Author Forensic Question: DNA and Donated Blood

Today, I'm posting a forensic medical question I had for Amryn Cross.

Jordyn Asks:

Can you tell if blood from a crime scene is from a donated pint of blood? If so, how?

Amryn Says:

You can actually tell the difference. A donated pint of blood will only have red blood cells and not the other components of blood (white blood cells, platelets, etc.). When the DNA from the donated blood is tested, the scientist would probably think it odd that they got little to no DNA yield (red blood cells don't have nuclear DNA). They might chalk it up to degraded blood, or they might look at it under the microscope and find only RBC, which should make them suspicious. But probably the first indicator is that the blood at the crime scene would not clot if it were from a donated unit. The investigator may or may not pick up on that, but a crime scene tech probably would.

Jordyn Asks:

What about a pint of whole blood? Would it still be the same? Would small amounts of dry blood give DNA?

Amryn Says:

Whole blood would give DNA results but wouldn't clot, so that would be something they would have to pick up on at the crime scene. If it was suspected and they wanted it verified, tests could be done for the preservatives in the bag.

Yes, if they were just droplets, they would still dry over time. And as long as it's whole blood, it will give lots of DNA.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense novels. Her first novel, Learning to Die, will be released in September. In her spare time, she enjoys college football, reading, watching movies, and researching her next novel. You can connect with Amryn via her website, Twitter andFacebook.

Author Question: Nursing 1940's

Anonymous Asks:

First and foremost, I have to say that I am in love with Medical Edge. I've been spending a lot of time on it lately because I enjoy studying medicine and also because I am starting to do research for my novel. It's set in 1939 through to 1943. I have three questions for you.

One of my main characters is a nurse in Sioux Falls, South Dakota. I want to be able to write her doing her job correctly. I was wondering what kind of equipment they used, how they used it, and for what illnesses (No need to be extremely specific here, I think). Also, what would her responsibilities be within the hospital? Would she rotate through all the wards or do/did nurses have particular specialties like physicians?

Jordyn Says:

Thanks for your compliments on my blog! Glad you find it helpful.

Nursing in your time frame of 1939-1943 would have looked a lot different than it does today. They definitely wore uniforms and caps. Doctors would have been formally called "Dr. Smith" versus using first names like we do now (although not in front of patients).

Nursing work was viewed as inferior to the physician meaning—you do what the physician says. Now, a nurse’s input is more respected. Doctors and nurses realize they can't work separate from one another.

Nurses likely didn't specialize then like we do now and there was likely not a lot of physician specialties either as there weren't any intensive care units or emergency departments until the 1970s. Equipment would have been non-existent like the heart monitors and stuff we now use. Read through this info to get a general feel of how the floors or "wards" would have been split up.

This link is from Britain but would probably have some cross-over to the US. Here is a link to some personalized stories from people who nursed during your time frame. I would read through these for the 1930's and 1940's to get a feel for what their jobs were like.

This is also from the UK but should provide some insight. 

Question:

Another one of my main characters goes off to fight in the war. How severe would an injury have to be for him to be discharged? Presently, I have a situation designed where he is aiding a family out of a bomb shelter; there is an unexploded shell nearby, and a child accidentally kicks rubble at it and sets it off. Big boom, main character loses part of his leg and half of his body is burnt. I'm also thinking that he loses his hearing. Would this be plausible?

Jordyn Says:

I would search military discharge related to a medical condition two ways. One—what medical conditions are prohibitive for military service and those conditions that would lead to discharge.

 I found this list, but you could probably find more and if it's the 1939-1942 time frame it may be different than those that cause discharge in these times.

The injuries you list related to the bomb blast are realistic and I think would be enough to cause his discharge from the military as well.

I contacted a cousin of mine who serves in the medical corp of the military and he said to look at AR 40-501 which is the standard of medical fitness. Basically, if you couldn't do what's listed than you could be discharged from service. He did say that there are personnel who are still serving who have amputated limbs.

Question:

Lastly, my nurse has a patient, a woman in her 40s or 50s, who she loves with all her heart. I want this patient to die. What would be a good way to kill this woman off? I need her to have been in the hospital for around four years. I also want to have her weak but able to speak with my other characters. What's a good malady for this situation?

Jordyn Says:

This kind of criteria would mean the character would need a chronic illness that's debilitating. You could look into multiple sclerosis, Lou Gehrig's Disease, Huntington's Chorea or some of the autoimmune disease like Lupus or Sarcoidosis.

These diseases fall on a spectrum (more MS and the autoimmune diseases) but Lou Gehrig's Disease and Huntington's Chorea lead to neuromuscular wasting, etc that does lead to death and there is currently no cure.

In that time frame you're looking at you'd have to determine if they were able to diagnose these diseases. To do that you could Google search "When was Lou Gehrig's Disease discovered?" That should get you in the ballpark to know if the medical community knew about whatever disease you chose for your time frame.

Keep in mind—it would be highly unusual for someone to be hospitalized for four years straight.

Pediatric ER Nurse Warning: Amber Beads for Teething Relief

Working in a pediatric ER, you see parents do lots of curious things. In the last three months or so, I began seeing a fair number of infants come in with these beaded amber necklaces around their necks.

