Up and Coming

This coming week is going to be one of my favorites. So much going on!

Monday: I love this author question because nothing bothers me more than an injured character doing something they shouldn't be able to do-- moments after they are maimed. This post, a realistic view on how a fracture will inhibit this character.

Tuesday: I'm crossing over between here and the WordServe Water Cooler. Special announcement and contest!

Wednesday and Friday: So honored to have Peter Golden stopping by to discuss his novel Comback Love. A female med student and the tumultuous 60s. Peter found out some very interesting facts about this era.

Looking forward to seeing everyone this week.

Medical Question: Orderly Conduct

CT asks:

I’m working on a short story that takes place in a hospital. The patient is in the room with his family when an orderly shows up. What does this orderly say?  Does he introduce himself in a friendly way or is the relationship strictly analytical and dry?

How can I avoid clichés when describing this scene? Is a clipboard mandatory? Would they wear scrubs and a stethoscope? Also, what should I avoid in the “doctor-talking” between patients and doctors/nurses/orderlies? Any information or advice you have is appreciated. And thank you for your help and your time.

Amitha says:

My first reaction when reading this was–what the heck is an orderly? I vaguely remembered an old Jerry Lewis movie called The Disorderly Orderly. I knew this wasn’t a made up job description, and ended up using Wikipedia to find out the answer. You can find that here: http://en.wikipedia.org/wiki/Orderly

For those who don’t know, an orderly is a type of medical assistant no longer used in the US health care system, but still exists in other countries. Thus, if your story relies on the existence of an orderly it will be very clear that your story does not take place in the US.

Asking whether the orderly is friendly or not is kind of like asking whether a lawyer is friendly or mean, or if a shoe-salesman comes to greet you in a store or not. It depends entirely on the person. This answer is a little bit of a cop-out so I’ll try my best to give you some hints.

How a person talks to a patient also depends slightly on the type of information they need. Naturally, if he is someone like a hospital administrator who just needs basic facts to fill out forms–name, birthdate, social security number, etc.–his demeanor will be less engaging, and more fact-based so they can efficiently move on to the next patient.

If he is a doctor or a nurse who needs the answer to broader questions–about the history of the patient’s illness, the patient’s medical history, etc.–he will try to be more sympathetic, friendly, and engaging to get more information. It is difficult to get answers from people if they don’t like you.

In general, the professional thing to do when working at a hospital is to be kind and courteous. Doctors and nurses try not to talk down to patients or use too much jargon. Remember that these are real people, so the way they interact with others also depends on their personality, how tired they are, etc. I can say that in general, it is unprofessional to talk about a patient in a way they can’t understand in front of the patient. But this doesn’t mean that people don’t do it from time to time.

What a person wears depends on where they work and what their role is. For example, doctors usually don’t wear scrubs, but rather professional attire (pants, blouses, button-down shirts, ties). If they are on call or are surgeons, they may wear scrubs and even then it is considered more professional/cleaner to only wear scrubs in the OR.

Nurses often wear scrubs no matter where they are in the hospital as do medical assistants because they do handle more bodily fluids than doctors tend to. But if you were to have a doctor wearing scrubs or a nurse wearing regular pants, this wouldn’t really be “incorrect” either.

Clipboards–if someone needs to fill out forms a lot, they may carry a clipboard, or they might just use the table that’s in every hospital room. It depends again on the person. I used to carry a clipboard as a med student and as a starting out intern, but as I got busier, I quickly realized the clipboard was just something that didn’t fit in my white coat pocket, and thus could potentially be left somewhere on accident. But if you have more of a desk job or something more patient-intake oriented, it would make sense to keep one around.

To make a long story short–you are the one writing your story, not me, so it’s up to decide how people will interact with each other. Likewise, I can’t help you choose which details tell the most about a person. I can only tell you whether things are realistic or not. Deciding what is or isn’t cliché, unfortunately, is up to you.

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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/.

Rare Disorders – Flesh Eating Disease

I'm so pleased to host Tanya Goodwin, OB/GYN extraordinaire. She'll be stopping by on a monthly basis to offer her insight into all things medical.

Welcome, Tanya!

http://www.medicinenet.com/necrotizing_fasciitis/article.htm

As a medical student I was taught about a barrage of diseases, acute and chronic, common and rare. One of the rare was necrotizing fasciitis.

Thinking I’d never encounter this deadly disease, I forgot about it until one night as a second year OB/GYN resident (4 year specialty training after medical school) when I was called to evaluate a woman who was transferred from a community hospital to our large teaching institution with possible necrotizing fasciitis.



I briefly reviewed this disease before I took the elevator, along with my intern (aka 1^st year resident) to the ninth floor, ready to evaluate this young woman.

It was midnight when we entered her room. My attending (supervising physician) had accepted her transfer as a direct admission, bypassing her need to enter via the emergency department.

She laid in the bed, covered with a white hospital sheet, her husband holding her hand. He darted his eyes towards us. Why would he trust us? His wife’s condition had worsened despite being hospitalized for the last three days.

During that time, she’d received intravenous antibiotics upon the recommendation of a doctor who specialized in infectious diseases. The consult was requested by her obstetrician who had admitted her to the hospital one week after she had given birth vaginally to a healthy baby boy.

