Author Question: The ER Doc and the EarthQuake

Patrick Asks:

In my novel, I have an ER doc on vacation with his family. An earthquake strikes. His 14 y/o son suffers grievous injuries (I'm thinking a concrete pillar falls across his midsection.) The doc knows that in the best of situations, in an equipped trauma center, he'd only have a slim chance of saving his son's life. As it is all he can do is try to comfort his son and be with him as he dies.

So my questions are threefold:

1.  What would be the signs that would convince him that his son is doomed and there's nothing he can do?

2.  How long would it take for the poor kid to die?

3.  How would the doctor identify himself, or think of himself, in a casual situation?

Jordyn Says:

Hi Patrick! I am happy to help with your question.

#1: What would be the signs that the son is going to die?

Essentially the scenario you've set up would be death from hypovolemic shock (the son is bleeding out). Or, organ dysfunction from crush injury. But, let’s stick with hypovolemic shock as it will work well in this scenario.

What would be more concerning to the father and trained ER doctor would be his signs of shock--- this would lead to his death. I'm going to use the medical words because this is how your ER doctor would think and then I'll put what they mean in parenthesis.

I think one thing that helps is to understand the symptoms in light of the injury. When you're bleeding out, you're losing blood. Blood carries oxygen. So the body compensates by trying to circulate those remaining red blood cells faster.

Shock is your body's inability to meet its oxygen demands (hypovolemic shock is one type of shock.) So, initial signs of hypovolemic shock are: tachycardia (increased heart rate to circulate the blood faster), tachypnea (increased breathing rate to load more oxygen on the cells that remain), complaints of thirst, pallor (pale skin-- circulating red blood cells gives you your color) and diaphoresis (sweating). Also, diminished, weak, rapid peripheral pulses. Peripheral pulses are those at your wrist (radial) and feet (pedal). This would progress to central pulses--those in your neck (carotid) and groin (femoral)--- being weak and thready.

In kids (this is my area of specialty)-- the blood pressure will be normal initially because kids can do really well at compensating for shock up to a point.

So-- hypotension (or low blood pressure) is then an ominous sign. One way a trained ER doctor can estimate what his son’s blood pressure is is by palpating his pulses.

eMedicine

For instance:

If you have carotid, femoral and radial pulses: Your BP is at least 70mmHG systolic.

If you have carotid and femoral Pulses: Your BP is at least >50mmHG systolic.

If you have only a carotid pulse: Your BP is about 40mmHG systolic.

You cannot discern diastolic pressure using this method.

As his shock progresses, his level of consciousness will begin to wan. He'd have periods of being coherent-- then unresponsive (depending on how fast you'd want this death to occur). The brain is oxygen hungry so when it doesn't have enough-- you become unconscious.

His ultimate sign of impending death will actually be bradycardia (low heart rate-- less than 60 beats/minute) progressing to asystole (no heart beat). This is how kids generally die. The child would become unconscious. His breathing would slow/stop. His heart rate would slow then stop. Pupils will dilate and become unresponsive to light.

#2. How fast would this happen?

This is really your choice. If your character has a major aortic rupture (this is a major blood vessel--your descending aorta-- that is in your abdomen) death could take place in 1-2 minutes. Also the spleen and liver are highly vascular (meaning they have a lot of blood vessels) and crush injuries to these organs would lead to rapid exsanguination (bleeding out) as well. Or, you could have slow leaking type bleeding that could take longer to die from. All bleeding-- if not stemmed-- can lead to death.

#3. How would he refer to himself? "Hey, I'm Dan, I'm an ER doctor."

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Patrick J. Worden is the author of several books, including the just released novel, Voracious. He blogs on culture and current events at http://pworden.com/.

Up and Coming

WOW! Is this summer zipping by for everyone else as fast as it is for me?

Hopefully, everyone is finding some time to enjoy the super HOT weather. Yikes!

For you this week:

Monday: Author Question: The ER Doctor and the Earthquake.

Wednesday: What exactly makes a novel a medical thriller?

Friday: Why McDreamy of Grey's Anatomy is the worst neurosurgeon ever!!

Hope these posts provide you some knowledge and entertainment.

Jordyn

Hypothermia or Death by Drowning? The Titanic.

