Florence Nightingale Diagnosis Henry VIII: Part 1/3

I'm so excited about hosting JoAnn Spears and her series on Henry VIII's medical issues. I have my own personal theories as to what caused Henry's demise. What are yours?

Welcome, JoAnn!

Henry VIII never had nursing care as we know it today.  In his time, care of the sick fell to family members or servants, generally female.  Henry’s last wife, Katherine Parr, certainly fulfilled this role for Henry.

Obviously, the modern medical testing which can categorically confirm or rule out disease cannot be brought to bear on Henry’s case.  Nursing diagnosis, which evaluates the human responses to alterations in health status, can be, and can elicit useful medical information about Henry VIII for those writing Tudor fiction.

A mind is a terrible thing…

Nursing Diagnosis:  Risk for Injury

Nursing Diagnosis:  Thought Process, Disturbed

Nursing Diagnosis:  Violence, Risk for

Henry VIII excelled in all of the sports and athletic activities enjoyed by the Tudor nobility.  He wrestled, hunted on horseback, played tennis, jousted and danced.

Henry VIII suffered a serious fall from a horse while jousting in 1536, at the age of forty-four.  He lost consciousness for a period of time after the fall, indicating that a significant brain injury may have occurred. 

This event coincided with the beginning of Henry’s divesting himself of his second wife, Ann Boleyn.  As is well known, he eventually went on to execute Ann, another wife, and numerous friends and political advisors.

It has been suggested that this head injury ‘turned’ Henry VIII violent.  In view of his track record prior to the injury, this theory is not 100% supportable.  That track record includes the executions of Bishops More and Fisher and the ruinations of Henry’s first wife and of his erstwhile friend Cardinal Wolsey.

Porphyria, a genetic condition of the metabolism, has also been mooted as a cause of Henry’s mental proclivities.  The disease causes numerous physical and mental symptoms, including mental irritability and derangement. Arguments that porphyria caused the “madness” of George III, a distant Tudor relative, bolster the porphyria theory, but not convincingly. McLeod Syndrome, a genetic blood disorder with some similar symptoms to porphyria, seems a likewise distant possibility.

Of course, there is no physical evidence extant to support any argument for a genetic condition causing Henry VIII’s various symptoms.   A look at his family tree, though, might shed some future light on such a possibility.

Henry’s elder sister, Margaret, was, like Henry, significantly overweight.  A descendant of Margaret’s, Queen Anne the Good (1665-1714), is probably the Tudor relation whose health issues most closely resemble Henry’s.  She suffered severe obesity later in life, lower leg pain and ulceration, functional immobility, and a very sad reproductive history.  She had at least seventeen pregnancies, which produced only four live children who died in infancy and one very frail hydrocephalic boy who died in his teens.  Her possible medical diagnoses have never aroused the interest that Henry’s have, but a thorough comparative study of Anne’s and Henry’s health issues might prove informative.  Diabetes, hypothyroidism, and Cushing’s Syndrome would all likely feature as “rule in/rule out” diagnoses in such research.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration.  Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.   

Six of One was begun in JoAnn’s native New Jersey.  It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Up and Coming

This week will prove to be very interesting at Redwood's. I'm so excited to host JoAnn Spears who will be guest blogging all this week on Henry VIII's ailments. Fascinating look into history and the medical care he received.

So, do you think you know what caused Henry VIII's death?

Treatment of Minors in the ED

It may surprise you to learn that there are circumstances where an underage minor can sign themselves into the ER for medical treatment without parental consent. In most states, if the patient is 13 y/o and up and requesting treatment over concern for a sexually transmitted disease or concern for pregnancy, they can seek treatment and we cannot call their parents.

This is one area that can be a huge source of conflict in the ED and most doctors and nurses I work with are very uncomfortable with the situation. More sticky would not be the patient who presents alone, but one that does present with a parent. Let's take a situation where a teen girl presents with her parents over complaints of abdominal pain. We do a pregnancy test and guess what... she's got a little bun in the oven. How do we disclose those results?

First off, we ask to speak to the teen alone. We will tell her the results. We tell her that legally we cannot tell her parents though we would like her to tell them and we will help her tell them if she would like.

Let's assume the teen says "no". She doesn't want her parents to know. Then we can't disclose it to them.

Now, parents are very smart and they will likely know what tests were performed. They may ask specifically, "What about the pregnancy test?" What we'll say is, "Mom, I can't legally tell you the results of that test. You need to speak to your daughter about that." A mother's intuition will kick in. After all, what would be the big deal if the test were negative?

