Sarah Sundin: WW II Nursing

This is Sarah's final installment concerning her research into WWII nursing, but don't despair as Sarah will be back in December with more historical medical offerings. I want to thank Sarah for all the great information she provided. I know I learned a lot. What was one interesting thing you learned?

US Army Nursing in World War II—Part 3

“Lieutenant Holmes is going into anaphylaxis.”

 Harriet’s elfin face blanched. “Oh no. Thank goodness Dr. Sinclair is on the ward.”

“Not yet.” Ruth grabbed a tray and put two sterilized syringes on top.

“So—so why are you already getting the meds?”

“I want to be ready when he comes. I can’t waste any time.” One vial of adrenaline.

“But he hasn’t ordered them yet.”

 Ruth leveled a look at the girl. “I know the treatment for anaphylaxis.”

“That—that’s presumptuous of you. You’ll make the doctor angry.”

Ruth pulled a vial of morphine. “I don’t care about the doctor’s feelings. I care about my patient’s life.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty, serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. On November 26th, I discussed the training the nurses underwent and rank in the Army Nurse Corps. And today I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Uniforms

On the job, nurses wore a white ward dress with the white nurse’s cap. They were also issued a set of “dress blues,” a dark blue service jacket and a medium blue skirt, a white or blue shirt, black tie, black shoes, and a dark blue garrison cap or service cap. This uniform is pictured on the cover of A Memory Between Us. A dark blue cape lined with red and an overcoat were also used for outdoors wear. Starting in July 1943, the blue uniform was replaced with an olive drab service jacket and skirt and cap, khaki shirt and tie, and brown shoes—but implementation was slow and sporadic.

In combat areas, white ward dresses and skirted suits were absurdly impractical, but the Army was slow to provide appropriate clothing for women. In 1942 during the early campaign in North Africa, the women resorted to wearing men’s fatigues and boots—in men’s sizes. In time the nurses were issued WAC (Women’s Army Corps) field uniforms and the popular Parson’s field jacket, as well as easily laundered seersucker ward outfits, both dresses and pantsuits.

Nursing Practice

On the ward, the nurse was assisted by a male medic, an enlisted man. Some men had serious problems taking orders from women, and some didn’t. In stateside hospitals, Red Cross nurses’ aides also served. Physicians entered the Medical Corps with the rank of captain and only male physicians were admitted to the Corps. As was typical in the 1940s, the physicians expected unquestioning, speedy obedience from nurses.

For the writer, it’s important to remember this was long before our disposable, single-use, universal precautions era. Syringes were made of glass and were sterilized in bichloride of mercury before reuse. Gloves were washed and reused—and holes were even patched. Improvisation was the rule, especially in combat areas, and nurses used their creativity and imagination to turn trash into useful items.

Resources

http://history.amedd.army.mil/ANCWebsite/anchome.html (The official website for Army Nurse Corps history.)

Sarnecky, Mary T. “A History of the U.S. Army Nurse Corps.” Philadelphia: University of Pennsylvania Press, 1999. (A comprehensive history with a thick section on WWII).

Tomblin, Barbara Brooks. “G.I. Nightingales: the Army Nurse Corps in World War II.” Lexington: University Press of Kentucky, 1996. (A wonderful history, including all theaters, full of personal stories).

Brayley, Martin. “World War II Allied Nursing Services.” Oxford: Osprey Publishing, 2002. (Detailed information on military nurses’ uniforms).

http://library.uncg.edu/dp/wv/ (The Women Veterans Historical Project—a vast collection of oral histories, letters, photographs, diaries and other treasures).

http://history.amedd.army.mil/books.html (Prepare to get lost...this website contains dozens of on-line historical medical texts, from detailed—800 page!—books describing medical services in each theater, to period textbooks used for neuropsychiatry to infectious disease to orthopedic surgery).

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing

We're continuing our three part series with historical author Sarah Sundin about her research into WWII nursing.

US Army Nursing in World War II—Part 2

Ruth hugged her knees to her chest, her dark blue cape tented around her against the gray chill.

            Where would the money come from? Promotions were meager in the Army Nurse Corps. All the nurses were second lieutenants except the chief nurse, a first lieutenant. At twenty-three, Ruth was too young and inexperienced to become a chief nurse.

            She’d always solved her own problems, but now she longed for advice, and she kept thinking about Major Novak.

