Friday, July 8, 2011

Western Medicine Circa 1890: Part 2/4

Lacy Williams is back with part two of her four part Friday series on western medicine during the 1890's. She is running a fantastic contest so be sure to leave a comment and check out the full details posted on June 30th. Nothing like a chance to win four books!

I know I’m not alone in the fact that Janette Oke really inspired me to want to read and write inspirational fiction (waaaay back when it was just a dream for me). The next inspirational author that I fell in love with was Al Lacy, who writes westerns/western romance (I liked that his last name was the same as my first name…).

One problem that Mr. Lacy’s characters (a lot of times it was the bad guys) ran into was gunshot wounds. Mostly they didn’t survive, which I think is realistic. My issue when writing MARRYING MISS MARSHAL was that I had a main character, a marshal, who found herself trading bullets with some outlaws… What if she got shot? How bad could I make her injury and still reasonably expect her to go about her duties?

GUNSHOT WOUNDS

Difficult enough to treat with today’s modern medicines, I imagine treating gunshot wounds was probably something that Wild West doctors dreaded. Part of the problem was the damage that a bullet could do to a person’s insides—not pretty to put back together. Another problem was the threat of infection. If any foreign object (a piece of bullet, fabric remnant, dirt, etc.) remained in the wound after cleansing, it could cause major problems, which might lead to amputation or death for the wounded person.

Family Physician: A manual of domestic medicine (1886) suggests that serious wounds requiring surgery only be treated by a doctor, and doesn’t go into explicit detail about the treatment of these wounds, which would probably include gunshot wounds. It does share some information on treating “lighter” types of wounds. Here’s an excerpt:

The after-treatment of a wound cannot be of too simple a character. Where there is no pain or discomfort about the wounded part, there can be no object in disturbing the first dressing applied, and this should be left undisturbed for from two to four days, according to the severity of the injury. If all has gone well, it is quite possible that a skin wound may heal at once, and merely require the application of a piece of plaster over it, to protect it for a few additional days. If, however, it is found on carefully soaking off the original dressing that the wound is open and discharging, the best application will be the " water-dressing."…

Because I needed my heroine to be able to be active, not laid up by a gunshot wound, I chose to give her a “flesh wound”, more of a scrape. The bullet that hit her did not pierce her skin, per se. Here’s an excerpt from Marrying Miss Marshal chapter 16 that shows the hero (her husband) helping her treat the wound:

"Do you need help?" He waited for her answer before he turned around.

Danna sighed, a little huff of air to let him know she wasn't happy about it. "Yes. It's difficult for me to reach the wound."

He faced her, and had to swallow hard. She wore an undershirt and had the quilt from the bed wrapped around her; only her shoulder and injured arm emerged. It was her hair that unmanned him, the dark locks falling in waves down her back. She must've loosed them from the braid so they would dry.

His knees threatened to knock together as he approached her. She flushed under his gaze and averted her face, pointing to the array of doctoring supplies she'd laid out across the bed.

"You'll need to clean it out first," she said. "The wound isn't bad, but if infection sets in…"

"Yes, I know." And he did know how bad infection could get. He'd met plenty of men missing limbs or on the brink of dying because of infection from injuries. "I can't believe you went all morning with a bullet wound and didn't tell me."

He located an antiseptic and some clean cloths and moved in front of Danna so her crown was at his chin. He began by wiping the blood off of the inside of her arm. He was entirely too conscious of how soft her skin felt against his palm, and how she smelled sweet, even though the rain must've washed away any scent of soap or perfume.

"There wasn't anything you could do, even if I did tell you."

"You would've told your first husband."

"Fred—" She bit out the one word. That was it.

He kept his gaze on what he was doing, but he could see her jaw flex from the corner of his eye, as if she'd chomped down on what she really wanted to say.

He leaned away so he could look her in the face. He didn't release his hold on her upper arm. "Say it."

Her gaze didn't waver from his. "Fred would've known without me telling him."

Well. Chas looked down to apply the antiseptic to a rag, pretending her words didn't sting. He dabbed the rag against the bloody furrow in her skin—she was lucky the bullet hadn't entered her flesh—and heard her soft intake of breath.