Same goes for STD testing. I've had parents call back in a few days for these test results. Again, positive or negative, I can't disclose if the parent knows the test was performed. If the parent doesn't know the test was performed, I can't even disclose they had the test.

Can they get the results through medical records? This is iffy. An astute medical records department will be savvy enough not to disclose but I can see this being a potential gap in the system.

Also, when the insurance bill arrives, the test may be disclosed on that. Or, the parent may call the hospital billing department and ask specifically what test was run. This may be a potential way for them to learn about the test. But again, billing personnel don't have access to lab results.

I want to make clear that all ER professionals I know will make every effort to get the teen to disclose the results to their parent. Other potential areas of conflict. What if the parent is a drug user? An abuser? What should the ER team do then?

ED Treatment: Peds versus Vehicle (2/2)

We’re continuing with Mart’s question. Briefly from last post, a 16 y/o has been struck by a car. What would medical treatment be? She bounces off the hood and these are her injuries. Her elbow stung and her right leg turned back and blue almost instantly. Right hand is swollen. Her shin looked like a giant Easter egg lived under its skin.

EMS Response: Dianna

Contusion is the medical term for bruise. Contused areas don’t color immediately; it takes time – hours to days, sometimes only minutes depending on the injury and how easily the patient bruises, so include in her dialogue she bruises easily, but have most of the coloring appear later (not at the scene). However, patients feel contused pain immediately and a hematoma (mass swelling) can develop within seconds or minutes. The Easter egg you describe is called a hematoma.

Like human crutches, we’ll assist her inside the ambulance or we’ll place her on our stretcher and wheel her inside our ambulance. We typically assist the walking wounded instead of using the stretcher. Once inside our ambulance, I’ll ask her to lie on the stretcher. I’ll hook her up to our cardiac monitor to obtain a 12-lead just to verify her heart is functioning normal (heart rhythm is normal).

I’ll insert her index finger in a pulse ox to obtain her SPO2 level (blood oxygen saturation). I’ll calculate her breathing rate and heart rate and I’ll take her blood pressure and evaluate her skin and pupils. I’ll perform a rapid trauma assessment, head to toe, to ascertain full extent of injury.

I’ll disinfect all abrasions and control any bleeding. I’ll splint any suspected fractured bones or joints. We'll offer her Fentanyl (pain reliever) but we'll only administer it if she allows us to transport her -- we can't inject pain meds and then leave the patient (not transport to an ED).   

To clear the patient of C-spine immobilization: I’ll perform an examination of her neck, spine and all extremities, and if she denies any pain, tingling or numbness and I find no abnormalities, then it’s suspected the patient didn’t suffer any neck or back injury, thus no cervical collar or back boarding is necessary.

ER Care: Jordyn

When the patient arrives in the ED, if they are able to walk (a patient in C-spine precautions precludes this), we first obtain a weight. This is important in pediatrics because medications are dose dependent on that weight.

We’ll take report from the ambulance crew. Set of vital signs. Connect to a monitor. Assess pain level. Check IV site to make sure it is patent (lines can come out upon patient movement/transfer). Check splints to make sure distal part of extremity is getting good blood flow. The nurse will listen to her heart and lungs. Quick neuro exam. We’ll likely x-ray the right elbow, right hand and right lower leg. Even though suspicion of fracture might be minimal, the ED doctor has to disprove otherwise. Wounds cleaned and dressed.

Tetanus shot if none in the last five years. This is done for injuries that break the skin. Otherwise, you're okay for ten years.

If the area is fractured, a splint will be applied. If no fracture, an ace wrap may be applied for comfort. It is important to note that often we will splint even if the x-ray is negative. This is both for support, comfort and compression. And also if the radiologist comes back and reads it as positive. The patient is instructed to leave the splint in place for about a week and if the extremity is still bothersome, to seek another evaluation of the injury. Some fractures won’t show up on x-ray initially but will later when they begin to calcify.

The patient is sent home with R.I.C.E instructions. Rest. Ice. Compression (leave your splint on). And Elevate. Generally, over-the-counter Ibuprofen is sufficient for pain control.

Dianna Benson: EMS Treatment of a Minor (1/2)

Mart asks: My MC is 16 yrs old. She gets hit by a truck. She has road rash. Right leg turned black and blue. Shin welled up. But other than feeling like she literally was hit by a truck, she is okay....she thinks. What would most likely occur after an incident like this? In short, how can I make it so a 16 yr old girl who has been hit by a car, stalls at home before her Mom takes her to the ER?

I hope there is a way.

