Author Beware: Implausible Killing Methods

I know the difficulty writers face at having to come up with unique and unusual methods of killing off their fictional characters. Hence, the constant hunt for lethal, undetectable poisons.

One popular author came up with the following scenario for his serial killer. I read this detailed scene with great interest but in the end, the implausibility of the scenario kept me up that night. I continually analyzed the scene in my mind and wondered if the author might have posed the question to a medically sound person as to its plausibility.

In short, essentially the killer drilled holes into the victims ankles to drain her blood. This would be death by exsanguination. But then, plugged up the holes with glue. Proceeded to string the victim up. Then pulled off the glue plugs so the victim would hemorrhage to death.

Inventive... yes, absolutely. Haven't read anything quite like it. Plausible... not really. Here's why.

In order to bleed to death quickly, a major vessel needs to be disrupted. Preferably an artery. Your heels are not very vascular meaning they are not rich in blood supply. Imagine a cut on your heel and the same cut on your head. Which will bleed more swiftly? There are arteries in your feet. They are located on the top of your feet and near the inner malleolus which is the knobby bone on the inside of your foot. Drilling through the ankle into the heel likely will not catch either of these major arteries.

The other issue. Plugging up the holes. Any time bleeding is stemmed, the blood has a chance to clot. Now, in this novel, the killer was very busy for quite some time hoisting the victim. I think enough time for the victim's blood to clot. Therefore, when the plugs were removed, I think very little bleeding would have actually occurred.

What scenarios have you found in novels that are implausible? Were they enough to draw you out of the story? Please, keep the author's name and book title off any comments, otherwise they will be deleted.

Author Beware: Use of Medical Equipment

I'm an avid reader. Don't you have to be as a writer? I have to admit, there are a few authors I lean toward. Generally, I'll read most of what they publish.

I also have an issue. I know that it can be very hard to get medical details right in a manuscript. I faced this challenge when I wrote an OB scene and had an OB nurse review it. To put it mildly, she was displeased with what I wrote. I was actually relieved to find that out during the editing phase rather than have a whole lot of obstetrical nurses throwing my novel into the trash because they were offended at something I'd written.

Usually, I'll give a little leeway to those I read... a little. For instance, using EKG instead of ECG is okay... not great but I generally peruse by without much thought.

I was reading one mega-bestselling novelist when he began to write a hospital scene. The character had been beaten up fairly well and there was a description of the medical equipment that was attached to his body. It read something to the effect that, "He had nasal cannulas in his nose."

A nasal cannula (nasal prongs) is an oxygen delivery device. It's very common. The correct way to note the use of this piece of equipment would have been to say, "He had a nasal cannula in his nose."

The way the writer phrased it immediately brought an image to my mind of two of these stuck up his nose. Now, my story bubble has burst and I'm re-reading this sentence to be sure that's what he really said.

If you're unfamiliar with medical equipment, run the scene by someone familiar with its use to avoid simple mistakes like this one.

Author Beware: Medication Concentrations

Flashpoint is one of my favorite television shows. Within the last month was a fairly intense episode where an officer was shot six times at near point blank range in the chest. Luckily, he had his vest on (thank goodness because he is my favorite character) and suffered some gunshot wounds to the arms but was otherwise in good shape.

Off to the ER he goes.

Now, of course, my nursing/analytical brain turns on and I begin to look at every nuance to see how accurate they'll portray the scene. They didn't do too badly until the doctor orders the nurse, "Give the patient 10ml of Morphine."

Nice... if you want to kill your patient.

The issue with morphine is that it is prepared in multiple concentrations. The lowest concentration is 1mg/ml. In this scenario, the patient would have received 10mg of morphine which would have been okay. Most often you'll see smaller doses titrated up for pain control.

On our unit, we have two concentrations of morphine: 2mg/ml and 4mg/ml. I know I have very smart readers so you can see the potential problem. The physician ordering 10ml without specifying the concentration means this patient could either get 20mg or 40mg of Morphine. These are both potentially lethal doses and would have put our fine character in serious trouble.

The morphine dose should have been ordered in milligrams not milliliters. Drugs are rarely, if ever, just ordered in milliliters.

Be careful with drug dosing. You don't want to accidentally kill off a character you want to have around for awhile... or do you?

