford me.

In this post we'll deal with a male adult that is involved in a motor vehicle collision. The character was driving a van at a high rate of speed and took a header into a bus.

Initial treatment of the victim was good. Jaws of life. C-collar in place. Suspicion of drug use based on dilated pupils-- specifically PCP which is an accurate bodily response.

All good until this line: "The van driver was out on a gurney now, hooked up to a nasogastric tube and IV."

Anyone know what is wrong with this sentence?

Simply put, EMS is never going to put down a nasogastric tube.  Are paramedics trained to do the procedure? Yes. Have they ever in the field? Not that I've seen in twenty years of specialized nursing.

Now-- a flight team on a long transport-- maybe.

An nasogastric tube (or NG tube) runs from your nose to your mouth. It is used to drain/vent secretions and air from the stomach. If the stomach is retaining a lot of these things-- it can impact on the patient's ability to breath. A secondary use is as a feeding tube though there are many more comfortable styles (like a cor pak which is thin and flexible but doesn't drain well.)

All this sounds very good for the patient, right? Why not put one in in the field?

One-- patient priority is different in the field than in the hospital. It's basically secure the airway, breathing and circulation and get on your way . . . fast. Placing an NG would simply slow down scene time and they can be difficult to place.

Impacted Nurse

There are also contraindications to an NG tube placement. One is a basilar skull fracture. We all have bones that line the base of our skull. If these are broken-- there can be a direct conduit from your nose into your brain. Signs of basillar skull fracture are misshapen face, fluids (blood and serous drainage) leaking from the ears and nose. Mid face fractures.

That's what we don't want-- an NG tube in the brain. Yes, it can happen as evidenced by the photo that comes from this article which discusses just such a case.

Really, James, call me. 

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Up and Coming

Hello Redwood's Fans!

How is your week going? Is your summer winding down? Getting ready to go back to school?

I have recovered from camping, horse back riding and white water rafting. Looking back I think those were the easy things.

Coming up for me are my first 10K race (well, I am just hoping to finish) and a Warrior Dash-- the muddy 3-mile long obstacle course.

Yes, I am insane. But you knew that already.

For you this week.

I am taking on author James Patterson. Usually I don't rat out authors or their books if I give a medical critique of their scene. However, James is unique because he can certainly afford a team a medical consultants so I tend to give him a lot less leeway.

This week we'll look at the medical woes in one of his latest Alex Cross books-- Kill Alex Cross.

Have a GREAT week.

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News Stories for Authors: The Black Death Returns

Rats. Cute, right? Unless you think about the diseases they help to transmit. Here's a short list here.

Evidently, the Black Death or Plague has not died. Well, perhaps it never did but a curious thing is that it disappears for years on end and then . . . it . . . comes . . . back.

Which always makes for a good medical thriller.

But now, it seems that the Black Death is popping up on the West Coast. Some interesting points from this article.

1. In LA county, a squirrel tested positive for bubonic plague or The Black Death. It is genetically similar to the organism that killed 200 million people in the 14th century.

2. Plague is spread from fleas, to rodents and then to humans. You can read further about transmission here.

3. There have been almost 1,000 cases of plague in the US. New Mexico sees almost half of these cases.

4. The pathogen responsible for bubonic plague is Yersinia pestis. It can be successfully treated with antibiotics. It's death rate is around 11%.

5. There is a season for plague (just like flu and some other viruses) that runs from late spring to early fall. My guess is because that's when rodents are active and not hiding in the snow during winter.

6. Untreated, the bacteria will spread through the body in one to six days. When it reaches the lungs-- it can then become airborne and is then called pneumonic plague which is why some think it would make a good biological weapon.

7. Death can occur in as short as three days.

The question is-- why does it disappear? What factors cause this to happen? Do you think there could be a true pandemic of The Black Death again?

Has the Black Death returned? Click to Tweet.

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News Stories for Authors: Cure for HIV?

What would you think of a miracle cure for HIV that was too expensive and too labor intensive to cure most of the people who have HIV?

Well, that may be exactly what has occurred for two patients who are seemingly testing negative for the disease after receiving a bone marrow transplant for lymphoma.

Now, if that's not a medical thriller, I don't know what is.

Here are some of the highlights of the article that discusses this "cure". I put that in quotation marks because two patients with no evidence of disease (NED) does not a proven cure make. Much, much more research needs to be done.

1. Evidently, when people with HIV receive bone marrow transplants, they stop taking their HIV meds. In these two cases, the patients continued to take their HIV medication.

2. From #1, it is theorized that continuing to take their HIV medication kept the virus from taking hold once the new immune system was transplanted because the viral load was kept low.

3. Since the bone marrow transplant, both patients stayed on their HIV medication for a period of time but have now stopped taking their medication. One for seven weeks and the other for 15 weeks and the virus has not returned. This does not mean that it won't at some point but this does sound very promising.