Dianna says:

A 16-year-old can accept EMS treatment and transport to a hospital. However, a 16-year-old cannot refuse treatment and/or transport – EMS has a refusal form that requires a signature from the patient, a minimum of age 18, or from a parent or legal guardian of a minor aged patient, 17-years-old or younger. EMS will not leave a patient at the scene until we obtain a signed refusal form (we wait for as long as it takes to obtain that signature).

It’s not uncommon for patients to refuse an ambulance transport to avoid additional medical bills and then have someone drive them to the ED.

From your scene description, it sounds like the patient was a pedestrian stuck from a truck at low speed, propelling her body in the air slightly; her leg skidded on the road, stopping her.

A pedestrian struck by a moving vehicle is a serious mechanism of injury thus a high priority trauma. EMS will encourage both treatment and transport by explaining to your patient she may have internal injuries.

I actually say to patients, “I don’t have x-ray vision or CT scan capabilities inside my ambulance, so I’m unable to verify if you’ve sustained internal injuries or not.” If transport is still declined, I obtain a signature of refusal from a parent or legal guardian (the uncle wouldn’t be enough). The way around this legal issue is for the MC to call her mom and EMS waits for her to arrive on scene.

Was the truck driver at fault for hitting the MC? If the driver is legally at fault, then most patients tend to accept EMS treatment and transport (think law suit). Regardless of any pending law suit, I think the uncle would insist the main character be transported.

Once the mom arrives on scene, I find it unbelievable (and not likeable or smart of the mom) that a mom would refuse transport to a hospital for their injured teenager struck by a moving truck as a pedestrian. That’s a serious mechanism of injury (most car accidents are minor, but being hit by a car as a pedestrian is serious). However, if you prefer to avoid an ambulance ride in your story, then write in the following: 1) Keep the injuries extremely minor – EMS finds no abnormalities beyond right lower extremity minor swelling and abrasions with slight oozing blood.  2) All her vital signs are within normal limits. 3) The patient assessment from EMS cleared C-spine immobilization (backboard and neck collar).

However, since the mechanism of injury is significant, in order for those three above points to be believable, you’ll need to write in the following: 1) The truck was moving at extreme low speed (like 5 miles per hour); it’s amazing how much damage just 10 miles per hour causes. 2) The truck is small or it’s a small car. 3) She wasn’t thrown far in the air (height or distance) and didn’t hit anything else. 3) Her behavior and signs and symptoms indicate she suffered no injuries beyond minor contusions and abrasions. 4) She’s adamant against a trip to the ED.

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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 

Up and Coming

This week at Redwood's Medical Edge, we're focusing on the special issues that relate to the medical treatment of minors.

Monday: Dianna Benson posts about treatment of a minor patient in the field. Can a minor refuse transport?

Wednesday: Dianna and I tackle care of a minor patient involved in an accident. What does the EMS through ER care look like? What specifically is done for the patient?

Friday: Did you know we can treat minors in the ER without parental consent? Find out what those special situations are.

Hope you all have a terrific week!!

Jordyn

How to Write a Hospital Scene: Amitha Knight

As a doctor, I don’t like reading books or TV shows about doctors. Not because I’m jaded and think I’ve heard it all before (quite the contrary) but because often, it feels like the writers just haven’t done their research. I’m not talking about highly involved medical research—it’s the basics that can trip you up.

Here are a few questions to think about when writing a character’s hospital scene (please note that some of this is for US hospitals only).

1. Is your character on the right floor?

As many people know, hospitals are set up with different patients in different areas of the hospital. There are pediatric floors, adult floors, surgical floors, maternity floors, ICU’s, etc. Knowing where your character/patient would be placed in the hospital depends a lot on the type of hospital you’ve chosen for your story. Is it a small community hospital in a small town? Or a large teaching hospital in a major metropolitan area? The smaller the hospital, the fewer wards there will be (and often the really serious cases would quickly be sent over by ambulance to a bigger hospital). In larger hospitals, the ward will be more specialized so you shouldn’t expect to see mixing of patient types (i.e., adult surgery patients in a medical ICU ward).

Why does this matter? It has to do with your setting details. For example: If your character is in the ICU, he/she won’t see a lot of patients walking around with IV poles in their hands. And the rooms in maternity ward have more privacy than in an ICU setting. If your character is the doctor rather than the patient—they won’t be wandering around random hospital wards. Your medical intern isn’t going to be regularly wandering around the pediatric wards and playing with kids there.