Diagnosis? Necrotizing fasciitis.

Necrotizing means dying or death and fasciitis refers to inflammation of the fascia, a tough connective tissue overlying muscle. Rare, the incidence of NF is approximately 1 in 450,000 or 600 people per year.

Otherwise known by the moniker, Flesh Eating Disease.

During childbirth, the obstetrician performed an episiotomy, a surgical incision of the perineum, that skin between the vagina and anus to afford a wider opening to deliver the baby. After the delivery, the episiotomy was sutured closed. The woman went home with her baby, but had called the OB’s office several times with complaints of episiotomy pain, a common occurrence.

Instructed, as usual, to apply anesthetic foam and to take an oral pain medicine, she did so but with no improvement. After multiple phone calls, she now complained of not only refractory episiotomy pain, but fever and chills, malaise, and reddening of her genitals and inner thighs. She was told to come to the doctor’s office.

Diagnosed with an episiotomy infection, her OB admitted her to the hospital for intravenous antibiotics. The redness spread, her fever continued, she was now nauseated, and her blood work showed a significantly elevated white blood cell count consistent with a severe infection. An infectious disease consult was then made by her OB.

Necrotizing fasciitis is caused by invasion of bacteria into the fascia after a break in the skin. Many bacteria or a single offender are the culprits. Typical bacteria are of the streptococci family such as Group A streptococcus or a staphylococcus, both found on our skin. The disease really is not “flesh eating” as the toxins from the bacteria do the damage.

Some have contracted NF by swimming in water containing Vibrio vulnificans. These victims of NF had a portal of entry: a skin scrape or laceration. Those at risk for necrotizing fasciitis are people with lowered immunity from chronic diseases such as autoimmune disorders, diabetes, and liver disease, but it is also seen in healthy people or those that have had surgery or an incision. Symptoms are pain, swelling, redness, feeling poorly, nausea, vomiting, and fever.

What I saw that night still sticks in my memory 20 years later. The woman’s thighs down to just above her knees looked like the worst sunburn I’d seen. At this point, she felt nothing in the affected area as numbness had set in.

My attending physician had examined her as well. After explaining the gravity of the situation, the woman was taken to the operating room to debride, or cut out, the dead tissue. In two surgeries, the first taking all night, she had her vaginal tissues and thighs removed.

She died the second day in the intensive care unit. The bacteria had spread to all her deep tissues. She became septic and died of multiple organ failure, leaving a grieving husband and a newborn son.

NF has a mortality rate greater than 70%. If diagnosed early and treated promptly with surgical debridement, some literature suggests a mortality rate of 33%. Unfortunately for this woman, the diagnosis was correct, but the initial and critical treatment was not.

Hopefully as more providers are aware of this deadly disease, more cases of necrotizing fasciitis will be correctly diagnosed and promptly treated, saving lives.

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Tanya Goodwin is an obstetrician/gynecologist and a novelist of romantic suspense with slice of medicine. She enjoys sprinkling unusual medical conditions in her writing. A character in one of her novels has the misfortune of contracting necrotizing fasciitis, and in her debut novel, If Memory Serves, due for release in November by Knight Romance Publishing, her main character, Dr. Tara Ross has dissociative fugue, a rare disorder as well. You can find out more about Tanya at www.tanyagoodwin.com.

Author Question: Refusing Medical Treatment

Carrie Asks:

My novel is set in the US and my MC, who's eighteen, is injured. He's suffering from concussion, blood loss, and hypothermia, and is very weak and quite disorientated. He is, however, conscious and responding, and adamant that he does not want to be treated or taken to a hospital (and the plot requires him not to be). I understand that he'd be able to refuse treatment if he signed a form saying so. My question is, is there a standard procedure that an EMT would follow before letting him sign?

Jordyn Says: Thanks for e-mailing me your question. You have an interesting scenario here.

I'm going to come from the standpoint of this person presenting to the ER. Put simply, we are not going to let this patient sign out AMA. A couple of things in your statement about his condition will prevent this. Almost everything you've listed as far as his medical condition makes it impossible for him to make a reasonable decision regarding his care--concussion, disorientation, hypothermia. Even though he can talk, it doesn't mean he has enough medical capacity to make an appropriate decision regarding his care until these issues are straightened out.

We would do everything in our power to keep him in the ED. Considering that-- you have a couple of options. Make him a lot less sick. Maybe just a few bumps and scrapes. Or, he could elope from the ED somehow, but if we were really concerned about his medical condition we might send the police to fetch him back. Of course, this could add conflict into your story.

I did verify this through an EMS friend of mine as well. The issue is not whether or not they can talk, it's whether or not they are medically competent to make a decision about refusing care. This character's condition precludes that.

Up and Coming

How has the week been Redwood's fans?

Finally, spring seems to be staying. Warm weather, flowers starting to bloom-- though as a night person the early sunrise is a little problematic.

This week:

Monday: Author question about refusing medical treatment. You might be surprised by the answer. Can anyone refuse treatment regardless of their medical condition?

Wednesday: So excited to have OB/GYN MD Tanya Goodwin as a guest blogger. She will be stopping by every month or so. This post, she's talking about a rare disorder, necrotizing faciitis. These are good ideas when it comes to injuring your characters.