Not Kidding Around: Alina Adams

I'm pleased to host Alina Adams today as she writes about the importance of research and how she forayed into worlds she didn't have a clue how to write about-- including mine-- pediatric medicine.

Welcome, Alina!

My first two published books were Regency romances, set in Regency England (think Jane Austen).

I know nothing about Regency England.  (I am of the mindset that nothing romantic could have possibly happened prior to the invention of indoor plumbing). 

Yet, the AVON editor who rejected my submitted contemporary romance in 1993 told me that new authors had the best chance of breaking in by writing a Regency romance.  So I did some research (i.e. I read a book called “What Jane Austen Ate and Charles Dickens Knew”), and a Regency romance I dutifully wrote, “The Fictitious Marquis,” followed by “Thieves at Heart.”  (I was later informed by a copy editor that I’d missed the true Regency period by several decades.)

My first contemporary romance, “Annie’s Wild Ride” featured two Air Force pilots.  I know nothing about Air Force pilots.  (I’m not even a big fan of flying.  In fact, my entire writing career comes down to wanting to write books that can make your cross-country flight feel shorter and less arduous.)  I also know nothing about the Air Force Academy in Colorado, or the engineering of roller-coasters, all of which play a big part in the story.

So, once again, I read a book.  (Luckily, while I was writing “Annie’s Wild Ride,” Kelly Flinn, one of the few female pilots in the Air Force was being drummed out for adultery, so there was a great deal of relevant information on the news: http://en.wikipedia.org/wiki/Kelly_Flinn).

My second contemporary, “When a Man Loves a Woman,” in the initial stages was merely the story of two doctors.  Turns out, doctors need a specialty.  So I – what else? – read a book.  Several books.  And I learned several fascinating things.

Namely that children are not small adults.

But that not everyone in the medical profession seems to be aware of that.

My characters, Dr. James Elliot and Dr. Deborah Brody (best-friends since medical school and probably in love, too, but Deb was kind of already married when they met – oops) are a pediatric trauma surgeon and a pediatric neurosurgeon, respectively.

And it was through them that I learned such things as that not only do pediatric patients require custom-built, smaller medical equipment, but that procedures that work perfectly well on adults might have the opposite effect on children.

One example that really sticks out in my mind is that an adult patient suffering from heavy bleeding can have his/her spleen removed, and go home none the worse for wear.  A child can undergo the same procedure and also go home seemingly perfectly healthy.  Only to die from a cold down the road because their immune system has been completely compromised.

The most important thing I learned courtesy of Drs. Elliot and Brody was, when faced with taking your child to an emergency room, you should do your best to make sure that the hospital has a pediatric emergency room.  Both for the specialized equipment and for staff that knows about the spleen issue… and a million others.

It’s a lesson that came in handy with my own child last year.  In NYC, we are fortunate in that we have quite a few hospitals to choose from.  So when it came time to decide which one to go to, I did have a moment of freezing.

And then I remembered “When a Man Loves a Woman.”  Choice made!  (Another reason to go to a pediatric emergency room: The experienced nurse on duty took one look at my son and, before any x-Rays were so much as ordered said, “His arm’s broken.”  It was.)

“When a Man Loves a Woman” was released by AVON in 2000 as a paperback.  This September 2011, I am re-releasing it as an enhanced e-book.

What’s an enhanced e-book?  It’s a book that offers the same text as the original in electronic form… plus a little bit extra.  In this case, it’s a soundtrack of songs to compliment the story.

Please check out “When a Man Loves a Woman: Enhanced Multimedia Edition” at http://www.alinaadams.com/.

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Alina Adams wrote Regency romances for AVON, contemporaries for DELL and a Figure Skating Mystery series for Berkley Prime Crime.  Her soap opera tie-ins, Oakdale Confidential and Jonathan’s Story were NY Times best-sellers.  Another tie-in, The Man From Oakdale, won the 2010 SCRIBE Award.  Alina is currently working on turning her entire back list into enhanced e-books, spearheaded by Soap Opera 451: A Time Capsule of Daytime Drama’s Greatest Moments.  Visit her at: http://www.alinaadams.com/.

Medical Question: Life Threatening Condition 1830's

This medical question for a current work in progress came to me via Facebook. Remember, I am always looking for those pesky medical questions to answer to make sure your medical stuff has the ring of truth... even if it is fiction.

