Author Question: Power of Attorney 2/2

We're continuing with author Christy Barritt's question. You can find Part I here that deals with a gunshot wound to the head and brain bleeding. 

Christy Asks:

The victim's father had Power of Attorney and the father lived four hours away, would it be possible for the father to request that his son be transferred to a hospital closer to his home so he could keep an eye on him? Or is that not done with victims with brain injuries? I need something for the fiancee and the future in laws to fight about.

Jordyn Says:

Yes, hospital transfer is possible but it depends on what type of injuries you pick. For instance, if you go the brain swelling route and there are no critical care services where the father lives—the hospital can't transfer just based on that. Plus, my guess is they would wait until he was a little more stable anyway.

There would need to be appropriate hospital services there (where the father lives) that would be able to care for his injuries before the transfer would be approved.

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Christy Barritt is an author, freelance writer and speaker who lives in Virginia. She's married to her Prince Charming, a man who thinks she's hilarious--but only when she's not trying to be. Christy's a self-proclaimed klutz, an avid music lover who's known for spontaneously bursting into song, and a road trip aficionado. She's only won one contest in her life--and her prize was kissing a pig (okay, okay... actually she did win the Daphne du Maurier Award for Excellence in Suspense and Mystery for her book Suspicious Minds also). Her current claim to fame is showing off her mother, who looks just like former First Lady Barbara Bush. When she's not working or spending time with her family, she enjoys singing, playing the guitar, and exploring small, unsuspecting towns where people have no idea how accident prone she is. For more information, visit her website at: www.christybarritt.com.

 

Author Question: Brain Bleeding 1/2

I'll be handling Christy's question in two parts. Part one today.

Christy Asks:

A bullet grazes my hero's brain. He's taken to the hospital where he has an intracranial hematoma.Would he be in a medically induced coma after this? If so, for how long? When do doctors decide to take someone out of a medically induced coma? What would a victim be like after the fact? Sedated? When would they know the extent of the injuries?

Jordyn Says:

It depends. Let’s start from the top.

A bullet grazing someone’s brain. Okay—well in order for it to even hit the brain it has to come through the skull. So, it’s not going to be a minor injury considering that. Not like a bullet grazing your arm.

An intracranial hematoma means you have bleeding on the brain but you haven’t really specified the area. For instance, epidural hematomas occur between the dura (which is a tough membranous covering) and the skull. These are almost always taken to surgery.

In a subdural hematoma the bleeding occurs between the dura and the arachnoid layer. These are not always evacuated by surgery. It depends on their size. Intracranial bleeding can mean a lot of things—that the bleeding is just within skull (which includes the two things I’ve mentioned) or in the brain tissue itself. Bleeding within the brain tissue itself is much harder to deal with.

Would he be in a medically induced coma? It depends. The decision to put someone in a medically induced coma is more based on whether or not the doctors think the brain will swell as a result of the injury and not necessarily because there was a bleed. For instance—epidural hematomas are generally taken to surgery and evacuated without the patient needing to be put into a coma.

If they think they see a significant amount of swelling of the brain tissue then a medically induced coma is more likely. A patient is generally placed into a coma through the period of peak swelling which is generally 48-72 hours post injury. The patient gets a special monitor (a bolt) that monitors their brain pressure (or ICP—intracranial pressure). 

After that peak period of swelling comes and goes a decision will be made to wean the patient off their sedation. The pressure may stay high. If the pressure stays high the patient may proceed to brain death (caused by herniation or hypoxia related to the pressure), or significant brain injury, or recover. It may not be known for several months what the outcome is though generally if a patient is going to suffer brain death they will do it in that 48-72 hr window. Past that, if they live but the pressures have been high—more a vegetative state or significant neurological impairment. If pressures have stayed lower—the patient may recover okay.

I have seen miracles, though, too so this is not cut and dried.

As far as knowing the extent of injures—they’ll know that pretty quickly based on CT imaging. However, what won’t be known is the affect on the patient. People can have the same exact brain injury—some die—some fully recover so there is a lot of writing leeway here. It may not be known for years how the patient will recover or what their lives post-injury will look like. 