Friday: Disorderly Conduct! Amitha Knight is back to discuss hospital roles and if those orderlies still exist as part of the medical team.

Hope everyone has a great weekend!

Ten Myths of Drug Addiction 2/2

Today, we're concluding Dr. Rita Hancock's guest post on the ten myths of drug addiction. Today, we're finishing the last five. These posts have been a wealth of information. Thanks, Rita.

Myth #6:

Most addicts have a "favorite" class of drugs to abuse. Crank addicts don't necessarily like barbiturates b/c crank addicts like uppers. They might like cocaine, though, b/c that's also an upper.

Myth #7:

If you're going to use the term "narcotics," make sure you know what the term means. Not all habit-forming drugs are "narcotics." Narcotics are only one specific type of drugs, even though the term "narcotics" is mistakenly used to describe all varieties of illicit drugs. E.g. a "narcotics" police officer actually investigates abuse of non-narcotic drugs, as well. Drugs that are potentially addictive but are non-narcotic include, amphetamines, cocaine, marijuana, hallucinogens, barbiturates, benzodiazepines, etc.

Myth #8:

Naloxone is a medicine used as a antidote for narcotic overdoses. But it does NOT treat overdoses of ALL (e.g. NON-narcotic) controlled substances. On TV shows, I've seen it given for barbiturate overdoses, and that's utterly wrong. It's used ONLY to reverse narcotic overdoses (with examples of narcotics being morphine, codeine, hydrocodone, oxycodone, methadone, etc.). Moreover, the effects of naloxone don't last very long. If the overdose is on a long-acting narcotic like methadone, you're going to have to repeat the naloxone dose after only a short time (like minutes). You might have to give the patient many doses of the naloxone before they're "safe."

Myth #9:

Flumazenil is a medicine used as an antidote for benzodiazepine withdrawals (e.g. Valium, Librium, Xanax, etc). In the same way that naloxone is specific for narcotic OD's, flumazenil is specific for benzodiazepine withdrawals. Again, some benzo's are longer-acting than others. If your character overdoses on a long-acting benzo, like Librium, he or she may need several doses of Flumazenil in the E.R. 

Myth #10:

There's a drug called buprenorphine (an orally absorbable narcotic) that's mixed with naloxone (a narcotic antidote) to form a new type of drug called Subutex (aka Suboxone). It's novel and interesting b/c it can't be abused easily and it's often used to help addicts come off the drugs more safely. It gives the desired therapeutic effect only when you let it dissolve on the tongue. In contrast, if you try to abuse it by swallowing it or by altering it (by crushing, dissolving, etc.), the naloxone takes effect, overriding the narcotic portion, and causes you to go into withdrawals. Doctors have to apply for special licenses to administer Subutex, and they're limited to having only a small number of patients on it at any given time for the purposes of detox.

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Dr. Rita Hancock, a full-time physician and author of Christian health books, writes about how emotional and spiritual factors contribute to physical disease through the mind-body-Spirit connection. According to Dr. Rita, “Once these underlying barriers fall away in the healing light of God’s truth, patients automatically feel less physical pain, experience fewer stress-induced symptoms, lose weight, and shed addictive behaviors more easily.” Dr. Rita is the author of The Eden Diet (Zondervan, 2008) and an as-yet untitled release with Charisma House, pending January 2013. She resides in Oklahoma City with husband Ed, and two wonderful children, Lindsey and Cory.

Ten Myths About Drug Addiction 1/2

Dr. Rita Hancock, a specialist in pain management, is stopping by Redwood's Medical Edge to discuss the Top Ten Myths about drug addiction. Today, we're covering the first five. On Friday, we'll finish off with the last five.

Welcome, Rita!

Myth #1:

If you claim a character in your story is "addicted," make sure you know the accurate definition of the word. People confuse the terms "physiological tolerance" (meaning your body gets used to the medicine and, over time, you can need more and more medicine to get the same amount of pain relief), "physiological dependence" (meaning if you don't take the medicine you go through physical withdrawals), and "psychological dependence" (THIS means "addicted," i.e. you're dependent on the medicine to cope with stress, anxiety, etc).

The first two are normal physical phenomena that happen in ALL patients who take heavy doses of narcotics, but only the last one is abnormal/pathological. Thus, if you claim your character is addicted, his or her behavior should show at least a few pathological psychological features (bad relationships, inability to hold a job, stealing to pay for fixes, lying to doctors for drugs, etc.).

Myth #2:

You don't become physiologically tolerant and/or physically dependent on ALL drugs. Thus, you don't necessarily go through withdrawals when you come off certain controlled substances (e.g. hallucinogens like marijuana and PCP don't cause withdrawals). And not all withdrawal symptoms are the same. They depend on the drug in question. E.g. withdrawals symptoms and overdose treatment for alcohol/benzodiazepines/ barbiturates are similar. However, the symptoms of stimulant withdrawal and overdose will be totally different. The point is the writer needs to research the specific overdose and/or withdrawal symptoms for the individual drug his or her character is hooked on.