Question: Is there a life-threatening condition that twins could have that could be fixed with minor surgery in the 1830's?

http://www.sciencephoto.com/media/155709/enlarge

Answer: This question sets up a very difficult scenario for the author to work through. First conundrum is the "life-threatening", " minor surgery" and "1830's". First of all, most life-threatening conditions require a fairly extensive surgery to fix. One life-threatening option that might easily be fixed would be to have a severed artery that could be tied off. But, this doesn't fit with the twin scenario. Next problem is that surgery wasn't all that advanced in this time period. No OR's... etc.

Secondly, a condition that affects the twins. First thought that came to my mind was a congenital heart defect present in identical twins that would require surgery. But again, limited by the chosen era. Not a good solution.

Then, I thought of the post I did on milk sickness http://www.jordynredwood.com/2011/06/anna-bigsby-milk-sickness.html. A good idea for this time era would actually be a medical condition that the local doctor could figure out and treat. Something along the lines of a toxic plant poison passed through the mother's milk or a metabolic disorder that could be managed by diet. It would take a very crafty doctor to figure out and would be a plausible option given the constraints of that time period. Here's an extensive list: http://emedicine.medscape.com/pediatrics_genetics.

Any other thoughts for this writer?

Old versus New Medicine: Blistering

Prior to the birth of modern medical theory, the pervading thought for illness was that disease was caused by an imbalance of body fluids. To right this, common medical practices included purging, starving, blistering or blood-letting to place things back in order.

Maybe you think we don't use any of these practices anymore. Think again.

Let's consider blistering a patient.

In historical medicine, blistering used a caustic substance on a portion of the patient's skin to induce a burn or blister. The goal was to create infection as physicians of the day thought that the subsequent puss draining from the wound would be beneficial for the patient.



Blister Beetle



 

Blistering is still used as a medical treatment. Molluscum is a wart-like virus that is very common in pediatrics. Cantharone is a blistering agent made from beetles. Some physicians will refer to it lovingly as "bug juice". A very minute amount (this stuff is powerful) is applied to the lesion with a wooden stick. Over the next several hours, it will cause a water blister to form over the lesion. The goal is that when the blister forms, it will pull up the viral core, to resolve the lesion more quickly.



You can read more about that here: http://www.childrensmemorial.org/depts/dermatology/mollus.aspx


Does it surprise you that a blistering agent is still used as a medical treatment?

Perinatal Providers: Scopes of Practice

Heidi Creston returns today for her monthly blog post. Today, she covers a very important topic: scope of practice for different obstetrical providers. Scope of practice dictates what a medical provider can and cannot do so it is important to know a particular providers limitations. For instance, as a registered nurse, I cannot diagnose illness though most nurses are very good at this very thing and we may indicate to a family what we think is going on. However, only a physician, nurse practitioner, or physician's assistant can diagnose.

Now, I'll turn it over to Heidi.

It is especially challenging for the perinatal patient to understand the scopes of practice that different providers offer. As authors, we must remember that our audiences are impressionable, and may believe your fictional story as the Gospel truth. If your character is a perinatal provider it is imperative, that you keep them working within the means that their occupation allows.

The providers:  Obstetrician-Gynecologist, Perinatologist, Family practitioner, Certified Nurse Midwives, and Doula's.

Obstetrician-Gynecologist (OB/GYN) is a medical doctor who provides both clinical and surgical care for their patients. The OBGYN serves not only the perinatal patient but all women's medical issues from puberty to post hysterectomy.

Perinatologist is an obstetrician who specializes in the care management of high-risk pregnancies. Patients assigned to a perinatologist are referred out by their OBGYN or family practitioner due to the extensive or specialized care that is required maternally and or for the fetus. Patients with cardiac issues, diabetes, Eclampsia or HELLP, and multiple gestations are prime examples of patients referred to perinatologists. Fetuses with severe abnormalities such as gastrocentisis or Tetralogy of Fallot are also referred.

Family practitioner is a medical doctor who specializes in the health care of all family members. They are prepared to provide normal OB/GYN care, but usually refer pregnancies and other women’s health issues to an OB/GYN. All family practitioners are trained to perform Cesarean births in an emergency and also to assist other specialists in doing the procedure.