I'm so pleased to host Paula Moldenhauer today at Redwood's Medical Edge. It was 100 years ago that the Titanic sunk and there is still speculation on many fronts. Cause of death of the victims in the water reamains one of them.

What do you think--did those victims die from hypothermia or did they drown?

Welcome Paula!

“For forty-five minutes the eerie, distressed cries reached across the frosty depths, tugging at our very souls. Their words were unintelligible at this distance but not their agony. They cried with decreasing volume as the mass of dying humanity became a crowd, a cluster, and finally a solitary whimper.

The quiet that followed, may the gods help me, brought great relief. At first my tortured ears strained without permission, listening for that one more sound of life, but I knew it would not come. Not from those frozen corpses shrouded in darkness. Not from that bitter grave.

It was finally—mercifully—silent.”

                                                                        Excerpt from Titanic: Legacy of Betrayal

In the historical research for Titanic: Legacy of Betrayal, most first-hand accounts of survivors talked about the horrible sound of the victim's screams that started as a roar and tapered off as those in the water were rendered unconscious or dead. 

Now, one-hundred years later, there is still some dispute over whether the majority of the RMS Titanic’s victims drowned or died from hypothermia.

Paula Moldenhauer

According to the Pacific Yachting Magazine, "Cold water carries heat away from the body 25 times faster than air of the same temperature and as a result, the body core immediately begins to lose heat to the outside environment. At first, the body tries to generate more heat by shivering, but this is not enough to offset the loss of heat to the water. Within 20 to 30 minutes, depending on water temperature, body core temperature drops to below 35° C (95° F) cognitive functioning and judgment become affected. This cooling, if not checked, leads to disorientation, unconsciousness and eventually death."*

Still, most statistics tell us that most people die of drowning, not hypothermia. 

Maybe "Cold Shock," the initial minute or two of exposure to cold water, provides an explanation. It signals a "gasp" reflex, which can cause serious problems if your head is under water. Next, you hyperventilate, your heart races, and blood pressure spikes. It's hard to breathe and panic increases. In some people these symptoms cause cardiac arrest. Even healthy individuals can have difficulty keeping their head above water in such stressful situations!

Kathy Kovach

Cold Shock is followed by Cold Incapacity. During this time, "neuromuscular activity slows and body fluids literally congeal in the muscles."* It becomes increasingly difficult to do anything that requires manual dexterity. Your hands and fingers stop working first, then the deeper tissues of the arms and legs cease operating properly. After ten minutes, they no longer respond to your will. Even experienced swimmers find short swims difficult or impossible. Without proper flotation equipment it is hard to keep your face out of the water and prevent inhalation.

If victims survive the first two stages, hypothermia sets in after 20-30 minutes of exposure. The body's core temperature drops to 95 degrees F. Once hypothermia begins the victim's clothing, body fat, and other factors come into play. On average, there is about another 30 minutes of "useful consciousness" left. 

According to PYC, "During this last period, it is still likely victims will die from drowning, unable to keep their airways above water as they slip into disorientation and unconsciousness. The only victims who actually die of hypothermia are those who have managed to keep their airways above water, even after unconsciousness, by securing themselves to floating wreckage or through the use of self-righting lifejackets."*

Which brings us back to the RMS Titanic. Experts say Titanic’s life jackets kept victims afloat, but were not-self-righting. (You can learn more about this here.) Since survivors report hearing cries for help for 40 minutes to an hour despite the frigid 31 degree water, this seems to indicate that at least some of the victims were able to avoid drowning and succumbed to hypothermia.

Still, despite the obvious fact that that the RMS Titanic victims were in freezing water, the technical cause of death could still be drowning in most cases, as people lost the ability to keep their head above water.

Either way even now, 100 years later, I'm haunted by the thought of almost 1,500 people left in the water, crying for help.

(BTW, Here's what to do to prevent hypothermia according to the Red Cross.)

*The direct quotes were taken from The Chilling Truth About Water. You can also find a chart there that breaks down survival times in cold water.