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. Today I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Recruitment and Training

The American Red Cross served as the traditional reserve for the Army Nurse Corps. On October 9, 1940, the ANC called the reserves to active duty, to volunteer for a one-year commitment. At first there was no formal military training for nurses. On July 19, 1943, the first basic training center for nurses opened. Training centers were located at Fort Devens, MA; Halloran General Hospital, Staten Island, NY; Camp McCoy, WI; and Brooke General Hospital in San Antonio, TX. The nurses trained for four weeks, learning military courtesy and practices, sanitation, ward management, camouflage, the use of gas masks, and map reading. They also drilled and underwent physical training.

To train the increased number of nurses needed during the war, Congress authorized the Cadet Nurse Corps on July 1, 1943. The government paid for women to attend civilian nursing programs in exchange for service in the Army Nurse Corps upon graduation. The women in this accelerated program (two and a half years instead of three) had their own special cadet uniforms.

Rank

Nurses entered the ANC as second lieutenants, and the vast majority of them stayed at that rank. The chief nurse of a hospital was usually a first lieutenant, but sometimes a second lieutenant or a captain. The highest rank in the ANC was held by the superintendent of the ANC, a colonel.

Even so, nurses held “relative rank.” They held the title, wore the insignia, were admitted to officers’ clubs, and had the privilege of the salute, but they had limited authority in the line of duty and initially received less pay than men of similar rank. On December 22, 1942, Congress authorized military nurses to receive pay equivalent to a man of the same rank without dependents, and on June 22, 1944, Congress authorized temporary commissions with full pay and privileges.

One of the main reasons nurses were granted officer status was to “protect” them from the great crowd of enlisted men, and—it was often thought—for male officers to keep the women for themselves. The Army had rules against fraternization between officers and enlisted personnel.

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing

Redwood's Medical Edge is pleased to host historical author Sarah Sundin who has done extensive research regarding nursing during WWII.

US Army Nursing in World War II—Part 1

“I love this smell, don’t you?” May said.

            “Bichloride of mercury?” Ruth laughed and shook water from a pair of gloves. “Only a nurse would like this smell.”

            May rolled syringes in a pan of the blue green disinfectant. “In the orphanage I had no control over my life, but with soapy water and a stiff brush, I could scrub away the smells and pretend I lived in a castle.”

            Ruth draped the brown latex gloves over a clothesline to dry before being sterilized. “Cleanliness may not be next to godliness, but it beats back the demons of poverty.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting at first, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

Combat produces injuries. Injuries require treatment. If you write a novel set during World War II, you may have to write a medical scene—and you’ll want to get the details right about your nurse characters.

During World War II, 57,000 women served in the US Army Nurse Corps (ANC), 11,000 in the Navy Nurse Corps (NNC), and 6500 in the Army Air Forces. More than two hundred nurses died serving their country.

Today I’ll cover requirements to serve in the Army Nurse Corps. On November 26th, I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Requirements

To serve in the Army Nurse Corps, women had to be 21-40 years old (raised to 45 later in the war), unmarried (married nurses were accepted starting in late 1942), a high school graduate, a graduate of a 3-year nursing training program, licensed in at least one state, a US citizen or a citizen of an Allied country, 5’0”-6’0,” have a physician’s certificate of health and a letter testifying to moral and professional excellence.

Pregnancy was the main cause of discharge from the Army Nurse Corps, or as the women called it, PWOP (Pregnant WithOut Permission). To discourage pregnancy, the Army had a cumbersome process to gain approval for marriage. Other methods to prevent pregnancy included careful placement of nurses’ quarters, discouraging drinking, and encouraging the women to socialize in groups. The second main reason for discharge was “neuropsychiatric,” what we call combat fatigue nowadays.

Remember that gender and race discrimination was still rampant in the 1940s. Male nurses were not allowed in the ANC during World War II, and only a limited number of African-American nurses. Despite a large number of black registered nurses in the United States, fewer than five hundred were allowed to serve, and then only to care for black patients or for prisoners of war.

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist

Dianna Benson: EMS Professional

I'm proud to host Dianna Benson on a monthly basis here at Redwood's Medical Edge. Dianna is a seasoned EMS professional and will be blogging about real life in emergency medical services.