Myth #3:

Only SOME people are susceptible to addiction to controlled substances (don't make the mistake of thinking that ALL people who take controlled substances eventually become addicted). People susceptible to addiction tend to exhibit addictive tendencies early on (teenage or young adult addictions to smoking, alcohol, etc). In general, young people are more susceptible to developing addiction because their coping skills aren't yet developed and they can learn to rely on drugs for dealing with the underlying anxiety that leads them into addiction.

Myth #4:

I see many elderly people with severe, painful joint pathology who don't want to take narcotics b/c they're afraid of getting addicted. But if they've taken narcotics periodically during their lives for e.g. root canals, fractures, etc, and have never had a problem getting off the drugs, they're at lower risk for addiction. As noted above, though, they will (especially if they're on large doses) eventually become physically dependent).

Myth #5:

There's a difference between pain and suffering. Pain happens when an inciting event causes pain receptors to fire (e.g. a burn, a sprain, a pulled muscle, etc.). However, that physical pain is interpreted by the brain in the context of the person's emotional state. A highly anxious patient or one with a volatile psych history (history of abuse, etc.) is more likely to experience psychological "suffering" with a low level of pain.
Thus, if the person tries to medicate his or her subjective experience with pain using pain pills, he or she is likely to over-medicate to quell the anxiety. You're not supposed to treat your anxiety with pain pills. That's how you become addicted. Many, many chronic pain patients suffer with psych issues, and often those psych issues long pre-dated their chronic pain. Psych issues are a definite risk factor for chronic pain and addiction.

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Dr. Rita Hancock, a full-time physician and author of Christian health books, writes about how emotional and spiritual factors contribute to physical disease through the mind-body-Spirit connection. According to Dr. Rita, “Once these underlying barriers fall away in the healing light of God’s truth, patients automatically feel less physical pain, experience fewer stress-induced symptoms, lose weight, and shed addictive behaviors more easily.” Dr. Rita is the author of The Eden Diet (Zondervan, 2008) and an as-yet untitled release with Charisma House, pending January 2013. She resides in Oklahoma City with husband Ed, and two wonderful children, Lindsey and Cory. 

What's the Difference Between?

Today, I'm pleased to host guest blogger Jason Joyner. Have you ever been confused by certain letters behind health care provider's names? Jason is here to clear that up.

Welcome, Jason!

When I interviewed for the physician assistant program at my university, the program director offered this scenario to me.

"You are working as a PA, and you need to consult with your supervising physician on a patient. You go to the exam room he's in, knock softly, and when you don't hear an answer, you crack the door to see if he's really in there. You find him making love to a patient. You shut the door quietly, apparently escaping detection. What do you do?"

 Recently there was a guest post by Amitha Knight on How To Write A Hospital Scene that described the different levels of medical training from med students to interns, residents, and attending physicians. There are other levels of health care providers that can be in a hospital or clinic setting, with potential for deeper conflict and development in a story.

A relatively new concept is the "mid-level provider," a clinician that is under a doctor but can still see and treat patients. There are three main types of mid-levels: nurse practitioner, nurse midwife, and physician assistant. They function in similar ways and are often indistinguishable to a patient, but there are training, legal, and practice differences.

A nurse practitioner has to be a graduate from an RN (registered nurse) program first, with a bachelor's level degree. Most of the time they will have practiced as a nurse before going back to school. They are trained in the nursing model, with an emphasis on patient care and learning diagnosis and treatment algorithms to treat patients. They often can practice independently - an NP could hang out a shingle and see their own patients, but they are usually working with other physicians. This may vary by state. NP's are often trained in a specific field, such as pediatrics, ob/gyn, or internal medicine.

A nurse midwife is similar in that they are RN's first, but then do advanced training that focuses on ob/gyn. They are an option for uncomplicated deliveries, but have to be able to have back-up in case of complications.

A physician assistant is trained in the medical model like a regular physician, but with a shortened time frame. The average program is two years, and it is mostly a master's level degree anymore. A PA is required to work under the supervision of a physician, but it does not mean that the doc has to see every patient the PA does. It means that the doc has to review a certain amount of the PA's charts and be available for consult. The PA could be hundreds of miles away from their supervising physician in a rural area, if the doc is available by phone. PA's are trained in primary care, not usually specializing at first. They can be trained by their supervising physician for specialties such as orthopedics, cardiology, or urology.

Oh, and my pet peeve? It is physician assistant. No "apostrophe 's'". We're not someone's possession.

Mid-level providers have received a lot of acceptance in the medical field by both patients and professionals alike, but there are still barriers. I get asked when I'm going to finish medical school by patients. Cardiologists in hospitals fight against giving privileges to an NP, because they don't want to be asked to consult by a "lowly" mid-level. PA's and NP's have a friendly rivalry, but there can be sniping between the two groups. Nurses and mid-levels can be partners together against a tyrannical MD, but may have turf battles or issues on their own.

Many patients now prefer to see mid-levels, feeling the PA or NP listens to their concerns better. Doctors are so busy that they may rush through patient visits more (of course this is stereotypical - there are very caring physicians and mid-levels that have the bedside manner of moldy bread). Mid-levels are working more and more in hospitals to help alleviate shortages of physicians, so it is realistic to have one involved in a medical scene.