***********************************************************************
Paula Moldenhauer co-authored, Titanic: Legacy of Betrayal, with Kathleen E. Kovach. Author, speaker, and mom of four, Paula has published over 300 times. Her first two novels released in 2012. She serves as the Colorado Coordinator for the American Christian Fiction Writers and homeschools. Paula loves peppermint ice cream and walking barefoot. Her greatest desire is to be close enough to Jesus to breathe His fragrance. Her website offers homeschooling and parenting articles, devotionals, and information about her books. www.paulamoldenhauer.com Visit her on facebook at: http://www.facebook.com/PaulaMoldenhauerAuthor

Author Question: Bleeding to Death

S.W. asks: This is the scenario: A woman has given birth attended only by her partner. After an exhausting long labor, the birth goes reasonably well, but a couple of hours later, she hemorrhages. My question is, would it be possible for her to bleed to death while sleeping?

My plot needs her partner to be in the same room, under the influence of alcohol or drugs which he takes to 'celebrate' after the birth. I need him to not realize what's happening until it's too late to save her.

Jordyn Says:

I do think this scenario is plausible on a couple of levels.

When a woman has bleeding complications related to delivery-- she's obviously losing blood. Simply, blood carries oxygen to each of your organs.

When there has been significant blood loss-- the woman will lose consciousness because of two aspects: not enough blood to carry the oxygen to her brain and/or low blood pressure. You have to have a certain blood pressure to perfuse your brain-- and therefore stay conscious.

She would go unconscious and could appear just to be sleeping to the one who's under the influence of all those meds/alcohol.

The pregnant woman would continue to bleed and never regain consciousness. She would die from exsanguination.

The Psychology of the Serial Killer

I'm so pleased to host Nelda Copas today as she guest blogs about the psychology of the serial killer. I found this information fascinating.

Welcome to Redwood's Medical Edge, Nelda!

Serial Killers are a fairly recent phenomenon. The public is fascinated by their crimes. The prevalence of serial murder in this county is yet unknown. There have been estimates that there are 20-50 working in this country at any given time. The terms most often used to describe the serial killer are “psychopath” or “sociopath.”

TYPES OF SERIAL KILLERS

The FBI Crime Classification Manual put serial killers in three categories.

1. Organized/nonsocial offenders:

     These offenders usually have above average intelligence. They often plan quite methodically, usually abducting victims, killing in one place and disposing of the body in another. They often lure victims with ploys. Ted Bundy for example would put his arm in a fake cast and ask women to help him carry something to his car.  Others specifically target prostitutes, who are likely to go willingly.  They maintain high degree of control over the crime scene and have a solid knowledge of forensics that helps them escape detection.  They follow their crimes in the news.  The organized killer is usually socially adequate, has friends and lovers, sometimes a spouse and children.  When captured they are usually described as kind and unable to harm anyone.

Examples of Organized Serial Killers: John Wayne Gacy and Ted Bundy.

2.  Disorganized/asocial offenders:

     These offenders are often of low intelligence and commit crimes impulsively.  The disorganized killer will murder someone when the opportunity arises, rarely disposing of the body.  They usually carry out 'blitz' attacks and will carry out whatever rituals they feel compelled to carry out i.e.: mutilation, necrophilia, cannibalism, etc. once the victim is dead.  They rarely cover their tracks, but may evade capture due to their need to keep on the move.  Often they are socially inadequate with few friends, may have a history of mental problems and be regarded as 'creepy' by associates.  They also tend to be introverted.

3.   Mixed offenders:
      Combination of the both.

Characteristics of a Serial Killer

1.   Majority are single, white males.
2.   Often intelligent, with IQ's in the "bright normal" range.
3.   Despite their high IQ's they do poorly in school, trouble holding down jobs, often work menial jobs.
4.   Tend to come from unstable families.
5.   Abandoned by their fathers as children, raised by domineering mothers.
6.   Often family histories of alcoholic, criminal, and psychiatric histories.
7.   Often mistrustful of their parents.
8.   As children it is common to find they were abused-psychologically, physically and/or sexually-by a family member.
9.   Many spend time in institutions as children and records of early psychiatric problems.
10. From an early age, many are intensely interested in voyeurism, fetishism, and sadomasochistic pornography.
11. More than 60 % wet their beds beyond 14. Involved in sadistic activity or torturing small animals.