One of the main goals in nursing is accident and death prevention. That's why we talk about using helmets and wearing your seatbelt. Honestly, some of us would like to see trampolines outlawed because they are responsible for so many childhood injuries.

We also don't like to see anything around a child's neck that would pose a risk for strangulation. Things like this would include wearing a sling at night. We generally don't recommend this for concern that the child may get caught up in it and get strangled to death. 

The first time I saw these beaded necklaces-- I was surprised at how heavy they were. I asked the mother why the child was wearing them.

She said, "Oh, they're for teething."

Hmmm.

I explained my concern to her that I thought they posed a significant strangulation hazard and whatever perceived benefit they had for teething pain would not outweigh this risk in my mind.

And she promptly removed them.

But now I see many infants coming in and wearing these so I thought it was time to blog about my concern for these infants' safety. 

 These amber beads seem to have originated in Europe where the claim is that when the beads are warmed up by the infants skin, they give off a pain relieving substance that is absorbed through the skin.  

This article provides an excellent overview of how these claims are categorically false. 

In fact, Health Canada issued a safety warning about the risk of these amber beaded necklaces use in children and France and Switzerland don't allow them to be sold in pharmacies. 

This article highlights a near miss of a toddler who became entangled in her necklace while she napped. 

Point being-- nothing should ever be placed around your child's neck regardless of any claims for perceived health benefits. 

Commentor Question: Lacerations and Plastic Surgeons

This blog is generated from a comment on this post: Medical Myth: Lacerations Need a Plastic Surgeon.

I do read each and every comment to the blog. Usually, I don't comment on real life medical scenarios but I thought this had several good teaching points that could serve the public good.

The comment:

I just brought my 5 y/o into an ED with a puncture wound to the center of his forehead through which you could see his skull. I thought the attending would close the wound, but the resident did under supervision. First year, and it was late July. What are the chances of a good outcome? The attending had to tell the resident that knots were backward, etc. Should I have insisted that the attending close, or that they call plastics? It was a large urban Children's ER.

Jordyn Says:

Thanks so much for leaving this comment and I hope you see this post.

As a mother and a nurse, I get the parental anxiety around closing lacerations. The truth is that anything that requires sutures is going to leave a scar. That's life. Now, how big or thick the scar is depends on many factors. How it was closed. There is a learning curve to closing the skin. Lacerations can actually be closed too tightly which can be as problematic as not bringing the edges close enough together.

That being said, there are many other factors that determine how the scar will look. Does it become infected? How does the patient normally scar? Some people genetically develop very heavy scarring (called keloid scarring) and there's nothing we can really do about that. Also, after healing, how much is it exposed to the sun?

Now, should you have allowed a resident to suture your child?

From the medical side-- students need to learn and must practice, at some point, on live patients. I'm glad this first year was being monitored during the procedure. That's what should have happened. Knots being tied backwards and needing to be redone doesn't mean you'll have a bad outcome. Experienced physicians redo sutures all the time. It's more the final closure that's important.

From my nursing/mother standpoint-- you have the right to refuse a resident practicing on your child. If you are uncomfortable then absolutely speak up and state your request plainly-- "I'm sorry, but I'd like an attending to close this laceration."

Some people are uncomfortable with a nurse practitioner or physician's assistant doing a laceration repair and request an attending. Keep in mind, that mid-level provider may have more experience than your attending physician. They may have been in practice four times as long! So maybe ask how many years they've been practicing as an attending before you pass over on a mid-level provider.

If you feel that you can't make this request to the doctor directly, then you need to tell your nurse who should advocate for you.

Should you have insisted on a plastic surgeon? The truth is that pediatric ER providers close lacerations every day on moving targets-- we don't commonly sedate kids for simple laceration repairs. Plastic surgeons are generally only utilized for complex laceration repairs and would honestly be annoyed to come to the ER for a simple repair.

If you don't like how the wound healed and the scar it left behind then you can consult a plastic surgeon to investigate a scar revision.

Hope this helps.

Author Question: Surgical Spleen Removal

Amanda Asks:

I have a character who was shot in the side, not life threatening, but he had to have surgery to remove his spleen as well as the bullet because some rib fragments damaged his spleen.

My question is how long would he be in the hospital after surgery? I'm sure when he first comes home he'll be getting around in a wheelchair or something while he heals and gets his strength back. When could I plausibly have him on his feet slowly walking around? I don't want any dramatic complications with his injury or anything. He's going to heal up great and be perfectly fine afterward.

Jordyn Says:

I ran this question by some of my nursing cohorts who focus in adult surgery.

Having your spleen removed would require a couple days stay in an intensive care unit. This would be due to risk of post-surgical bleeding and concern for infection.

The surgical nurse I spoke to said these patients are up and walking by the time they come to the floor so there would be no need for the character to use a wheelchair.

Once research point that is helpful with this question is that you can Google search for discharge instructions regarding many kinds of operations. For this one, I searched for Home Care Instructions after Spleen Removal. This document gives excellent information that can be translated into your novel.

For instance-- how long the patient should expect to have pain. Driving and lifting restrictions which can help determine what they would physically be capable of in your novel.

FYI-- patients who have had their spleens removed are at more risk of serious infection. Your spleen is part of your immune system. So some infections that would normally not be a big deal for the general population can be life threatening to those who have had their spleen removed.