2. Who will be taking care of your character/patient?

This can be confusing and again, depends a lot on the type of hospital in your story. Let’s say you choose a teaching hospital. Who will be taking care of your character? I’m going to focus on the different types of doctors and doctors-in-training because that’s what I know the most about.

Medical students: These are students in medical school. They have not yet yearned their MDs so they are not “doctors”. Medical students are often allowed to see the patient first and ask questions—but not in an emergency situation. They do not make medical decisions for your patients.

Residents and Interns: These people have graduated from medical school and thus are “doctors”. They see their own patients and make some medical decisions, but are still in training and run major decisions by an attending physician (see below). Interns are what residents are called when they are in their first year of residency. In some specialties, residents have to do a separate intern year at a different program before beginning their specialty training. That’s why the distinction is made.

Fellows: These are people who have finished their residency but are doing further specialization and are also overseen by an attending physician, though less closely than a resident.

Attending Physicians: An “attending” is the doctor who is ultimately in charge of your patient during their hospital stay. All major decisions will have to be run by him or her.

This hierarchy can make a huge difference to the believability of your story. For example—a medical student or an intern will not be in charge of breaking bad news to a patient unless they have forged some strong bond with your patient. This is generally the role of the attending physician. Likewise, the attending physician will not be doing “scut work” (tedious hospital work, ordering tests) unless they are in a hospital where they don’t have interns and residents around.

3. Which patient will your doctor characters see?

This is one of the reasons I can’t watch Grey’s Anatomy. If you are a surgery resident, you will not be delivering babies. If you wanted to do that, you would have done ob/gyn. If you are an ob/gyn resident, you will not be taking care of babies in the neonatal ICU. If you wanted to that, you would have done pediatrics. And if you are a pediatric resident, you will not be doing surgeries. Please, get it right! Your doctor characters really can’t do it all!

Originally posted to the Guide to Literary Agents Blog. Reposted with author permission.

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 Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/.

C.J. Lyons Interview: Part 2/2

Today, I'm concluding my two-part interview with New York Time's bestselling author C.J. Lyons. If you're a fan of medical thrillers and haven't read C.J.'s books, now is the time to start. The focus of today's questions is on aspects of the writing craft.

Jordyn:  After reading through several of your past interviews, I discovered we’re really kindred spirits. I, too, started writing at a very young age. Do you still have these stories? Have you adapted any of them into your current novels?

CJ: LOL! No, they'll never see the light of day. My stories when I was young usually involved a girl and her horse off fighting some form of injustice in history (I was fascinated by history as a kid, so my stories were set in the Wild West or Civil War or American Revolution).

Jordyn:  I think you’re one author who has successfully navigated both traditional and e-book publishing. What would you say are the best three ways to market a novel?

CJ:  Know your reader, know your story, know your strengths. Write a story your reader will love and use your strengths to connect with them and let them know it's out there. Really, it's that simple. Marketing is making a promise to your readers and keeping it. How you do that depends on where your strengths lie.

Jordyn:  Your novels are character driven. What are some strategies you use to develop imperfect heroes and sympathetic villains?

CJ:  It all starts with my character's default action at the start of the story. What they think is their greatest strength on page one, I slowly make their greatest weakness by the end of the story until they sacrifice that old default action and learn a new one. Villains are on their own hero's journey (no one wakes up one day deciding to be the bad guy, we all think we're heroes of our own lives) so I do the same with them, only in the end they don't make that sacrifice and learn from their mistakes, allowing the hero to defeat them.

Jordyn:  I was sad to learn of the tragic murder of a friend of yours during your residency. How did writing serve to help manage the chaos in your life during that time?

CJ:  After Jeff's death I wrote my first crime fiction story, Borrowed Time. I think I needed to switch from the SF/F I had been writing before then because suddenly I needed to know that justice could be served and that good guys could win, despite the forces rallied against them. I've been writing thrillers ever since.

Jordyn:  What was it like co-authoring a novel with Erin Brockovich? How did you divvy up the writing?   

CJ:  Erin and I have never actually met in person—her travel and work schedule is crazy! We spoke on the phone and via email. It was so amazing to work with a personal hero of mine and I love it that we were able to create a character that embodies the philosophy that both she and I share: that heroes are born everyday.

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As a pediatric ER doctor, New York Times Bestseller CJ Lyons has lived the life she writes about in her cutting edge Thrillers with Heart.  

CJ has been called a "master within the genre" (Pittsburgh Magazine) and her work has been praised as "breathtakingly fast-paced" and "riveting" (Publishers Weekly) with "characters with beating hearts and three dimensions" (Newsday).