As my opening hook suggested, there can be a lot of drama created by utilizing a PA, NP, or nurse midwife in a story. What if a doctor orders the wrong medicine for a patient, but the NP sees it in the chart? What if a PA makes a mistake and has to tell their supervising physician?

A good novel has many layers of depth and sub-plots going on that help drive the plot or challenge the characters. I would encourage a writer to use mid-levels in their books to give them a better prognosis.

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Jason works as a physician assistant in southeast Idaho, while trying to keep up with three crazy boys and a little princess. He is working on a medical suspense with international flair. Follow him on Twitter @JasonCJoyner or his blog at http://spoiledfortheordinary.blogspot.com/

Congratulations!!

Congratulations to Marcia Maston and Jo Denton who have each won a free copy of
Renee Yancy's book A Secret Hope!

Thanks for leaving your comments and thank you, Renee, for being so gracious in giving your book to two people.

Ladies, contact me at jredwood1@gmail.com and I'll get you hooked up.

Jordyn

Up and Coming

Hello, Redwood's fans! How has your week been treating you?

Me? Well, to be honest, a little overwhelmed. Ever had one of those weeks when the tasks keep piling up and treading water would seem like a relief?

This is the next two weeks for me but lots of exciting things happening.

For you:

Monday: Jason Joyner stops by to unravel the mystery of all the mid-level providers. Ever wonder what the difference is between a PA and NP and what those letters mean?

Wednesday and Friday: So happy to have Dr. Rita Hancock here to dispel some medical myths. She's tackling the top ten myths of drug addiction. Rita is a pain management specialist so has very special insight into this issue.

Hope your week is well. Just keep swimming....

Renee Yancy: Ancient Medicine in Ireland

I'm so pleased to host author Renee Yancy today as she discusses her research into ancient medicine in Ireland. And, as a special treat, if there are 10 or more comments, she is giving away a free copy of her book!

Welcome, Renee!

In my 5th century historical novel, A Secret Hope, my heroine Ciara is studying to become a druid physician. Having a medical background myself, it was a delight to research ancient medicine in Ireland. Here are some of the tidbits I found.

In the 21st century we know Lambs Ear as the soft, silvery-green leaves in a flower garden that children love to “pet.” But once upon a time, Lambs Ear was known as Woundwort, because the leaves were believed to have healing properties. During the Civil War, Lambs Ear leaves were used as bandages. And what did people do before Band-Aids were invented? A single wooly Lambs Ear leaf is perfect to roll around a hurt finger. A long blade of grass or a pine needle could be used as a fastener.

Another staple of ancient medicine was the water-loving willow tree. Willow bark

contains salicin, and salicin is used to create acetylsalicylic acid, better known today as aspirin. The ancient Celts would simmer willow bark, let it steep, and drink the resulting tea. In the cold, damp areas of Britain, Scotland, Wales, and Ireland, the magical willow bark tea would have been a precious commodity for people who suffered the pains of rheumatism and arthritis.

Another fascinating plant is comfrey. Comfrey has had lots of names over the course of history: Blackwort, Knitbone, and Boneset, to name a few. The last two names give a hint as to one of the major uses of comfrey in ancient medicine.

The leaves would be ground to make a vivid green poultice for bruises and sprains. For broken bones, the fresh roots would be grated and applied over the fracture. This root poultice would turn rock hard and be left over the limb until the bones would “knit”. Comfrey contains several vitamins and minerals, allantoin (which aids cell growth) and 18 amino acids. This amazing plant is known as far back as the 1st century, and is mentioned in the writings of Dioscorides, considered to be the Father of modern pharmacology.

Honey has been used for at least 2,000 years as a dressing for wounds and burns. The ancients didn’t know that honey has anti-inflammatory and anti-bacterial properties but they knew that it worked. The use of honey reduced healing time and decreased scar formation. Plus it smells good!

When antibiotics came on the scene in the 1940’s, the use of honey declined. Now seventy years later when overuse of antibiotics has resulted in scary drug-resistant microorganisms, the use of honey is once again current. In my research I read the report of a 15 year old boy who contracted meningococcal septicemia. He developed peripheral necrosis (tissue death) of his hands and feet. He had to endure bilateral amputations of both legs mid-tibia (shin bone) and lost most of his fingers. His hands healed well but he had many unsuccessful skin grafts to his legs. The pain was so intense that his dressing changes had to be done under anesthesia.

Finally honey dressings were tried. Within a few days the skin on his legs began to improve. In ten weeks his wounds had healed and he went on to successful rehabilitation. Something to think about the next time you stir a teaspoon of honey into your tea!

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Renee Yancy has been living vicariously through historical fiction since she was a young girl. Her all time favorite book is Shogun by James Clavel. One of her writing goals is to be as historically and archaeologically as accurate as possible. Every object she describes in her novels, including jewelry, dishes, furniture and glassware, are actually in museums all over the worlds. In her other life she is an RN with many years of nursing experience and presently works in an Endoscopy Unit. Learn more about Renee by visiting her website and blog at http://www.reneeyancy.com/ and http://www.reneeyancy.blogspot.com/.

Clipston Family Story: A Leap of Faith

I'm so pleased to host Amy Clipston today as she shares her story about being an organ donor.