Clinical studies of Serial Killers found that they have unusual or unnatural relationships with their mothers. Her death is often one of the most fantasized during adolescence. Later on, she may become one of the victims. Many have had intense, smothering relationships with their mothers. These relationships maybe filled with both abuse and sexual attraction.
***********************************************************************

Nelda Copas graduated with a BS in Psychology/Criminology and a Master's degree in Mental Health Counseling both from Western Kentucky University. She has worked extensively with law enforcement and is frequently a workshop presenter on the topic of Serial Killers. Nelda retired from the United States Army, where she worked as a nurse and combat medic. Twisted Desires was her debut novel, which was followed by it's sequel Twisted Revenge. She lives with her husband near Fort Knox, Kentucky. Nelda is currently working on the third installment of the Detective Delsey MacKay series, a true crime novel, and a young adult zombie apocalypse novel. www.neldacopas.com

Up and Coming

Hey Redwood's Fans!

How's the summer going? What types of fun activities have you been up to?

This week for you...

Monday: Nelda Copas shares a fascinating post on serial killers.

Wednesday: Author Question. You know I love these! This one deals with bleeding to death. Always important for those manuscript details.

Friday: Author Paula Moldenhauer shares a post on the Titanic victims. What about you? Do you think they died from hypothermia or drowning? This is an excellent post that talks about the two competing theories.

Jordyn

A Scoliosis Journey: Dianna Benson

If you want your character to struggle with a disease starting in childhood and worsening in adulthood, scoliosis may be the right one to choose to create long-term drama and conflict.

At age nine my daughter was diagnosed with scoliosis with a twenty degree double curvature; meaning, her spine was S-shaped due to a thoracic curve and a lumbar curve jutted in opposite directions. For a year she only had x-rays every few months to monitor the curvature as she grew.

At age ten it increased to twenty-eight degrees, so she was placed in a full body (torso) bending brace twelve hours a day. The bending brace overcorrected her spine to allow only twelve hours per day wear versus twenty-four. She wore the brace for five years and had x-rays regularly to monitor the curvature.

At age fifteen, an x-ray of her hip showed the growth plate closed, indicating she was nearly done growing. Scoliosis protocol at that point indicates the brace is no longer necessary.  

Every patient is different, and for her the curvature worsened out of the brace, the first year to thirty-three degrees. An increase isn’t uncommon as the body adjusts to life without a brace, but unfortunately her increase continued and was rapid and severe.

When she was seventeen, her curve worsened to thirty-seven degrees. Less than a year later to forty-four degrees, which led to her five-hour surgery May 2012 performed by the top scoliosis surgeon in America who operates on professional and college athletes.

Her freshman year in college (fall 2011), she started to suffer with acute back pain. A full scholarship college swimmer, she pushed through the pain during the swim season, even at ACC Championships in February and NCAA Championships in March. From fall to spring, she endured three in-hospital spinal injections, plus took pain meds and an anti-inflammatory regularly.

Due to the year of intense pain she suffered, her Virginia Tech coach was stunned by her performance at ACCs—she broke records, swam the fastest 100 backstroke time of the meet, and her performance qualified her for NCAA Championships, which is tougher to qualify for than US Olympic Trials.

At NCAAs, her right leg numbed due to nerve involvement and her back muscles froze to protect her spine, forcing the need for the VT trainers to drag her out of the pool after her last event, the 200 backstroke. Soon after, an x-ray showed her curvature at forty-four degrees. Surgery from T5-L1 (thoracic #5 to lumbar #1) was now inevitable.

The five-hour surgery on May 2 was successful—her spine is now straight and she no longer has a rotation. Due to the rotation of her curvature, her rib cage was concaved in four inches (think: thoracic spine curved to the side and twisted inward), which explains her respiratory issues through the years.

Parallel titanium rods and twelve screws now hold her spine straight in-line. Less than a week post surgery, her body rejected some of the internal stitches and caused a three-inch infection along her thirteen-inch incision. Days later, her body rejected more stitches, but antibiotics cleared the infection and she’s now on the road to recovery.

She’s battling pain as her body adjusts to the new positioning of her spine, scapulas, shoulders and rib cage as well as all the surrounding muscles, tendons and ligaments. She’s in the process of returning to her practice schedule to prepare for the US Olympic Swim Team Trials in June to compete for a spot on the 2012 US Olympic Swim Team headed to London. My husband and I simply focus on the blessing of her positive attitude and internal strength.