Certified Nurse Midwives are registered nurses who have earned their master's degree in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor, or delivery. CMW’S can assist with cesarean sections but can not perform them independently.

Doulas are not licensed or certified personnel. Doulas are support liaisons hired by the patient, to assist them through the pregnancy, and offer support during the labor process. There currently are no mandatory qualifications, regulations or requirements necessary in order for someone to become a doula.

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Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished. 

Personal Protective Equipment (PPE)


Dianna Benson is back for her monthly post discussing the different types of personal protective equipment healthcare professionals wear in different types of situations. As a writer, these will help you write authentically.

As an EMT, a Haz-Mat-Operative, and a FEMA Mass Casualty Incident Operative, PPE (Personal Protective Equipment) is vital to my safety and health. At a bare minimum, I wear medical gloves and wash my hands post removing those gloves. At a maximum, I wear my bio hazard suit, head to boot, complete with full face respirator, air tank and haz-mat outer gloves.

Depending on the type of EMS call and the situation, I could wear one, all, or a combination of the following PPE: long armed and legged paper gown, plastic face shield, plastic eye goggles, a HEPA or N95 (mouth and nose surgical mask), and a helmet. In a MVC (motor vehicle collision) I wear a bright yellow traffic vest stamped with EMS on the back. If I need to climb inside a damaged vehicle on scene to medically examine, assess, and treat a patient as well as help extricate them onto a backboard and stretcher, I wear my turn out gear: heavy thick pants, coat and gloves over my EMS uniform and medical gloves, plus I wear a helmet with a thick plastic face shield and I slip the yellow traffic vest over the coat.

If I have a blood borne pathogen exposure via a contaminated needle or a patient’s mucous membranes, blood, urine, vomitus, feces, etc. or an airborne pathogen exposure, I immediately contact my district chief 24/7. Within minutes, my district chief will inform the EMS medical team and they will advise me on how to proceed in seeking medical care for myself.

Never in the history of EMS, fire or law enforcement have any of us contracted HIV while performing our duties due to the fact the HIV virus dies once it’s exposed to either air or light. Hepatitis C and MRSA (Methicillin-resistant Staphylococcus Aureus) are two diseases I’m concerned about contracting from a patient. Unlike Hepatitis A and B (both of which I was vaccinated against before my first EMS shift back in 2005) there currently is no Hepatitis C vaccination. Along with about most of the rest of the world, I probably already have MRSA cells in my system and they’ll never cause me any harm, but if I do become systematic with MRSA, it could be an arduous process to heal or I may never heal. However, I just follow PPE guidelines and leave it in God’s hands.

On the start of my every shift, I attach my tiny blue plastic name plate to the ceiling of my ambulance via Velcro. The name plate says: D. Benson. This name plate is mostly for a MCI (Mass Casualty Incident) or a structure fire, but can be helpful in any situation and is used for the following reason: When I enter a scene, my name plate will inform all other rescue personnel, especially EMS, who exactly went into a structure or scene without anyone having to waste precious time researching that information.  

Can you think of specific situations where I’d wear certain equipment? Hint: A long armed and legged paper gown I’d wear when I deliver a baby.

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

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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. An EMT and Haz-Mat Operative 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 

Medical Question: Suicidal Pregnant Patient

Lisa Asks:

I just found your site and it looks great! I'm writing my first mystery novel and I have a character who attempts suicide by taking an overdose of Ambien. She is discovered in time and pumped out, but I'd like to know:

If she was unconscious when they found her, would they give her adrenaline or anything to wake her up, or just let her sleep it off? Would she be on oxygen or on an IV with some sort of drugs to counteract the sleeping drug? If her family visited her right afterward is there a chance she'd still be sleeping? Would she be in a regular ward or the ICU on the first day? Or would she be shipped right to a psych ward?

Jordyn Says:

An unconscious patient is approached in a very step-wise fashion. This is drilled into medical people from the day they start school. Are they responsive? If not, open the airway. Is there anything in the airway that needs to come out? If not, the airway is clear. Is the patient breathing? If yes, how well? What are her breath sounds? What is her oxygen level? Does she have signs of respiratory distress? If the patient is not breathing well, she'll be assisted at that point. Next, is there a heartrate? If so, is it adequate? What is the blood pressure?