The majority of the general public believes EMS crews, haz-mat teams, and firefighters jump into any situation to help victims, but the harsh reality is we have firm protocols to follow. There are multiple emergency scenes we simply cannot enter even though a civilian’s life depends on our rescue and medical care. When I see emergency personnel break this protocol in a movie or I read it in a book, I lose interest in the story. When I see or hear about it in reality, I shake my head – instead of being heroic and helpful, that crew has created additional chaos to the situation by becoming part of the problem, thus making the issue at hand larger and more disastrous.

Below are circumstances prohibiting rescue crews from entering a scene:

1)      The rescue crew on-scene is not trained for the situation at hand.

2)      The equipment available is not efficient for the situation at hand.

3)      The structure itself is unsafe and there’s nothing we can do nor equipment we can wear to make it safe for entry. To be clear, safe means safe for us with our training, knowledge, experience, and equipment. It doesn’t mean safe for the average lay person (a civilian).   

4)      Unstable and/or armed perpetrator(s) are inside the hot zone.

5)      The air quality inside the hot zone is deadly, so even if we extricated any victims, they wouldn’t survive since they’re already exposed, so it’s pointless for us to put ourselves at risk by entering a toxic environment. Believe me, I know this sounds extremely cruel – these situations are awful, and they taunt me to turn in my badge and credentials forever.

We are able to rectify some of the scenarios above:

Scenarios #1 and #2 – Once it’s concluded the on-scene crew or equipment is inefficient, the correct replacements and/or additions are immediately dispatched to arrive on at scene. Depending on the location of the scene, however, and what is needed, it may be a long wait. Example: A tiny town several hours from a city. What other factors can you think up that would delay the arrival of efficient help?   

Scenario #3 – Every situation is different, and this would depend on an array of factors. If we can’t immediately make a scene safe for entry, we’ll work on making it safe. In cases of fire, there are times we must allow the fire to burn itself out. Why do you think that is?

Scenario #4 – Various law enforcement is in control of these scenes. If they aren’t able to eliminate the threat of an armed perp, no one but law enforcement may enter the scene, but they have protocols to follow in doing so. With unstable but unarmed perps, EMS will forcibly restrain the individual onto a stretcher. At that point, that person becomes our patient and we refer to them as a psych patient. If necessary, we then chemically restrain them as well as maintain the physical restraints. However, in order for EMS to enter a scene of a potential psych patient, the scene must be safe. What ideas can you plot that would prohibit us from entering a scene of an unstable but unarmed individual?

Scenario #5 – This is a sad and unfixable scenario for real life, but in fiction this could work as excellent conflict, both emotional (characterization) and physical (plot). To be honest, this is how I handle these types of real circumstances – I pretend I’m an actress playing out a screenplay I’ve written, which helps me deal as I work the scene as a competent professional. I’ve taught several other rescue personnel this tactic, and it works for them as well.     

Thank you in advance for reading and for your participation and comments. If you have any questions, please do not hesitate to ask.

Dianna T. Benson

Thriller/Suspense Writer

EMT and Haz-Mat Operative

http://www.diannatbenson.com/

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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. A EMT and Haz-Mat Ops in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com/ 

The Invention of the Stethoscope

I'm pleased to host historical author Ruth Axtell Morren as she posts about some of the medical research she did for her novel The Healing Season. You can find out more about Ruth by checking out her website at http://www.ruthaxtellmorren.com/index.html. Welcome Ruth!

The stethoscope was invented by a French doctor, Laennec, in 1816. He discovered that you could hear sounds better from a certain distance, if there was something in between.

Back in those days, modesty many times prevented a (male) doctor from hearing a female patient’s heartbeat, because the only way you could hear it, was putting your ear up to the person’s chest.

Laennec rolled up some paper and put it against the patient’s chest and his ear to the other end, and voilà, the heartbeat sounded even clearer than if he had had his ear pressed against her.

I did a lot of research on medicine in the early nineteenth century for my regency novel, The Healing Season. 

I traveled to London and toured a museum that used to be an apothecary’s shop. It was part of the St. Guy’s/St. Thomas’s Hospital complex of that time. It was fascinating to see all the things used at that a time, especially the herbs and how pills were made.

Another interesting thing I found about that period was that at that time three kinds of medical practitioners existed: the physician, the apothecary and the surgeon.

The physician was the “profession,” only practiced by the aristocratic, university educated man. The apothecary was our pharmacist, but he learned through apprenticeship. Then there was the lowly surgeon, who evolved from the butcher, and he was strictly called in for cuts, broken bones or amputations and the few surgeries performed in those days (kidney stones being one). The physician hardly touched the patient, just prescribed tonics and dealt with “humors.” Medicine was more theoretical for this guy. The medicines he prescribed were made up by the apothecary.