Learn more about CJ's Thrillers with Heart at http://www.cjlyons.net/

CJ Lyons Interview: Part 1/2

I'm honored to have had the chance to interview CJ Lyons, past pediatric ER doctor and now full-time author extraordinaire. If you haven't checked out CJ's books, now is time time, particularly if you're a fan of medical thrillers.

Today we're going to focus on aspects of medicine in writing. On Wednesday, we'll focus just on the writing craft.

Jordyn:  Thanks so much for stopping by. It’s my great honor to have you here. Redwood’s Medical Edge is all about dispelling medical myth. Along those lines, what do you see as the most common medical mistakes perpetuated in fiction writing?

CJ:  The most common (and irritating) mistakes I see deal with the characters. For instance, the popular TV show Grey's Anatomy has interns, who'd be maybe 25 years old, sleeping with "world renown" surgical attendings…well, to be a "world renown" neurosurgeon you'd have to have 12 years of primary education, 4 years of college, 4 years of medical school, 7 years of residency, probably another 3 year fellowship, and then be in practice a long time, at least 5-10 years…so the 25 year old intern's love interest would be old enough to be her father! Gross!

Not only that, a surgical intern doesn't have time to sleep or bathe (interns eat on the run) so sex isn't the first thing you think of doing when you finally do make it to a call room.

Don't even get me started on stories where a "doctor" can do everything from take x-rays (99.9% of us wouldn't even know where the "on" button is) to diagnose rare diseases from glancing into a microscope to doing brain surgery one minute and heart surgery the next…while I love the idea of doctors being heroes, let's at least make us human.

Oh, and I've only met two physicians who drove Porsches, both orthopedic surgeons, freshly divorced and shopping for new wives. At the community pediatric practice where I worked, the guys who plowed the snow were paid more than we were. So just because a character is a doctor doesn't mean they're rich.

Jordyn:  What about the most common medical myths?

CJ:  Those magical "blacked out" incidents. Where the character is hit on the head and wakes eight hours later in perfect condition, ready to chase after the bad guys…or the Taser hit that instead of lasting the five seconds it does in real life, knocks someone out for a prolonged time.

Sorry. In real life, your guy with the head injury would probably be dead or dying of a brain bleed and people who are Tasered don't black out at all (although they might wish they did)—in fact some of them stay perfectly functional while being Tased, much to police officers' dismay.

Jordyn:  I read with interest that you had worked with a community group of pediatricians that served an Amish community. Amish books are selling briskly on the inspirational market. Do the Amish have any medical beliefs that differ from western medicine? What are some of the unique aspects of working within the Amish community as a doctor?

CJ:  We had a variety of patients when I was working at a community pediatric practice in Pennsylvania, including Amish. But also Chinese, Russian, Pakistani, Turkish….and every demographic from the very poor to millionaires who kept their family home in our idyllic mountain setting and flew their privates jets to and from their offices in DC or NYC every week. It was a great experience, because like the ER, you learned very quickly not to judge anyone because of their appearance or accent or attitude.

Jordyn:  You spoke once about how you had a fascination with ghost stories. Speaking as a physician, do you have any thoughts on near-death experiences and what they might mean?

CJ:  I think there's more going on in the universe than we understand or can imagine. It's hubris to think we have all the answers—or ever will. As for near-death experiences, I actually used one in Borrowed Time to set things up for the main character. She's a cop, shot and killed in the line of duty on page 3, and brought back to life by a trauma surgeon. But she's now seeing things, visions of other people's deaths, and suddenly everything she once had faith in: her abilities as a cop, her trust in herself and her fellow officers, even her sanity is questioned.

Jordyn:  What are three things you’d like President Obama to know about the healthcare system after serving families for seventeen years as a physician.

CJ: Not just the president, but everyone. First, just because kids don't vote shouldn't mean that their health care is put last. It should be top priority along with education and feeding them. Without healthy kids energized to learn the skills they need to take us into the next century, we have no future.

Second, there is no universal formula doctors can follow. Yes, we need evidence based medicine to help us tailor our choices, but it can't be about cost, it has to be about effectiveness, about what's best for the patient in front of us here and now.

Third, from my point of view as a physician on the front lines, the HMOs already cut all the fat from the medical field and put that cash into their own pockets decades ago. The only place left to cut now is trimming the bureaucracy. Which would not only save money but improve health care quality because then doctors would have time to spend with patients instead of wasting it arguing with administrators.

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As a pediatric ER doctor, New York Times Bestseller CJ Lyons has lived the life she writes about in her cutting edge Thrillers with Heart.  