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Christy Barritt is an author, freelance writer and speaker who lives in Virginia. She's married to her

Prince Charming, a man who thinks she's hilarious--but only when she's not trying to be. Christy's a self-proclaimed klutz, an avid music lover who's known for spontaneously bursting into song, and a road trip aficionado. She's only won one contest in her life--and her prize was kissing a pig (okay, okay... actually she did win the Daphne du Maurier Award for Excellence in Suspense and Mystery for her book Suspicious Minds also).

Her current claim to fame is showing off her mother, who looks just like former First Lady Barbara Bush. When she's not working or spending time with her family, she enjoys singing, playing the guitar, and exploring small, unsuspecting towns where people have no idea how accident prone she is. For more information, visit her website at: www.christybarritt.com.

Up and Coming

Well, I survived the Zombie Apocalypse-- oh, I mean traveling across country to OK with my two daughters and my father. A generational tour you could call it. Overall, the trip was good until about the last two hours of our 11 hour drive (which was turning into 13 hours after road trip stops) when we stopped in Limon, CO for a potty break.

It was dark, cold and rainy. My youngest had complained for the past hour about the need to pee but then couldn't find her flip-flops in the car to walk into the gas station. There was some encouragement (all right-- yelling) about putting anything on her feet she could find and hence we entered the gas station with her in her Sponge Bob slippers to a non-functioning toilet.

One of my childhood homes.

The joy of road trips.

It is fun to look back. For a brief time, my family lived in small Kansas town. The house was pretty close to some major streets. I was about 4-5 during those years. One day, I remember a man beckoning me to follow him. And so what did I do? Tell my mom?

Oh no-- I followed.

A neighbor found me walking along the highway and picked me up and brought me back home. Who knows what would have happened if that man got a hold of me. I think back to the situation as a good beginning for a suspense novel.

When I was returned safely home my mother didn't know whether to beat me to death or hug me to death. It was a little of both and I remember crying into my Snoopy sheets until my father got home. I'm sure my mother felt like if I was locked in my room I wasn't wandering down lonely Kansas highways.

My father took me by that house-- as seen in the picture-- and it's fun to try and remember what it was like living there.

I'm amazed it still stands.

For you this week--

Author Christy Barritt stops by with a few author questions for me to tackle. One regarding medically induced comas and the other about medical power of attorney.

Hope you guys have a GREAT week! Anyone road tripping it for the holidays?

Two Important Questions

I'm pleased to welcome back fellow medical thriller author and good friend Dr. Richard Mabry.

Richard's latest and greatest novel, Heart Failure, has just released and I hope you'll take some time to read his work if you're a fan of this genre. Personally, I can't wait to get my hands on it!

Welcome back, Richard!


I wish I had a nickel for every time I was asked, “Where do you get your ideas?” And the answer, for me and for most authors of fiction, is pretty much always the same—ideas are all around us, if you ask the right questions.

Early in my writing experience, Alton Gansky taught me that the most important question for an author to ask is, “What if?” I’ve taken that advice to heart, and it’s led me to the plots of all my books. For the latest, Heart Failure, I read a story about a man living under another name in an unfamiliar city because he’d been placed in the Witness Security Program.

I wondered, “What if the man fell in love and was about to be married? Would he tell his fiancé about his past? What if something happened that forced him to reveal his secret?”

And thereby hangs a tale, as the saying goes.

Jeff Gerke is responsible for the other question I’ve learned to ask myself when considering a plot: “So what?” I spent a very frustrating half-hour in the lounge at the Mount Hermon Conference trying to explain a story idea to Jeff, and each time I paused for breath he’d ask, “So what?” I finally figured out what he meant. If the protagonist fails, what would be the consequences? What would failure mean? If the stakes aren’t high enough, the reader will lose interest. That’s why this is such an important question.

For Heart Failure, the “so what” was initially that the protagonist might lose the woman he’d come to love. However, as the plot develops, it becomes obvious that both their lives are in danger, and the driving force changes to staying alive.

For all the writers reading this blog, I’d urge you to ask two questions when developing a plot—“what if” and “so what?” When you get the right answers to those questions, you’re on your way.

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Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and author of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award.  You can follow Richard on his blog, on Twitter, and his Facebook fan page.