Actually, this has recently been reversed by the American Heart Association. Generally, there is a quick pulse check first. If no pulse... CPR is started right away. Then after a round of compressions, the patient is assessed for breathing. The components I mentioned above still apply.

 Based on this assessment, the EMS crew would determine what interventions need to be done. There are two medications that can be given as reversal: Narcan and Flumazenil. These only work for opiates and benzodiazepines.

 Adrenaline is Epineprhine. It would depend on what her other vital signs were at the time of her discovery. We don't give epinephrine just for unconsciousness. If she doesn't have a pulse and is not breathing and she has a particular arrhythmia (v-fib, v-tach, pulseless electrical activity) then these would be an indication for epinephrine. If she requires epinephrine, she likely will need someone to breathe for her as well.

 One thing I noticed is that you say her "stomach has been pumped out". This really isn't part of emergency care for overdose anymore. Many people don't understand what it means. We basically shove a garden hose down your throat and irrigate the stomach out with saline. The issue became that the risks of the patient having complications from the procedure were not worth the risk (risk to benefit ratio). Such complications could be inhaling vomit into their lungs and developing pneumonia or creating an electrolyte imbalance from using large amounts of saline to clear the stomach.

Generally, if a patient is discovered within one hour of their ingestion, we will give activated charcoal which is essentially ground up charcoal mixed with sugar. It looks like black sludge. The patient can either voluntarily drink it or we can put a tube into their stomach and give it that way. This medication will absorb the drug from their stomach, bind it so it becomes inactive, and then they poop it out.

Heidi adds:

It's pretty tough to over dose on Ambien unless it was your intention, so I'd definitely call that a suicide attempt. We'd probably monitor her ( on the obstetrics floor) for twenty four hours, put in a psych consult and have a sitter (a suicidal patient can't be left unattended).

You can keep a baby on the monitor starting at about 24 weeks, any GA (gestational age) before that you use a Doppler. We probably wouldn't keep her on the monitor but we'd admit her so she couldn't leave. Basically scare her into staying for "the sake of the baby" if nothing else. That way if she goes AMA (against medical advice) the hospital is not liable for either her or the baby.

Most level 2 and above hospitals see 24 weeks as the cut off for viability and there lots of things we can do to keep the fetus alive in cases of PPROM (Premature Rupture of Membranes), accidents, that kind of thing and with the right staff and facility you can maintain the viability of a 17 weeker.  

As for Ambien, we'd watch her more for maternal sake then baby. L&D nurses are good at getting the real story too, better than the counselors sometimes.  Ambien in a nut shell: 24 hours observation, intermittent monitoring, sitter, and consults. To get mama back in the game we do bedside ultrasounds so she can bond with baby and turn up the monitor so she can hear the baby, make life more real for her.  Nurses little tricks.

Any other thoughts for Lisa?

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Lisa Mladinich is the author of "Be an Amazing Catechist: Inspire the Faith of Children" and the founder of AmazingCatechists.com and Catholic Writers of Long Island. Her weekly catechetical column can be found at http://www.patheos.com/About-Patheos/Lisa-Mladinich.html

Sorting though Disaster: Triage and 9/11

As a tribute to the upcoming ten year anniversary of 9/11, I thought it would be nice to have our resident ER doc write about triage.

Where were you on 9/11? Please, leave a comment today.

Most people over the age of twenty probably have some memory burned into their mind of the fire consuming the World Trade Towers and their ultimate collapse and destruction.

northernlight220

I had just flown in from Chicago the night before. I remember waking up to the incessant ringing of our phone. Tired from the previous night, I was adamant about letting the machine pick it up. It became clear after about five minutes of solid ringing that perhaps it was an emergency. I answered and a good friend of mine was on the other end blubbering, crying—nonsensical. I remember fragments of her words—“planes crashed” , “New York”, “Thank God you’re back!”--“Just turn on your TV!”

I think I sat on the couch watching the tragedy unfold for the next three days.

A good friend of mine was working as a nurse at the time of the attacks. She’d just gotten off the night shift and was getting settled into sleep when the events broke. Immediately, she hustled back out of her apartment to go back to the hospital.

Upon her arrival, they were setting up for multiple victims, beginning to formulate a plan of how they would triage the patients.

Here’s triage from the ED doctor’s perspective: Dr. Edwards.