4. One patient was transplanted with cells that carried a mutation, CCR5, that evidently prevents infection with HIV by blocking it from infecting the immune system. This is an area of interest for research in gene therapy.

All good news, right?

Well . . . maybe. From the article . . .

"Many clinicians would agree, however, that the three possible treatment options described in the article-- including that used in the two highlighted cases-- are not practical in a treatment setting, or may present too many safety and tolerability risks for the vast majority of HIV- infected patients."-- emphasis mine. 

My thoughts: Bone marrow transplants are arduous procedures. They are timely and expensive. It's hard to find donors as they have to be an HLA match. Hence, donor registries.

According to the CDC, nearly 1.2 million people are living with HIV in the US alone. World wide there are 33.4 million people.

Sadly, what it will come down to if this proves to be a cure is who can afford it or not. This is one thing I fear with more and more health systems being run by governments. It's pencil pushers deciding who gets treatment or not. Who gets the cure or not.

What do you think? If this proves to be a cure, how does everyone get it? Should everyone get it despite the expense?

A true cure for HIV or just another plot for a medical thriller? Click to Tweet.

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Fungal Fright: Sprial by Paul McEuen

I wish I could say exactly how I discovered Spiral by Paul McEuen. I want to say it was a Goodreads review and I'm always looking for new medical thriller authors-- particularly ones that can back it up with good sound expertise.

Paul is a professor at Cornell University and has received the Agilent Technologies Europhysics Prize, a Packard Fellowship, and a Presidential Young Investigator Award as listed in his bio. I am just guessing he's one really smart dude.

This debut medical thriller also won the International Thriller Writer's Debut Category for 2012. Strong work, Paul-- as I like to say.

Spiral begins the first part of the book in the past-- specifically a close examination of two war ships in the ocean-- of a few men in a raft-- and the large gun ship swiftly disposing of them because they want to come aboard.

The reason they aren't rescued-- and actually murdered-- is because of the fear that they have been infected with a deadly fungus named Uzumaki.

The early scenes of the novel-- from the terror realized as the infection manifests, to the other ship trying to "quarantine" the fungus in the middle of the ocean until one stray bird lands on the infected vessel . . . and then takes off. . . 

I never thought a bird landing on a ship would lead to heart palpitations-- seriously.

Fast forward and the young military fungal specialist is now a well-acclaimed university professor specializing in fungus and one of the few who know about Uzumaki-- and now others want the fungus born again for nefarious reasons.

What I really liked about this novel was it reminded me of the early Robin Cook books. Take a medical concept and take it to the worst case scenario. Or take something theoretical, somewhat expiramental and think about the way it can run amok on humanity. I think that's what makes a medical thriller--- well-- thrilling!

I liked learning about fungi and the tiny robots called microcrawlers (and how deadly they can be!) In fact, I wanted to look up some of these concepts to see how "true to life" they really were. I also liked the examination of how prevalent antibiotic usage can be detrimental.

I would have enjoyed more of the fungus unleashed on humanity. Instead, there were only a few infected people. The story centered more on the family and how the secret of the fungus was kept hidden.

Overall, a good read for medical thriller fans. I'll be excited to read this author's future works.   

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Fungal Fright: Killer Spores

In preparation for Thursday's post-- I did a quick Google University search for "deadly fungus" and up came Cryptococcus-- again. I first blogged about this fungus here.

The interesting thing about fungal infections is that they are like the unwanted orphans of pathogens. Their infections can take a while to manifest and be equally as difficult to treat-- often requiring months of anti-fungal therapy.

I first blogged about Cryptococcus two years ago but have you even heard of it? The reason bacteria and viral infections get much more press is that they tend to spread and manifest much more quickly-- thereby meeting our need for instant gratification. We'll know, likely within a few weeks, whether you're going to live or die.

Not so much with a fungal infection.

A person gets infected by cryptococcus by directly inhaling the spores. There are two species that are responsible for MOST human infections. C. neoformans, found in the soil, generally infects people with weakened immune systems like those with the HIV virus. The other, C. gattii, affects more healthy populations.

What's interesting is that these fungus spores are continuing to spread along the western sea board. Compared to when I first wrote about this infection, the death rate has risen to about 33% from 25%. What's more interesting is that the same fungal infection for Canadians only has a death rate of about 10%.

It makes me wonder if the difference in geography plays into the host, the fungus, and/or the ability to fight the infection. All good plot points for a medical thriller.

Treatment is antifungal medications for many months but if these prove inneffective then surgery may be required.

What about you? Have you heard of this deadly spore?

You can check out the following links if you want to read more about Cryptococcus and these links are also where I got the information for this post.

http://www.realclearscience.com/articles/2013/05/28/cryptococcus_spread_of_a_deadly_fungus_106543.html

http://www.cdc.gov/fungal/cryptococcosis-gattii/

http://www.ncbi.nlm.nih.gov/pubmed/20570552

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669189/

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Winner!!