CJ has been called a "master within the genre" (Pittsburgh Magazine) and her work has been praised as "breathtakingly fast-paced" and "riveting" (Publishers Weekly) with "characters with beating hearts and three dimensions" (Newsday). You can find out more about C.J. by visiting her website: http://cjlyons.net/ 

Up and Coming

I am so excited for this week at Redwood's Medical Edge. Can you see me Snoopy dancing?

Can I just say I got to interview New York Time's bestselling author CJ Lyons!! I am so honored to have her here. CJ was a pediatric ER doc (so she holds a special place in my heart just for that) who segued her life into a full time writing career. Great information on medical accuracy and the writing life.

Monday: CJ Lyons interview Part I-- Medical accuracy in fiction.

Wednesday: CJ Lyons interview Part II-- The writing craft.

Friday: Amitha Knight guest posts about how to accurately write a hospital scene. Let me just say-- don't use Grey's Anatomy as a template for medical accuracy.

Hope everyone has a great week!

Jordyn

Learning from Darkness: Robert P. Bennett

Researching a Protagonist with Disabilities

My new nephew, Seth Morris, is only five months old and I’m learning quite a bit from him already. For example, I already knew that we live in a very visual world, but what I didn’t realize was that it is through vision that we first interact with the world. My nephew can’t speak yet, of course. In fact he can’t do much of anything except lay there and be cute. But he is learning, every day in fact. He is learning to notice the things and people around him. He is learning to pay attention and to focus his attention, and I am learning to do this more as I watch his progress.

Seven years ago, when I decided to create a blind protagonist for my mystery novels, I didn’t really know much about the world blind people live in. I’d been writing articles about disability issues for many years prior but most of those seemed to be focused more on mobility impairments than anything else.  However, since I’ve always worked by the adage ‘write what you can find out about’ I decided to learn about blindness.

I wrote an article about a device that used GPS and virtual reality to help blind people navigate their world, and I incorporated the technology into my stories. Back in 1983, when I was in social work school, I met a blind man who was able to tell how far stores and things were from his home just from the number of steps he took to get there. I met another who, through describing his own experiences, taught me about the prejudices and obstacles blind people face in our visual society.

I made lots of calls and sent out many emails trying to solicit help in my quest for knowledge. I took a course in sign language, even though it is a visual communication technique, just so I could learn about how different people communicate.

That led me to researching the history behind the creation of the Braille language, which I then incorporated into my fiction work. I learned about different ways to compete in sports too.

For instance, I learned that Judo was the perfect martial art for a blind person because the combatants are virtually always touching, which eliminates the need to hunt for your opponent. I spoke to the sports director of a rehab facility and learned about Beep baseball, which is like regular baseball but adds sound to the ball and pylons with sound emitters to the bases. My protagonist now participates in both of these sports.

My protagonist needed to be able to take care of his daily needs, so I had to learn how he could do that. One of the more interesting things I discovered was about the treatment of money. Blind or sighted we all need to learn to use money. In many countries paper bills of varying denominations are in different sizes while U.S currency is all uniformly sized. So, blind people have to learn how to fold there bills in order to recognize each by touch.

That may change. In 2009 the Treasury Department was sued by The American Council for the Blind resulting in an order to begin printing currency which blind people can recognize by touch alone.

Writers need to learn a lot in order to create believable characters. They need to know how their characters move and think. They need to know how the character will interact with the world that is created for them. That all requires research and the willingness to learn and adapt one’s worldview. By watching my nephew I have become even more aware of what I need to do in order to make my own protagonist grow as a ‘real’ person.

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Robert Bennett, a former social worker turned writer, lives in the house he grew up in with his mother, one of his two brothers, two dogs that don’t get along, and a turtle.  His lifelong focus has been a concern for the needs of society’s disenfranchised.  His articles span a wide range of topics from sports to technology and from politics to social justice.  His fiction is grounded in real world events and technologies as well as his own philosophical concerns.  "It is the act of truly living and believing in yourself that is important, not the manner in which that action is undertaken."  Mr. Bennett has spoken to groups of physical therapy students, church members and senior citizens, and has appeared on several radio programs.  Contact Mr. Bennett through his website at http://www.enablingwords.com/

My Path to Writerhood: Robert P. Bennett

I’ve never believed in the concept of fiction. In my opinion a writer and his work are made of the sum of his or her life experiences. In that vein, my journey to writerhood has been a journey of meeting people and experiences head-on. Everything I am, everything I have ever been, comes from and goes into my writing.