What began happening, though, was that generally there weren’t that many physicians, especially away from the large cities, so apothecaries began taking over more and more of his duties. Surgeons, who also worked aboard navy ships and accompanied armies, began to perfect their technique on the battlefield (primitive triage). So, the professional lines began to blur, and the apothecary began to change into what would become the General Practitioner.

My story is about a surgeon. I also included his uncle and made him an apothecary. Some of the resources I used were Irvine Loudon’s Medical Care and the General Practitioner 1750-1850; Sherwin B. Nuland’s Doctors: The Biography of Medicine (excellent resource!); And Roy Porter’s Quacks, Fakers & Charlatans in Medicine.

Medical Scene Diagnosis: Part 2/2

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

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

"I'm Dr McGregor, your attending physician. Arnold says you remember the accident?"

"Just parts of it."

"Do you know what day it is?"

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

The doctor made some notes on the chart. (Many hospitals have gone to computer charting. But, you would have some latitude as a writer here because it's likely not 100%)

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

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

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

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

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

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

"I'd like to have my head up."

"I think we can arrange that." 

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

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

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

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

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

"My liver?"

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

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

"A person can't live without a liver, can they, doctor?"

"Your only option at this point is a liver transplant." (I liked this a lot because I learned something new. As a confessed medical nerd, the first thing I thought was really? Went and looked and transplant can be used in cases of severe traumatic injury to the liver. Check it out here if you're interested: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669949/)

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

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

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

"That's true."

"So, what other alternatives do we have?"

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

Tony's heart sank. This didn't sound good. "So what exactly are you saying?"

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

"My parents are dead and I'm an only child."

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

This writer deserves a lot of credit for setting up some nasty odds and conflict for this character. Strong work!!

Medical Scene Diagnosis: Part 1/2

This medical scene was submitted anonymously by a fellow writer who wanted some critique but not necessarily her name to be published. The scene begins with a victim of a motor vehicle collision coming into the ER. His car rolled several times during the accident. What follows is her scene. My thoughts will be in parentheses at the end of the sentence. I'm only going to comment on the medical accuracy. Grammar editing is not the focus.

new4me/Photobucket

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

"Hey, take it easy. You're all right. You need that oxygen."

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

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

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

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

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

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

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

He waited until Tony complied before continuing. "You're in the Regional Medical Center in San Jose."

"Accident?"

Arnold's smile faded. "Yes. Doctor said you're lucky to be alive."

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

"Where is the doctor?"

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

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

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

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

Truly Historical Medical Question: Head Injury 1870's

For those of you pining for a truly historical medical scenario, April poses this question.

I have a question regarding medicine in the 1870's.  What would brain/cranial surgery consist of then?  I've tried to find some information on this type of operation from this time period, but have had very little luck so far.  In a quick scenario, there's been a serious buggy accident, and the heroine of the novel has bleeding on the brain--I know one proposed procedure for this was to actually drill a hole into the skull to let out the influx of blood--was this happening and being practiced in the 1870's, though--this is what I cannot find.  Also, what would the medical instruments of the day have been to achieve such a surgery?

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Yes, you could definitely set up the scenario for a craniotomy (drilling a hole in the head or creating a burr hole) to be used to relieve pressure within the skull. The procedure would have been called Trephining. The following are references regarding the procedure.

1. http://www.actaitalica.it/issues/2007/3-07/Sperati.pdf. This reference shows photos of the surgical instruments used.

2. http://en.wikipedia.org/wiki/Trepanning

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April Skelly is a  high school English teacher, just married over a year to the "Most Amazing Man in the World", and recently moved to Cleveland, OH.  Her first book, To Be A Warrior, A Story of Battle, is a tweener story of allegorical fiction based on the scriptures found in Ephesians 6 and was released in the summer of 2008 (Tate Publishing).  She is passionate about the written and spoken work.  April also enjoys singing with the Praise Team at her church.

Historical Medical Question

Some of you may be pondering... why is a question set in 1977 historical? In the sense of a historical novel, this time period would probably be considered contemporary. However, think about how much medical care has changed since the 1970's. That decade saw the beginning of EMS services and dedicated cardiovascular ICU's. So in the medical sense, I am considering this a historical question. I will focus on 19th century medicine in the future.