Just a quick post on this happy Monday to announce the winner of the Who Will Survive The Zombie Apocalypse Contest-- or at least have fun trying whilst reading a copy of either Proof or Poison.

The winner is: Audrey Allyn Reilly!!

Audrey-- e-mail me at jredwood1(at)gmail(dot)com and I'll tell you how to claim your prize.

Thanks for playing everyone. It was fun to see your percentages. I'm not sure I'll be hanging with those of you who scored under 65%-- you might have to fight those zombies off on your own. Now-- as Crystal said-- time to stock up on canned foods and weapons.

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Up and Coming

Hello Redwood's Fans!

Our group hitting a rock.

How has your summer been? Ours-- very busy. For the first time since living in Colorado for almost seven years we finally braved the wilderness and took our two daughters camping-- twice. I know some of you may not think this is a major miracle-- but it is.

It's not that I don't enjoy camping-- I really do. Nighttime-- not so much. It just gets too cold. Of late, I've resorted to boiling hot water and putting it into water bottles and lining my sleeping bag with four or five of them. Even with that and wearing three layers it is hard to stay warm.

If anyone knows of an electric sleeping bag-- let me know.

Then going backwards!

One of my favorite activities is to go white water rafting and this year we decided to torture-- I mean-- let our children experience this fun adventure.

And yes-- I am in this boat!

For you this week:

All is right again!

Monday: Winner announced. Have you taken the Zombie Apocalypse Quiz yet? Check out this post for a chance to win Proof or Poison for details.

Tuesday: Fungal Fright: What is cryptococcus and just how deadly is it?

Thursday: Fungal Fright: The medical thriller Spiral by Paul McEuen.

Hope you have a great week!

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Author Question: Fever Reduction in Unconscious Patient

Alyssa Asks:

One of my characters has a high fever. I know that there are several different herbs that can help to reduce fevers, but he is unconscious. What might the healer do to help him?

Jordyn Says:

Obviously it's hard to get an unconscious person to ingest something.

You're writing medieval times?

If a person can't swallow but you want to reduce a fever-- you can strip their clothing off and put them in tepid to cool water. This should help bring down their body temperature.


Depending on your time era-- medications can also be given rectally or intravenously. For instance, acetaminophen (commonly known as Tylenol) can be give rectally.


NSAIDS (non-steroidal anti-inflammatory drugs) can be given IV and are fever reducers though this is not the primary reason to give an NSAID IV. Most common reason if for pain.

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Author Question: Speech Therapy after Traumatic Brain Injury

Karen Asks:

I’m writing a story about a man who is shot in the head in a way that impacts his ability to speak.  Long months of rehab restore his speech but leave him with a stutter.  Is this feasible?  Which part of the head would he need to be shot in?  What else could be impacted by such a wound?  Can you recommend any websites or resources about gunshot wounds or speech therapy?

Jordyn Says:

Karen-- thanks so much for sending me your question.

Generally, the left side of the head is considered to contain the speech centers of the brain--in most cases. It might depend on whether or not your character is right or left handed.

97% of right handed people have their speech centers on the left hemisphere.

19% of left handed people have their speech centers on the right hemisphere-- which may be where the phrase "left-handed people are the only ones in their right mind" come from. I LOVE this phrase speaking as a left-handed person.

68% of people have language abilities in BOTH hemisphere.

To read more on these areas-- check out this link: http://webspace.ship.edu/cgboer/speechbrain.html

A good case to look into would be former Arizona Congresswoman Gabrielle Gifford's. She received a serious gunshot wound to the head and had extensive rehab-- over many many months. It might give you an idea of how long the road to recover is for some of these victims. It can be years.

http://www1.uabhealth.org/BoneandJoint/victims-gunshot-head-daunting-road-ahead

http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Gunshot%20Wound%20Head%20Trauma.aspx

http://www.everydayhealth.com/blog/dr-black-brain-health/the-outlook-for-recovery-from-a-gunshot-wound-to-the-brain/

I think you have a lot of leeway as an author to decide what you want to do after brain injury because we don't understand as much about the brain as we do other organs. It might be hard to pinpoint sources of "speech therapy after gunshot wound to the head" (which is how I first started to Google your inquiry) but a gunshot wound would be considered a traumatic brain injury so I started to Google that and came up with several other resources as well. Here's a great You Tube Video that demonstrated a speech therapy session that could be great for a fiction novel.

What else could be impacted? Anything really. Again-- you have a lot of leeway here. There could be motor issues as well. Difficulty walking. Difficulty with fine motor skills. To the other extreme which would be coma.

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After creating Christian education curriculum for 25 years and writing over 250 published articles, Karen Wingate has turned her attention toward historical and contemporary fiction.  She lives with her husband and Welsh Corgi in Western Illinois.

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