Welcome, Amy!

On June 14, 2011, I donated a kidney to a stranger in order to help my husband, Joe, receive a second kidney transplant. I became a kidney donor through a leap of faith. I felt that God had chosen me to be a donor since I've always enjoyed good health and have a common blood type.

Kidney disease has been a black cloud over our lives since Joe was diagnosed in 2000. He spent a year on dialysis before receiving his first kidney transplant from his brother in 2004. Unfortunately, his first transplanted kidney only lasted four years, and Joe went back on dialysis in July 2008. Since he had rejected a kidney, he was a difficult match. My donating a kidney was his best chance of receiving one from a matching donor.

My kidney recipient, who was a stranger before the surgery, is now my dear friend. Once she received my kidney, it immediately began to work in her body. I met her for the first time a few days after the transplant, and it was one of the most emotional experiences in my life. We hugged and thanked each other. Just as my kidney worked for her, her husband's kidney immediately began to work in Joe's body.

Becoming a kidney donor was a natural choice for me. Watching my husband suffer with an illness was heartbreaking, and I sobbed the day I found out I couldn’t be his donor. I’m honored and humbled that I could help a family who had suffered like ours, and I never thought twice about my decision, despite negative comments I often heard.

Joe’s illness was also difficult for our boys, who are 11 and 6. There were days when Joe was too ill to spend time with them. We couldn’t plan vacations, since coordinating dialysis out of town is complicated, and as Joe would say, it wouldn’t be fun for him to be sick in the hotel room. However, now that Joe is well, I notice that my boys smile more, which warms my heart. Aside from the emotional toll of Joe’s illness, we also suffered from financial worries. Since Joe was only well enough to work part-time, I carried the financial burden by working full-time and also writing Christian fiction.

Before June 14, I had never undergone a serious surgery, and I was nervous. However, I knew in my heart that I was meant to be a donor for Joe. Many people were counting on me -- my kidney recipient, Joe, and my children, who missed seeing their daddy healthy. The most exhilarating moment for me was when I spoke to my 6-year-old on the phone after the surgery, and without any prompting he said, “Mommy, I’m proud of you.”

It seems appropriate that our kidney transplant took place on June 14, which was seven days after Joe turned 40 and six days before our 13th wedding anniversary. Through the transplant, Joe and I began a new life together, a chapter in our relationship. I'm so very glad I took that leap of faith. I'm so very thankful that God called me to donate a kidney. I saved two lives -- my husband's life and my recipient's life.
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Amy Clipston is the author of the bestselling Kauffman Amish Bakery novels. She has a degree in communications from Virginia Wesleyan College and currently works for the city of Charlotte, North Carolina. Amy lives with her husband, two sons, and four spoiled-rotten cats. Visit her on the web at http://www.amyclipston.com/.

Unbelievable Real Life, Believable Fiction

When I hear a reader say: “That’s not realistic; all of that couldn’t happen to one character.” I think, “That reader has skirted through life with little trial.”

Spring 2009, a cop barreled into our car, injuring my oldest daughter, my son and myself. My husband and our youngest daughter escaped uninjured. The two kids healed; I suffered a shoulder and cervical injury. Actually, those injuries initially occurred when I was in a bicycle accident (a driver ran a stop sign); the car accident worsened those injuries.

A few months following the car accident, my husband’s biopsy on an enlarged lymph node was negative, but a few months later he was diagnosed with head and neck cancer (the biopsy results were wrong). In 2009 and 2010 he endured two surgeries and cancer treatments.

During this same time, our son battled a mysterious illness I suspected was Lyme disease since he had fourteen Lyme’s symptoms, but Curtis didn’t test positive so no physician would listen—see Brandilyn Collins’ posts May 2011 titled: The Lyme Wars. Most Lyme’s patients don’t test positive.

For the love of hockey, Curtis fought the pain and continued to play; unfortunately, he suffered a shoulder separation during a game. In a sling for that injury, he had a MRI on a large cyst behind his knee; it tested benign. Hoping I was wrong about Lyme, I agreed to allergy injections to treat Curtis’ allergy-like symptoms. Days after the injections started, he developed a systemic rash. The allergist responded, “There’s an underlining cause.” So, I told an infectious disease MD, “Don’t think of me as a mom; as an EMT I’m telling you this patient has Lyme disease. Please help him.”

After several months of Lyme’s antibiotics, Curtis improved but still battled bilateral knee and ankle arthritis. My orthopedic surgeon (explanation later in this paragraph) diagnosed Curtis with Lyme arthritis saying, “Bring on the CDC; this kid has Lyme disease and I’m treating him as so.”

During the several months of Curtis enduring tons of doctor appointments (pediatrician, allergist, dermatologist, infectious disease, rheumatologist and orthopedist) plus countless tests, my shoulder worsened to the point I needed surgery to repair a labral tear. To date, Curtis still suffers with Lyme arthritis and may for years. Unbelievably, fall 2011 he suffered a severe concussion from head trauma in a hockey game and was out of school for three weeks. 