He hated that she was injured. Hated that they hadn't been able to capture the outlaws. Hated that he had no control over any of this.

Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.


REFERENCE:
Family Physician: A manual of domestic medicine (1886) is available in the public domain on Googlebooks:
(Treatment of Wounds begins page 712)

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

As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 

A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website www.lacywilliams.net. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).

Wednesday, July 6, 2011

Welcome Dr. Frank Edwards!


I’m so pleased to announce a new monthly guest blogger to Redwood’s Medical Edge. Dr. Edwards is an emergency medicine physician and will be adding a wealth of information concerning adult ED medicine. I hope you'll take the time to check out his medical thriller, Final Mercy. Welcome, Dr. Edwards!

Cracking Joints

Frank J. Edwards, MD


You’re coming down a set of steps and become distracted, or you’re jogging and don’t see the pothole, or you’re playing soccer, or maybe you’re strolling in the park at dusk, when suddenly an ankle you’ve always taken for granted painfully twists inward and you hear a snap.  Next morning, the outward (lateral) side of your ankle is swollen and bruised, and weight bearing is not a happy experience.  Surely, it is broken.  You even felt the crack.

Ankle injuries are among the most common presenting complaints to emergency departments and urgent care centers.   The ankle is a very flexible hinge-type joint, held together by ligaments and mainly designed to flex upwards and push downwards when we ambulate.  It also allows for inward and outward movements (inversion and eversion) and even some degree of rotation side to side.  Every joint has inherent weaknesses, and the ankle’s Achilles’ heel (so to speak) is excessive inversion.  In other words, it does not take much force to twist the ankle inwards beyond its structural limitations.  Reach down and check it out.   When this happens, the ligaments on the outside (lateral aspect) of the ankle will stretch and tear, or sometimes even rip off a sliver of bone.   By definition, this is a sprain.  However, given enough force, the same mechanism of injury can cause true fractures, sometimes even severe enough to require surgery.

The vast majority of ankle injuries, however, do not involve broken bones and are completely healed within a week.  The question is—when do you need an x-ray?  Fortunately, we have some good research to guide us, something called the Ottawa Ankle Rules (thank the cost-conscious Canadians for this one), which that allows us to predict the likelihood of fracture. 

Basically, the Ottawa Ankle Rules say that: 1) if the patient was able to bear weight right after the injury; 2) if there is no tenderness to pressure over the tip of the fibula (the bone running down the outside of the lower leg); 3) if there is no tenderness over the base of the fifth metatarsal (the outermost of the five long bones in the foot), and; 4) if the ankle is otherwise stable—the chance of a significant fracture is slight. 

When a patient meets these criteria, we can skip the x-ray for now.  Give the injured person a splint and crutches, and save tens of millions of health care dollars a year.  Many health care providers, however, are either unfamiliar with the rules or unwilling to disappoint a patient’s expectations that the visit is incomplete without some radiation.   Especially if the patient “heard it snap.”   However, in my years of ED experience, this sensation usually points toward a sprain.  It is like cracking your knuckles.

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

Frank Edwards was born and raised in Western New York.  After serving as an Army helicopter pilot in Vietnam, he studied English and Chemistry at UNC Chapel Hill, then received an M.D. from the University of Rochester.  Along the way he earned an MFA in Writing at Warren Wilson College.  He continues to write, teach and practice emergency medicine. More information can be found at http://www.frankjedwards.com/.

Monday, July 4, 2011

Firework Injuries

What kind of nurse would I be, really, if I didn't post something about firework injuries on July 4th?



This is one of those time specific things ED's deal with. One thing you may not know is that in most ED's I've worked, the local fire department likes us to keep track of firecracker related injuries and submit that data to them. It's generally age and type of injury to avoid violating the patient's HIPPA rights.

This link is for firework safety: http://www.cpsc.gov/info/fireworks/

Firework related injuries: http://www.traumaf.org/featured/6-29-04fireworks.html

Stats of firework injures: http://www.usfa.dhs.gov/citizens/focus/fireworks.shtm

So, please, enjoy the holiday. But, stay safe and legal! I'll be working and I don't want to see you in the ED.