Jean asks:

In my novel set in the seventies, I need to know how a person could kill someone and let it be misdiagnosed as a heart attack. This is in a small community hospital in 1977.  Would an overdose of caffeine pills like you buy at truck stops do it if her heart was weak already?  Or would air bubbles in a needle work better?  I want her buried without an autopsy so the killer gets away with her murder until he is caught attempting to do it again to the daughter.

Jean, I want to back track your question a little. How old is this woman? I was thinking, what condition can this woman have where it wouldn’t be unexpected for her to die of a heart attack? Heart disease is lower in women who are in their child-bearing years because of the heart protective effects of estrogen. Check that out here: http://highbloodpressure.about.com/od/informationforwomen/f/protection.htm

Then I was thinking, could there be a genetic heart condition that could translate to the daughter as well so that if she presented with these same symptoms, it may not be initially too suspicious until some clever character figured it out?

There is a genetic condition called Hypertrophic Cardiomyopathy that occurs in 1 in 500 people and 1/2 these cases have a genetic link. When you have this condition, one of the effects is that you can develop congestive heart failure. If you have congestive heart failure... you can easily die of a heart attack. See where I'm going with this? The daughter could get the same condition. Check out more information of this condition here: http://www.genetichealth.com/hd_what_is_cardiomyopathy.shtml

OK... how to kill off these characters? Caffeine is a possibility, but I think something more dramatic could be found. Common abuse drugs during this time period were methamphetamine/cocaine. Cocaine could be smoked which would have been common in the 70's--maybe her cigarette could be spiked with the drug? A physician co-worker of mine asked if the character was a tea-drinker. If so, you could use the plant foxglove-- which is where digitalis comes from. Digitalis is a potent heart medication.

Any other thoughts for Jean?

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Jean Kinsey began writing seriously five years ago when her husband died. She's been published multiple times in both Chicken Soup and Cup of Comfort anthologies. The Light Keeper's Daughter, her historical novel, is finished but as of now unpublished. Currently, she is at work on Willow Shade,  a mystery set about her hometown.

Jean lives in Brooks, KY, and teaches adult Sunday School at Calvary Hill Separate Baptist Church. She has three children and seven grandchildren. Her hobbies include reading, writing and traveling.

Research Tool: Web MD Symptom Checker

Today, I have a gift for the research interested writer and all fellow hypochondriacs... though I am not openly claiming to being one personally (a hypochondriac that is). I love tools that can broaden your thoughts on how to injure, maim, or kill your fictional characters.

While perusing the Internet, I found a symptoms checker hosted at Web MD. You can find it, hopefully, by using this link: http://symptoms.webmd.com/symptomchecker.

How can we use this for our fiction? Start by inputting the age and sex of your character. Then you get to select a body part by scrolling over the animation. You can even do the backside. Pick a body part and then the tool will zoom in on that area. Now you can pick a more specific area and it will give you a list of symptoms. There may be some you've never heard of. Once you pick from this list, it will give you a list of potential diseases that can cause those symptoms. After you pick a disease, input this over at Google University and see if it will work for your novel. Maybe your male character presents with the classic heart attack symptoms: chest pain, left arm pain, chest pressure, sweating... but you don't want him to have a heart attack. You want to confound the medical team. This would be a good way to find some alternatives.

My current novels have a medical mystery at their core and I found this tool a good way to open up the medical possibilities. I hope you find it useful as well.

If you checked out the Symptom Checker, leave the age and sex of your character, a few symptoms and one disease it came up with in the comment section.

Stab Wound: Medical Question

One of the features of this blog will be to field medical based questions for your manuscripts. Sandi Rog poses this question.

Where can you place a stab wound that wouldn’t instantly kill your character, but keep him around for a few hours?

Sandi, you have a couple of options here. One would be a stab wound into the right side of the chest. This could partially collapse a lung and cause some bleeding as well. Think of the lung as a balloon. A small nick to the lung could cause it to slowly leak air into the chest, keeping the character alive for a few hours but killing him in the end if the collapsed lung isn't treated. The more collapsed the lung is, the less it is able to function. The more air that accumalates in the chest, the more it will push other structures.