Amazon Photo

When I was younger I wanted to be a lawyer. I’d always heard the cries of society’s disenfranchised and thought the best place to address those challenges was in a legal forum. I’ve also had my own challenges in life, as we all have. These obstacles have both informed and influenced the direction and decisions of my life.

I was born with a birth defect called Spina Bifida, a problem where the neural tube, the embryonic structure from which the brain and spinal cord form, fails to close leaving the spinal cord partially exposed. People with this condition face the possibility of suffering from several developmental difficulties including limited mobility and cognitive deficits.

Prior to 1988 my condition was not very serious. I had what some might call an awkward gait, but not much else. That all changed though when, in July of that year, I was the victim of a car crash. Since then I’ve lost the use of my legs and have a few other problems all in some way related to the original Spina Bifida (without which the accident might not have been so bad).

All of this, plus my slightly unconventional, liberal philosophies sent me on two career paths. First, after college, I tried to get into law school. So-so grades and lousy LSAT scores stopped me cold. So, still wishing to help the disenfranchised, I attended graduate school and attained a Master’s Degree in Social Work.

I took that and worked for two years in a group home for mentally challenged men. Then the car accident changed my path. With plenty of time on my hands recovering from the accident, I decided to pursue my lifelong desire to write. Here again I wanted my work to help those who needed help. So, for roughly the past twenty years I’ve been writing about disability issues, everything from sports to politics. I’ve written articles for both local and national publications.

One of those articles, about a real-world GPS/virtual reality device that allows blind people to navigate their world, helped launch my career as a novelist. My Blind Traveler mystery series (Blind Traveler Down a Dark River and Blind Traveler’s Blues) stars Douglas Abledan, a blind computer technologist who uses this kind of device, and his remaining senses, to uncover and solve murders.

Every writer has a reason they do what they do. Every writer has a story to tell, one that is personal to just them. Being born with a disability, and learning how to deal with both it and the ramifications of an accident, are my reasons and my focus as a writer. Through my own experiences I try to help people. In my fiction I’ve created a protagonist who finds tools to deal with his disability, in his case it is blindness. I try to show my readers the trials and obstacles that a blind man faces daily. But, I also attempt to demonstrate how full life can be no matter the challenges one faces.

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Robert Bennett, a former social worker turned writer, lives in the house he grew up in with his mother, one of his two brothers, two dogs that don’t get along, and a turtle.  His lifelong focus has been a concern for the needs of society’s disenfranchised.  His articles span a wide range of topics from sports to technology and from politics to social justice.  His fiction is grounded in real world events and technologies as well as his own philosophical concerns.  "It is the act of truly living and believing in yourself that is important, not the manner in which that action is undertaken."  Mr. Bennett has spoken to groups of physical therapy students, church members and senior citizens, and has appeared on several radio programs.  Contact Mr. Bennett through his website at http://www.enablingwords.com/

Medical Question: Exsanguination

Dee asks: How long would it take a character to bleed out if they were shot in the arm and the back? What organs can be hit to bleed but not be lethal?

Jordyn says:

If an artery is hit, bleeding out (exsanguination) can happen very quickly. Like a matter of minutes. So, if you want these people alive, I wouldn't have the bullet hit any artery. You have several major arteries in your chest (aorta, pulmonary artery, etc) and the brachial artery in your arm that lies under your bicep. A truly severed artery will pump blood out with each heart beat and the bleeding is hard to control. So, I would go for venous bleeding which can also be dangerous but will allow more time and can be easier to stop.

Dee asks: I’d like the character to be in the hospital for a few days. What is the option there?

Jordyn says:

You’d asked what organ could be hit but not be lethal. I would personally go with a lung injury if there is a bullet to the chest/back. The lung could collapse and cause bleeding as well. This would require placement of a chest tube to resolve so they’d be hospitalized for 3-5 days depending on how the lung re-inflated.

Keep in mind, venous bleeding can be deadly as well. If some of the larger veins are hit like the subclavian vein which is up by your clavicle-- bleeding could be swift enough if not stopped to cause death. All bleeding can lead to death if it's not stemmed (either by your blood clotting or by someone applying pressure to keep the blood in place until the blood clots). I once heard a coroner give a talk about a man who was drunk and on Coumadin which is a blood thinner. He dropped a knife onto his foot and happened to cut an artery. Well, in his drunken state, he didn't realize how serious it was and he bled to death. Sad but true.

Up and Coming

This week at Redwood's Medical Edge:

Monday: How much can your character bleed before they die? This writerly medical question deals with exsanguination.