Jordyn

Friday, July 1, 2011

Western Medicine Circa 1890: Part 1/4

I'm very pleased to host Lacy Williams as a guest blogger this month. She is doing a four-part Friday series on western medicine during the 1890's. Lacy has developed a great contest so check yesterday's post for details. Though, I'm not sure I'm pleased with her reading the end of books first. I might have to chat with her about that....

Welcome Lacy!

Just want to say a quick thank you to Jordyn for hosting me on her blog this month! I’m really excited to be here and I plan to share some book excerpts and do a book giveaway that you won’t find anywhere else, so stay tuned the next few Fridays.

 I did a considerable amount of historical medical research for my novel, Marrying Miss Marshal, mostly because it seemed my heroine (a town marshal) kept getting into scrapes! Some of the basic research indicated that folks in the Wild West didn’t always have access to a doctor, mostly because there was a shortage of doctors in the less-populated areas. So they tended to doctor themselves. My heroine, Danna Carpenter, is the widow of the former town marshal and often had to doctor him up, so she does have some experience with tending injuries. She also grew up on a ranch, so in my mind, she would have also seen treatment of animals, which was often done by common sense.

DISLOCATED SHOULDER

In the first chapter of Marrying Miss Marshal, the hero falls down a ravine and dislocates his shoulder. One of the sources I used in my research, The Modern Family Physician (1915), gives two methods for treating a dislocated shoulder. One, Stimson’s method, wouldn’t work for my story because both hero and heroine are stranded outdoors in the dark. Here’s an excerpt that tells about the second method of treatment:

The more ordinary method consists in putting the patient on his back on the floor, the operator also sitting on the floor with his stockinged foot against the patient's side under the armpit of the injured shoulder and grasping the injured arm at the elbow, he pulls the arm directly outward (i. e., with the arm at right angles with the body) and away from the trunk. An assistant may at the same time aid by lifting the head of the arm bone upward with his fingers in the patient's armpit and his thumbs over the injured shoulder.

Although this isn’t exactly how it happened in Marrying Miss Marshal, this information is what I based my scene on. My brother-in-law (shout out to Ben!) dislocated his shoulder several times during high school, and had either a family member or friend put the joint back into place on the spot, so I know it’s possible for a layman to do it.

How do you think my scene turned out?

From Marrying Miss Marshal chapter 1:

When she reached him, Danna knelt at his head and studied the man. His hat had slipped to one side, and his sweat-matted hair was dark next to his fair skin.

"Mister, you've sure got a way of getting into some pretty good scrapes," she muttered. She probed his scalp and neck gently with her fingertips, searching for injury. Though obscured by a few days growth stubble, he had a strong jawline.

He gasped when her palm brushed his right shoulder. Keeping her touch as light as she could, Danna ran her fingers over the arm and shoulder, and he moaned again. "Hurts."

"I know. Looks like you've knocked it out of place." She prodded his torso and legs, but found no additional trauma. She did find a gun belt and weapon at his hip, but ignored it for now. "I can reset it for you."

She smoothed a hand over his forehead, as if she was comforting her almost-niece, Ellie. "Tell me your name."

"Chas." A breath. "O'Grady."

She filed the name away. O'Grady sounded Irish. She nodded absently and murmured, "I'm Danna Carpenter," as she considered the best way to get his shoulder back into the socket. "What brings you to Wyoming?"

"Job."

"Not cattle."

One corner of his mouth quirked upward. "How'd you know?"

"Lawyer?"

He snorted a laugh, then grimaced as if the movement pained him.

"Railroad surveyor?" she guessed, and gave a mighty tug.

O'Grady's upper arm and the shoulder slid into place with an audible click. She was impressed when he didn't cry out, just rolled his head and looked at her with those blue eyes.

"Thanks. You're a doll."

Then he passed out.

Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.

REFERENCE:
The Modern Family Physician (1915) is available in the public domain on Googlebooks:
Volume 1
Volume 2 (dislocated shoulder information starts on page 412 of this volume)

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


As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 

A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).