As for my daughters: In 2010 my oldest was being recruited by countless college swim coaches. They were in and out of our home and Sabrina traveled on college recruiting trips; exciting yet stressful. My youngest, Fiona, dealt with anxiety from watching her family endure this mess. 

How can one family battle all that in two years? For starters, God carried the five of us. Plus, Leo and I are well practiced in dealing with life’s mountains. Leo’s brother committed suicide when I was pregnant with Sabrina; I went into labor at the funeral. When Leo was sixteen, his dad suffered a heart attack; Leo drove him to the hospital in time. At age seventeen, I lost my family when my dad was killed in a bicycle accident. Also, Leo and I lost three babies, one of them in my second trimester due to a disease that prevented the development of limbs and caused a miscarriage.

My attitude during 2009-2010 was calling the five of us: “As the Bensons Turn.” Laughter, a positive attitude and our faith, plus the love and support of our family and friends, carried us through.      

All that said (whew), next time you think something is unrealistic, really ask yourself – “Is it?”

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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

I'm very excited about this week at Redwood's Medical Edge. Great posts for both contemporary and historical authors.

Monday: Ever feel like the crux of a novel is unrealistic? Surely, so many bad things cannot happen to one character. Dianna Benson shares how real people can live through very trying circumstances. I know I've seen this in my own nursing career working with families. When it rains it pours seems to be a real life daily event.

Wednesday: Amy Clipston will share her real life story about being a kidney donor. This post is amazing and inspired a thread in my new novel. Thanks, Amy!

Friday: For a little historical flavor, Renee Yancy will post on ancient medicine in Ireland. For my readers who love to learn about plants and their medicinal value-- this post is for you.

Hope everyone enjoys their weekend!

Jordyn

Every Day’s a Good Day when You’re Not in a Coma!

James Pence concludes the miraculous story of Nate Lytle. Hope you'll check out his novel, More God.

Welcome back, James!

Part 2

The doctors called Nate Lytle’s injury “non-survivable”.

Nate Lytle, a 24-year-old surfer from Victoria, Texas sustained a severe head injury in a fall from a ten-foot ladder. When the doctors did a CAT scan, they discovered the extent of his injuries:

·        He had a softball-sized hole in the left side of his skull.

·        The impact of falling off a ten-foot ladder drove skull fragments deep into his brain.

·        In emergency surgery, the neurosurgeon removed three massive hematomas. When he removed the third, the left side of Nate’s brain collapsed.

·        The CAT scan showed early herniation of the brain stem, a potentially life-threatening complication.

·        The scan also showed a midline shift (the impact caused the brain to shift off-center). The ER physician said that a shift of one or two millimeters was considered “grave.” Nate’s brain shifted 1.7 centimeters off center.

The doctors did not hold out much hope for Nate’s survival. If he did manage to survive, they gave even less hope for his potential quality of life. The areas of Nate's brain that had been damaged were the parts that control movement, speech and communication. The neurosurgeon said even if Nate were to survive, he would never walk or talk or even communicate again.

Surrounded by family and friends from their church, the only thing Billy and Tammy knew to do was pray. And pray they did.

Tammy knew that Nate could cope with living in a wheelchair, but it would absolutely kill him if he couldn't communicate. Nate was a strong Christian with a passion for sharing his faith, and she knew that he would rather die than be unable to communicate. So she asked her pastor to pray that Nate would recover, and if he couldn’t recover, that God would take him home.

Nate survived the first night.

Then another.

And another.

The ICU team had its hands full, trying to manage Nate's fever. And there were some scares when it appeared that he had a blood infection. But day by day, Nate slowly stabilized. He was in a full coma for two weeks and semi-comatose for four weeks after that.

When it appeared that Nate was going to survive, the neurosurgeon suggested that Tammy and Billy tried to get him into rehab. He still didn't expect Nate to ever be able to communicate, but suggested that rehab might at least help him have some quality of life.

When Tammy asked the neurosurgeon what would be the best facility for Nate to do rehab, he told her TIRR Memorial Hermann in Houston, Texas (The same place where Gabrielle Giffords would do her rehab a few years later). But because Nate had no health insurance and lived out of county, it was very unlikely that he would be able to go there.

Tammy, Billy and the Church began to pray again and within a few short weeks. Nate was admitted to TIRR Memorial Hermann.

Two weeks after he arrived at TIRR Nate woke up from his coma. He was able to walk and, although he stuttered badly, he could talk.

Nate's road to recovery was long and challenging. After he was discharged from TIRR, he went on to do three months of inpatient rehab at TLC (Transitional Learning Center) in Galveston, Texas. Then more outpatient rehab and speech therapy once he was back home in Victoria.

Although his recovery was nearly total, Nate still bears some after-effects of his TBI. He has problems with short-term memory. At times—particularly when he’s tired—he struggles with aphasia and apraxia (speech disabilities where he knows what he wants to say but has difficulty finding the words and saying them), and he has to stay on seizure medicine.

Amazingly, though, Nate has no physical disabilities other than his shattered his left wrist. (Because of the severity of his head injury, the doctors weren’t able to repair his wrist right away and it healed incorrectly.) But despite massive trauma to the left side of his brain, Nate has no paralysis whatever on the right side of his body. In fact, one year to the day after his injury, Nate began surfing again. It was challenging at first, mostly because of the restricted movement in his left wrist, but before long he was surfing as if nothing had ever happened.