Some extraordinarily difficult decisions have to be made when you're dealing with a mass casualty situation. Unless you have unlimited resources to treat everyone, victims will have to be triaged.  Triage comes from the French verb trier--meaning to sort--and classically we think of three triage categories: 1) those victims so gravely injured they will not survive regardless of what you do; 2) those who can probably be saved if the right things are done quickly; and 3) those with lesser injuries who may be in distress but who can obviously wait (i.e., the walking wounded). 

 Battlefields have always been the crucible of innovations in trauma care, and indeed the modern concept of triage dates to the Napoleonic Wars of the late eighteenth and early nineteenth centuries.  The individual credited with inventing it (as well as field hospitals and fast-moving ambulances manned by trained individuals) was Dominique Jean Larrey, the French emperor's surgeon-in-chief. 

 Partly in response to 9/11, disaster medicine is now an actual specialty unto itself, with post-graduate fellowships and board exams.  Because of this, triage grows into more of a science each year as we evolve ever more sophisticated rating scales based upon injuries and vital signs to help providers make those fateful decisions about whom they will race to save.  

 The person assigned to triage duty must be trained to rapidly differentiate hopeless cases from those who might be saved, Typically, that individual will attach a color-coded tag alerting the rest of the team to the patient's category, and will also perform immediate life-saving maneuvers including the control of external bleeding, needle decompression of pneumothoraces (collapsed lungs), the insertion of mechanical airways, the initiation of field IV fluid resuscitation.  But more often primary triage involves deciding who must be transported to the hospital first. 

 When a mass casualty event occurs, hospitals switch into "disaster mode."  Carefully worked out plans involving the assignment of crisis team roles and the mobilization of additional staff--all practiced in regular drills, lest we become complacent--are activated.  Hallways and lounges become triage and treatment areas.  Larrey would have been impressed.

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Frank Edwards was born and raised in Western New York.  After serving as an Army helicopter pilot in Vietnam, he studied English and Chemistry at UNC Chapel Hill, then received an M.D. from the University of Rochester.  Along the way he earned an MFA in Writing at Warren Wilson College.  He continues to write, teach and practice emergency medicine. More information can be found at http://www.frankjedwards.com/.

Ways to Induce Labor According to the Old Wives

Have a pregnant character in your novel? What lengths might they go to to put themselves into labor? Would those methods actually work?

I'm pleased to host guest blogger Erin MacPherson today at Redwood's Medical Edge to discuss those ever popular myths (and some truths) about how to get a woman to go into labor. Erin has a wicked sense of humor so this should not only be informational but give you a chuckle as well. She hosts the equally funny Christian Mama's Guide.

If you're interested, I've started doing a twice monthly guest post over at Erin's blog giving "real life" girlfriend to girlfriend advice about pediatric issues. Ever wonder what a pediatric ER nurse thinks about things? This is the place to look. You can find my first post there that discusses if it's truly a risk taking a less than two-month old out in public. http://www.christianmamasguide.com/2011/08/31/newborns-and-the-er/

Welcome, Erin! I think her non-fiction book would be a great gift for anyone expecting a little one.

Somewhere between 36 and 41 weeks of pregnancy, you might decide to take matters into your own hands and try to induce labor at home. I fully support this. Not because I think it will work—it probably won't—but because the diversion of trying to induce labor at home will probably keep you from destroying the still-dirty baseboards in your nursery or wasting more gas on another trip to the hospital. Here are the old wives' best labor-inducing tricks:

1.        Eating spicy food. The story goes that eating a spicy burrito will get your whole digestive track moving and doing the Macarena, and your cervix will want to join the fun. The only effect I ever felt from eating spicy food was heartburn, but it's worth a try. A little Thai curry never hurt anybody.

2.        Walking. I tried this—a lot—at the end of my first pregnancy. I'd get home from work, grab a snack, lace up my tennies and start roaming the neighborhood. I didn't want to roam too far from home in case I actually went into labor, so I spent most of the time pacing in front of my house and looking psycho in front of my neighbors. It never did jump-start contractions, but it did soothe my nerves to be outside and get some fresh air.