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

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

Embryo: J.A. Schneider

I'm pleased to host Joyce Schneider as she discusses the medical plot elements of her medical thriller Embryo.

Welcome, Joyce!

Embryo’s plot: An intern is determined to investigate tragedies at a famous fertility & genetic engineering hospital. My husband, a physician of endless patience, helped with the medical details, which I interwove into this story idea that nagged and wouldn’t let go.

Details: “Maria Moran’s first inkling of trouble was the coppery taste in her mouth. It came suddenly, a rushing whoosh of something that made her gag, and when she reached to wipe her mouth, her hand came away smeared with blood.”

So begins this thriller about a young intern, Jill Raney, determined to investigate tragedies and terror at a famous fertility and genetic engineering hospital. When two pregnant women die and a fetus is delivered with severe chromosomal abnormalities, Jill’s superiors - including handsome, smitten-with-her resident David Levine – insist there’s no common link.

But her suspicions deepen with the grotesque murder near the hospital of another pregnant woman - her belly drained of amniotic fluid. And when a woman miscarries in the hospital and then disappears, Jill frantically searches for her - following a terrifying path that seems to link all the victims: Is someone playing with life...and the structures of human life itself?

An unforgettable tale of suspense with a shocking denouement, Embryo takes you deep into the mind of malignant genius.
What is special about Jill Rainey? “The job” is vitally important to her, but on her terms. She is strong, smart and brave, someone you like right away – but she also questions every premise and order from superiors; she sees what others don’t or won’t see and takes independent, determined action. This includes falling in love when superiors warn her against it. She’s stubborn! Her own woman!

Why does this novel stand out? A story about malignant geniuses tinkering with IVF and human genetic engineering hasn’t been done before. Some will call this sci/fi, but the technology is really there. That’s what’s scary and why this idea wouldn’t let go. The irony is that Jill’s profession should never have drawn her into suspenseful situations. Her profession should be about saving lives; bringing joyous new lives into the world. But the famous hospital she chose to train in staffs scientists monkeying with life to terrible consequences – and that’s what unexpectedly draws in this brilliant young woman.

Something else that’s unique here is EMBRYO’S fast pace. For example David Levine is a terrific OB/GYN surgeon. This is shown in as few words as possible. Here he has begun a C-section: “His hand moved so fast that it looked as if he’d drawn a red line. He made a single midline incision from below the navel to the pubis. It was a shallow cut, through the skin and subcutaneous tissue only. Beads of blood enlarged and spilled down both sides of the abdomen.” There’s a bit more, but no need to go into pages and pages of textbook surgical description. That’s boring and slows the urgency.

A timely and frightening idea, super characters, and fast pacing are what makes

EMBRYO a can’t-put-down thriller and a real page turner.

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J.A. (Joyce Anne) Schneider is a former staffer at Newsweek. She has published Flora Tristan and Darkness Falls (Simon & Schuster, Pocket Books); Embryo is her first ebook. She is passionate about reading & writing - especially thrillers, medical thrillers, and mysteries. Decades of being married to a physician and patient explainer means that there'll be fascinating medical angles even in "regular" thrillers that she writes. She canNOT fall asleep without reading a favorite book...even after a long day of writing.

Treatment of Infected Wounds

This post is in direct response to a question from Sue Harrison about taking care of infected wounds. What exactly is the treatment protocol.

Treatment of infected skin wounds is usually one of the easiest things we can do from a medical perspective. Unless it's a superbug which is another concern entirely-- but we'll keep it simple for this post.

Here's a short list of the treatment protocol.

1. Keep the wound from getting infected.  This boils down to a couple of things. In the ER-- doing good wound irrigation for things like road rash and lacerations. Washing wounds physically removes the bacteria. If the bacteria aren't present-- they can't fester to produce infection. Once the wound is cleansed-- apply a topical antibiotic (like Neosporin or equivalent) to stem infection from developing.

2. Dressings should be changed once or twice daily. Unless it's saturated-- it can be left alone. The more things are mucked with-- sometimes the more apt they are to become infected. You introduce more bacteria by touching.

Okay-- say you've done all those really great things and it STILL gets infected.

One-- is it really infected? Sometimes, people assume that mild redness is infection (this should only be 1-2mm around the wound edges) when it really is normal healing process. If the redness extends beyond 1-2mm-- then there is more concern for infection.