Nate now conducts surf camps for blind, disabled, and autistic children and adults. He also speaks to TBI survivors and their families. His amazing story is told in full in the book I co-wrote with him: More God: Seeing the Blessings through the Pain.

Nate’s infectious, optimistic personality is often reflected in his unique quotes, called “Nateisms” by his friends. My favorite, which inspired the title for this post, is: “Every day’s a good day when you’re not in a coma.”

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James H. (Jim) Pence is a man of many talents. He’s a performance chalk artist, singer, speaker, published author, editor, collaborator, and in his spare time he teaches karate to homeschoolers. Jim has been called a “Renaissance man,” but he prefers to be known simply as a follower of Jesus Christ and a storyteller. Jim has been published in both fiction and nonfiction. Recently, Thomas Nelson published "The Encounter," a novella that Jim wrote in collaboration with bestselling author Stephen Arterburn. Jim's newest book, More God: Seeing the Blessings through the Pain, is available in hardcover, softcover, and e-book format.

Links:

James’ Web site: http://www.jamespence.com/

YouTube Video about Nate Lytle: http://www.youtube.com/watch?v=l_oyX4rA07s

Nate’s Web Site: http://www.natelytle.com/

Photos courtesy of Alan Lindholm, G. Scott Imaging, and Danny Vivian

Every Day’s a Good Day when You’re Not in a Coma!

I'm pleased to host James Pence today who talks about his writing experience with a family whose child suffered a traumatic brain injury and had a truly miraculous recovery.

Welcome, James!

Part 1

Like many others, over the last year I’ve closely followed the story of Gabrielle Giffords. Her recovery from a gunshot wound to the head has been nothing less than remarkable.  However, Congresswoman Giffords’ story was of special interest to me because as her ordeal unfolded, I was completing work on a book about another remarkable traumatic-brain-injury (TBI) survivor: Nate Lytle.

Nate is a young surfer from Victoria, Texas, whose life changed in an instant on June 4^th, 2007. Nate had gotten out of the Coast Guard only a few months earlier and was preparing to move to Tallahassee, Florida to be the youth and college pastor at a new church. Since he still had a week before he was to leave for Tallahassee, he offered to help out at his father Billy’s business, Engenco, a company that supplies engine parts to the oil and gas industry.

Nate was atop a ten-foot ladder, trying to help his dad maneuver a 300-pound diesel manifold off a twelve-foot shelf and onto a lift. They lost control of the manifold, and as it fell it clipped the bottom rung of the ladder, catapulting Nate into the air.

As Nate came down, he put out his left hand to try to break his fall, but succeeded only in shattering his wrist. After he landed, he heard a high-pitched ringing in his ears.

Billy climbed down from the shelf and found Nate conscious, but in extreme pain.

“Did you hit your head?” Billy asked.

“My wrist, my wrist,” Nate said, as he cradled his left arm with his right. His hand was a sickening sight, hanging loose, apparently attached only by muscles and tendons.

“Did you hit your head?” Billy repeated.

“No, my wrist. I hurt my wrist,” Nate replied.

Billy ran to get his truck. Because the location of his business was remote and difficult to find, he knew that he would get Nate to the hospital faster by driving himself. What neither Nate nor Billy knew was that Nate had sustained a severe head injury when he landed. Because he was wearing a baseball cap, Billy couldn’t see the huge dent in the left side of his son’s skull.

Billy put Nate in the back seat of his pickup truck’s cab and rushed to the hospital. In the back seat, Nate began to shout Coast Guard commands.

Nate’s mother Tammy arrived at the hospital about the same time that Billy pulled. She helped Nate into a wheelchair and took him into the ER waiting room while Billy parked the truck.

That’s when Nate crashed.

First, he began to talk gibberish. Then he stiffened and started to slip out of the chair.

A security guard helped Tammy wheel him back to a trauma room. The last thing Tammy heard as they closed the door was Nate, saying “I’m gonna puke!”

Over the next few hours, she and Billy would learn that Nate had suffered a massive head injury, He had a softball-sized hole in the left side of his skull, and the bone fragments had been driven deep into his brain.

The neurosurgeon told Billy and Tammy that they should think about making funeral arrangements.

Return Friday for Part II!

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James H. (Jim) Pence is a man of many talents. He’s a performance chalk artist, singer, speaker, published author, editor, collaborator, and in his spare time he teaches karate to homeschoolers. Jim has been called a “Renaissance man,” but he prefers to be known simply as a follower of Jesus Christ and a storyteller. Jim has been published in both fiction and nonfiction. Recently, Thomas Nelson published "The Encounter," a novella that Jim wrote in collaboration with bestselling author Stephen Arterburn. Jim's newest book, More God: Seeing the Blessings through the Pain, is available in hardcover, softcover, and e-book format.

Links:

James’ Web site: http://www.jamespence.com/

YouTube Video about Nate Lytle: http://www.youtube.com/watch?v=l_oyX4rA07s

Nate’s Web Site: http://www.natelytle.com/

Photos courtesy of Alan Lindholm, G. Scott Imaging, and Danny Vivian