3.        Sex. The gist of this method—which I'm sure was "discovered" by a man—is that sperm on the cervix can help spur it into dilating. Sounds a bit fishy to me, but my husband thought this sounded like a great idea, so I agreed to give it a try. It did not work out as well as my hubby or I had hoped. Not only did I not go into labor, but it was a bit tricky navigating around a really, really huge pregnant belly. But, you can rest assured, the same "professionals" who suggest this method, also assure you that it will in no way hurt your baby, so if you're wanting to give it a try, feel free.

4.        Castor oil. Castor oil makes your bowels move. The theory here is that —aside from giving you a really bad case of diarrhea— your moving bowels will somehow trigger a chain-reaction and the rest of your body will start moving as well. I have yet to know anyone that got anything other than diarrhea and some abdominal cramping from taking castor oil, but if you're a glutton for punishment—and ready to spend the day in the bathroom—then drink up.

5.        Nipple stimulation. I want to go on record as telling you not to try this one at home. I have a girlfriend whose doctor assisted her with nipple stimulation using a breast pump in the doctor's office with access to medical help, but most doctors don't recommend this method at all. Why? Because it actually works. Something about how nipple stimulation mimics a baby's suckling and causes your body to start contracting. The problem is that the contractions are often super-close together and super-unproductive, so it can pose a danger to you and your baby. So, if you absolutely must try this, I suggest that you talk to your doctor or midwife very candidly about it first and stay close to the hospital (say, in the parking lot) when you actually do it.

6.        Acupressure. Tell your hubby you want a foot rub—he groans and moans. Tell your hubby you need him to perform some acupressure to induce labor and suddenly he puts on his superhero glasses and gets focused on the task at hand. The general idea here is that by putting pressure on certain pressure points around your body, you can stimulate your uterus into contracting. Look up the pressure points online and ask your doctor if you're at all nervous. At the very least, you'll get a nice foot rub.

7.      Raspberry leaf tea. Raspberry leaf is on the pregnancy no-no list because it has a tendency to produce contractions. But if producing contractions is your aim, raspberry leaf tea can move off of the ix-nay list and onto the A-OK list. My doctor said it was safe after thirty-eight weeks, but before you go making yourself a big pitcher of raspberry iced tea, you might want to call your doctor just to be uber-certain that it's okay. It's always better safe than sorry.

8.      Begging and pleading with God for mercy. I guarantee that God will eventually hear your pleas and put you out of your misery.

QUESTION: What did you (or WOULD you) do to induce labor? Have you written a scene with a pregnant woman in labor?

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Religious Objection to Medical Care

Some religions object to medical care. Some believe in faith-healing. Other's will accept some medical treatment but object to some procedures such as blood transfusions.

When I worked in the pediatric intensive care unit, one of these instances arose. The child was on a breathing machine and not doing very well. The patient's hemoglobin level was low. You may know this as anemia. However, that's just one type of anemia. What's hemoglobin? It's the part of your red blood cell that carries oxygen. When you don't have enough hemoglobin to carry oxygen, your cells begin to starve and die. This leads to shock and death. It doesn't matter how much oxygen we deliver, if there's nothing to carry it to those individual cells, the patient can still die.

This problem is easy to solve. We give the child a blood transfusion. The parents, based on their religious beliefs, refused. This child's levels were so low, he was at risk for complications and he's already critically ill. It won't take much to tip him over the edge. What are the options?

In pediatrics, often tests can be run with a lot less blood so we do micro-sampling and keep track of every drop of blood we take. Micro-containers generally fill with about a 1/2ml of blood whereas adult tubes take up to 3ml's. Generally, patients in the ICU get labs every day to track their progress. The physician may choose to decrease the amount of labs done on a daily basis to conserve blood.

We ended up getting a court order to transfuse blood. The ICU docs were willing to respect the parent's position up to a point, but they were not willing to let the child die.

Imagine being the nurse at the bedside in the morning, trying as best as you can to only take a small amount of blood. Then getting the results back and wondering if you'll have to be the one to transfuse this patient.

The child survived and ended up not getting a blood transfusion and actually did really well. The nursing staff met with the family and a member of their church to discuss the issues that surrounded their child's care. A nurse asked the mother, "What would it have been like for you if we did give your child blood?" The mother responds, "It would have been like you raped my baby."

Those are strong, powerful words. I remember them to this day. Enough conflict? I think so and I definitely felt it at the time.