Other signs: pain, swelling, pus draining, foul smell, red streaks running from the wound, swollen lymph nodes near the area, and fever.

Treatment:

First question: Should the wound/abscess be drained? Drainage is good because, just like irrigation above, it removes the bacteria. Some MRSA wounds are being managed just this way-- with just drainage and no antibiotics-- which is good to help prevent more resistant strains of bacteria from forming.

Second question: Place on oral antibiotics-- but which one? This will be a good one to run by a doctor if it is important for the integrity of your ms. The most common one for surface skin infection is Keflex. But for abscesses-- maybe something more along the lines of Clindamycin.

Sue-- hoped this helped!!

Up and Coming

Hello Redwood's Fans!

How's your week been?

Mine...oohhh... very nice from an author's standpoint. Just got the final cover from my publisher, Kregel, for the #2 book cover in the bloodline trilogy, Poison. Can't wait to give you a preview soon!

For you this week:

Monday: For my friend, Sue H., Treatment of Infected Wounds. I know, seems a strange gift to give to a friend. But, it really does show how much I love her.

Wednesday: Author Joyce Schneider stops by to talk about the medical elements of her thriller Embryo.

Friday: Dianna Benson stops by for her monthly post. On this day she shares a very personal story of her daughter's life with scoliosis. Very important for those first person type details.

Hope you all are having a fabulous weekend!

A Histrionic Fit 3/3

JoAnn Spears returns to let her nursing prowess diagnose mental illness among long lost monarchs. This series focuses on Elizabeth I and Mary Queen of Scots. Her popular previous series on Henry VIII's illnesses can be found here:

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Parts I and II were on Monday and Wednesday.

Today, JoAnn concludes this fascinating series.

A recap of Mary’s career is called for in arguing that she may indeed have had Histrionic Personality Disorder. 

·         The infant Queen of Scots, a fatherless political football, is punted to France.

Overall, the etiology of histrionic tendencies is poorly researched.  Early loss of a parent, or unpredictable parental attention, may contribute to it. 

·         Adolescent Mary, pampered and acclaimed for beauty and talent, becomes Queen of France.

Lack of constructive criticism and discipline may lead to the emergence of a histrionic personality in adolescence.  The pubescent Mary was almost universally doted on. Interestingly, her mother-in-law, that clear-sighted Machiavellian survivor Catherine De’Medici, was not nearly so sanguine about the burgeoning Mary.

·         ‘Frenemy’ Mary makes cousinly noises toward Elizabeth I, Queen of England, while touting her own superior Catholic claim to Elizabeth’s throne.

Dramatic statements and lack of sincerity are strongly associated with the histrionic type.  Being easily influenced by others is also characteristic; some aver that Mary’s strike at Elizabeth was incited by her scheming French relatives.

·         Tragically widowed, Mary returns to backward, barbaric Scotland to reign.  She and the unruly Scots clansmen learn the meaning of cultural clash.

Mary made the histrionic decision in choosing not to subdue the flashing of her considerable beauty, style, and elegance at the austere and Puritan Scots court, damaging her chances of political success.

·         Wanton Mary, marrying in haste, repents at leisure, heavily pregnant, when her profligate husband helps murder her Secretary, Rizzio, right before her eyes. 

Perceiving relationships as being deeper or meaningful than they are, or entering too deeply into shallow relationships, comes with the histrionic territory.  Clearly, Mary’s initial assessment of her relationship with Lord Darnley was far from accurate.   Likewise, she couldn’t or wouldn’t see how extreme and inappropriate the favoritism she showed her exotic Italian secretary was perceived by those around her.

·         Desperate Mary re-widowed via a remarkably sloppy murder.  The murderer, Bothwell, is believed to be in cahoots with Mary, if not her lover.

Dependency, the primrose path to getting others to do one’s dirty work, goes hand in hand with histrionic personality disorder.

·         Mary is abducted and raped by Bothwell; even her supporters are confused when she marries him shortly thereafter.  The legendary ‘Casket Letters’, written by Mary at this time, muddy the waters even further.  Political mayhem ensues; Mary is captured by the Scottish clansmen.