Wednesday: So pleased to host Robert P. Bennett. He's writing from a unique perspective and has incorporated his experiences into a protagonist with disabilities.

Friday: Robert P. Bennett discusses his research into how to make a blind protagonist authentic. I found this piece quite interesting and learned things I never thought about.

Hope you enjoy and have a blessed week.

Jordyn

Historical Medicine: Ann Shorey

I'm pleased to have Ann Shorey back with us today as she discusses some uniquie aspects of 19th century medicine with a fun quiz. Do you know the answers? Don't fear, they're posted.

Welcome back, Ann!

As people of the 21^st Century, we’re accustomed to hearing about advanced medical tests, such as an MRI or a CAT scan, even though we may hope we never need the technology. We think of blood tests, urine samples, even DNA testing, as the norm.

But if we lived in the same time and place as the characters in my At Home in Beldon Grove series, none of those advances would be available. The series begins in 1838 with The Edge of Light and concludes in 1857 with The Dawn of a Dream. The “middle child” in the series, The Promise of Morning, is set in 1846.

Here are a few medical questions that arise in the series. The answers appear at the end of the post.

1.      Dr. Karl Spengler is a continuing character throughout the Beldon Grove series. Try to put yourself in his place when faced with a diagnosis of cholera. What was a popular treatment of the day?

2.      What was common therapy for a croupy baby?

3.      How would a doctor have cared for a serious injury to an eye?

4.      When faced with a listless infant who wouldn’t eat and whose limbs lacked any strength, what would the doctor’s diagnosis have been? And if he’d known what was wrong, would he have recognized the cause?

5.      What were the signs of acute heart failure, and with what medication would the patient have been treated? For that matter, what did the medical community call heart failure?

Here are the answers. Some were gleaned from family accounts written at the time, others from research.

1.      Cholera was commonly treated with heavy doses of calomel (mercurous chloride), which we know now is poisonous, and bloodletting via leeches or cutting. Your chances of survival were better without the treatment.

2.       A croupy baby would have had to endure a piece of flannel saturated with turpentine wrapped around its throat.

3.      For an injury to an eye, a poultice of slippery elm bark was placed on the wound. Then the head was wrapped in a bandage and the patient was made to lie flat until healing took place.

4.      The doctor would have had no idea what was wrong with the infant. Only until many years later would it be known as infant botulism, one cause being feeding honey to babies under one year of age.

5.      The signs of acute heart failure haven’t changed (shortness of breath, fluid retention), although diagnosis and treatment are much more sophisticated today. In the mid-1800’s,  the condition may have been treated with a carefully monitored digitalis decoction. In that sense, the medication was the same, although today’s compounds are far safer.

At that time the condition would possibly have been called edema of the lungs, or dropsy. The term “heart failure” wasn’t commonly used until 1895, and “heart attack” came into our vocabulary in the 1930’s.

Makes be glad to be living now. The good old days weren’t all that good, at least not if you or someone you loved was sick!

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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Historical Medical Question: Laudanum Dosing

I have the great pleasure of hosting Ann Shorey today and Friday. First, I'd like to give her my warmest congratulations on the release of her novel Where Wildflowers Bloom that released Jan 1, 2012. What a great New Year's Day gift. I hope you'll check it out.

Ann Asks:

My wip is set in 1867. One of my characters is a doctor. Here are a couple of questions:

How much laudanum would be needed to give pain control to a four-year-old? How much for an adult male? How would it be administered--diluted in water, or swallowed straight?

Jordyn Says:

First thing to understand about laudanum is that it is an opiate based pain killer. Its contemporary counterparts would be drugs like Fentanyl and Morphine. Therefore, it could have the same type of adverse reactions that these drugs have. If a patient were to receive too much, their respiratory drive could slow down and/or stop. Also, these are not uncommon drugs to have an allergic reaction to.

I found a great resource for Ann. It's an old medical text written by Dr. Chase, a physician during this time period. I was able to link to the exact information she needed. You can view it here:

http://www.archive.org/stream/drchasesrecipes01chas#page/132/mode/2up. The text gives a recipe on how to mix the drug and states: "From 10-30 drops for an adult, according to the strength of the patient or the severity of the pain." So for children, I would imagine you would start with single drops.

I also wanted to point to this post written by historical author Ann Love (who I think has the best historical author name ever!) over at Anne's Love Notes. She writes a more in-depth piece concerning Dr. Chase that will be of interest for historical authors. You can find it here: http://anneslovenotes.blogspot.com/2011/11/researching-19th-century-primary-source.html.

Any other thoughts for Ann?

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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.