We call this a tension pneumothorax.

photo-online/Photobucket

Imagine the right chest is now full of air. Air will keep building unless it is given a way out (like a chest tube) and can actually push structures on the other side of the chest. If left untreated, this could cause the patient to die either from an accumulated tension pneumothorax or bleeding... called a hemothorax. A lung collapse combined with bleeding into the chest is a hemopneumothorax.

Why not a stab wound to the left chest? This has an increased chance to kill instantly becuase you have the heart and several blood vessels that come off the heart that sit there... can anyone say aorta?

Another option would be to have a stab wound to the belly. All sorts of stuff in there. If you wanted the character to die in a few hours, this could happen from untreated bleeding. There are two organs that sit in your abdomen that have a rich blood supply, the spleen and the liver. The medical term is highly vascularized... meaning rich with blood supply. You could also have an infection set in and this could keep him alive for a couple of days until he is overwhelmed by sepsis.

What symptoms would a patient with a pneumothorax (collapsed lung) have?

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Sandi Rog is an award-winning author. Her latest book, THE MASTER'S WALL, released November 1, 2010. Sandi lived in Holland for thirteen years and now lives in Colorado with her husband, four children, a cat and too many spiders. Check out her website at www.sandirog.com.

Nursing vs. Tess Gerritsen

Last post ended with a medical question: What is dextrocardia? Dextrocardia is when your heart is on the right side of your body versus its normal position on the left. It is rare... I think I've seen only one or two cases in my nursing career. Even if it is on the wrong side, it can still function normally.

I was recently perusing other medical writer's blogs when I came across an interesting controversy that I thought warranted discussion here at Redwood's Medical Edge. The focus of this blog is strategies to write medically accurate fiction. The foremost premise being do good research. What happens when the research is accurate but the reader thinks otherwise? What if those readers are nurses and you're a physician author?

Tess Gerritsen, an acclaimed novelist/physician published a novel called The Bone Garden. From her blog dated 10/17/10 she writes:

"Recently I’ve been taken to task by a number of nurses who are outraged that in my novel The Bone Garden, a book about childbed fever, I make no mention of Florence Nightingale. Instead, my book focuses on Dr. Oliver Wendell Holmes and how his theory of infectiousness revolutionized American medicine. How dare I write a story focusing ONLY on a doctor’s contributions, and ignore the contribution of Nightingale?
Here I offer my defense."

It definitely is worth the read. http://www.tessgerritsen.com/. Go to her blog and check out the post for October 17th.

I think this controversy may highlight a couple of different issues. My only plea is that you read this whole post. The first issue: Are nurses jealous of physicians? Of their value and position in society?

Imagine a nurse who gets asked the question, "Why didn't you go to medical school?" I doubt physicians get asked the reverse question. When I get asked this, I feel like what they are really saying is: Being a nurse is below you. You should have used your intelligence in a more practical way. Or, I like this comment better. "You're just the nurse. I want to double check that with the doctor." The self talk becomes... They don't trust my opinion. They think a nurse doesn't know anything about medicine. Now, I want to prove how smart I am. What better way than to out a physician for some perceived error like not doing appropriate research for a fiction novel?

Now, I don't know the exact motive for these nurses to write Tess Gerritsen. This is one theory as to a possible reason. I also don't want to throw my compatriots under the bus. However, if you're going to stir up trouble, just ensure your facts are in order.

Now, before all nurses everywhere skewer me, I have an alternative theory as to what I think may be the more likely motive. These nurses want the value and contribution of nursing to be recognized.

Sometimes, it's easy to feel undervalued as a nurse. Imagine with me for a moment the ER nurse caring for a person who has ingested some prescription medication. She is watching for those subtle signs that the patient is worsening and begins to notice that there are wide swings in the patient's heart rate and requests an order from the physician for an IV... just in case. Her nursing intuition is throwing up red flag after red flag... so she goes to grab an appropriate sized resuscitation bag and hooks it up and makes sure the oxygen is flowing through it. And when the patient does stop breathing, this nurse immediately begins to resuscitate the patient as she hits the call light to get more help. The patient is stabilized by the medical team. The family is relieved and thankful and they go up to the physician and say..."Thank you so much for saving their life."

Of course this doesn't happen on all occasions. Lots of families do recognize that it is the nurse who is largely at the bedside providing their care and having an influence on their loved one's outcome but I also think all nurses everywhere have encountered this situation.

So I do thank those nurses for trying to ensure that those people who have contributed to the professionalism of nursing get the recognition they deserve.

Which motive do you think it was?