Histrionic individuals are known to rashly shift from one perspective or plan to another.  This can put them in the way of situations and relationships that are unstable or even threatening to their well-being or safety. 

Histrionic communication comes across broad and vivid, creating an abstract-art, paint-can canvas of feelings rather than a crisp, clear snapshot or a delicately layered oil painting. In light of this, the heaving emotion and incidental minutiae of the Casket Letters comes as no surprise.

·         Charmer Mary wriggles out of Scotland and over to England.  Bothwell legs it to Denmark, where he dies after years spent chained by the ankle to a stake in a miniscule basement cell.

Darnley, Rizzio and Bothwell were not the only men who came a cropper in Mary’s wake.  The poet Chastelard was executed for romantically hiding under her bed.  England’s prime nobleman, Norfolk, was brought low by scheming to marry her.  Her sex appeal blasted the career and marriage of Lord Shrewsbury, her eventual jailor. Lack of concern for the impact of one’s drama on others highlights the histrionic trajectory.

·         Mary is imprisoned in England; her earlier claims to the throne of Elizabeth I have come back to haunt her. For years, she is moved from prison to prison by her jailors, and feels justified in plotting with politicos across Europe to assassinate Elizabeth I.  She is a poor plotter, though, and falls for a sting operation known as The Babbington Plot.

Histrionic people have a strong need to be at center stage.  Fading into background, keeping a low profile, and having only a bit part to play do not sit well with them.  Mary could not allow herself to be forgotten by the European political world.  She did all she could to stay on stage with them, even at risk of her own life.

·          Mary, touting herself as a Catholic martyr, is executed by decapitation; her terrier dog is found hiding in her skirts at the scene and dies a few days later from grief.

Constant seeking of the approval and reassurance of others rounds out the histrionic personality.  Mary, with histrionic insouciance, took herself from screaming drama queen to subdued sainthood without blinking.  Such sainthood would bring her the approval of Catholic Europe, and ultimate vindication both from heaven and earth.

Mary’s legendary terrier dog, and his sad fate, bring home the final point about people with Histrionic Personality Disorder.  View them as you will, saints, sinners, charmers, or victims, they are among the most compelling people you will ever meet.

Thank you JoAnn for such a wonderful series. Fascinating person she was!

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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”.

Drama Queens 2/3

JoAnn Spears returns to let her nursing prowess diagnose mental illness among long lost monarchs. This series focuses on Elizabeth I and Mary Queen of Scots. Her popular previous series on Henry VIII's illnesses can be found here:

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Part I was Monday.

 

There are four types of Cluster B personality disorders.  Two of them, the Antisocial and Borderline Personality types, tend toward, but are not absolutely divided between, gender lines.

Antisocial personality is a diagnosis most often associated with law-breaking males.  Disregard for the feelings or rights of others are hallmarks of this disorder, as are scorn for rules and social norms in general.

 Elizabeth I’s father, Henry VIII, went from Defender of the Catholic Faith to excommunicated renegade over non-consummation of his sexual relationship with Elizabeth’s mother, the enigmatic Ann Boleyn.  He could easily be touted as a prime example of this disorder.  Mary Queen of Scots’ father, James V of Scotland, likewise had antisocial tendencies.  His acknowledged illegitimate offspring outnumbered his legitimate children 3:1.

Borderline Personality has, in what is perhaps a gross oversimplification, been interpreted as the female side of the antisocial disorder.  Fragmentation of personality, ‘bleeding into’ significant others, and detachment from reality, often for manipulative or self-serving purposes, are associated with this disorder; when it comes to the latter, one is tempted to invite Ann Boleyn to take a bow.

Both Mary Queen of Scots and Elizabeth I could behave in remarkably self-serving and unrealistic ways.  However, each maintained, despite ups and downs, a solid and defined self from which each might venture at times, but to which stronghold each always returned, Mary on the Catholic side, and Elizabeth on the Protestant.

Where, then, do these two legendary queens fall on the personality disorder continuum?

There are two remaining personality disorders in Cluster B.  Drama is central to both.  The narcissistic personality could be said to generate drama within the self and inflict it on others.  The histrionic personality, on the other hand, often drags drama from others, or somehow incites it from them.  Those ‘others’ can be a varied lot; charmed volunteers, partners in crime, unwitting victims, or opportunists with an eye on the main chance.

Narcissistic personalities are preoccupied with issues of personal adequacy, power, prestige and vanity.  These are ego-building structures in most people, but can become ego- challenges when underpinned by extremes of parenting in vulnerable individuals.  Elizabeth I never knew her mother.  Her father, Henry VIII, vacillated between tolerating Elizabeth, neglecting her, and avoiding her.  A trusted stepmother, Katharine Parr, exposed her to exploitation by an irresponsible would-be stepfather. A fond surrogate mother, Kat Ashley, probably spoiled Elizabeth rotten, and ultimately set the stage for the conflicted personality that was inherent in Elizabeth, but yet to emerge.  The likes of Walter Raleigh, Francis Drake, Shakespeare, the Lord Essex, and many more knew what it was like to live in the glare of that drama, directly or indirectly.  For some, like Drake, it led to glory; for the likes of Essex, it led to an early death; for Sir Walter Raleigh, it brought both defeat and victory.

And so we are left to consider Mary, Queen of Scots, and the diagnosis of histrionic personality disorder.

JoAnn will conclude her series on Friday.

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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”.

Disorders in the Court 1/3

JoAnn Spears returns to let her nursing prowess diagnose illness among long lost monarchs. This series focuses on Elizabeth I and Mary Queen of Scots. Her popular previous series on Henry VIII's illnesses can be found here:

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Part I is today. Parts II and III will be on Wednesday.

Welcome back, JoAnn!

It’s said that good judgment comes from experience, and that experience comes from bad judgment.  England’s Elizabeth I is a fine example of this aphorism.  Early misalliances with her exploitive stepfather Tom Seymour, and the less-than-suitable Earl of Leicester, for example, cost her dearly on a number of fronts.  Nevertheless, she learned some lessons and finished the game as England’s own Gloriana, its supreme diva and arguably most successful monarch.

Mary Queen of Scots’ fund of experiences was also remarkable, even for someone of her rank and stature.  Unfortunately, the tragic Stuart queen failed consistently at making her fund pay dividends of sound judgment and good choices.  She was less challenged and far more advantaged, at the outset of their reigns, than her most famous contemporary–and relative–Elizabeth I.  Still, she made choice after choice that led to an almost unbelievably disastrous trajectory and culminated in a lengthy and ignominious imprisonment.  She died facing Elizabeth I’s executioner on what amounted to a gibbet of her own devising.  What made the difference in the way things went for these two powerful and legendary women? 

The point at which combinations of personality traits amount to health and success, or dysfunction and disaster, is not always easy to identify.  Mental Health diagnosticians use a guide called the Diagnostic and Statistical Manual (DSM), now in its fourth revision, to help them make this determination in a systematic way.

The DSM IV categorizes mental health conditions into different spectrums, or Axes. 

The first Axis contains the major mental disorders.  These are the ones non-professionals often associate with mental health and illness; bipolar disorder and schizophrenia, for example. 

The second axis categorizes conditions known as personality disorders.  These are characterized by enduring, pervasive patterns in the way individuals think, feel, relate to others, and control–or fail to control–their impulses.  There are three clusters of personality disorders.

People with Cluster A disorders tend to behave in ways that would be considered odd, eccentric, isolative, or even paranoid.  Certainly, neither Mary nor Elizabeth were ever dismissed as odd; both were far too flamboyant and vivid for that, and both were at their best performing to an appreciative audience. 

Cluster C disorders are associated with anxiety, inhibition, neediness, preoccupation, rigidity, and submissiveness.  ‘Bloody Mary’ Tudor, sister of Elizabeth I, comes to mind here.    Her religious zeal, which lead to the burning of numerous ‘heretics’, is what history at large remembers her for.  Tudor aficionados will also note the pathetic, neurotic quality of her relations with the world at large, and with her husband, Prince Philip of Spain, the prototype ‘Cold Fish’ of the Renaissance era.

This leaves us, obviously, with Cluster B personality disorders.  Dramatic, erratic, impulsive, tumultuous, and attention-getting, the folks in this Cluster are the ones who, in modern parlance, command the room.  Clearly, both Mary Queen of Scots and Elizabeth I deserve a second look from a perspective that minimizes judgment of them, and demands a full and constructive exploration of their complex and fascinating personalities.

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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”.